Paradigm shifts in prostate biopsy strategies in the era of precision medicine

The escalating global burden of prostate cancer necessitates continuous refinement of diagnostic strategies. Although prostate biopsy remains the gold standard for diagnosis, key procedural aspects, including biopsy template, guidance methods, and biopsy route, remain subjects of ongoing debate. Current approaches have yet to achieve the dual goals of high sensitivity and high specificity in diagnostic performance. In recent years, ongoing advancements in related fields have generated substantial clinical evidence, offering further insights into optimizing biopsy strategies. This review provides a synthesized framework for navigating the paradigm shift from traditional, standardized biopsy toward personalized, precision-based approaches. We not only trace the evolution of biopsy techniques but also offer a comprehensive, in-depth exploration of how patient-specific factors, such as prostate volume, prostate-specific antigen density, and Prostate Imaging Reporting and Data System scores, can inform individualized biopsy decisions, thereby providing practical clinical guidance. In addition to critically evaluating conventional biopsy paradigms, we systematically examine emerging biopsy strategies and synthesize high-quality studies at the forefront of this field. Finally, against the backdrop of the artificial intelligence era, we highlight the transformative potential of artificial intelligence and robotic platforms across the diagnosis. By integrating current development and future directions, this review offers a structured framework for personalized biopsy decision-making, ultimately aiming to achieve both high sensitivity and high specificity in individualized prostate cancer diagnosis.