Evolution of the prostate cancer diagnostic paradigm: integrated evidence and clinical pathways from targeted biopsy to biopsy-free strategy.

The field of prostate cancer (PCa) diagnosis is undergoing a profound transformation from traditional invasive procedures toward precision, minimally invasive, and even non-invasive approaches. This article systematically outlines this evolutionary trajectory: first, starting with the selection of patients for biopsy, it emphasizes precision-based initial screening and risk-stratified biopsy strategies utilizing multiparametric magnetic resonance imaging (mpMRI) and prostate-specific antigen density; second, by comparing transrectal and transperineal biopsy, it elucidates the significant advantages of the transperineal approach in reducing the risk of infection and its status as the new standard pathway; further, it focuses on how biopsy strategies have evolved from systematic template biopsy to targeted, individualized fusion biopsyunder the guidance of precision imaging modalities such as mpMRI and prostate-specific membrane antigen positron emission tomography/computed tomography; finally, we explore the application prospects, clinical validation pathways, and practical frameworks of the new "biopsy-free diagnosis" paradigm-based on advanced imaging and molecular biomarkers-in radical surgery decision-making and active surveillance. The full text integrates the latest evidence-based data and proposes a structured clinical pathway, aiming to advance PCa diagnosis into a new era characterized by greater safety, precision, and individualization.