title: Necessity of repeat biopsies in men for suspected prostate cancer.
abstract: BACKGROUND
  The indications for repeat prostate needle biopsy in men whose initial biopsy results revealed no evidence of cancer are not defined.
  
  
  METHODS
  We retrospectively studied 218 consecutive cases of men undergoing prostate biopsies for suspected cancer. Men in whom cancer was found on repeat biopsy were compared with others with regard to age, digital rectal examination, serum prostate-specific antigen (PSA) concentration, prostate volume, PSA density, PSA slope and the frequency of prostatic intraepithelial neoplasia (PIN) on initial prostate biopsy.
  
  
  RESULTS
  Of the 114 cancers detected, 99 (87%) were diagnosed on initial biopsy and 15 (131%) were diagnosed on repeat biopsy. Mean PSA concentration and mean PSA density were significantly higher in patients with cancer on initial biopsy than on repeat biopsy (P<0.05), but they were similar among patients with and without cancer on repeat biopsy. The PSA slope showed a more progressive increase in patients with cancer on repeat biopsy than in those patients without cancer at 6 month intervals. Of the 218 patients undergoing prostate biopsy, seven (3.2%)) were identified with high grade PIN but without concurrent prostate cancer. Prostate cancers were detected in two of these seven patients (29%) on repeat biopsy.
  
  
  CONCLUSIONS
  Serum PSA levels and PSA density did not provide useful predictive information about the indications of repeat biopsy. We conclude that men with a more progressive increase in PSA levels at 6 months intervals and high grade PIN on prostate needle biopsy should undergo repeat sampling to exclude missed cancer.
authors.affiliation: Department of Urology, Kurume University School of Medicine, Japan. masanori@kurume.ktarn.or.jp
authors.forename: M
authors.initials: M
authors.lastname: Noguchi
authors.forename: J
authors.initials: J
authors.lastname: Yahara
authors.forename: H
authors.initials: H
authors.lastname: Koga
authors.forename: O
authors.initials: O
authors.lastname: Nakashima
authors.forename: S
authors.initials: S
authors.lastname: Noda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods*; D003937:Diagnosis, Differential; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D019048:Prostatic Intraepithelial Neoplasia / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D012007:Rectum / Q000000981:diagnostic imaging; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen