UroToday - In an article by a group of French investigators that appears in the online version of European Urology, they examine the issue of whether one negative extended prostate cancer (CaP) biopsy should reassure patients that they do not have CaP.

Between 2001 and 2007, 953 men had initial negative extended prostate biopsies, and 231 underwent at least one more set of 21-core biopsies. Indications for repeat biopsies included persistently increased or rising PSA level, prior PIN or ASAP, or a persistent prostate nodule upon digital rectal examination (DRM). The complex needle placement of the 21-core schema is shown in a figure in the manuscript.

The mean number of repeated 21-core biopsy procedures was 2.4. Only 8 adverse events were reported. Detection rates for CaP, PIN and ASAP were 25.1%, 8.6%, and 4.9%, respectively. CaP was detected in 18% of the second biopsy sets, 17% of the third sets and 14% of the fourth procedures. CaP prevalence was 16% for men who had a PIN lesion on the first biopsy. Three out of seven men (42%) with initial ASAP had CaP on the second set of biopsies. Among men with an initial biopsy that had no CaP, PIN, or ASAP, the risk of finding CaP was 17% on the second biopsy and 16%, 14%, and 0% on the third, fourth and fifth biopsies, respectively

Prostate cancer detection rates were 21% for men with a PSA 20ng/ml. The 21-core sample detected CaP in 25.1%, compared to 13% and 22.1% if only the 6 sextant or 12 cores (sextant plus 6 lateral cores) were counted, respectively. On multivariate analysis, ASAP, prostate volume, and PSAD were found to be predictive of positive biopsies. Of 43 men who underwent radical prostatectomy, 85.2% had significant CaP.

Campos-Fernandes JL, Bastien L, Nicolaiew N, Robert G, Terry S, Vacherot F, Salomon L, Allory Y, Vordos D, Hoznek A, Yiou R, Patard JJ, Abbou CC, de la Taille A
Eur Urol. 2008 Jun 23. Epub ahead of print.
doi:10.1016/j.eururo.2008.06.043

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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