Lack of standardised procedures means that large variations in cancer detection remain In the linked study (doi:10.1136/bmj.d7894), Rosario and colleagues assess the effects of transrectal ultrasound guided prostate biopsy in primary and secondary healthcare on patient reported outcomes.1 Transrectal ultrasound guided prostate biopsy is the core means but also the core problem of diagnosing prostate cancer. New and old serum markers, such as prostate specific antigen and its isoforms p2PSA and benign prostatic hyperplasia associated PSA,2 and improved imaging techniques based on fusion of images guided by transrectal ultrasound and magnetic resonance imaging, will certainly optimise patient selection, thus improving specificity (by reducing the number of men undergoing unnecessary biopsy procedures). However, the entire process is handicapped by an ailing biopsy procedure, which has changed little since the introduction of Stamey’s sextant biopsy technique. Most of today’s research aims to identify new and better serum markers for prostate cancer.3 The main concern is that most of these studies rely on the biopsy procedure and its outcome to judge the statistical performance of the test. The biopsy procedure itself is not standardised across the study participants. The number of …