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Addressing the need for repeat prostate biopsy: new technology and approaches

Nature Reviews Urology volume 12, pages 435–444 (2015)Cite this article

Subjects

Key Points

  • No formal guidelines exist regarding management of patients following negative findings on initial biopsy sample analysis, despite high or elevated serum PSA levels that suggest the presence of prostate cancer

  • Analysis of repeat biopsy samples leads to a diagnosis of prostate cancer in 15–23% of patients who had a negative initial result

  • The development of new imaging modalities and molecular biomarkers for diagnosis and/or monitoring of patients in this clinical setting has provided new options for the management of these patients

  • Diagnosis and/or surveillance options, which have different advantages, include various serum PSA-based measurements, urinary prostate-cancer associated 3 (PCA3) RNA levels, MRI, ultrasonography and epigenetic tissue-based assays

  • A strategy for identifying men at an increased risk of prostate cancer is presented, with the aim of increasing diagnostic accuracy while decreasing the number of unnecessary biopsy procedures

Abstract

No guidelines currently exist that address the need for rebiopsy in patients with a negative diagnosis of prostate cancer on initial biopsy sample analysis. Accurate diagnosis of prostate cancer in these patients is often complicated by continued elevation of serum PSA levels that are suggestive of prostate cancer, resulting in a distinct management challenge. Following negative initial findings of biopsy sample analysis, total serum PSA levels and serum PSA kinetics are ineffective indicators of a need for a repeat biopsy; therefore, patients suspected of having prostate cancer might undergo several unnecessary biopsy procedures. Several alternative strategies exist for identifying men who might be at risk of prostate cancer despite negative findings of biopsy sample analysis. Use of other serum PSA-related measurements enables more sensitive and specific diagnosis and can be combined with knowledge of clinicopathological features to improve outcomes. Other options include the FDA-approved Progensa® test and prostate imaging using MRI. Newer tissue-based assays that measure methylation changes in normal prostate tissue are currently being developed. A cost-effective strategy is proposed in order to address this challenging clinical scenario, and potential directions of future studies in this area are also described.

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Figure 1: Management of patients who continue to have elevated serum PSA levels despite a negative diagnosis of prostate cancer on analysis of a biopsy sample.

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Acknowledgements

This work was supported by a training grant T32 from the US National Institute of Health (5T32CA009614-24) (M.L.B.).

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Authors and Affiliations

  1. Department of Urology,University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, 53705, WI, USA

    Michael L. Blute Jr, E. Jason Abel, Tracy M. Downs & David F. Jarrard

  2. Department of Radiology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, 53705, WI, USA

    Frederick Kelcz

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M.L.B. and D.F.J. researched data and made significant contributions to manuscript writing. All other authors contributed to writing, reviewing, and editing of this article prior to submission.

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Correspondence to David F. Jarrard.

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Blute, M., Abel, E., Downs, T. et al. Addressing the need for repeat prostate biopsy: new technology and approaches. Nat Rev Urol 12, 435–444 (2015). https://doi.org/10.1038/nrurol.2015.159

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