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Eur Urol. 2011 Oct;60(4):834-41. doi: 10.1016/j.eururo.2011.07.036. Epub 2011 Jul 30.

The optimal rebiopsy prostatic scheme depends on patient clinical characteristics: results of a recursive partitioning analysis based on a 24-core systematic scheme.

Author information

1
Department of Urology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy. scattoni.vincenzo@hsr.it

Abstract

BACKGROUND:

The most beneficial number and the location of prostate biopsies remain matters of debate, especially after an initial negative biopsy.

OBJECTIVE:

To identify the optimal combination of sampling sites (number and location) to detect prostate cancer (PCa) in patients previously submitted to an initial negative prostatic biopsy.

DESIGN, SETTING, AND PARTICIPANTS:

A transrectal ultrasound-guided systematic 24-core prostate biopsy (24PBx) was performed prospectively in 340 consecutive patients after a first negative biopsy (at least 12 cores).

MEASUREMENTS:

We relied on a classification and regression tree analysis to identify three clinically different subgroups of patients at dissimilar risk of harboring PCa at second biopsy. Subsequently, we set the cancer-positive rate of the 24PBx at 100% and calculated PCa detection rates for 255 possible combinations of sampling sites. We selected the optimal biopsy scheme (defined as the combination of sampling sites that detected 95% of all the cancers with the minimal number of biopsy cores) for each patient subgroup.

RESULTS AND LIMITATIONS:

After an initial negative biopsy, cancer was detected at rebiopsy in 95 men (27.9%). At a given number of cores, the cancer detection rates varied significantly according to the different combination of sites considered. Three different PCa risk groups were identified: (1) previous report of atypical small acinar proliferation of the prostate (ASAP), (2) no previous ASAP and ratio of free prostate-specific antigen (fPSA) to total PSA (%fPSA) ≤10%, and (3) no previous ASAP and %fPSA >10%. For patients with previous ASAP or patients with no previous ASAP and %fPSA ≤10%, two schemes with different combinations of 14 cores were most favorable. The optimal sampling in patients with no previous ASAP and %fPSA >10% was a scheme with a combination of 20 cores.

CONCLUSIONS:

Both the number and the location of biopsy cores taken affect cancer detection rates in a repeated biopsy setting. We developed an internally validated flowchart to identify the most advantageous set of sampling sites according to patient characteristics.

PMID:
21820797
DOI:
10.1016/j.eururo.2011.07.036
[Indexed for MEDLINE]

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