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Repeat transrectal prostate biopsies in diagnosing prostate cancer.

Ivan V Bakardzhiev¹, Ivan D Dechev, Thilo Wenig

¹Department of Urology, Medical University, St George University Hospital, Plovdiv, Bulgaria. ivanbakardzhiev@yahoo.com

|October 30, 2012

Summary

Repeat prostate biopsies detect prostate cancer (PCa) infrequently, especially after the second negative biopsy. Transurethral resection of the prostate (TURP) offers an alternative for tissue diagnosis in select cases.

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Area of Science:

Urology
Oncology
Pathology

Background:

Persistent suspicion of prostate cancer (PCa) after a negative biopsy presents a diagnostic challenge.
Accurate diagnosis is crucial for appropriate patient management and treatment decisions.

Purpose of the Study:

To determine the frequency of PCa detection on repeat prostate biopsies.
To identify factors associated with a higher likelihood of a positive cancer diagnosis on repeat biopsy.

Main Methods:

Retrospective analysis of 113 patients with initial negative prostate biopsies who underwent repeat biopsies.
Patients had Prostate Specific Antigen (PSA) levels < 12.5 ng/ml and no suspicious digital rectal examination (DRE) findings.
Biopsy schemes varied based on patient age and prostate volume; Transurethral resection of the prostate (TURP) was also analyzed.

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Main Results:

The overall PCa detection rate on repeat biopsy was 22.1% (25/113).
PCa was detected in 15.9% (18/113) on repeat biopsy.
PCa detection rates decreased significantly with more repeat biopsies (8.6% for 3 biopsies, 5.5% for 4+ biopsies).
TURP revealed PCa in 20% (3/15) of patients with at least two prior negative biopsies.

Conclusions:

The interval between biopsies does not significantly predict a positive prostate biopsy result.
The likelihood of detecting PCa after a second negative transrectal biopsy is low.
TURP serves as a viable alternative for obtaining adequate tissue for pathological examination, particularly in patients with obstructive voiding symptoms.