Elevated serum prostate specific antigen levels in conjunction with an initial prostatic biopsy negative for carcinoma: who should undergo a repeat biopsy?

Abstract

Objective To determine the outcome of repeated prostatic biopsies in men attending with suspected prostate cancer but an initial negative biopsy. Patients and methods Patients who had undergone two or more transrectal ultrasonography (TRUS)‐guided prostate biopsies were identified from the Hospital Information Support System database. Indications for TRUS were a raised prostate‐specific antigen (PSA) level (>4.0 ng/mL), with or without an abnormal digital rectal examination (DRE). Sextant prostate biopsies plus biopsies of any suspicious hypoechoic area or area of DRE abnormality were obtained for histology. Forty‐eight patients underwent repeat TRUS‐guided prostatic biopsies (mean age 67.5, sd 7.25, range 53–82 years). Results The mean (sd, median, range) PSA level was 16.9 (13.5, 11.6, 5.2–61.8) ng/mL. Fifteen patients (31%) had carcinoma on repeat biopsy, 11 after the second and four after a third biopsy. The positive repeat biopsy rate was 24% where the PSA level was 4.0–9.9 ng/mL, 33% if the level was 10.0–19.9 ng/mL and 39% if it was ≥20.0 ng/mL. There was no significant difference in age or initial PSA concentration between those men with positive and those with negative repeat biopsies. However, patients with cancer had significantly higher PSA levels before repeat biopsy than at first biopsy (P=0.0043) and had greater PSA velocities than had patients with no diagnosis of cancer (P=0.0067). Conclusion Where sufficient clinical suspicion exists, despite an initial negative biopsy, repeat TRUS‐guided prostate biopsies should be carried out to exclude carcinoma of the prostate.

Association between human papillomavirus and prostate cancer: A meta-analysis

“…BHP is the enlargement of the prostate gland by increased tissue mass in the transition zone of the prostate, a prevalent, chronic and progressive disease (87). Preliminary works reported that 11-44% of BHP progressed to PCa within 7 years (88)(89)(90). HPV infection was also identified in the BHP tissue samples of the included studies.…”

Human kallikrein-2 gene and protein expression predicts prostate cancer at repeat biopsy

“…Multiple needle cores are obtained randomly within targeted areas of the prostate gland, since tumour foci are too small to be visualized. Despite the multiple samplings, areas of cancer may be missed by the biopsy procedure and the false negative rate has ranged from 10% to 30% (Rietbergen et al 1998; Durkan & Greene 1999). The practice of conducting a repeat biopsy after an initial negative biopsy is variable and not well established due to the lack of definitive predictor variables that can identify patients at high risk for having prostate cancer (Djavan et al 2000; Roehl et al 2002).…”

Is histological prostate inflammation in an initial prostate biopsy a predictor of prostate cancer on repeat biopsy?

“…In the present study, 33 % of patients were diagnosed with prostate cancer in the initial biopsy and 26.3 % of the patients were diagnosed with prostate cancer after a repeat prostate biopsy. Because of the possibility of failure in the initial biopsy and the possibility of detection of prostate cancer in a repeat biopsy, repeat prostate biopsy is considered to be necessary for many patients [11,12]. Indications for repeat prostate biopsy include rising or persistent PSA levels, suspicious DRE results, atypical small acinar proliferation, and extensive high-grade prostatic intraepithelial neoplasia (i.e., in multiple biopsy sites) [13].…”