OBJECTIVE: To determine the impact of repeating prostate biopsies on the risk of detecting clinically insignificant prostate cancer (PCa) in larger prostate glands.
METHODS: We performed a retrospective cohort study using patients enrolled in our institutional PCa registry from 1991 to 2008 to assess the association of prostate volume and clinically insignificant PCa in men undergoing multiple prostate biopsies. Patients were stratified by prostate volume into 2 cohorts (< 50 cm3 or ≥50 cm3). Additionally, patients were stratified by prostate biopsy on which PCa was identified (1 biopsy or ≥3 biopsies).
RESULTS: Within the subgroup of patients with prostate volume ≥50 cm3 requiring ≥3 biopsies before cancer diagnosis, 72.6% (45/62) had pathologic Gleason scores ≤ 6 and 81.6% (49/60) had an estimated tumor volume of ≤ 10% at the time of radical prostatectomy. This was significantly different from patients with prostate volume < 50 cm3 diagnosed on their first biopsy, in which only 48.5% (656/1349) were found to have Gleason scores ≤ 6 and 54.2% (705/1300) had estimated tumor volume ≤ 10% (P < .01). There was no significant difference in the rate of Gleason score upgrading at time of prostatectomy between any of the subgroups.
CONCLUSION: PCas detected in men with prostatic enlargement requiring multiple biopsies are more likely to be low-grade, low-volume tumors at final pathology than men without prostate enlargement. Men with larger prostates who have already had prior negative biopsies should be counseled regarding the increased risk of detecting clinically insignificant PCa with additional biopsies.
Written by:
Pietzak EJ, Resnick MJ, Mucksavage P, Van Arsdalen K, Wein AJ, Malkowicz SB, Guzzo TJ. Are you the author?
Division of Urology Department of Surgery, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA; Department of Urologic Surgery, Vanderbilt University Medical Center, and the Tennessee Valley VA Health Care System, Nashville, TN.
Reference: Urology. 2014 Jun 12. pii: S0090-4295(14)00398-7.
doi: 10.1016/j.urology.2014.04.029
PubMed Abstract
PMID: 24929944
UroToday.com Prostate Cancer Section
