title: Prostate cancer detection after one or more negative extended needle biopsy: results of a multicenter case-findings protocol.
abstract: OBJECTIVE
  To evaluate PCa incidence in patients with one or more negative extended prostate biopsy who underwent repeat biopsy or TURP.
  
  
  METHODS
  From June 2003 to February 2008, 308 patients were submitted to repeat prostate biopsy (median 20.5 cores) and 120 patients underwent TURP after one or more 12 cores prostate biopsy. Indications for biopsy were: abnormal DRE; PSA > 10 ng/mL; PSA included between 4.1-10 or 2.6-4 ng/mL with free/total PSA < or = 25% and < or = 20%, respectively 262 and 46 underwent a second and a third biopsy: 218 because for high levels of PSA, 40 and 50 patients for a previous diagnosis of HGPIN and ASAP, 28 had an abnormal DRE. PSA in patients who underwent TURP was 11.6 ng/mL (median); in all cases DRE was negative and only 76 patients referred LUTS.
  
  
  RESULTS
  PCa incidence at repeat biopsy was 16.9%; 96.2% of cancers were diagnosed at a second biopsy and 3.8% at a third one. PCa incidence was higher in patients with previous ASAP (43.4% and 50%) vs patients with HGPIN (25% and 0%) or benign pathology (11.9% and 0%). PCa was diagnosed in 11.1% and 19% of patients who underwent TURP previously submitted to a first and a second biopsy, respectively.
  
  
  CONCLUSIONS
  In case of persistent suspicion of PCa after a repeated negative saturation biopsy, TURP should be proposed as part of the diagnostic procedure aside from LUTS, especially in patients with a life expectancy greater than 10 years.
authors.affiliation: Urology Unit, Cannizzaro Hospital Catania, Italy. piepepe@hotmail.com
authors.forename: Pietro
authors.initials: P
authors.lastname: Pepe
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Dibenedetto
authors.forename: Massimo
authors.initials: M
authors.lastname: Gulletta
authors.forename: Francesco
authors.initials: F
authors.lastname: Pietropaolo
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Minaldi
authors.forename: Venerando
authors.initials: V
authors.lastname: Gulino
authors.forename: Michele
authors.initials: M
authors.lastname: Barbera
authors.forename: Salvatore
authors.initials: S
authors.lastname: Rotondo
authors.forename: Guido
authors.initials: G
authors.lastname: Azzarello
authors.forename: Franco
authors.initials: F
authors.lastname: Amico
authors.forename: Francesco
authors.initials: F
authors.lastname: Aragona
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000473:pathology*