Many patients with a negative prostate biopsy (PBx) but persistent clinical suspicion of prostate cancer (PCa) undergo repeat PBx. On repeat PBx, there are higher rates of low-grade and organ-confined PCa, which are associated with lower risk of disease progression and cancer-specific mortality  and . Increasing emphasis is being placed on treating only clinically significant disease . We hypothesize that a considerable risk of clinically significant PCa remains on repeat PBx. Therefore, we reviewed a contemporary cohort of patients who underwent one or more PBx.
We retrospectively reviewed the data from a cohort of 25 584 patients who underwent PBx at two institutions. One dedicated uropathologist evaluated 90% of PBx specimens; the remaining specimens were evaluated by two other uropathologists. To ensure current pathologic grading standards, the study was limited to patients biopsied from 2004 to 2010. Only patients with at least 10 cores taken were included. Statistical analysis was performed using SPSS v.17.0 (SPSS Inc., IBM Corp., Armonk, NY, USA). Descriptive statistics are reported as medians with interquartile ranges (IQRs). All tests were two-sided, and a p value of 0.05 was considered statistically significant.
Of 25 584 patients, 6729 met the inclusion criteria, and 764 (11.3%) of those underwent a second PBx after negative initial biopsy. The median age was 65 yr (IQR: 9.0), prostate-specific antigen (PSA) was 6.20 ng/ml (IQR: 4.79), and prostate volume was 47
|Parameter||Positive initial biopsy||Positive second biopsy||p|
|Age, median (IQR)||65.0 (9.0)||66.0 (9.25)||>0.05a|
|PSA, median (IQR)||6.54 (3.00)||7.26 (5.02)||>0.05a|
|Volume, median (IQR)||43.0 (26.0)||47.5 (30.0)||<0.01a|
|TRUS volume, n (%)||<0.01b|
|607 (17.1)||21 (11.5)|
|1635 (46.2)||71 (38.8)|
|776 (21.9)||50 (27.3)|
|523 (14.8)||41 (22.4)|
|Gleason grade, n (%)||<0.01b|
|1693 (46.1)||121 (60.8)|
|1479 (40.3)||60 (30.2)|
|497 (13.5)||18 (9.0)|
|Low risk, n (%)||865 (23.6)||72 (36.2)||<0.01b|
a Wilcoxon rank-sum test.
b Chi-square test.
Despite having a negative initial PBx, more than a quarter of men who underwent a repeat biopsy in our large cohort had PCa detected. As expected, men with larger prostates were less likely to be diagnosed on initial biopsy . Despite the pathologic characteristics being more favorable on repeat PBx, almost two-thirds of these men still had intermediate- or high-risk PCa. Conclusions from our study are limited by its retrospective design and its lack of long-term clinical and survival outcomes to further examine the significance of our findings.
In conclusion, men for whom there is persistent suspicion of PCa despite a negative PBx should be counseled that repeat biopsies detect high numbers of clinically significant PCa.
Conflicts of interest
The authors have nothing to disclose.
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-  F.H. Schröder, R.C.N. van den Bergh, T. Wolters, et al. Eleven-year outcome of patients with prostate cancers diagnosed during screening after initial negative sextant biopsies. Eur Urol. 2010;57:256-266
-  J.L. Letran, G.E. Meyer, F.R. Loberiza, M.K. Brawer. The effect of prostate volume on the yield of needle biopsy. J Urol. 1998;160:1718-1721
a Department of Urology, Weill Cornell Medical Center of Cornell University, New York, NY, USA
b Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
c Martini Clinic - Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
d Division of Medical Oncology, Weill Cornell Medical Center of Cornell University, New York, NY, USA
Both authors contributed equally to the manuscript.
© 2011 European Association of Urology, Published by Elsevier B.V.