Society Of Urologic Oncology Meeting - Repeat Prostate Biopsy - When, Where And How?

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Clinical Trials / Drug Trials;  Conferences
Article Date: 31 May 2008 - 0:00 PDT

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ORLANDO, FL (UroToday.com) - Dr. Presti discussed that the adequacy of the initial biopsy must be assessed. One must examine how many cores were taken on the first biopsy. If it was only 6 cores, there was a 40% chance of finding cancer on the second biopsy as compared to 24% when an extended pattern was initially performed. Prostate volume was also important: there was an inverse trend between size and detection. PSA indices are useful on repeat biopsy. Free/total PSA outperforms other indices such as PSAD-TZ or PSAD. PSA kinetics has not been shown to be too useful in detection on repeat prostate biopsy.

PCA3 has preliminary data that suggest that it may be useful, but needs validation in a larger cohort. Multifocal high-grade PIN is more useful than unifocal PIN and 50% of men with ASAP on initial biopsy are found to have cancer. This is most commonly in the same region of the prostate. A saturation biopsy results in a 34% detection rate according to a report from the Mayo clinic, he said. Site specific unique detection rate with a prior sextant biopsy shows that there is unique detection in 7% in the apex, almost 15% in the lateral base and 8% in the lateral mid-gland and 4% in the anterior cores. If an extended biopsy was initially performed, then the major yield is in the apex. This high yield is due to the apex being all peripheral zone tissue. Thus, in a repeat biopsy in a man with an initial sextant biopsy, the apex and lateral prostate should be focused on but if an extended pattern was initially done, then the apex is the highest yield.

Presented by Joseph Presti, Jr., MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

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

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