title: Prostate cancers detected on repeat prostate biopsies show spatial distributions that differ from those detected on the initial biopsies.
abstract: OBJECTIVE
  To evaluate the spatial distribution of prostate cancer detected at a single positive biopsy (PBx) and a repeat PBx (rPBx).
  
  
  METHODS
  We evaluated 533 consecutive men diagnosed with prostate cancer who underwent radical prostatectomy using a clinical map document based on XML (cMDX©)-based map model of the prostate. We determined the number of cancer foci, relative tumour volume, Gleason score, zone of origin, localisation, and pathological stage after stratification according to the number of PBx sessions (PBx vs rPBx). The distribution of 3966 prostate cancer foci was analysed and visualised on heat maps. The colour gradient of the heat map was reduced to six colours representing the frequency classification of prostate cancer using an image posterisation effect. Additionally, the spatial distribution of organ-confined prostate cancer between PBx and rPBx was evaluated.
  
  
  RESULTS
  Prostate cancer diagnosed on PBx was mostly localised to the apical portion and the peripheral zone of the prostate. Prostate cancer diagnosed on rPBx was more frequently found in the anterior portion and the base of the prostate. Organ-confined prostate cancer foci were mostly localised in the dorsolateral zone of the prostate in men at PBx, whereas men at rPBx had more prostate cancer foci in the anterior portion.
  
  
  CONCLUSIONS
  The spatial distribution of prostate cancer with rPBx differs significantly from the spatial distribution of prostate cancer with PBx. The whole anterior portion of the prostate should be considered by rPBx.
authors.affiliation: Department of Urology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Okyaz
authors.initials: O
authors.lastname: Eminaga
authors.affiliation: Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany.
authors.forename: Reemt
authors.initials: R
authors.lastname: Hinkelammert
authors.affiliation: Institute for Pathology, Hannover Medical School, Hannover, Germany.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abbas
authors.affiliation: Prostate Center, Gerhard-Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Titze
authors.affiliation: Institute for Pathology Saarbrücken-Rastpfuhl, Saarbrücken, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Eltze
authors.affiliation: Institute of Pathology and Cytology, Schüttorf, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Bettendorf
authors.affiliation: Prostate Center, Gerhard-Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Wötzel
authors.affiliation: Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bögemann
authors.affiliation: Prostate Center, Department of Urology, University Hospital Muenster, Muenster, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Semjonow
mesh_terms: D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*
keywords: biopsy; cMDX; diagnostic tools; prostate cancer; prostate-specific antigen (PSA); spatial distribution