Prospective Evaluation of Prostate Cancer Detected on Biopsies 1, 2, 3 and 4: When Should We Stop?

Djavan, Bob; Ravery, V.; Zlotta, A.; Dobroński, P.; Dobrovits, Michael; Fakhari, Mitra; Seitz, Christian; Susani, Martin; Borkowski, Andrzej; Boccon-Gibod, L; Schulman, Claude; Marberger, Michael

doi:10.1016/s0022-5347(05)65652-2

Cited by 391 publications

(243 citation statements)

References 26 publications

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“…In men with an earlier negative biopsy, standard TRUS re-biopsy has a low rate of cancer detection with yields of 10-20% for the second biopsy, [14][15][16] and below 10% for subsequent biopsies. 14,16 This has led to increased use for repeat biopsies of a saturation approach sampling 18 to 50 or more cores.…”

Section: Discussionmentioning

confidence: 99%

“…14,16 This has led to increased use for repeat biopsies of a saturation approach sampling 18 to 50 or more cores. Increasing the number of cores does appear to increase detection rate in this setting.…”

Section: Discussionmentioning

confidence: 99%

“…For each biopsy core, the template coordinate and the offset from base were recorded. Biopsy regions included posterior prostate (3,4,12,13,21,22), posterior lateral (2,5,11,14,20,23), anterior lateral (1,6,9,10,15,16), anterior apex (19,24), and TZ (7,8,17,18) After completion of all sampling, patients underwent cystoscopic evaluation.…”

Section: Methodsmentioning

confidence: 99%

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Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

Taira

Merrick

Galbreath

et al. 2009

Prostate Cancer Prostatic Dis

259

171

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Transrectal ultrasound (TRUS) biopsy can miss 20-30% of clinically significant cancers. We evaluate an alternative approach-transperineal template-guided mapping biopsy (TTMB) in the initial and repeat biopsy setting. From January 2005 through September 2008, 373 consecutive men underwent TTMB (294 men with X1 prior negative biopsy and 79 men as the initial biopsy). The location of each positive biopsy core, number of positive cores, and percent involvement of each core was recorded. Cancer detection rate for the initial biopsy was 75.9%. For men with 1, 2, and X3 prior negative biopsies detection rates were 55.5%, 41.7%, and 34.4%, respectively. In all, 55.5% of the cancers identified were Gleason X7. The majority of the cancers were multifocal. There was no significant change in the number of positive cores or Gleason score as the number of prior biopsies increased. The anterior and apical aspects of the prostate were among the most common cancer locations. TTMB provides a high rate of cancer detection as initial and repeat biopsy. TTMB was particularly effective at diagnosing anterior and apical cancer. TTMB may have particular application for men considering active surveillance, with prior negative TRUS biopsies, and those considering subtotal gland or other minimally invasive treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

Taira

Merrick

Galbreath

et al. 2009

Prostate Cancer Prostatic Dis

259

171

View full text Add to dashboard Cite

show abstract

“…2 Moreover in patients with persistently increased PSA and negative PB, the repetition of biopsies does not increase the detection rate of PCa, which indeed decreases progressively. 3 Because of the additional number of samples there is a significant risk of complications (infection, bleeding, acute urinary retention), anxiety and social-sanitary costs. 4 Recently various biomarkers have been studied to increase the ability to predict PCa diagnosis, especially in patients with persistent suspicion of cancer and a previous negative PB.…”

mentioning

confidence: 99%

The Roles of Multiparametric Magnetic Resonance Imaging, PCA3 and Prostate Health Index—Which is the Best Predictor of Prostate Cancer after a Negative Biopsy?

et al. 2014

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Purpose: In patients with a negative prostate biopsy and persistent suspicion of prostate cancer, additional analyses such as the PCA3 score, PHI and multiparametric magnetic resonance imaging have been proposed to reduce the number of unnecessary repeat biopsies. In this study we evaluate the diagnostic accuracy of PCA3, PHI, multiparametric magnetic resonance imaging and various combinations of these tests in the repeat biopsy setting. Materials and Methods: A total of 170 patients with an initial negative prostate biopsy and persistent suspicion of prostate cancer were enrolled in this prospective study. The patients underwent measurements of the total prostate specific antigen and free prostate specific antigen rate, along with PHI, PCA3 tests and multiparametric magnetic resonance imaging before standard repeat biopsy that was performed by urologists blinded to the multiparametric magnetic resonance imaging results. Multivariate logistic regression models with various combinations of PCA3, PHI and multiparametric magnetic resonance imaging were used to identify the predictors of prostate cancer with repeat biopsy, and the performance of these models was compared using ROC curves, AUC analysis and decision curve analysis. Results: In the ROC analysis the most significant contribution was provided by multiparametric magnetic resonance imaging (AUC 0.936), which was greater than the contribution of the PHIþPCA3 model (p <0.001). In the multivariate logistic regression analysis only multiparametric magnetic resonance imaging was a significant independent predictor of prostate cancer diagnosis with repeat biopsy (p <0.001). The results of the decision curve analysis confirmed that the most significant improvement in the net benefit was provided by multiparametric magnetic resonance imaging.

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“…Additionally, the probability of having a positive biopsy decreases with each subsequent biopsy. 5 Thus, it is important to define who is at greatest risk of having prostate cancer on repeat biopsy.…”

Section: Introductionmentioning

confidence: 99%

Utility of PCA3 in patients undergoing repeat biopsy for prostate cancer

Reese

Cooperberg

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND: Men with persistently elevated and/or rising PSA levels after negative prostate biopsy often undergo multiple repeat biopsies. Prostate cancer antigen 3 (PCA3) has emerged as a predictor of prostate cancer. METHODS:We sought to define the utility of PCA3 in combination with other clinical data in predicting the risk of prostate cancer on repeat biopsy. We retrospectively obtained PCA3, PSA, PSA density (PSAD), digital rectal examination (DRE) and transrectal ultrasound (TRUS) findings from 103 patients at a single institution who had at least one prior negative prostate biopsy. The sensitivity and specificity of PCA3 in detecting prostate cancer was determined. Receiver operating characteristics curves were produced for each variable individually and in multivariable analysis, controlling for PCA3, PSAD, TRUS, PSA and DRE. A nomogram was created, internally validated and compared to another recently published nomogram. RESULTS:Of the 103 patients, 37 (31%) had prostate cancer on repeat biopsy. The sensitivity and specificity of PCA3 (using a cut point of 25) was 0.67 and 0.64, respectively. In multivariable analyses, PCA3 was independently associated with prostate cancer (odds ratio: 1.02, 95% confidence interval: 1.01-1.04), with area under the curve (AUC) of 0.64. A multivariable model containing PCA3, PSAD, PSA, DRE and TRUS findings showed the most diagnostic accuracy (AUC: 0.82). CONCLUSIONS:In the setting of prior negative biopsies, PCA3 was independently associated with prostate cancer in a multivariable model. In combination with other clinical data, PCA3 is a valuable tool in assessing the risk of prostate cancer on repeat biopsy.

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Prospective Evaluation of Prostate Cancer Detected on Biopsies 1, 2, 3 and 4: When Should We Stop?

Cited by 391 publications

References 26 publications

Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

Performance of transperineal template-guided mapping biopsy in detecting prostate cancer in the initial and repeat biopsy setting

The Roles of Multiparametric Magnetic Resonance Imaging, PCA3 and Prostate Health Index—Which is the Best Predictor of Prostate Cancer after a Negative Biopsy?

Utility of PCA3 in patients undergoing repeat biopsy for prostate cancer

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