Risk of repeat biopsy and prostate cancer detection after an initial extended negative biopsy: longitudinal follow‐up from a prospective trial. (4th March 2013)

• Record Type: Journal Article
• Authors: Ploussard, Guillaume; Nicolaiew, Nathalie; Marchand, Charles; Terry, Stéphane; Allory, Yves; Vacherot, Francis; Abbou, Claude‐Clément; Salomon, Laurent; de la, Alexandre
• Is Part Of: BJU international. Volume 111:Number 6(2013:Mar.)
• Page Start: 988
• Page End: 996
• Publication Date: 2013-03-04
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11607.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11607-sec-1001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11607-list-1001" list-type="bullet"> <list-item> <p>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.</p> </list-item> <list-item> <p>In addition to PSA and PSAD, low prostate volume and %fPSA are interesting time‐varying risk factors and are relevant in biopsy decision‐making.</p> </list-item> </list> </p> </sec> <sec id="bju11607-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju11607-list-0001" list-type="bullet"> <list-item> <p>To assess prospectively the time‐varying risk of rebiopsy and of prostate cancer (PCa) detection after an initial negative biopsy protocol.</p> </list-item> </list> </p> </sec> <sec id="bju11607-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju11607-list-0002" list-type="bullet"> <list-item> <p>Over a period of 10 years, 1995 consecutive patients with initially negative biopsies were followed.</p> </list-item> <list-item> <p>Rebiopsies were performed in patients who had a persistent suspicion of PCa.</p> </list-item> <list-item> <p>Predictive factors for rebiopsy and for PCa detection were tested using univariate, multivariate and time‐dependent models.</p> </list-item> </list> </p> </sec> <sec id="bju11607-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju11607-list-0003" list-type="bullet"> <list-item> <p>A total of 617 men (31%) underwent at least one rebiopsy after a mean follow‐up of 19 months.</p> </list-item> <list-item> <p>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%.</p> </list-item> <list-item> <p>The 5‐year rebiopsy‐free and PCa‐free survival rates were 65.9 and 92.5%, respectively.</p> </list-item> <list-item> <p>Indications for rebiopsy were more frequently reported in patients having a high prostate‐specific antigen (PSA) level (<italic>P</italic> = 0.006) or a high PSA density (PSAD; <italic>P</italic> < 0.001) and in younger patients (<italic>P</italic> = 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.</p> </list-item> <list-item> <p>The main study limitation was the lack of control of the absence of PCa and PSA kinetics in men not rebiopsied.</p> </list-item> </list> </p> </sec> <sec id="bju11607-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11607-list-0004" list-type="bullet"> <list-item> <p>The overall risk of detected PCa after an initial negative biopsy was low.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> </abstract>