Strategies for repeat prostate biopsies

Terris, Martha K.

doi:10.1007/s11918-009-0009-7

Cited by 3 publications

(5 citation statements)

References 60 publications

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“…We chose the cutoff of one year for inclusion of incident cases based on earlier unpublished work that showed the cumulative incidence distribution of prostate cancer in men with a benign prostate specimen in our cohort formed a left skewed distribution with the majority of cases diagnosed within three months of the time of benign prostate specimen collection with a steady decline of incident cases thereafter. Since the slope in this decline leveled off at one year, and because a year would also generally encompass the time of any re‐evaluation of suspicious biopsy findings, we chose one year of follow‐up as the cutoff for study eligibility, which should eliminate most of the men with prostate cancers that were “missed” at time of cohort entry.…”

Section: Discussionmentioning

confidence: 99%

Methylation in benign prostate and risk of disease progression in men subsequently diagnosed with prostate cancer

Rybicki

Rundle

Kryvenko

et al. 2016

Intl Journal of Cancer

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In DNA from prostate tumors, methylation patterns in gene promoter regions can be a biomarker for disease progression. It remains unclear whether methylation patterns in benign prostate tissue—prior to malignant transformation—may provide similar prognostic information. To determine whether early methylation events predict prostate cancer outcomes, we evaluated histologically benign prostate specimens from 353 men who eventually developed prostate cancer and received “definitive” treatment [radical prostatectomy (58%) or radiation therapy (42%)]. Cases were drawn from a large hospital-based cohort of men with benign prostate biopsy specimens collected between 1990 and 2002. Risk of disease progression associated with methylation was estimated using time-to-event analyses. Average follow-up was over 5 years; biochemical recurrence (BCR) occurred in 91 cases (26%). In White men, methylation of the APC gene was associated with increased risk of BCR, even after adjusting for standard clinical risk factors for prostate cancer progression (adjusted hazard ratio (aHR) = 2.26; 95%CI 1.23–4.16). APC methylation was most strongly associated with a significant increased risk of BCR in White men with low prostate specific antigen at cohort entry (HR = 3.66; 95%CI 1.51–8.85). In additional stratified analyses, we found that methylation of the RARB gene significantly increased risk of BCR in African American cases who demonstrated methylation of at least one of the other four genes under study (HR = 3.80; 95%CI 1.07–13.53). These findings may have implications in the early identification of aggressive prostate cancer as well as reducing unnecessary medical procedures and emotional distress for men who present with markers of indolent disease.

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Section: Discussionmentioning

confidence: 99%

Methylation in benign prostate and risk of disease progression in men subsequently diagnosed with prostate cancer

Rybicki

Rundle

Kryvenko

et al. 2016

Intl Journal of Cancer

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“…4 A recent observation suggested that, after a negative PBx, PSA was of no use in assessing patient risk for PCa. 22 In contrast, Thompson et al showed that the performance of PSA is well maintained in repeat PBx populations.…”

Section: Prostate-specific Antigen Indices As Indications For Repeat Pbxmentioning

confidence: 99%

“…Although the authors recommend a 14-core protocol using the standard 12-core biopsy scheme plus two additional cores taken from the extreme anterior apex, the optimal number of cores is still controversial. 3 Ravery et al 4 and Guichard et al 5 showed the superiority of a transrectal 20-or 21-core PBx over the conventional transrectal 12-core PBx in 1491 and 1000 patients, respectively. Conversely, Pepe et al 6 and Jones et al 7 noted that a transrectal protocol above 24-core offered no advantage over a 12-core PBx.…”

Section: Editorial Comment To Prostate Cancer Detection After a Negatmentioning

confidence: 99%

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Prostate cancer detection after a negative prostate biopsy: Lessons learnt in the Cleveland Clinic experience

