Purpose: The relatively simultaneous development of spring-loaded biop
sy devices and the proliferation of transrectal ultrasonography for tr
ansrectal guidance of biopsy needles have led to the general use of bo
th technologies for transrectal prostate biopsy. This review was done
because the incremental cost of ultrasonographic guidance is considera
ble and the marginal improvement of sensitivity over digital guidance
alone is unknown. Materials and Methods: A total of 200 consecutive me
n underwent prostate biopsy with digital and ultrasound guidance. Resu
lts: Biopsy sensitivity was superior for ultrasound guidance in all ca
tegories of tumors studied, with an overall sensitivity of 88% compare
d to 74% for digital guidance. Nevertheless, 12% of the tumors were de
tected with digital rectal examination guidance alone. Conclusions: Th
ese data suggest that the optimal method of prostate biopsy may includ
e ultrasound and digital guidance.