Risk of repeat biopsy and prostate cancer detection after an initial extended negative biopsy: longitudinal follow‐up from a prospective trial

Abstract

What's known on the subject? and What does the study add?• Even after a negative set of prostate biopsies, the risk of undetected prostate cancer remains clinically significant.Predictive markers of such a risk are undefined.• In addition to PSA and PSAD, low prostate volume and %fPSA are interesting time-varying risk factors and are relevant in biopsy decision-making. Objective• To assess prospectively the time-varying risk of rebiopsy and of prostate cancer (PCa) detection after an initial negative biopsy protocol. Patients and Methods• Over a period of 10 years, 1995 consecutive patients with initially negative biopsies were followed. • Rebiopsies were performed in patients who had a persistent suspicion of PCa.• Predictive factors for rebiopsy and for PCa detection were tested using univariate, multivariate and time-dependent models. Results• A total of 617 men (31%) underwent at least one rebiopsy after a mean follow-up of 19 months. • PCa detection rates during second, third, and fourth sets of biopsies were 16.7, 16.9 and 12.5%, respectively. The overall rate of detected PCa was 7.0%. • The 5-year rebiopsy-free and PCa-free survival rates were 65.9 and 92.5%, respectively. • Indications for rebiopsy were more frequently reported in patients having a high prostate-specific antigen (PSA) level (P = 0.006) or a high PSA density (PSAD; P < 0.001) and in younger patients (P = 0.008). The risk of PCa on rebiopsies was not correlated with age, but significantly increased more than twofold in cases of PSA >6 ng/mL, PSAD >0.15 ng/mL/g, free-to-total PSA ratio (%fPSA) <15, and/or prostate volume <50 mL. Time-dependent analyses were in line with these findings.• The main study limitation was the lack of control of the absence of PCa and PSA kinetics in men not rebiopsied. Conclusions• The overall risk of detected PCa after an initial negative biopsy was low.• In addition to PSA and PSAD, which are well-used in rebiopsy indications, low prostate volume and %fPSA are interesting time-varying risk factors for PCa on rebiopsy and could be relevant in biopsy decision-making.

Global Hypomethylation (LINE-1) and Gene-Specific Hypermethylation (GSTP1) on Initial Negative Prostate Biopsy as Markers of Prostate Cancer on a Rebiopsy

“…Various clinical and pathologic parameters have been considered as predictive of prostate cancer on a rebiopsy, such as PSA, PSA density, percent free PSA, prostate volume, digital rectal examination finding, age, family history of prostate cancer, number of cores taken at biopsy, time between first biopsy and rebiopsy, and presence of high-grade prostate intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) at first biopsy (5)(6)(7)(8)(9). Several nomograms containing some of these parameters have been developed to aid the rebiopsy decision, but they are hampered by low accuracy (76%-86%; 10, 11).…”

Metabolomic Imaging for Human Prostate Cancer Detection using MR Spectroscopy at 7-T

“…The mostly slow and heterogeneous growth of PCa lesions probably plays a major role in this issue. The consequence is a substantial number of false negatives in histopathological PCa detection, which is reported between 15 and 30% among first biopsy sampling 47,49,50 . In patients with high PSA levels but repeatedly negative biospies, MRI was proven to increase the detection rate by guided biopsy 27,28,51 .…”

“…With histopathology currently being the gold standard in PCa diagnosis, a definite diagnosis can only be made by histopathological evaluation 46 . There is a lack of cancer-targeted biopsies, as the standard TRUS has limits to differentiate between malignant and benign prostatic lesions 47,48 . The mostly slow and heterogeneous growth of PCa lesions probably plays a major role in this issue.…”

Association between systemic inflammation and serum prostatespecific antigen in a healthy Korean population

“…Systemic inflammation is related to various conditions associated with elevated PSA levels. [3] However, PCa is not clearly accompanied by local inflammation histologically. [4] Many kinds of cancer are associated with systemic inflammation, such as chronic inflammation and other factors.…”