Korean J Urol.  2015 Dec;56(12):796-802. 10.4111/kju.2015.56.12.796.

Multiple cores of high grade prostatic intraepithelial neoplasia and any core of atypia on first biopsy are significant predictor for cancer detection at a repeat biopsy

• Kim TS
• Ko KJ
• Shin SJ
• Ryoo HS
• Song W
• Sung HH
• Han DH
• Jeong BC
• Seo SI
• Jeon SS
• Lee KS
• Lee SW
• Lee HM
• Choi HY
• Jeon HG

• KMID: 2359871
• DOI: http://doi.org/10.4111/kju.2015.56.12.796

Abstract

PURPOSE
To investigate the differences in the cancer detection rate and pathological findings on a second prostate biopsy according to benign diagnosis, high-grade prostatic intraepithelial neoplasia (HGPIN), and atypical small acinar proliferation (ASAP) on first biopsy.
MATERIALS AND METHODS
We retrospectively reviewed the records of 1,323 patients who underwent a second prostate biopsy between March 1995 and November 2012. We divided the patients into three groups according to the pathologic findings on the first biopsy (benign diagnosis, HGPIN, and ASAP). We compared the cancer detection rate and Gleason scores on second biopsy and the unfavorable disease rate after radical prostatectomy among the three groups.
RESULTS
A total of 214 patients (16.2%) were diagnosed with prostate cancer on a second biopsy. The rate of cancer detection was 14.6% in the benign diagnosis group, 22.1% in the HGPIN group, and 32.1% in the ASAP group, respectively (p<0.001). When patients were divided into subgroups according to the number of positive cores, the rate of cancer detection was 16.7%, 30.5%, 31.0%, and 36.4% in patients with a single core of HGPIN, more than one core of HGPIN, a single core of ASAP, and more than one core of ASAP, respectively. There were no significant differences in Gleason scores on second biopsy (p=0.324) or in the unfavorable disease rate after radical prostatectomy among the three groups (benign diagnosis vs. HGPIN, p=0.857, and benign diagnosis vs. ASAP, p=0.957, respectively).
CONCLUSIONS
Patients with multiple cores of HGPIN or any core number of ASAP on a first biopsy had a significantly higher cancer detection rate on a second biopsy. Repeat biopsy should be considered and not be delayed in those patients.

Keyword

Biopsy; Prostatic intraepithelial neoplasia; Prostate neoplasms

MeSH Terms

Aged
Biopsy, Needle/methods
Humans
Kallikreins/blood
Male
Middle Aged
Neoplasm Grading
Precancerous Conditions/*pathology/surgery
Predictive Value of Tests
Prostate-Specific Antigen/blood
Prostatectomy
Prostatic Intraepithelial Neoplasia/*pathology/surgery
Prostatic Neoplasms/*pathology/surgery
Retrospective Studies
Kallikreins
Prostate-Specific Antigen

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