OBJECTIVE: To identify the ability of transrectal saturation prostate biopsy (SPBx) as the initial diagnostic approach to reduce the likelihood of finding previously unrecognized prostate cancer (PCa) during repeat prostate biopsy.
MATERIALS AND METHODS: We reviewed PCa detection in 561 men who underwent first repeat SPBx after initial negative biopsy between March 2002 and April 2012. We divided the patients on the basis of the number of cores retrieved on initial biopsy (group 1, initial negative SPBx [n = 81] and group 2, initial negative extended prostate biopsy [n = 480]). The yield of repeat SPBx was compared between the 2 groups. Insignificant PCa and low-risk PCa were defined according to Epstein criteria and D'Amico risk criteria, respectively.
RESULTS: PCa detection on first repeat SPBx was 43.1% lower in group 1 (19.8% vs 34.8%; P = .008). Moreover, lower rate of significant PCa (31.3% vs 74.3%; P < .001) and intermediate- and/or high-risk PCa (25.0% vs 50.9%; P = .048) in group 1. Multivariate analysis confirmed that initial negative SPBx decreased PCa detection on first repeat SPBx (odds ratio = 0.41, 95% confidence interval 0.22-0.78).
CONCLUSION: Men whose initial biopsy was per transrectal saturation technique were less likely to have cancer identified during repeat biopsy. Furthermore, PCa diagnosed after negative initial SPBx was much more likely to be clinically insignificant. These findings suggest that SPBx may be less likely to miss clinically significant cancer during initial prostate biopsy. If confirmed in other studies, this suggests that initial biopsy by saturation technique may eliminate the need for most men to undergo repeat biopsy.
Written by:
Li YH, Elshafei A, Li J, Hatem A, Zippe CD, Fareed K, Jones JS. Are you the author?
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou, People's Republic of China; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Department of Urology, Cleveland VA/Case Medical Center, Cleveland, OH.
Reference: Urology. 2014 Apr;83(4):714-8.
doi: 10.1016/j.urology.2013.12.029
PubMed Abstract
PMID: 24680442
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