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Determining variables for repeat prostate biopsy

Abstract

During the evaluation of prostate cancer, men who have undergone transrectal ultrasound-guided biopsy with negative results present a dilemma as to what further follow-up is required. Multiple variables have been proposed throughout the literature to improve cancer detection rates not only in initial biopsy results, but also on repeat evaluation. These variables include prostate-specific antigen (PSA) velocity, PSA density, free-percent PSA, and histological findings, each of which may singly or collectively dictate the need for further biopsy. After performing a Medline literature search using specific Medical Subject Headings (prostate biopsy, repeat prostate biopsy, PSA velocity, PSA density, free-percent PSA, prostate inflammation), we critically evaluated pertinent articles. Using this accumulated data and information, we composed an algorithm to assist in the decision process for repeat biopsy.

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References

  1. Greenlee RT, Hill-Harmon MB, Murray T, Thun M . Cancer statistics, 2001. CA Cancer J Clin 2001; 51 (1): 15–36.

    Article  CAS  Google Scholar 

  2. Scardino PT . Early detection of prostate cancer. Urol Clin N Am 1989; 16: 635–655.

    CAS  Google Scholar 

  3. Matlaga BR, Eskew LA, McCullough DL . Prostate biopsy: indications and technique. J Urol 2003; 169: 12–19.

    Article  Google Scholar 

  4. Carvalhal GF et al. Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4ng./ml. or less. J Urol 1999; 161: 835–839.

    Article  CAS  Google Scholar 

  5. Dall’Era MA, Evans CP . Tumor markers. In: Carroll PR, Grossfeld GD (eds). American Cancer Society Atlas of Clinical Oncology: Prostate Cancer: B.C. Decker Publishing: Hamilton, Ontario 2001.

    Google Scholar 

  6. Hodge KK, McNeal JE, Terris MK, Stamey TA . Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol 1989; 142: 71–74, discussion 74–75.

    Article  CAS  Google Scholar 

  7. Chang JJ, Shinohara K, Bhargava V, Presti Jr JC . Prospective evaluation of lateral biopsies of the peripheral zone for prostate cancer detection. J Urol 1998; 160: 2111–2114.

    Article  CAS  Google Scholar 

  8. Eskew LA, Bare RL, McCullough DL . Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol 1997; 157: 199–202, discussion 202–193..

    Article  CAS  Google Scholar 

  9. Babaian RJ et al. A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol 2000; 163: 152–157.

    Article  CAS  Google Scholar 

  10. Presti Jr JC, Chang JJ, Bhargava V, Shinohara K . The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol 2000; 163: 163–166, discussion 166–167..

    Article  Google Scholar 

  11. Mian BM et al. Predictors of cancer in repeat extended multisite prostate biopsy in men with previous negative extended multisite biopsy. Urology 2002; 60: 836–840.

    Article  Google Scholar 

  12. Terris MK, Pham TQ, Issa MM, Kabalin JN . Routine transition zone and seminal vesicle biopsies in all patients undergoing transrectal ultrasound guided prostate biopsies are not indicated. J Urol 1997; 157: 204–206.

    Article  CAS  Google Scholar 

  13. Liu IJ, Macy M, Lai YH, Terris MK . Critical evaluation of the current indications for transition zone biopsies. Urology 2001; 57: 1117–1120.

    Article  CAS  Google Scholar 

  14. Keetch DW, Catalona WJ . Prostatic transition zone biopsies in men with previous negative biopsies and persistently elevated serum prostate specific antigen values. J Urol 1995; 154: 1795–1797.

    Article  CAS  Google Scholar 

  15. Djavan B et al. Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men. J Urol 2000; 163: 1144–1148, discussion 1148–1149..

    Article  CAS  Google Scholar 

  16. Remzi M et al. Can total and transition zone volume of the prostate determine whether to perform a repeat biopsy? Urology 2003; 61: 161–166.

    Article  CAS  Google Scholar 

  17. Basillote JB, Armenakas NA, Hochberg DA, Fracchia JA . Influence of prostate volume in the detection of prostate cancer. Urology 2003; 61: 167–171.

    Article  Google Scholar 

  18. Ung JO et al. The relationship of prostate gland volume to extended needle biopsy on prostate cancer detection. J Urol 2003; 169: 130–135.

