title: Recutting prostate needle core biopsies with high grade prostatic intraepithelial neoplasia increases detection of adenocarcinoma.
abstract: OBJECTIVE
  We sought to evaluate the ability of biopsy core recutting to increase cancer detection in patients with high grade prostatic intraepithelial neoplasia (HGPIN).
  
  
  METHODS
  This prospective study encompasses all patients undergoing 12 core TRUS guided prostate biopsy between February 2004 and January 2007. In patients with HGPIN on initial biopsy, the paraffin blocks were resampled for cancer by additional deeper levels per core. Additional analysis was performed in the patients with HGPIN in order to detect whether significant differences in prebiopsy variables were associated with patients subsequently found to have benign versus carcinoma on recutting. Last, the costs associated with this procedure were studied.
  
  
  RESULTS
  Forty of 584 (6.8%) patients undergoing prostate biopsy were found to have HGPIN in the absence of prostatic adenocarcinoma on initial histopathology. Following recutting, 12.5% (5/40) of these patients were found to have prostatic adenocarcinoma not previously detected. Of the remaining 35 patients, 18 underwent repeat biopsy. Of these, five patients were found to have adenocarcinoma and three were found to have persistent HGPIN. The PSA, PSA density (PSAD), and PSA velocity (PSAV) prior to initial biopsy were not statistically different when comparing patients found to have benign tissue versus carcinoma on recutting. In patients with HGPIN, at our institution, recutting the biopsy would yield a cost savings of $436/patient as opposed to universal rebiopsy.
  
  
  CONCLUSIONS
  Our data suggest that prostate biopsy recutting may increase cancer detection in patients initially found to have HGPIN. Additionally, a significant cost savings is associated with the recutting protocol.
authors.affiliation: Department of Surgery, University of Chicago Hospitals, Chicago, Illinois, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Rapp
authors.forename: Lambda P
authors.initials: LP
authors.lastname: Msezane
authors.forename: W Stuart
authors.initials: WS
authors.lastname: Reynolds
authors.forename: Tamara L
authors.initials: TL
authors.lastname: Lotan
authors.forename: Piotr
authors.initials: P
authors.lastname: Obara
authors.forename: R Corey
authors.initials: RC
authors.lastname: O'Connor
authors.forename: Jerome B
authors.initials: JB
authors.lastname: Taxy
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Gerber
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Zagaja
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D019048:Prostatic Intraepithelial Neoplasia / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*