title: Anterior prostate biopsy at initial and repeat evaluation: is it useful to detect significant prostate cancer?
abstract: OBJECTIVE
  Detection rate for anterior prostate cancer (PCa) in men who underwent initial and repeat biopsy has been prospectively evaluated.
  
  
  METHODS
  From January 2013 to March 2014, 400 patients all of Caucasian origin (median age 63.5 years) underwent initial (285 cases) and repeat (115 cases) prostate biopsy; all the men had negative digital rectal examination and the indications to biopsy were: PSA values > 10 ng/mL, PSA between 4.1-10 or 2.6-4 ng/mL with free/total PSA≤ 25% and ≤ 20%, respectively. A median of 22 (initial biopsy) and 31 cores (repeat biopsy) were transperineally performed including 4 cores of the anterior zone (AZ) and 4 cores of the AZ plus 2 cores of the transition zone (TZ), respectively.
  
  
  RESULTS
  Median PSA was 7.9 ng/mL; overall, a PCa was found in 180 (45%) patients: in 135 (47.4%) and 45 (36%) of the men who underwent initial and repeat biopsy, respectively. An exclusive PCa of the anterior zone was found in the 8.9 (initial biopsy) vs 13.3% (repeat biopsy) of the men: a single microfocus of cancer was found in the 61.2% of the cases; moreover, in 7 out 18 AZ PCa the biopsy histology was predictive of significant cancer in 2 (28.5%) and 5 (71.5%) men who underwent initial and repeat biopsy, respectively.
  
  
  CONCLUSIONS
  However AZ biopsies increased detection rate for PCa (10% of the cases), the majority of AZ PCa with histological findings predictive of clinically significant cancer were found at repeat biopsy (about 70% of the cases).
authors.affiliation: Unità Urologia, Ospedale Cannizzaro, Catania, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pepe
authors.affiliation: Unità Urologia, Ospedale Cannizzaro, Catania, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pennisi
authors.affiliation: Unità Patologia, Ospedale Cannizzaro, Catania, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Fraggetta
mesh_terms: D000368:Aged; D062005:Biopsy, Large-Core Needle / Q000379:methods*; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology*; D012015:Reference Standards; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen