Departments of Urology and Pathology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA.
Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b.
What's known on the subject? and What does the study add? The accuracy of TRUS guided biopsies in identifying the location of an index cancer at surgery of low. When 2 biopsies show cancer in the same location, the concordance between the biopsy and surgical location of the cancer increases.
To evaluate the ability of repeat prostate biopsies to determine the location of the index cancer for men on prostate cancer surveillance.
Forty-five men on active surveillance had a record of the locations of their positive diagnostic biopsy, repeat surveillance biopsy and index cancer (i.e. largest cancer) from prostatectomy specimens. Logistic regression analysis was used to evaluate the association between two consecutive needle biopsies showing cancer in an identical location and the outcome of finding the index cancer at the same location as the initial diagnostic biopsy.
Eighteen of 45 (40%) men ultimately had an index cancer at the same location as their diagnostic biopsy. Thirteen men had two consecutive biopsies that showed cancer at the same location each time; nine of these men ultimately had an index cancer at that same location. In multivariable logistic regression analysis of men with at least two biopsies, having two initial consecutive biopsies with the same location increased the odds (odds ratio 5.9; 95% CI 1.1-31, P= 0.037) of having an index cancer at the same location as the initial biopsy in a cohort of men on active surveillance.
A substantial proportion of men in an active surveillance cohort who undergo prostatectomy ultimately have evidence of an index cancer at the same location as their initial biopsy. This is more likely to be the case when a repeat biopsy shows evidence of cancer at the same location.
Tseng KS, Landis P, Brimo F, Partin AW, Epstein JI, Carter HB. Are you the author?
Reference: BJU Int. 2011 Mar 28. Epub ahead of print.