title: Extensive biopsies and transurethral prostate resection in men with previous negative biopsies and high or increasing prostate specific antigen.
abstract: OBJECTIVE
  We determined the diagnostic role of an extensive biopsy protocol associated with transurethral prostate resection in patients with persistently increased or increasing prostate specific antigen without evidence of prostate cancer after 2 or more extended negative sets of biopsies.
  
  
  METHODS
  A new set of 21-core biopsies was done in 113 patients under general anesthesia in association with transurethral prostate resection. Demographics, clinical and biological data, operative parameters, pathological results and followup were recorded prospectively.
  
  
  RESULTS
  Extended biopsies provided an 18.6% detection rate and detected 77.8% of prostate cancers. Transurethral prostate resection significantly increased the detection rate by 28.5% for an overall 23.9% prostate cancer detection rate (p = 0.035). Most prostate cancer detected on chips and/or biopsy was clinically significant and 30% were scored as Gleason 7 or greater. Of prostatectomy specimens 19% showed pT3a-pT4 cancer with a median Gleason score of 7. In patients with no cancer mean prostate specific antigen 1 year after transurethral prostate resection was 4.5 ng/ml (range 0.3 to 16.3), which remained stable during followup. A third of these patients underwent repeat biopsy with a 16.7% prostate cancer detection rate.
  
  
  CONCLUSIONS
  About a fourth of patients with at least 2 extended negative sets of prostate biopsies remain at risk for prostate cancer and most tumors missed on initial procedures are clinically significant. Repeat biopsy using general anesthesia detects three-fourths of these prostate cancers. However, the diagnostic yield of transurethral prostate resection appears significant and may provide additional data of clinical importance in select, informed patients.
authors.affiliation: Institut National en Santé et Recherche Médicale U955 EQ7, Department of Urology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.forename: Francis
authors.initials: F
authors.lastname: Dubosq
authors.forename: Véronique
authors.initials: V
authors.lastname: Boublil
authors.forename: Yves
authors.initials: Y
authors.lastname: Allory
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Dimitri
authors.initials: D
authors.lastname: Vordos
authors.forename: Andras
authors.initials: A
authors.lastname: Hoznek
authors.forename: Claude-Clément
authors.initials: CC
authors.lastname: Abbou
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D020728:Transurethral Resection of Prostate
chemical_list: D017430:Prostate-Specific Antigen