Eleven-year outcome of patients with prostate cancers diagnosed during screening after initial negative sextant biopsies.
BACKGROUND
The appropriate way of biopsying a prostate remains controversial. Is sextant biopsy still adequate with repeat screening?


OBJECTIVE
Within the European Randomized Study of Screening for Prostate Cancer (ERSPC), lateralized sextant biopsies were applied. In this analysis we use distant end points to study the fate of prostate cancers (PCa) potentially missed by initial biopsies.


METHODS
This retrospective study included 19 970 men ages 55-74 identified from the Rotterdam population registry and screened repeatedly for PCa between 1993 and 2005. PCa detected later in men with initially negative biopsies were considered as missed. Rescreening every 4 yr and a complete follow-up of 11 yr allowed an inventory of progressive and deadly disease in these men.


METHODS
Sextant biopsies initially, later lateralized, in screen-positive men.


METHODS
The fate of PCa potentially missed by initial sextant biopsies in terms of progression-free and PCa-specific survival were the main outcome measures. Kaplan-Meier analysis was used to evaluate differences between subgroups.


CONCLUSIONS
In 3056 men with negative biopsies at the first screen, 287 PCa were subsequently detected. Of these 287 cases, 26 developed progressive disease and 7 died of PCa. Poor outcomes were encountered mainly in 20 interval cases. The seven PCa deaths in men with initially negative biopsies amounted to only 0.03% compared to the 0.35% PCa death rate in the whole population of 19 970 men. Limitations include the retrospective character of this analysis.


CONCLUSIONS
The number of potentially missed cancers with a poor outcome in terms of progression-free survival and deaths from PCa is very low. Despite some limitations, our data show that lateralized sextant biopsy is not obsolete if repeated screening is applied.
Schröder
Fritz H
FH
Department of Urology, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. secr.schroder@erasmusmc.nl
van den Bergh
Roderick C N
RC
Wolters
Tineke
T
van Leeuwen
Pim J
PJ
Bangma
Chris H
CH
van der Kwast
Theo H
TH
Roobol
Monique J
MJ
D000368:Aged; D001706:Biopsy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome