Journal Article (Review Article)

DKFZ-2026-01094

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Reducing overdiagnosis—how to do I correctly assess the indication for prostate biopsy? [Der Anfang der Übertherapie – Wie stelle ich die Indikation zur Prostatabiopsie richtig?]

Seelemeyer, F. ; Al-Monajjed, R.DKFZ* ; Dib, M. ; Lakes, J. ; Busshoff, I. ; Handke, A. ; Boschheidgen, M. ; Antoch, G. ; Albers, P.DKFZ* ; Radtke, J. P.DKFZ* ; Schimmöller, L.

2026
Springer Medizin New York]

Abstract: The indication for prostate biopsy represents the key interface between prostate-specific antigen (PSA)-based early detection and primary diagnostic evaluation in patients with suspected prostate cancer. The aim is to reduce overdiagnosis while ensuring detection of clinically significant prostate cancer (csPCa; International Society of Urological Pathology [ISUP] grade ≥ 2). PSA remains the most important initial test but is limited by low specificity; digital rectal examination provides no relevant additional value. In cases of clinical suspicion, diagnostic work-up includes multiparametric magnetic resonance imaging (MRI) for risk stratification and reduction of unnecessary biopsies. Diagnostic performance depends on image quality and reader expertise. Biparametric MRI may be an alternative under appropriate conditions but does not match the full diagnostic scope of mpMRI. In the presence of suspicious MRI findings, the combination of targeted and systematic biopsy remains the reference standard, with higher detection rates for csPCa but also increased detection of clinically insignificant tumors. Alternative approaches such as perilesional sampling are under investigation. PSA density, serum biomarkers (e.g., 4KScore, Stockholm-3), and risk calculators may further improve prebiopsy selection. This review provides an evidence-based overview and outlines a guideline-conform, risk-adapted diagnostic pathway for biopsy indication.

Keyword(s): Biomarkers ; Biopsy ; Early diagnosis ; Prostate cancer ; Prostate-specific antigen

Note: epub

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Contributing Institute(s):

1. Personalisierte Früherkennung des Prostatakarzinoms (C130)
2. E010 Radiologie (E010)

Research Program(s):

1. 313 - Krebsrisikofaktoren und Prävention (POF4-313) (POF4-313)

Appears in the scientific report 2026

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; DEAL Springer ; DEAL Springer ; Essential Science Indicators ; IF < 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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