title: Potential benefit of transrectal saturation prostate biopsy as an initial biopsy strategy: decreased likelihood of finding significant cancer on future biopsy.
abstract: OBJECTIVE
  To identify the ability of transrectal saturation prostate biopsy (SPBx) as the initial diagnostic approach to reduce the likelihood of finding previously unrecognized prostate cancer (PCa) during repeat prostate biopsy.
  
  
  METHODS
  We reviewed PCa detection in 561 men who underwent first repeat SPBx after initial negative biopsy between March 2002 and April 2012. We divided the patients on the basis of the number of cores retrieved on initial biopsy (group 1, initial negative SPBx [n = 81] and group 2, initial negative extended prostate biopsy [n = 480]). The yield of repeat SPBx was compared between the 2 groups. Insignificant PCa and low-risk PCa were defined according to Epstein criteria and D'Amico risk criteria, respectively.
  
  
  RESULTS
  PCa detection on first repeat SPBx was 43.1% lower in group 1 (19.8% vs 34.8%; P = .008). Moreover, lower rate of significant PCa (31.3% vs 74.3%; P <.001) and intermediate- and/or high-risk PCa (25.0% vs 50.9%; P = .048) in group 1. Multivariate analysis confirmed that initial negative SPBx decreased PCa detection on first repeat SPBx (odds ratio = 0.41, 95% confidence interval 0.22-0.78).
  
  
  CONCLUSIONS
  Men whose initial biopsy was per transrectal saturation technique were less likely to have cancer identified during repeat biopsy. Furthermore, PCa diagnosed after negative initial SPBx was much more likely to be clinically insignificant. These findings suggest that SPBx may be less likely to miss clinically significant cancer during initial prostate biopsy. If confirmed in other studies, this suggests that initial biopsy by saturation technique may eliminate the need for most men to undergo repeat biopsy.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China.
authors.forename: Yong-Hong
authors.initials: YH
authors.lastname: Li
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elshafei
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Hatem
authors.affiliation: Department of Urology, Cleveland VA/Case Medical Center, Cleveland, OH.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Zippe
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Khaled
authors.initials: K
authors.lastname: Fareed
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: joness7@ccf.org.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D016208:Databases, Factual; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D012007:Rectum / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D017430:Prostate-Specific Antigen