Objectives. To compare prostate cancer detection rates of extended 2D versus 3D biopsies and to further assess the clinical impact of this method in day-to-day practice. Methods. We analyzed the data of a cohort of 220 consecutive patients with no prior history of prostate cancer who underwent an initial prostate biopsy in daily practice due to an abnormal PSA and/or DRE using, respectively, the classical 2D and the new 3D systems. All the biopsies were done by a single experienced operator using the same standardized protocol. Results. There was no significant difference in terms of age, total PSA, or prostate volume between the two groups. However, cancer detection rate was significantly higher using the 3D versus the 2D system, 50% versus 34% ( ). There was no statistically significant difference while comparing the 2 groups in term of nonsignificant cancer detection. Conclusion. There is reasonable evidence demonstrating the superiority of the 3D-guided biopsies in detecting prostate cancers that would have been missed using the 2D extended protocol. 1. Introduction Prostate cancer (PC) is the most common cancer in elderly men and the second most common cause of cancer death in the western world [1, 2]. Grey scale (GS) two dimension (2D) transrectal ultrasound- (TRUS-) guided systematic prostate biopsy sampling is the clinical standard for PC diagnosis [3]. In clinical practice, PC detection rate of GS 2D TRUS-guided needle biopsies is only 30–40% in initial prostate biopsy [4–7] in a screened population and 30% to 50% of PC that require definitive treatment remain undetected [8, 9]. Furthermore, prostate remains the only organ where biopsy is a blind uniform sampling technique due to the poor visibility of cancer in GS 2D TRUS images and the limited anatomical context to guide needles to suspicious locations in the 2D TRUS plane [10]. Recent developments in systems and imaging modalities have led to a promising advance in mapping and correctly tracking target regions. In the last years, the GS three dimension (3D) TRUS-guided biopsy has been introduced as a new technique that improves prostate sampling as well as clinical quality management [11]. Based on these findings, we compare a consecutive series of 220 patients who underwent a prostate biopsy in order to assess the impact of 3D versus 2D TRUS-guided systematic prostate biopsy on the detection of PC and its clinical effect in a routine day-to-day practice. 2. Materials and Methods The study involved a cohort of 220 consecutive patients, with no prior history of prostate cancer, who underwent
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