Zaytoun

Jones

2011

Int J of Urology

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Abstract:Urologists are often faced with the dilemma of managing patients with a negative initial prostate biopsy in whom clinical or pathological risk for prostate cancer still exists. Such real-life challenging scenarios might raise questions such as: Who should undergo further biopsies? What are the optimal predictors for prostate cancer on subsequent biopsies? What is the optimal biopsy protocol that should be used? When to stop the biopsy cascade? The last decade has witnessed numerous studies that have analyzed factors conferring a significant risk for cancer discovered on repeat biopsies. We and others have developed predictive models to aid decision-making regarding pursuing further biopsies. For decades, high-grade prostatic intraepithelial neoplasia has been considered a strong risk indicator for subsequent cancer. However, it has been recently shown that only through segmentation of this heterogeneous population does the real risk profile emerge. Biopsy templates underwent modification regarding the number and location of cores with emergence of the transrectal or brachytherapy grid transperineal saturation biopsy. However, the best biopsy protocol remains controversial. We have refined the initial biopsy template to a 14 core initial biopsy template that optimizes cancer detection, and have shown that transrectal saturation biopsy significantly improves cancer detection for repeat biopsy. Another concern is the overdiagnosis of clinically insignificant cancer on repeat biopsies, so we explored ways to limit this, and to deal with its ramifications. Through carrying out a Medline literature search, we critically evaluated pertinent articles together with emphasis of our own journey in this arena to assist in the decision-making process for repeat biopsy population.

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“…The adoption of extended TRUS-guided biopsy schemes of 12 or 18 cores improved the detection rate for PCa to 38.9% [3] and 49% [4] , respectively. After several sets of negative biopsies, the areas in which cancer is frequently found are the transition and the anterior zones [5] ; at present, a transition zone (TZ) sampling is recommended at repeated biopsy [6] , although the cancer detection rate in this region only ranges from 1.8 to 6.9% [7][8][9][10] , and a considerable number of cancers not found at biopsy are subsequently diagnosed by transurethral prostate resection (TURP) or open adenomectomy. Therefore, some authors [7,8] consider directed biopsy cores unsuitable and unnecessary for detecting cancer of the TZ.…”

Section: Introductionmentioning

confidence: 99%

Is Transition Zone Sampling at Repeated Saturation Prostate Biopsy Still Useful

Pepe

Candiano²,

Fraggetta³

et al. 2010

Urol Int

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Objectives: To evaluate retrospectively the detection rate of prostate cancer (PCa) located only in the transition zone (TZ) by directed cores at repeated saturation prostate biopsy (SPB). Methods: From July 2001 to December 2009, 380 and 43 patients (median age: 63 years) underwent second and third SPB because they were persistently suspicious for PCa. Indications for biopsy were: prostate-specific antigen (PSA) of >10 ng/ml, and PSA between 4.1 and 10 ng/ml or 2.6 and 4 ng/ml with free/total PSA of ≤25 and ≤20%, respectively. A median of 23 cores were taken in the posterior zone, including 3 (median) cores in the TZ. The median PSA was 12.8 and 19.5 ng/ml and the digital rectal examination was positive in 36 (9.5%) and in no cases at second and third SPB, respectively. In patients with persistent and/or increasing PSA or abnormal free/total PSA values after negative second and third SPB, a transurethral prostate resection (TURP) was suggested to avoid the risk of missing a cancer localized in the TZ. Results: PCa was detected in the TZ only in 2/82 cases (2.5%), and in details in 1/79 (1.2%) and 1/3 (33.3%) of the men diagnosed at second and third SPB, respectively. After TURP, a PCa was found in 18/95 men (18.9%; 14 stage T1a and 4 stage T1b) and in 3/15 men (20%; 2 stage T1a and 1 stage T1b) previously having had negative second and third SPB. Conclusions: Sampling from the prostatic TZ by directed needle biopsies at repeated SPB was associated with a very low incidence of PCa (2.5%), especially if compared to TURP (19% detection rate), and could be omitted.

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Strategies for repeat prostate biopsies

Cited by 3 publications

References 60 publications

Methylation in benign prostate and risk of disease progression in men subsequently diagnosed with prostate cancer

Methylation in benign prostate and risk of disease progression in men subsequently diagnosed with prostate cancer

Prostate cancer detection after a negative prostate biopsy: Lessons learnt in the Cleveland Clinic experience

Is Transition Zone Sampling at Repeated Saturation Prostate Biopsy Still Useful

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