For more than 50 years, needle core and aspiration biopsy techniques have been used to detect carcinoma of the prostate. Each has had vigorous proponents and many technical innovations have been made to improve the techniques. This report summarizes the developmental history of the techniques, examines their individual merits, reviews studies comparing the methods, and discusses the complications associated with each. Presently, in patients with abnormal rectal examinations, small-gauge transrectal core biopsy and transrectal aspiration biopsy offer similar detection and false-negative rates with very low frequencies of complications.