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Prostate biopsy: who, how and when. An update.
Bob Djavan1, Shirin Milani, Mesut Remzi
1Department of Urology, University of Vienna, Vienna, Austria.
The Canadian Journal of Urology
|March 23, 2005
Summary
A second prostate biopsy is justified for men with initial negative results and PSA levels between 4-10 ng/mL. Subsequent biopsies (third and fourth) should be reserved for select cases due to lower cancer detection rates and increased morbidity.
Area of Science:
- Urology
- Oncology
- Medical Diagnostics
Background:
- Prostate cancer (CaP) detection often involves repeat biopsies in men with persistently elevated PSA levels.
- Evaluating the yield and characteristics of cancers detected on repeat prostate biopsies is crucial for clinical decision-making.
- Understanding biopsy-related morbidity is essential for patient management and risk assessment.
Purpose of the Study:
- To evaluate and compare biochemical parameters, pathological features, and biopsy-related morbidity of prostate cancer detected on repeat biopsies (second, third, and fourth) versus initial biopsy.
- To identify predictive parameters for cancer detection on repeat prostate biopsies.
- To assess the clinical utility and safety of repeat prostate biopsies in men with PSA 4-10 ng/mL.
Main Methods:
- Prospective study involving 1051 men with serum total PSA 4-10 ng/mL undergoing transrectal ultrasound (TRUS)-guided biopsies.
- Repeat biopsies (first, second, third, fourth) were performed at specified intervals for men with negative initial results.
- Pathological and clinical features of detected cancers were compared between initial and repeat biopsies; radical prostatectomy data were analyzed.
Main Results:
- Cancer detection rates decreased with repeat biopsies: 22% (initial), 10% (second), 5% (third), 4% (fourth).
- Percent free PSA and PSA-transition zone (PSA-TZ) were strong predictors for repeat biopsy cancer detection.
- Cancers on third and fourth biopsies showed significantly lower Gleason score, grade 4/5, volume, and stage compared to earlier biopsies, though initial and second biopsy cancers had similar features.
Conclusions:
- A second prostate biopsy is justified in cases of negative initial findings, given similar pathological and biochemical features to initial biopsy cancers.
- Third and fourth repeat biopsies should be reserved for highly selected patients due to diminishing detection rates and slightly increased complication rates.
- Advanced techniques like Power Doppler TRUS and artificial neural networks may further improve prostate cancer detection.