Early detection of prostate cancer with ultrasound-guided systematic needle biopsy.
BACKGROUND
Prostate biopsy strategies have greatly evolved over the past 2 decades.


METHODS
We performed a literature review which addressed the initial and repeat biopsy schemes, pathologic risk factors for a positive repeat biopsy, and the ideal timing as well as the number of repeat biopsy sessions.


RESULTS
Extended biopsy schemes (11-13 cores) should be used at initial and repeat biopsy. In the era of extended biopsy schemes, high-grade prostatic intraepithelial neoplasia no longer represents an independent predictor of prostate cancer on repeat biopsy. Conversely, the risk is appreciably increased with atypical small acinar proliferation, and its presence warrants a repeat biopsy, which may be performed as soon as the pathologic findings of the previous biopsy become available. Second and subsequent repeat biopsies carry a low detection yield. In most instances, the decision regarding the indications and the timing of a third or subsequent biopsy may be made after a 6 to 12 months interval following the repeat biopsy.


CONCLUSIONS
Biopsy strategies and pathologic predictors of an increased risk of prostate cancer have appreciably changed over the past 2 decades.
Karakiewicz
Pierre I
PI
The University of Montreal Health Center, Montreal, Quebec, Canada.
Perrotte
Paul
P
McCormack
Mike
M
Peloquin
François
F
Perreault
Jean-Paul
JP
Arjane
Philippe
P
Widmer
Hughes
H
Saad
Fred
F
D044963:Biopsy, Fine-Needle / Q000379:methods; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000379:methods