title: Clinical and pathologic features of prostate cancer detected after repeat false-negative biopsy in a screening population.
abstract: BACKGROUND
  The present study was designed to investigate whether the clinical or pathologic features of prostate cancer (PCa) are related to the number of repeat biopsies required to establish the diagnosis of PCa.
  
  
  METHODS
  Between February 1993 and August 2000, 653 patients were evaluated in this retrospective study. All patients underwent transrectal ultrasound-guided biopsy of the prostate prior to radical retropubic prostatectomy. The pathologic findings of specimens obtained at radical prostatectomy and pelvic lymph node dissection as well as PSA levels, findings on DRE, prostate volumes, transition zone volumes, and age were analyzed separately for all PCa patients diagnosed at the first set of biopsies (group A) and compared with the data of those diagnosed at the 2nd-5th set of biopsies (group B). In a second step, we compared the results obtained from patients diagnosed at the 2nd set of biopsies (group B1) with those of patients diagnosed at the 3rd to 5th set of biopsies (group B2).
  
  
  RESULTS
  Gleason scores, pathologic tumor stages, and tumor volumes in group B were found to be significantly decreased compared to group A. But from the 2nd to 5th serial biopsy no further decrease in pathologic stage, Gleason score, or tumor volume was observed. On the contrary, there was a tendency towards higher tumor stages and Gleason scores. Of the tumors detected after the second false-negative set of biopsies almost 70% were lesions with Gleason scores of 6 or higher.
  
  
  CONCLUSIONS
  False-negative results at the first needle biopsy are predictive of a lower pathologic stage and grade as well as smaller tumor volumes of PCa diagnosed at repeat sets of biopsies. False-negative results on repeat biopsy, however, have no prognostic significance for the tumor stage of PCas detected at subsequent sets of biopsies.
authors.affiliation: Department of Urology, University of Innsbruck, Innsbruck, Austria. hannes.steiner@uibk.ac.at
authors.forename: Hannes
authors.initials: H
authors.lastname: Steiner
authors.forename: Patrizia
authors.initials: P
authors.lastname: Moser
authors.forename: Martina
authors.initials: M
authors.lastname: Hager
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Berger
authors.forename: Helmut
authors.initials: H
authors.lastname: Klocker
authors.forename: Robert
authors.initials: R
authors.lastname: Spranger
authors.forename: Hermann
authors.initials: H
authors.lastname: Rogatsch
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
mesh_terms: D000368:Aged; D001706:Biopsy; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000503:physiopathology*; D012086:Reoperation; D012189:Retrospective Studies