Today, transrectal ultrasonography guided systematic prostate biopsy (TRUS-BX) is the most preferred diagnostic method for patients with suspicion of prostate cancer. Difficulties in diagnosis and false negative results bring about alternative diagnostic methods with recent technological developments. Technological developments in transrectal ultrasonography (TRUS) together with transperineal prostate biopsy and multiparametric magnetic resonance imaging guided prostate biopsy (MRI/TRUS fusion) will be revised in this review. Initial biopsy method for cases with a suspicion of prostate cancer consist of TRUS guided 12-core systematic prostate biopsy strategy involving far-lateral and apical samples. Transperineal prostate biopsy and MRI/TRUS fusion prostate biopsy demonstrates similar results in terms of cancer detection rates; however both techniques are not preferred as initial biopsy method due to practical considerations, learning curves, need for more equipment and expense. Transperineal prostate biopsy may be useful for whom suspicion of prostate cancer can not be excluded and repeat biopsy is planned because it may aid in better sampling of the anterior and apical regions of the prostate. MRI/TRUS fusion provides important advantages over standard biopsies by sampling fewer cores and with better detection of clinically significant cancer and less detection rates for clinically insignificant cancer. TRUS guided 12-core systematic prostate biopsy is the method of choice for the initial biopsy of patients with suspicion of prostate cancer. Considering the experience of the centers, both transperineal and MRI/TRUS fusion prostate biopsies may be useful for whom prostate cancer can not be excluded and repeat biopsy is planned.

Keywords: Biopsy, prostate cancer, transrectal, transperineal, MRI/TRUS fusion