title: Clinicopathologic differences between prostate cancers detected during initial and repeat transrectal ultrasound-guided biopsy in Korea.
abstract: OBJECTIVE
  The aim of this study was to investigate clinicopathologic differences between prostate cancer (PCa) detected at initial and repeat transrectal ultrasound-guided prostate biopsy in a large Korean cohort.
  
  
  METHODS
  From 2000 through 2012, a total of 7,001 patients underwent transrectal ultrasound-guided prostate biopsy at 6 centers in Daegu and Gyeongbuk provinces. Of these 7,001 patients, the initial biopsy was positive for PCa in 2,118 patients. Repeat biopsy was performed in 374 of the 4,883 patients with an initial negative finding and a persistently elevated prostate-specific antigen (PSA) level, nodules or asymmetry by digital rectal examination (DRE), high-grade prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Numbers of biopsy cores varied from 6 to 12 according to center and biopsy date.
  
  
  RESULTS
  Cancer was diagnosed in 2,118 of the 7,001 patients (30.3%) at initial biopsy and in 86 of the 374 patients (23.0%) at repeat biopsy. The repeat biopsy rate was 5.3%. Mean PSA values were 68.7±289.5 ng/mL at initial biopsy and 18.0±55.4 ng/mL at repeat biopsy (p<0.001). The mean number of cancer-positive cores per biopsy was 5.5±3.5 for initial biopsy and 3.0±2.9 for repeat biopsy (p<0.001). Mean Gleason score was 7.5±1.4 at initial biopsy and 6.6±1.3 at repeat biopsy (p<0.001). For detected cancers, the low-stage rate was higher for repeat biopsy than for initial biopsy (p=0.001).
  
  
  CONCLUSIONS
  Cancers detected at repeat biopsy tend to have lower Gleason scores and stages than cancers detected at initial biopsy. The present study shows that repeat biopsy is needed in patients with a persistently high PSA or abnormal DRE findings.
authors.affiliation: Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Park
authors.affiliation: Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.
authors.forename: Ki Ho
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Urology, Kyungpook National University, Daegu, Korea.
authors.forename: Tae Gwon
authors.initials: TG
authors.lastname: Kwon
authors.affiliation: Department of Urology, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Chun Ii
authors.initials: CI
authors.lastname: Kim
authors.affiliation: Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.
authors.forename: Cheol Hee
authors.initials: CH
authors.lastname: Park
authors.affiliation: Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Jae Shin
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.
authors.forename: Duck Youn
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Urology, Daegu Fatima Hospital, Daegu, Korea.
authors.forename: Jae Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Urology, Yeungnam University College of Medicine, Daegu, Korea.
authors.forename: Ki Hak
authors.initials: KH
authors.lastname: Moon
authors.affiliation: Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.
authors.forename: Kyung Seop
authors.initials: KS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019160:Endosonography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D012007:Rectum; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Biopsy; Gleason grading; Neoplasm staging; Prostatic neoplasms