@Article{,
AUTHOR = {Bob Djavan, Shirin Milani, Mesut Remzi},
TITLE = {Prostate biopsy: who, how and when. An update},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {12},
YEAR = {2005},
NUMBER = {Suppl.1},
PAGES = {44--48},
URL = {http://www.techscience.com/CJU/v12nSuppl.1/63381},
ISSN = {1488-5581},
ABSTRACT = {Biochemical parameters and pathological features as well
as biopsy related morbidity of prostate cancer detected
on second, third and fourth repeat prostate biopsy in men
with a serum total PSA level between 4 ng/mL and 10
ng/mL were evaluated and compared to those cancers
detected on initial prostate biopsy.<br/>
In a prospective European Prostate Cancer Detection
study, 1051 men with a total PSA level between 4 ng/
mL and 10 ng/mL underwent transrectal ultrasound
(TRUS)–guided sextant biopsy and two additional
transition zone biopsies. All subjects whose biopsy
samples were negative for prostate cancer (CaP)
underwent a first repeat biopsy after 6 weeks. If also
negative a third and even a fourth biopsy was performed
at 8 weeks intervals. Those with clinically localized
cancers underwent radical prostatectomy. Pathological
and clinical features of patients diagnosed with cancer
on either initial or repeat biopsy and clinically organ
confined disease who agreed to undergo radical
prostatectomy were compared.<br/>
Cancer detection rates on first, second, third and fourth
biopsy were 22% (231/1051), 10% (83/820), 5% (36/
737) and 4% (4/94), respectively. Percent free PSA and
PSA-TZ were the most powerful parameters to predict
cancer on repeat biopsy. Overall, of patients with
clinically localized disease (67% of cancers detected), 86%
underwent radical prostatectomy and 14% opted for
watchful waiting or radiation therapy. Overall, 58.0%,
60.9%, 86.3% and 100% had organ confined disease on
first, repeat, third and fourth biopsy, respectively.<br/>
Despite statistical significant differences with respect to
multifocality (p=0.009) and cancer location (p=0.001)
(cancers on second biopsy showing a lower rate of
multifocality and a more apico-dorsal location), there were
no differences with respect to stage (p=0.2), Gleason score
(p=0.3), percentage Gleason grade 4/5 (p=0.2), serum
PSA and patient age between first and second biopsy.
However, cancers detected on third and fourth biopsy had
a significantly lower Gleason score (p=0.001 and 0.001),
lower rate of grade 4/5 cancer (p=0.02), lower cancer
volume (p= 0.001 and 0.001) and lower stage (p= 0.001).
Morbidity of first and repeat biopsy were similar, whereas
third and fourth biopsy had a slightly higher complication
rate. Interestingly, patients under 60 years of age reported
a higher pain apprehension as quantified with the visual
analog pain scale (VAS). Further, the use of the Vienna
tables allowed an accurate calculation of the number of
biopsy cores required based on prostate volume and age.
Despite differences in location and multifocality,
pathological and biochemical features of cancers detected
on initial and second biopsy were similar, suggesting
similar biological behavior. Cancers detected on third
and fourth biopsy had a lower grade, stage and cancer
volume as compared to cancers on first and repeat biopsy.
Morbidity of first and repeat biopsy were similar, whereas
third and fourth biopsy had a slightly higher complication
rate. Hence, a second prostate biopsy in all cases of a
negative finding on initial biopsy appears justified. Third
and fourth repeat biopsies however, should only be
obtained in very selected patients with high suspicion of
cancer and/or poor prognostic factors on the first or
second biopsy. Power Doppler TRUS will further
enhance prostate cancer detection as will artificial neural
networks as patient selecting tools.},
DOI = {}
}