Repeat prostate biopsy in the prostate, lung, colorectal and ovarian cancer screening trial.
OBJECTIVE
To determine patterns of repeat prostate biopsy in a cohort of men undergoing prostate cancer screening who have a negative initial biopsy.


METHODS
The Prostate, Colorectal, Lung, and Ovarian (PLCO) cancer screening trial is an ongoing study the prostate component of which consists of six annual screens with measurements of prostate-specific antigen (PSA) level and a digital rectal examination (DRE). The diagnostic follow-up of positive screening results is done by the subject's healthcare provider outside the purview of the PLCO. We analysed the experience of repeat biopsy in men in the PLCO with an initial negative biopsy. Men were divided by indication for initial biopsy into those with suspicious PSA levels and those with suspicious DRE findings.


RESULTS
The probability of having a repeat biopsy within 3 years of initial biopsy was 43% for 1736 men with suspicious PSA levels and 13% for 1025 men with suspicious DRE findings. Rates of third and fourth biopsy after a previous negative biopsy were similar to the initial repeat biopsy rate in PSA-positive men. Most men had a repeat biopsy only after having an additional round of screening. The PSA level and PSA velocity determined after initial biopsy were independent risk factors for a repeat biopsy, both in PSA-positive and DRE-positive men. High-grade prostatic intraepithelial neoplasia was a risk factor for repeat biopsy before any repeat PSA or DRE testing.


CONCLUSIONS
The experience of this cohort should be generally representative of patterns of care for repeat biopsy in men undergoing periodic screening. These data can provide context to the debate over optimum practices for repeat biopsy.
Pinsky
Paul F
PF
Division of Cancer Prevention, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA. pp4f@nih.gov
Crawford
E David
ED
Kramer
Barnett S
BS
Andriole
Gerald L
GL
Gelmann
Edward P
EP
Grubb
Robert
R
Greenlee
Robert
R
Gohagan
John K
JK
D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D051517:Digital Rectal Examination; D005188:False Negative Reactions; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology*; D012307:Risk Factors
D017430:Prostate-Specific Antigen