Are More Low-Risk Prostate Cancers Detected by Repeated Biopsy? A Retrospective Pilot Study

Abstract

PurposeWe hypothesized that there might be a higher incidence of low-risk prostate cancer (PCa) in men diagnosed at a repeated biopsy. Thus, we investigated differences in clinicopathological results of PCa after primary and repeated biopsy.Materials and MethodsWe retrospectively reviewed patients diagnosed with PCa at a primary or repeated biopsy from January 2004 to April 2011. Patients were stratified into primary biopsy and repeated biopsy groups. We analyzed prostate-specific antigen, clinical stage, Gleason score (GS), positive core ratio, and low-risk group by using D'Amico classification. We also investigated GS upgrading and upstaging after radical prostatectomy (RP).ResultsAmong 448 primary and 37 repeated biopsy PCa patients, 82 (group 1) and 25 (group 2) underwent RP. The percentage of low-risk patients did not differ significantly between the groups. The positive biopsy core ratio was significantly lower in group 2 (p=0.009). The percentages of GS upgrading and upstaging were 42.7% and 47.6% in group 1, respectively (p=0.568), and 48.0% and 52.0% in group 2, respectively (p=0.901). In the analysis of low-risk patients, GS upgrading and upstaging were not significantly different between the groups (p=0.615 and p=0.959, respectively).ConclusionsA lower positive core ratio may imply a small volume of PCa and possibly insignificant PCa in the repeated biopsy group. However, no significant differences were observed for the ratio of low-risk cancers, GS upgrading, or upstaging between the groups. Therefore, PCa diagnosed at a repeated biopsy is not an additional indication for active surveillance.

Diagnostic Role of Prostate Resection in the Elderly Patients Who Experience Significant Co-Morbidity with a High Clinical Suspicion of Prostate Cancer

“…Zigeuner et al ( 8 ) proposed TURP as a diagnostic tool after a negative biopsy in a patient with voiding symptoms and suspicious DRE results. Though the systemic needle biopsy in the diagnosis of prostate cancer is undoubtedly the choice for diagnosis, the false-negative rate of systemic prostate biopsy is reportedly as high as 35% ( 16 - 19 ). Although 75 to 80% of all CaP originates from the peripheral zone, tumor tissue is also frequently found in the transition zone that is beyond the reach of a biopsy needle in the case of large-volume prostate needle biopsies ( 20 ).…”