Purpose of review The objective of this article is to examine the safety of prostate biopsy and discuss the emerging role of MRI - ultrasound fusion technology in improving diagnostic accuracy. Recent findings Men undergoing prostate biopsy frequently experience minor complications, including hematospermia, hematuria, and infection. Quinolone-resistant bacteria are a growing concern; thus transperineal access or modification of antibiotic prophylaxis based on local antibiograms is now used to avoid infectious complications. Multiparametric MRI allows visualization of many prostate cancers, and by fusing MRI with realtime ultrasound, a biopsy needle can be directed by a urologist into suspicious regions of interest. Using this new method, detection of clinically significant prostate cancer (csCaP) has increased and the incidence of falsely negative biopsies has decreased. Summary Prostate biopsy is generally a safe procedure, and with attention to local patterns of antibiotic resistance, infectious complications can be minimized. MRI - ultrasound fusion has significantly improved the accuracy of prostate biopsy, allowing tracking and targeting not previously possible.

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