Korean J Androl.  2011 Apr;29(1):62-68. 10.5534/kja.2011.29.1.62.

Clinical Predictive Factors in Patients with Prostate Cancer Diagnosed by Repeat Prostate Biopsy

• Joo KJ
• Kwon CH

• KMID: 2298627
• DOI: http://doi.org/10.5534/kja.2011.29.1.62

Abstract

PURPOSE
We investigated the predictive factors in patient with prostate cancer diagnosed by repeat prostate biopsy, where initial prostate biopsy results were negative for malignancy.
MATERIALS AND METHODS
Between March 2000 and June 2007, 1280 men with suspected prostatic cancer underwent transrectal ultrasound guided needle biopsy of the prostate, with 148 (11.6%) diagnosed as having prostate cancer. Of 1132 men whose biopsy results were negative for malignancy, 655 whose prostate specific antigen (PSA) was elevated persistently underwent second biopsy, and 462 underwent third biopsy as the same course. Twelve core biopsies were performed in the majority of patients. To determine predictive factors, we evaluated prostate volume, serum PSA, percent free PSA, PSA density (PSAD), transition zone PSAD, PSA velocity (PSAV) and pathological report of previous biopsy between the men with cancer detection and the men with negative biopsy in second and third biopsy.
RESULTS
Overall cancer detection rate was 16.3% (208/1280). From the first, second and third biopsies, the cancer detection rate were 11.6, 5.5 and 5.2%, respectively. There were significant differences in percent free PSA, transition zone PSAD, PSAV between cancer and negative biopsy groups after serial repeat biopsies (p<0.05). Multivariate logistic regression analysis revealed that the transition zone PSAD, PSAV, and presence of either atypical small acinar proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN) in initial biopsy specimen were significant predictors for prostate cancer diagnosed by repeat biopsy.
CONCLUSIONS
Of the men with negative results on the first biopsy, 60 (5.4%) were diagnosed prostate cancer after serial biopsies. The transition zone PSAD, PSAV, and presence of either ASAP or HGPIN in initial biopsy specimen are predictable factors for prostate cancer detection on repeat biopsy.

Keyword

Prostate neoplasm; Needle biopsy; Prostate specific antigen; Prostatic intraepithelial neoplasia

MeSH Terms

Biopsy
Biopsy, Needle
Humans
Logistic Models
Male
Prostate
Prostate-Specific Antigen
Prostatic Intraepithelial Neoplasia
Prostatic Neoplasms
Prostate-Specific Antigen

Reference

1). Keetch DW, McMurtry JM, Smith DS, Andriole GL, Catalona WJ. Prostate specific antigen density versus prostate specific antigen slope as predictors of prostate cancer in men with initially negative prostatic biopsies. J Urol. 1996; 156:428–31.

2). Ellis WJ, Brawer MK. Repeat prostate needle biopsy: Who needs it? J Urol. 1995; 153:1496–8.

3). Roehrborn CG, Pickens GJ, Sanders JS. Diagnostic yield of repeated transrectal ultrasound-guided biopsies stratified by specific histopathologic diagnosis and prostate specific antigen levels. Urology. 1996; 47:347–52.

4). Durkan GC, Greene DR. Elevated serum prostate specific antigen levels in conjunction with an initial prostate biopsy negative for carnicoma: Who should undergo a repeat biopsy? BJU Int. 1999; 83:34–8.

5). Epstein JI, Walsh PC, Carter HB. Importance of posterolateral needle biopsies in the detection of prostate cancer. Urology. 2001; 57:1112–6.

6). Roehl KA, Antenor JA, Catalona WJ. Serial biopsy results in prostate cancer screening study. J Urol. 2002; 167:2435–9.

7). Gann PH, Fought A, Deaton R, Catalona WJ, Vonesh E. Risk factors for prostate cancer detection after a negative biopsy: a novel multivariable longitudinal approach. J Clin Oncol. 2010; 28:1714–20.

8). Ryu SH, Chai SE, Choi HY. Predictive factors of prostatic cancer detection on repeat prostate biopsy. Korean J Urol. 2003; 44:1–5.

9). Park EK, Yang WJ, Choi YD, Chung BH, Rha KH, Yang SC, et al. The significance of repeat prostate biopsy for the detection of prostate cancer. Korean J Urol. 2005; 46:1268–71.

10). Kakehi Y, Naito S. Japanese Urological Association. Complication rates of ultrasound-guided prostate biopsy: a nationwide survey in Japan. Int J Urol. 2008; 15:319–21.

11). Okada K, Okihara K, Kitamura K, Mikami K, Ukimura O, Kawauchi A, et al. Community-based prostate cancer screening in Japan: predicting factors for positive repeat biopsy. Int J Urol. 2010; 17:541–7.

12). Morgan TO, McLeod DG, Leifer ES, Murphy GP, Moul JW. Prospective use of free prostate-specific antigen to avoid repeat prostate biopsies in men with elevated total prostate-specific antigen. Urology. 1996; 48(Suppl 6A):76–80.

13). Uemura H, Nakamura M, Hasumi H, Sugiura S, Fujinami K, Miyoshi Y, et al. Effectiveness of percent free prostate specific antigen as a predictor of prostate cancer detection on repeat biopsy. Int J Urol. 2004; 11:494–500.

14). Davidson D, Bostwick DG, Qian J, Wollan PC, Oesterling JE, Rudders RA, et al. Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma: predictive accuracy in needle biopsies. J Urol. 1995; 154:1295–9.

15). Langer JE, Rover ES, Coleman BG, Yin D, Arger PH, Malkowicz SB, et al. Strategy for repeat biopsy of patients with prostatic intraepithelial neoplasia detected by prostate needle biopsy. J Urol. 1996; 155:228–31.

16). Lefkowitz GK, Taneja SS, Brown J, Melamed J, Lepor H. Followup interval prostate biopsy 3 years after diagnosis of high grade prostatic intraepithelial neoplasia is associated with high likelihood of prostate cancer, independent of change in prostate specific antigen levels. J Urol. 2002; 168:1415–8.

17). Epstein JI, Herawi M. Prostate needle biopsies with foci suspicious for cancer or prostatic intraepithelial neoplasia: implications for patient care. J Urol. 2006; 175:820–34.

18). Chan TY, Epstein JI. Follow-up of atypical prostate needle biopsies suspicious for cancer. Urology. 1999; 53:351–5.

19). Ouyang RC, Kenwright DN, Nacey JN, Delahunt B. The presence of atypical small acinar proliferation in prostate needle biopsy is predictive of carcinoma on subsequent biopsy. BJU Int. 2001; 87:70–4.