Did you know that more than 1 million prostate biopsies are performed each year in the US alone? In order to appreciate how far prostate biopsy has come and how OnQ Prostate is helping change the game, it is important to look back at the history and evolution of prostate cancer screening. We know that prostate cancer is one of the most curable cancers if caught early. We also know that about 1 in 8 men will be diagnosed with prostate cancer in their lifetime and that most men die WITH their prostate cancer rather than FROM their prostate cancer.  

After widespread adoption of screening with the prostate specific antigen (PSA) test in the 1990s led to overdiagnosis and overtreatment of indolent disease, the Untied States Preventive Services Task Force recommended against screening regardless of age in 2012. This caused the pendulum to swing in the other direction and men began presenting with more advanced disease after their window of opportunity for a cure had passed. Two major challenges of the time were the treatment options: only radical whole-gland surgery or radiation, and the biopsy strategy: only “blind” systematic transrectal ultrasound (TRUS) biopsies were available. Thus, there was an urgent need for smarter screening that would avoid overdiagnosis while still catching clinically significant cancers that need treatment. Enter the new kid on the block: prostate MRI.  

Fun fact: the first MRI of the prostate was performed in 1982! However, it was the landmark PROMIS and PRECISION clinical trials in 2017 and 2018 respectively that laid the foundation for how prostate MRI is used in clinical practice today. They showed that the benefit of implementing of MRI before biopsy was two-fold: first that MRI could be used as a triage test to avoid biopsy in over a quart of men, and second that the MRI could be used to direct the biopsy to suspicious areas mostly likely to harbor clinically significant disease. Now in 2025 we are well into the era of MRI-guided biopsy being the standard of care. 

Whether it be with cognitive fusion or software fusion, with a transrectal or transperineal approach, the ability to see what you are targeting is paramount to ensuring accurate grading. That is where OnQ Prostate comes in with patented Restriction Spectrum Imaging (RSI) technology as the next step in the evolution of prostate MRI. RSI has been shown to improve detection and delineation of clinically significant prostate cancer, providing color-coded maps that clearly display lesions and have a strong correlation with underlying histopathology. OnQ Prostate is easily integrated into everyday biopsy workflows by informing targets drawn in DynaCAD for UroNav or importing directly into systems like Koeis and Focal Healthcare.  

With OnQ Prostate, clinicians are more confident than ever in their ability to both select patients and precisely target exactly where to stick their needles. This supports the goal of fewer unnecessary biopsies being performed and fewer aggressive cancers being missed or under-graded. The future of prostate biopsy is bright, with better imaging and advances in fusion technology at the forefront, and with patients at the center.