title: Indications for a second prostate biopsy in patients suspected with prostate cancer after an initial negative prostate biopsy.
abstract: BACKGROUND
  The present study aimed to evaluate the indications for a second prostate biopsy in patients suspected with prostate cancer after an initial negative prostate biopsy.
  
  
  METHODS
  The present study included 421 patients who underwent repeat prostate biopsy between January 2007 and December 2015 at three hospitals. Clinicopathological data, including patient age, body mass index, history of prostate biopsy, prostate volume, prostate-specific antigen (PSA) level, PSA density, PSA velocity, and PSA fluctuation patterns, were analyzed. The patients were stratified into two groups based on the first PSA pattern (increase/decrease) within 1 year after the initial negative prostate biopsy.
  
  
  RESULTS
  Prostate cancer was detected in 100 (23.8%) of the 421 patients at the second prostate biopsy. In patients with a PSA decrease at the first follow-up, prostate volume and number of increases in the PSA level from the initial prostate biopsy were predictors for prostate cancer diagnosis at the second prostate biopsy. In patients with a steady PSA increase after the initial prostate biopsy, prostate volume and number of biopsy cores were predictors for prostate cancer diagnosis at the second prostate biopsy.
  
  
  CONCLUSIONS
  The indications for a second prostate biopsy are a low prostate volume and a high number of increases in the PSA level among patients with a PSA decrease at the first follow-up and a low prostate volume and a high number of biopsy cores among patients with a PSA increase at the first follow-up.
authors.affiliation: Department of Urology, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kwang Suk
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Urology, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyo Chul
authors.initials: KC
authors.lastname: Koo
authors.affiliation: Department of Urology, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kang Su
authors.initials: KS
authors.lastname: Cho
authors.affiliation: Department of Urology, Sinchon Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Urology, Sinchon Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.affiliation: Department of Urology, Sinchon Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Young Deuk
authors.initials: YD
authors.lastname: Choi
authors.affiliation: Department of Urology, Sinchon Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
authors.forename: Sang Un
authors.initials: SU
authors.lastname: Park
authors.affiliation: Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
authors.forename: Suk Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Ko
authors.affiliation: Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
authors.forename: Young Sig
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Urology, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Byung Ha
authors.initials: BH
authors.lastname: Chung
keywords: Biopsy cores; Prostate biopsy; Prostate-specific antigen