title: Predictors of prostate cancer after initial negative systematic 12 core biopsy.
abstract: OBJECTIVE
  We determined the cancer detection rate at initial systematic 12 core (S12C) biopsy and identified features associated with cancer at repeat S12C biopsy after an initial negative S12C biopsy in patients with prostate specific antigen (PSA) parameters associated with a higher risk of prostate cancer.
  
  
  METHODS
  Between February 1999 and June 2002, 841 patients underwent initial S12C biopsy. Of these patients 99 underwent repeat S12C biopsy after initial negative S12C because of a percent free-to-total PSA of 15.0 or less and/or a yearly PSA velocity of 0.75 ng/ml or greater. The association between parameters revealed by initial biopsy and cancer at repeat biopsy was assessed.
  
  
  RESULTS
  Of the 99 patients 21 (21.2%) had cancer at repeat biopsy. Age (p = 0.01), PSA transitional zone density (p = 0.05), and high grade PIN at initial biopsy (p = 0.01) were associated with cancer at repeat biopsy.
  
  
  CONCLUSIONS
  In this select group of patients with PSA parameters associated with a higher risk of prostate cancer the cancer detection rate after initially negative S12C biopsy was 21%. Patients with high grade PIN on initial biopsy, advanced age and higher PSA transition zone density are at increased risk for cancer at repeat biopsy. Larger prospective studies are required to confirm these results and construct a nomogram that determines the probability of finding prostate cancer at subsequent biopsy.
authors.affiliation: Baylor Prostate Center, Scott Department of Urology, Houston, Texas 77030, USA.
authors.forename: Herb
authors.initials: H
authors.lastname: Singh
authors.forename: Eduardo I
authors.initials: EI
authors.lastname: Canto
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Dov
authors.initials: D
authors.lastname: Kadmon
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Miles
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Wheeler
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Slawin
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000473:pathology*