The South African Prostate Biopsy Guidelines 2026

Prostate cancer (PCa) is the second most common cancer globally in men. In South Africa, its prevalence has increased by about 60% over the last 15 years, and it is now the most common solid organ cancer in South Africa.1-3 It encompasses a diverse disease spectrum with clinical behaviour ranging from well-differentiated, non-invasive tumours to high-grade metastatic cancers associated with considerable morbidity and mortality. It is well-documented that patients in our setting commonly present at an advanced disease stage and with a higher histological grade.4,5 John et al.6 recently published evidence-based recommendations to guide clinicians on PCa screening and early diagnosis for South African men, applicable to both well-resourced private and under-resourced public sectors. Although a prostate biopsy is the cornerstone of PCa diagnosis, there are no prostate biopsy guidelines in South Africa. Various leading international urological societies have well-established guidelines for prostate biopsy.7 Due to our resource constraints, their guidelines are not entirely applicable in our context. Therefore, these guidelines aim to formulate evidence-based recommendations to assist practitioners in South Africa.