1457 WHEN SERIAL PROSTATE BIOPSY IS RECOMMENDED: MOST CANCERS DETECTED ARE CLINICALLY INSIGNIFICANT

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening II1 Apr 20121457 WHEN SERIAL PROSTATE BIOPSY IS RECOMMENDED: MOST CANCERS DETECTED ARE CLINICALLY INSIGNIFICANT Osama Zaytoun, Andrew Stephenson, Khaled Fareed, Tianming Gao, Levy David, and Stephen Jones Osama ZaytounOsama Zaytoun Cleveland, OH More articles by this author , Andrew StephensonAndrew Stephenson Cleveland, OH More articles by this author , Khaled FareedKhaled Fareed Cleveland, OH More articles by this author , Tianming GaoTianming Gao Cleveland, OH More articles by this author , Levy DavidLevy David Cleveland, OH More articles by this author , and Stephen JonesStephen Jones Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1951AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Most cases of prostate cancer (PCa) are detected on initial or one repeat biopsy, but persistent suspicion of PCa occasionally leads to serial biopsy, which we define as greater than two biopsy sessions. We recently demonstrated that transrectal saturation biopsy (sPBx)significantly increases cancer detection when compared to extended schemes (ePBx) in the initial repeat biopsy (second overall biopsy) population, and that the majority of cases identified are clinically significant. In this study, we seek to determine the risk of detecting clinically significant cancer during contemporary serial biopsy using both extended and saturation biopsy. METHODS In the past decade, 479 men underwent 749 repeat prostate biopsies after two prior negative biopsy sessions. The ePBx group encompassed 347 biopsies with 10-14 cores. The sPBx group included 402 biopsies with >20 cores. We analyzed overall cancer detection and risk of detecting clinically significant vs. insignificant tumors. RESULTS PCa was detected in 15.9% of 749 serial biopsies, representing a cumulative PCa detection rate of 24.8% (119/479 patients). The sPBx group had a significantly higher detection rate per biopsy session (18.6% vs. 12.7%, p=0.026). Nevertheless, a majority of positive biopsies 75/119 (63%) revealed clinically insignificant cancer, including 74.6% of cancers detected by saturation biopsy. CONCLUSIONS In men with two prior negative prostate biopsies, PCa detection remains low regardless of clinical indication or transrectal biopsy protocol; the majority of cancers identified are clinically insignificant, suggesting the threshold to repeat biopsy after more than one negative session should be very high. Indication Total detection (%) ePBx (%) sPBx (%) P value Benign biopsy 34/376(9) 13/170(7.6) 21/206(10.2) 0.4 Pathological findings HGPIN 51/253(20.1) 19/124(15.3) 28/129(21.7) 0.19 ASAP(± HGPIN) 34/120(28.3) 12/53(22.6) 26/67(38.8) 0.06 Total 85/373(22.8) 31/177(17.5) 54/196(27.6) 0.021 Group Total No cancer detected No.insignificant cancer % of insignificant cancer p-value ePBx 44 25 56.8 0.044 sPBx 75 56 74.6 Total 119 75 63 Prostate cancer category Frequency (%) Total Clinically significant Clinically insignificant P-Value Previous Benign Findings 34 8(23.5%) 26(76.5%) 0.0002 Previous HGPIN 51 20(39.2%) 31(60.8%) 0.03 Previous ASAP (+/− HGPIN) 34 16(47%) 18(53%) 0.6 Any Pathological suspicion 85 36(42.4%) 49(57.6%) 0.046 Total 85 44(37%) 75(63%) 0.0002 © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e590-e591 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Osama Zaytoun Cleveland, OH More articles by this author Andrew Stephenson Cleveland, OH More articles by this author Khaled Fareed Cleveland, OH More articles by this author Tianming Gao Cleveland, OH More articles by this author Levy David Cleveland, OH More articles by this author Stephen Jones Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...