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Serial biopsy results in prostate cancer screening study
Kimberly A Roehl1, Jo Ann V Antenor, William J Catalona
1Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
The Journal of Urology
|May 7, 2002
Summary
Repeat prostate biopsies are crucial for detecting prostate cancer missed in initial screenings. Serial biopsies increase the detection of organ-confined cancers, improving early diagnosis and treatment planning.
Area of Science:
- Urology
- Oncology
- Medical Screening
Background:
- Elevated prostate-specific antigen (PSA) levels and suspicious digital rectal examinations (DRE) are common indicators for prostate biopsy.
- Initial prostate biopsies may fail to detect cancer, necessitating further investigation.
Purpose of the Study:
- To evaluate the efficacy of serial prostate biopsies in detecting prostate cancer missed by initial negative biopsies.
- To assess cancer detection rates based on PSA levels and DRE findings in a large cohort.
Main Methods:
- A total of 2,526 men aged 40+ underwent one or more prostate biopsies based on PSA levels (>4.0 ng/ml pre-1995, >2.5 ng/ml post-1995) or suspicious DRE.
- Cancer detection rates were analyzed concerning serial biopsy numbers, DRE results, and PSA levels.
Main Results:
- Serial biopsies revealed significant cancer detection rates: 29% on the first, 17% on the second, and decreasing thereafter.
- No significant difference in cancer yield was found between the higher and lower PSA cutoff groups.
- Cancers detected via serial biopsies showed a trend towards being organ-confined (78%) compared to initial screenings (69%).
Conclusions:
- Nearly a quarter of prostate cancers were missed on initial biopsy, with 77% detected by the first four serial biopsies.
- Serial biopsies effectively detect organ-confined prostate cancers without over-identifying clinically insignificant tumors.
- Further research is recommended to explore initial biopsy strategies, such as increasing core numbers, to enhance early detection and reduce repeat procedures.