Predictors of cancer in repeat extended multisite prostate biopsy in men with previous negative extended multisite biopsy

The objective of this study is to evaluate the performance of urology residents at each training level in detecting prostate cancer with transrectal ultrasound-guided (TRUS) biopsy. The inclusion criteria were: (1) prostate-specific antigen (PSA) 4-10 ng/ml; and (2) 10-12 cores per biopsy session. Data from repeat biopsy sessions were excluded. Overall prostate cancer detection rate for 170 patients was 39.4%. PSA, digital rectal examination (DRE), and prostate volume were predictors of cancer detection. There were no significant differences in overall cancer detection rates, PSA, DRE, or prostate volume between resident levels. In conclusion, urology residents at all levels of training perform equally well at detecting cancer using TRUS prostate biopsy technology.

Section: Discussionmentioning

confidence: 99%

Impact of training level of urology residents on the detection of prostate cancer on TRUS biopsy

Karam¹,

Shulman²,

Benaim

2004

“…The yield was only 22% of initial biopsies, with repeat biopsies 6 weeks later producing an additional 10%. This yield is significantly lower than the studies by Chang et al 7 and Mian et al 11 Recently, the relationship of prostate volume to CaP detection rate has been scrutinized. 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.…”

Section: Biopsy Techniquementioning

confidence: 75%

“…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%

Determining variables for repeat prostate biopsy

Busby

Evans

2004

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.

“…5,6 Although the application of extended laterally based biopsy techniques has improved the cancer detection rate for TRUS biopsies, a false negative rate of 17-21.2% has been reported even with systematic 12 core biopsy techniques. 7,8 Identification of clinical and histopathologic parameters which are associated with the diagnosis of pCA, therefore, is critical to help determine which patients require a repeat biopsy. Figure 1 Within a benign prostatic gland is an eosinophilic, prostatic crystalloid.…”

Section: Discussionmentioning

confidence: 99%

“…7,13 Indeed, many studies have reported a high predictive value of HGPIN in identifying pCA utilizing sextant biopsy schemes, but in some reports using extended biopsy schemes, HGPIN was not predictive of the presence of pCA reported a high predictive value of HGPIN in identifying prostatic adenocarcinoma. 7,[13][14][15][16][17][18] Thus, attempts to determine the predictive ability of crystalloids in benign biopsy specimens are challenged by the low incidence of patients with crystalloids in benign biopsy specimens and the increased sampling efficiency afforded by extended biopsy schemes. To conclude that crystalloids do indeed represent a significant risk factor for a subsequent diagnosis of prostate cancer, will require a prospective investigation with standardized biopsy schemes and a large cohort to identify sufficient number of patients with crystalloids on benign biopsies.…”

Section: Crystalloids and Prostatic Adenocarcinoma Rs Svatek Et Almentioning

confidence: 99%

Intraluminal crystalloids are highly associated with prostatic adenocarcinoma on concurrent biopsy specimens

Svatek

Karam

Rogers

et al. 2007

Prostatic crystalloids are intraluminal eosinophilic structures with variable size and shape. Their presence has been described in conjunction with the occurrence of prostatic adenocarcinoma (pCA). We herein report the association of crystalloids and pCA in a prospective trial utilizing an extended multi-site transrectal ultrasound-guided (TRUS) prostate biopsy protocol. Three hundred and fortyfour consecutive patients were prospectively enrolled at the Dallas Veterans Administration Hospital from November 2002 to September 2003. Indications for biopsy included a prostatespecific antigen (PSA) X4 ng/ml and/or abnormal digital rectal exam. A single pathologist evaluated all biopsy cores and documented the presence or absence of significant histopathologic features. Univariate and multivariate logistic regression analysis were applied to test the association of these features with the presence of pCA on concurrent biopsy. Median number of core biopsies per patient was 12 (range 3-36). Overall cancer detection rate was 42.7%. pCA was diagnosed in 66 (81.5%) of 81 patients with crystalloids, 70 (69.3%) of 101 patients with high-grade prostatic intraepithelial neoplasia (HGPIN), and 32 (84.2%) of 38 patients with both HGPIN and crystalloids on biopsy. Multivariate analysis identified crystalloids (RR 4.53, 95% CI 2.30-8.88) and HGPIN (RR 3.20, 95% CI 1.84-5.57) as independent predictors of the presence of cancer on concurrent biopsy (Po0.001). In this prospective analysis, crystalloids were significantly associated with pCA on concurrent biopsy and more predictive of the presence of pCA than HGPIN. These findings suggest that the presence of crystalloids alone or in combination with HGPIN in prostate biopsies may be a more compelling indication for repeat biopsy than HGPIN alone.