Purpose: The relatively simultaneous development of spring-loaded biopsy devices and the proliferation of transrectal ultrasonography for transrectal guidance of biopsy needles have led to the general use of both technologies for transrectal prostate biopsy. This review was done because the incremental cost of ultrasonographic guidance is considerable and the marginal improvement of sensitivity over digital guidance alone is unknown. Materials and Methods: A total of 200 consecutive men underwent prostate biopsy with digital and ultrasound guidance. Results: Biopsy sensitivity was superior for ultrasound guidance in all categories of tumors studied, with an overall sensitivity of 88 percent compared to 74 percent for digital guidance. Nevertheless, 12 percent of the tumors were detected with digital rectal examination guidance alone. Conclusions: These data suggest that the optimal method of prostate biopsy may include ultrasound and digital guidance.
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