Prostate cancer detection rate in patients with repeated extended 21-sample needle biopsy.
BACKGROUND
Prevalence of prostate cancer (PCa) after a negative first extended prostate needle biopsy protocol is unknown.


OBJECTIVE
To evaluate the prevalence of significant PCa in patients who have had a negative first extended prostate biopsy protocol.


METHODS
Between March 2001 and May 2007, 2500 consecutive patients underwent an extended protocol of 21 biopsies. Of 953 patients who had a negative first extended prostate biopsy procedure, 231 patients underwent a second or more set of 21-core biopsies. Indications for repeated biopsies were persistently elevated prostate-specific antigen (PSA), PSA increase during the follow-up, or prior prostatic intraepithelial neoplasia (PIN), or atypical small acinar proliferation (ASAP).


METHODS
All participants underwent at least two extended prostate needle biopsy protocols.


METHODS
Clinical and pathologic factors (age, PSA, PSA doubling time, PIN, ASAP, digital rectal exam [DRE]) were analyzed for their ability to predict positive biopsy, and tumour parameters were assessed in patients undergoing radical prostatectomy.


CONCLUSIONS
Second, third, and fourth extended 21-sample biopsy procedures yielded a diagnosis of PCa in 18%, 17%, and 14% of patients respectively. Patients with prior PIN had 16% risk of prostate cancer; patients with ASAP had a 42% risk. The mean number of positive cores was 2.19. Prostate volume and PSA density were statistically significant predictors of positive biopsy (p<0.05). For the 43 patients who underwent radical prostatectomy, pathologic findings revealed mean Gleason score of 6.7 (6-8), pT2a-c in 72%, pT3a in16%, and pT4 in 7%. Mean cancer volume was 1.15 cc and 85.2% of tumours were clinically significant (tumour volume > 0.5 cc, Gleason > or = 7 and/or pT3).


CONCLUSIONS
Negative first extended biopsies should not reassure a patient of not having PCa. However, prostate cancers detected after two or more sets of extended procedures, appear to be localized (intracapsular disease) and well-differentiated prostate cancers, although they are still clinically significant.
Campos-Fernandes
Jean-Louis
JL
Department of Urology, CHU Mondor, Créteil, France.
Bastien
Laurence
L
Nicolaiew
Nathalie
N
Robert
Grégoire
G
Terry
Stéphane
S
Vacherot
Francis
F
Salomon
Laurent
L
Allory
Yves
Y
Vordos
Dimitri
D
Hoznek
Andras
A
Yiou
René
R
Patard
Jean Jacques
JJ
Abbou
Claude Clément
CC
de la Taille
Alexandre
A
D001707:Biopsy, Needle / Q000379:methods* / Q000706:statistics & numerical data*; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*