title: Multiple repeat prostate biopsies and the detection of clinically insignificant cancer in men with large prostates.
abstract: OBJECTIVE
  To determine the impact of repeating prostate biopsies on the risk of detecting clinically insignificant prostate cancer (PCa) in larger prostate glands.
  
  
  METHODS
  We performed a retrospective cohort study using patients enrolled in our institutional PCa registry from 1991 to 2008 to assess the association of prostate volume and clinically insignificant PCa in men undergoing multiple prostate biopsies. Patients were stratified by prostate volume into 2 cohorts (<50 cm(3) or ≥50 cm(3)). Additionally, patients were stratified by prostate biopsy on which PCa was identified (1 biopsy or ≥3 biopsies).
  
  
  RESULTS
  Within the subgroup of patients with prostate volume ≥50 cm(3) requiring ≥3 biopsies before cancer diagnosis, 72.6% (45/62) had pathologic Gleason scores ≤6 and 81.6% (49/60) had an estimated tumor volume of ≤10% at the time of radical prostatectomy. This was significantly different from patients with prostate volume <50 cm(3) diagnosed on their first biopsy, in which only 48.5% (656/1349) were found to have Gleason scores ≤6 and 54.2% (705/1300) had estimated tumor volume ≤10% (P <.01). There was no significant difference in the rate of Gleason score upgrading at time of prostatectomy between any of the subgroups.
  
  
  CONCLUSIONS
  PCas detected in men with prostatic enlargement requiring multiple biopsies are more likely to be low-grade, low-volume tumors at final pathology than men without prostate enlargement. Men with larger prostates who have already had prior negative biopsies should be counseled regarding the increased risk of detecting clinically insignificant PCa with additional biopsies.
authors.affiliation: Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: eugene.pietzak@uphs.upenn.edu.
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Pietzak
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, and the Tennessee Valley VA Health Care System, Nashville, TN.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Resnick
authors.affiliation: Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Philip
authors.initials: P
authors.lastname: Mucksavage
authors.affiliation: Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Keith
authors.initials: K
authors.lastname: Van Arsdalen
authors.affiliation: Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wein
authors.affiliation: Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: S Bruce
authors.initials: SB
authors.lastname: Malkowicz
authors.affiliation: Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Guzzo
mesh_terms: D001707:Biopsy, Needle / Q000706:statistics & numerical data; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors