Risk of repeat biopsy and prostate cancer detection after an initial extended negative biopsy: longitudinal follow-up from a prospective trial
Article first published online: 4 MAR 2013
© 2013 BJU International
Volume 111, Issue 6, pages 988–996, May 2013
How to Cite
Ploussard, G., Nicolaiew, N., Marchand, C., Terry, S., Allory, Y., Vacherot, F., Abbou, C.-C., Salomon, L. and de la Taille, A. (2013), Risk of repeat biopsy and prostate cancer detection after an initial extended negative biopsy: longitudinal follow-up from a prospective trial. BJU International, 111: 988–996. doi: 10.1111/j.1464-410X.2012.11607.x
- Issue published online: 25 APR 2013
- Article first published online: 4 MAR 2013
- prostate cancer;
- repeat biopsy;
- detection rate;
- low risk;
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.
- 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.
- 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.
- 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.