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Repeat prostate biopsy: who, how and when?. a review
Bob Djavan1, Mesut Remzi, Claude C Schulman
1Department of Urology, University of Vienna, Vienna, Austria.
European Urology
|August 6, 2002
Summary
Repeat prostate biopsies are crucial for detecting cancer missed in initial negative results. Increasing core samples and improving peripheral zone sampling enhance detection without significant morbidity.
Area of Science:
- Urology
- Oncology
- Diagnostic Imaging
Background:
- Urologists often encounter patients with high suspicion of prostate cancer (PCa) despite initial negative biopsies.
- Managing these cases requires careful consideration of repeat biopsy strategies.
Purpose of the Study:
- To review current knowledge on repeat prostate biopsies.
- To define optimal timing, patient selection, sampling techniques, and expected morbidity for repeat biopsies.
Main Methods:
- Review of available literature and the multicenter European Prostate Cancer Detection (EPCD) study.
- Analysis of data from 1051 men with PSA 4-10 ng/ml undergoing initial sextant biopsy and repeat biopsy if negative.
Main Results:
- Increasing biopsy cores and improving peripheral zone sampling significantly improve PCa detection without increased morbidity.
- Repeat biopsy, even 6 weeks later, showed no significant difference in pain or morbidity.
- At least 10% of patients with initial negative biopsies were diagnosed with PCa on repeat biopsy.
- Percent free PSA and PSA density of the transition zone are accurate predictors for repeat biopsy diagnosis.
- Cancers detected on initial and repeat biopsies showed similar pathological and biochemical features.
Conclusions:
- Repeat prostate biopsy is advocated for patients with negative initial findings and high suspicion of PCa.
- Optimized sampling techniques enhance cancer detection without compromising patient safety or quality of life.
- Further research is needed to determine optimal protocols for repeat biopsies after extensive initial sampling.