Fine needle aspiration biopsy (FNAB) and ultrasound-guided core biopsy using biopty gun both have a high, and approximately equal, accuracy in diagnosing and grading prostate cancer. The TRUS-guided technique provides a better estimation of the tumor extent and to some degree even of capsular involvement. It is therefore a recommendable part of the preoperative evaluation when radical prostatectomy is contemplated. On the other hand, the aspiration technique usually provides more epithelial cells. It entails a significantly lower risk of septic complications and of seeding tumor cells. It has also a lower cost than the core biopsies. The aspiration biopsy can easily be performed repeatedly in the follow-up procedure, which is of particular importance in cases managed with watchful waiting. We recommend the aspiration biopsy for routine use in the diagnostic work-up and follow-up. It is essential that not only the cytologic evaluation but as well the sampling from the prostate is performed with adequate expertise.