Innovations in prostate biopsy strategies for active surveillance and focal therapy

Purpose of review Active surveillance and focal therapy for prostate cancer have been proposed as treatment alternatives for prostate cancer. In this review, we track the emerging technologies that will support the viability of such management strategies. Recent findings Widespread prostate-specific antigen (PSA) testing and extended prostate biopsy practice patterns have resulted in a significant increase in the diagnosis of low-risk prostate cancer. As most low-risk prostate cancers may not require radical treatment, alternatives for appropriately selected patients have been proposed and implemented namely, active surveillance and focal therapy. Both alternatives to radical therapy require accurate mapping and precise targeting of lesions within the prostate, for which current technological shortfalls limit their clinical utility. The emerging tools that will help overcome these challenges include refined imaging modalities, three-dimensional modeling for planning and tracking intervention, elastic fusion image technology, and automated mechanical delivery of the intervention needle. Summary Current prostate biopsy technologies have largely advanced as separate entities. Further refinement of these innovations continue, but the ultimate challenge will be integrating them into one comprehensive platform.