Repeat prostate biopsy--when, where, and how.
Patients who have a persistently elevated or a rising PSA level following a prior negative prostate biopsy can be a stressful situation for both the urologist and the patient. This will be a brief review of the indications and techniques in patients undergoing a repeat biopsy. In patients with a prior negative biopsy, assessing the adequacy of the initial biopsy is important. F/T PSA is currently the most useful marker in predicting cancer on repeat biopsy although newer markers, such as PCA3, are promising. Repeat biopsies should include a minimum of 14 cores, the 12 cores recommended for an initial biopsy and 2 additional cores obtained form the right and left anterior apex. In patients for whom repeat biopsies fail to identify cancer, yet the clinical suspicion remains high, consideration for a saturation biopsy approach seems warranted.
Presti
Joseph C
JC
Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA. jpresti@stanford.edu
D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D013997:Time Factors
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen