Prostate Cancer Detection at Rebiopsy After an Initial Benign Diagnosis: Results Using Sextant Extended Prostate Biopsy

Abstract

INTRODUCTION: Sextant prostate biopsy remains the standard technique for the detection of prostate cancer. It is well known that after a diagnosis of small acinar proliferation (ASAP) or high grade prostate intraepithelial neoplasia (HGPIN), the possibility of finding cancer is approximately 40% and 30%, respectively. OBJECTIVE: We aim to analyze follow-up biopsies on patients who initially received a benign diagnosis after exclusion of HGPIN and ASAP. METHODS: From July 2000 to December 2003, 1177 patients were submitted to sextant extended prostate biopsy in our hospital. The mean patient age was 65.5 years old, and the median number of fragments collected at biopsy was 13. HGPIN and ASAP were excluded from our study. We only considered patients who had a diagnosis of benign at the first biopsy and were subjected to rebiopsies up until May 2005 because of a maintained suspicion of cancer. RESULTS: Cancer was initially detected in 524 patients (44.5%), and the diagnosis was benign in 415 (35.3%). Rebiopsy was indicated for 76 of the latter patients (18.3%) because of a persistent suspicion of cancer. Eight cases of adenocarcinoma (10.5%) were detected, six (75%) at the first rebiopsy. Six patients were submitted to radical prostatectomy, and all tumors were considered clinically significant. CONCLUSION: Our data indicate that in extended prostate biopsy, the first biopsy detects more cancer, and the first, second, and third rebiopsies after an initial benign diagnosis succeed in finding cancer in 7.9% (6/55), 5.9% (1/15) and 20% (1/4) of patients, respectively

Diagnosis of Prostate Cancer Using Differentially Expressed Genes in Stroma

“…However even the best current methods, including transrectal ultrasound (TRUS) procedures, may miss up to 30% of clinically significant prostate cancers (5). Indeed, about, 20-30% of patients that are negative on initial biopsy are re-biopsied in ~3 to ~12 months (~190,000 patients owing to the presence of prostatic intraepithelial neoplasia (PIN), high-grade prostatic intraepithelial neoplasia (HGPIN), atypical small acinar proliferation (ASAP) or other grounds for clinical suspicion of the presence of tumor (2-4, 6, 7). Many repeat biopsies are found to be adenocarcinoma.…”

Association of RNASEL and 8q24 variants with the presence and aggressiveness of hereditary and sporadic prostate cancer in a hispanic population

“…The population of the study included 83 patients diagnosed with PCa from two clinical centres: the Clinical Hospital of Pontificia Universidad Cat olica de Chile (PUC) and the S otero del R ıo Hospital, from Santiago, Chile. Twenty-one men over 40 years old without a PCa diagnosis (PSA <4 ng/ml and normal Digital Rectal Exam-DRE) were used as a control group according to the literature that has shown that patients with PSA levels less than 4 ng/ml and normal DRE have a lower incidence of PCa [14] than patients in whom a prostate needle biopsy is performed [15][16][17][18]. Patients with PCa were diagnosed by using the needle biopsy procedure.…”

Premalignant and Malignant Prostate Lesions: Pathologic Review

“…Therefore, most authors believe that ASAP is a diagnostic risk category and not a valid pathologic entity. [60][61][62][63][64] Its precise diagnostic cri- Fig 15. -Atypical small acinar proliferation. This focus is too small and nuclear detail is too obscured by hyperchromasia to definitively render a diagnosis of carcinoma (hematoxylin-eosin, magnification ×400).…”