    Article  Google Scholar 

  19. Letran JL, Meyer GE, Loberiza FR, Brawer MK . The effect of prostate volume on the yield of needle biopsy. J Urol 1998; 160: 1718–1721.

    Article  CAS  Google Scholar 

  20. Karakiewicz PI et al. Outcome of sextant biopsy according to gland volume. Urology 1997; 49: 55–59.

    Article  CAS  Google Scholar 

  21. Uzzo RG et al. The influence of prostate size on cancer detection. Urology 1995; 46: 831–836.

    Article  CAS  Google Scholar 

  22. Chen ME et al. Prostate cancer detection: relationship to prostate size. Urology 1999; 53: 764–768.

    Article  CAS  Google Scholar 

  23. Terris MK . Extended field prostate biopsies: too much of a good thing? Urology 2000; 55: 457–460.

    Article  CAS  Google Scholar 

  24. Carter HB et al. Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease. JAMA 1992; 267: 2215–2220.

    Article  CAS  Google Scholar 

  25. Carter HB et al. Estimation of prostatic growth using serial prostate-specific antigen measurements in men with and without prostate disease. Cancer Res 1992; 52: 3323–3328.

    PubMed  CAS  Google Scholar 

  26. Borboroglu PG, Comer SW, Riffenburgh RH, Amling CL . Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies. J Urol 2000; 163: 158–162.

    Article  CAS  Google Scholar 

  27. Keetch DW et al. Prostate specific antigen density versus prostate specific antigen slope as predictors of prostate cancer in men with initially negative prostatic biopsies. J Urol 1996; 156 (2 Part 1): 428–431.

    Article  CAS  Google Scholar 

  28. Djavan B et al. Repeat prostate biopsy: who, how and when? A review. Eur Urol 2002; 42: 93–103.

    Article  Google Scholar 

  29. Zlotta AR et al. The importance of measuring the prostatic transition zone: an anatomical and radiological study. BJU Int 1999; 84: 661–666.

    Article  CAS  Google Scholar 

  30. Catalona WJ et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA 1998; 279: 1542–1547.

    Article  CAS  Google Scholar 

  31. Morgan TO et al. Prospective use of free prostate-specific antigen to avoid repeat prostate biopsies in men with elevated total prostate-specific antigen. Urology 1996; 48 (6A Suppl): 76–80.

    Article  CAS  Google Scholar 

  32. Qian J, Wollan P, Bostwick DG . The extent and multicentricity of high-grade prostatic intraepithelial neoplasia in clinically localized prostatic adenocarcinoma. Hum Pathol 1997; 28: 143–148.

    Article  CAS  Google Scholar 

  33. Park S, Shinohara K, Grossfeld GD, Carroll PR . Prostate cancer detection in men with prior high grade prostatic intraepithelial neoplasia or atypical prostate biopsy. J Urol 2001; 165: 1409–1414.

    Article  CAS  Google Scholar 

  34. Bostwick DG . The pathology of early prostate cancer. CA Cancer J Clin 1989; 39: 376–393.

    Article  CAS  Google Scholar 

  35. Okada K et al. Correlation of histological inflammation in needle biopsy specimens with serum prostate-specific antigen levels in men with negative biopsy for prostate cancer. Urology 2000; 55: 892–898.

    Article  CAS  Google Scholar 

  36. Hasui Y et al. Relationship between serum prostate specific antigen and histological prostatitis in patients with benign prostatic hyperplasia. Prostate 1994; 25: 91–96.

    Article  CAS  Google Scholar 

  37. Nadler RB et al. Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol 1995; 154 (2 Part 1): 407–413.

    Article  CAS  Google Scholar 

  38. Morote J, Lopez M, Encabo G, de Torres IM . Effect of inflammation and benign prostatic enlargement on total and percent free serum prostatic specific antigen. Eur Urol 2000; 37: 537–540.

    Article  CAS  Google Scholar 

  39. Punglia RS et al. Effect of verification bias on screening for prostate cancer by measurement of prostate-specific antigen. N Engl J Med 2003; 349: 335–342.

    Article  Google Scholar 

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Correspondence to C P Evans.

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Busby, J., Evans, C. Determining variables for repeat prostate biopsy. Prostate Cancer Prostatic Dis 7, 93–98 (2004). https://doi.org/10.1038/sj.pcan.4500708

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