title: Are repeat biopsies required in men with PSA levels < or =4 ng/ml? A Multiinstitutional Prospective European Study.
abstract: OBJECTIVE
  Pathological and biochemical features of prostate cancers detected on repeat biopsies in men with total PSA level between 2.0 and 4 ng/ml were evaluated and compared to those cancers detected on first biopsy.
  
  
  METHODS
  315 men with PSA level between 2.0 and 4 ng/ml underwent transrectal ultrasound guided sextant biopsy and two additional transition zone biopsies (Octant Biopsy). All subjects whose biopsy samples were negative for prostate cancer underwent a repeat biopsy after 6 weeks. Those with clinically localized cancers were offered surgery or radiation therapy. Pathological and clinical features of patients diagnosed with prostate cancer on initial and repeat biopsy were compared.
  
  
  RESULTS
  Cancer detection rates on first and second biopsy were 24% (75/315) and 13% (29/224), respectively. Overall, of patients with clinically localized disease (83% of cancers detected), 87% underwent radical prostatectomy, 11% opted for radiation therapy and 2% opted for watchful waiting. Cancers found in the first biopsy group were more multifocal (p = 0.01) while cancers found on second biopsy were more located in the apical-dorsal region (p = 0.003). No significant differences were noted with respect to extracapsular extension, seminal vesical invasion, positive margins, final pathological stage, Gleason score, percentage Gleason grade 4/5, serum PSA and patient age between first and second biopsy.
  
  
  CONCLUSIONS
  With an octant biopsy regime, biochemical and pathological features of cancers detected on initial and repeat biopsy in the PSA range 2.0 to 4 ng/ml are comparable in terms of PSA, grade, stage and cancer volume suggesting identical cancer characteristics, thus advocating for a repeat prostate biopsy in case of a negative finding on initial biopsy.
authors.affiliation: Department of Urology University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. bdjavan@hotmail.com
authors.forename: Bob
authors.initials: B
authors.lastname: Djavan
authors.forename: Yan Kit
authors.initials: YK
authors.lastname: Fong
authors.forename: Vincent
authors.initials: V
authors.lastname: Ravery
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Martin
authors.initials: M
authors.lastname: Susani
authors.forename: Soren
authors.initials: S
authors.lastname: Kreuzer
authors.forename: Laurent
authors.initials: L
authors.lastname: Boccon-Gibod
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Michael
authors.initials: M
authors.lastname: Marberger
mesh_terms: D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*
chemical_list: D017430:Prostate-Specific Antigen