UroToday - AUA 2008 - Society of Urologic Oncology Meeting - Repeat Prostate Biopsy – When, Where and How

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Saturday, 17 May 2008

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 ph Presti, Jr., MD, at the Annual Meeting of the American Urological

Association (AUA) - May 17 - 22, 2008. Orange

County Convention

Center - Orlando,

Florida, USA.