title: More Favorable Pathological Outcomes in Men with Low Risk Prostate Cancer Diagnosed on Repeat versus Initial Transrectal Ultrasound Guided Prostate Biopsy.
abstract: We assessed the pathological outcomes after radical prostatectomy in men with favorable risk prostate cancer diagnosed on first/initial biopsy compared to those of men who were diagnosed on a subsequent/repeat prostate biopsy.
  
  
  
  We identified 422 patients who met National Comprehensive Cancer Network® very low (199) and low risk (223) prostate cancer definitions who instead underwent radical prostatectomy. In each risk category we compared adverse pathological outcomes, defined as Gleason score upgrading, extraprostatic extension, seminal vesicle invasion and positive surgical margins, between men diagnosed on initial prostate biopsy vs repeat/subsequent prostate biopsy after a negative biopsy(-ies).
  
  
  
  There were no significant differences in the baseline clinical and demographic characteristics between the groups. However, men who were diagnosed on initial prostate biopsy demonstrated a higher median maximum cancer percent per single core (p <0.001) and higher median percent of positive cores (p <0.001). Compared to repeat/subsequent prostate biopsy, men diagnosed on initial prostate biopsy had a higher Gleason score upgrade (7 or greater) (57.7% vs 42.1%, p=0.005) and extraprostatic extension (14.1% vs 5.4%, p=0.01). On stratified analysis comparing initial prostate biopsy to repeat/subsequent prostate biopsy, very low risk disease was associated with Gleason score upgrade (49.3% vs 31.8%, p=0.02) and low risk disease demonstrated higher rates of extraprostatic extension (19.9% vs 6.0%, p=0.02).
  
  
  
  The likelihood of adverse pathological outcomes at radical prostatectomy is lower in men diagnosed with favorable risk prostate cancer on repeat/subsequent prostate biopsy than in men diagnosed on initial prostate biopsy, and may represent an important consideration in risk stratifying cases of favorable risk prostate cancer.
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Urology Department, Al Kasr Al Aini Hospital, Cairo University, Giza, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: ElShafei
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Nyame
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Onder
authors.initials: O
authors.lastname: Kara
authors.affiliation: Urology Department, Faculty of Medicine, Menofiya University, Menofiya, Egypt.
authors.forename: Atef
authors.initials: A
authors.lastname: Badawy
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Ifeanyi
authors.initials: I
authors.lastname: Amujiogu
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Khaled
authors.initials: K
authors.lastname: Fareed
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Eric
authors.initials: E
authors.lastname: Klein
authors.affiliation: Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: joness7@ccf.org.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D003430:Cross-Sectional Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012306:Risk; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: biopsy; prostatectomy; prostatic neoplasms; risk; watchful waiting