Can total and transition zone volume of the prostate determine whether to perform a repeat biopsy?

Remzi, Mesut; Djavan, Bob; Wammack, R.; Momeni, Mohammad R.; Seitz, Christian; Erne, B.; Dobrovits, Michael; Alavi, S.; Marberger, Michael

doi:10.1016/s0090-4295(02)02099-x

Cited by 43 publications

(23 citation statements)

References 21 publications

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“…As would be expected, the recommended number of cores increases with prostate gland size, consistent with clinical study data. 1,3,4 The modeling approaches in this study are similar to those of Vashi et al 8 but they differ in specifics. Each entails a multifocality model and each includes the total prostate volume and the number of biopsy cores as input variables.…”

Section: Discussionmentioning

confidence: 96%

“…This hypothesis is supported by studies demonstrating a negative correlation between total prostate volume and biopsy yield, 1,2 and those in which larger prostate volume was a predictor of the positivity of repeat biopsy as well as the negativity of initial biopsy. 3,4 These findings led to the suggestion that biopsy core number should be adjusted according to patient age and prostate volume to optimize sampling. 5 Mathematical models have also been constructed to advise on biopsy strategies for men with different ages and prostate volumes.…”

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confidence: 99%

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Quantifying the Impact of Prostate Volumes, Number of Biopsy Cores and 5α-Reductase Inhibitor Therapy on the Probability of Prostate Cancer Detection Using Mathematical Modeling

et al. 2007

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Purpose: Previous studies demonstrated a negative correlation between prostate volume and biopsy yield. By decreasing prostate volume 5␣-reductase inhibitors may enhance cancer detection, which may explain the greater detection of high grade tumors in the finasteride arm of the Prostate Cancer Prevention Trial. Materials and Methods: A mathematical model was constructed to analyze the effects of prostate and tumor volumes, and biopsy core number on cancer detection. The effects of the volume reduction observed with finasteride in the Prostate Cancer Prevention Trial were also modeled, as was the potential reduction in tumor volume needed to explain the observed difference in prostate cancer detection. The model was also applied to the Reduction by Dutasteride of Prostate Cancer Events study. Results: A higher number of biopsies are required to ensure a detection probability of 0.90 or greater in larger glands or with smaller tumors. In the Prostate Cancer Prevention Trial for a tumor volume of 1 cc a 17% increase in the detection rate in the finasteride arm would be predicted if there was no change in tumor volume, likewise the rate would be 11% to 17% for the dutasteride arm of the Reduction by Dutasteride of Prostate Cancer Events study. The calculated reduction in tumor volume needed to explain the difference in cancer detection between the finasteride and placebo arms of the Prostate Cancer Prevention Trial would be 51% to 66%. Conclusions: This model provides guidance on the optimal number of biopsy cores that accord with an earlier model. These findings also suggest that, if there were no reduction in tumor volume, 5␣-reductase inhibitor therapy could lead to excess cancer detection, including high grade tumors.

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

Quantifying the Impact of Prostate Volumes, Number of Biopsy Cores and 5α-Reductase Inhibitor Therapy on the Probability of Prostate Cancer Detection Using Mathematical Modeling

et al. 2007

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“…26 Remzi et al noted in a repeat biopsy setting in men with PSA between 4 and 10 ng/mL that total prostate volume has a significant impact on the ability to predict prostate cancer on repeat biopsy. 27 Furthermore, Remzi et al recently reported that the optimal number of biopsy cores should be adjusted for prostate volume and age on repeat biopsy. 28 To consider the differences of the significance of the parameters between initial and repeat biopsy, present nomogram on initial biopsy cannot apply to repeat biopsy cases, and further study should be performed in the future.…”

Section: Discussionmentioning

confidence: 99%

Development of a new nomogram for predicting the probability of a positive initial prostate biopsy in Japanese patients with serum PSA levels less than 10 ng/mL

et al. 2008

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Objectives: Although several nomograms for prostate cancer detection have been developed for Western populations, the models constructed on Japanese data would be more useful for the Japanese population because of various differences between Western and Asian populations. We previously developed a model for predicting the probability of a positive initial prostate biopsy using clinical and laboratory data from Japanese males. In the present study, a predictive model for Japanese males with a prostate-specific antigen (PSA) < 10 ng/mL was developed to guide decision-making for prostate biopsies. Methods: The age, total PSA level, free to total PSA ratio, prostate volume, and the digital rectal examination findings of 1037 Japanese males with a PSA < 10 ng/mL undergoing initial prostate biopsy as part of individual screening were analyzed. For study validation, 20% of these data was randomly reserved. Logistic regression analysis estimated relative risk, 95% confidence intervals, and P-values. Results: Age and the independent predictors of a positive biopsy result (elevated PSA, decreased free to total PSA ratio, small prostate volume, and abnormal digital rectal examination findings) were used to develop a predictive nomogram. The area under the receiver operating characteristic curve was significantly higher for the model (73.0%) than for PSA alone (55.0%). If externally validated , the use of this nomogram could reduce unnecessary biopsies by 26% and overall prostate biopsies by 7.8%. Conclusions: This predictive nomogram could provide more precise risk-analysis information for individual Japanese patients with PSA levels less than 10 ng/mL and may help to identify patients who need a prostate biopsy.

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“…While initial evaluation of this issue revealed an increased false-negative rate in biopsies for those with increased volumes, further studies have yielded mixed results. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] These studies have also addressed the need for extended biopsy schemas in larger volume prostates. Ung et al 18 demonstrated no statistical difference in CaP detection rates in patients undergoing increased numbers of biopsies beyond nine cores.…”

Section: Biopsy Techniquementioning

confidence: 99%

“…Contrasting the findings of Ung et al are recent studies by two other groups. Remzi et al 16 showed that there were increased numbers of cancers discovered on repeat biopsy for those with prostate volume 20-80 cm 3 and for those whose TZ volume was 9-40 cm 3 . Beyond these size limits, they discourage repeat biopsy excepting cases with high likelihood of containing cancer (e.g.…”

Section: Biopsy Techniquementioning

confidence: 99%

Determining variables for repeat prostate biopsy

Busby

Evans

2004

Prostate Cancer Prostatic Dis

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During the evaluation of prostate cancer, men who have undergone transrectal ultrasound-guided biopsy with negative results present a dilemma as to what further follow-up is required. Multiple variables have been proposed throughout the literature to improve cancer detection rates not only in initial biopsy results, but also on repeat evaluation. These variables include prostate-specific antigen (PSA) velocity, PSA density, free-percent PSA, and histological findings, each of which may singly or collectively dictate the need for further biopsy. After performing a Medline literature search using specific Medical Subject Headings (prostate biopsy, repeat prostate biopsy, PSA velocity, PSA density, free-percent PSA, prostate inflammation), we critically evaluated pertinent articles. Using this accumulated data and information, we composed an algorithm to assist in the decision process for repeat biopsy.

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Can total and transition zone volume of the prostate determine whether to perform a repeat biopsy?

Cited by 43 publications

References 21 publications

Quantifying the Impact of Prostate Volumes, Number of Biopsy Cores and 5α-Reductase Inhibitor Therapy on the Probability of Prostate Cancer Detection Using Mathematical Modeling

Quantifying the Impact of Prostate Volumes, Number of Biopsy Cores and 5α-Reductase Inhibitor Therapy on the Probability of Prostate Cancer Detection Using Mathematical Modeling

Development of a new nomogram for predicting the probability of a positive initial prostate biopsy in Japanese patients with serum PSA levels less than 10 ng/mL

Determining variables for repeat prostate biopsy

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