The Development of the Modern Prostate Biopsy

In the 1950s prostate cancer was known to occur in about 20% of men over the age of 55 and was the cause of death in about 5% of white men over the age of 50 (Huggins and Johnson, 1947). It accounted for 90% of all male genital cancers and 63% of male genitourinary cancers and it was believed that 5-10% of prostatic cancers were diagnosed early enough to permit operation with a reasonable chance of cure (Kaufman et al., 1954). Clearly diagnosis was paramount in order to initiate treatment and improve prognosis. The current accepted practice of diagnosing prostate cancer relies on histopathological examination of prostatic tissue obtained through transrectal ultrasound (TRUS) guided biopsy of the gland (Heidenreich et al, 2010). The TRUS-guided transrectal method of obtaining prostatic tissue has been described since the mid-1980s but before then, other methods of sampling the prostate gland were used. This chapter describes the development of the modern prostate biopsy from the techniques of the early 1900s of transperineal open biopsy to the current method of using ultrasound guidance to allow transrectal prostate biopsies.