More Favorable Pathological Outcomes in Men with Low-Risk Prostate Cancer Diagnosed on Repeat versus Initial Transrectal Ultrasound-Guided Prostate Biopsy.

Objectives: To assess the pathological outcomes following radical prostatectomy (RP) in men with favorable-risk PCa diagnosed on their first/initial (IBPx) compared to men who were diagnosed on a subsequent/repeat (RPBx) prostate biopsy.

We identified 422 patients who met National Cancer Comprehensive Network (NCCN) very-low (N = 199) and low-risk (N = 223) PCa who instead underwent RP. In each risk category we compared adverse pathologic outcomes defined as Gleason score (GS) upgrading, extraprostatic extension (EPE), seminal vesicle invasion (SVI), and positive surgical margins between men diagnosed IPBx versus RPBx after a negative biopsy(-ies).

There were no significant differences in the baseline clinical and demographic characteristics between groups. However, men who were diagnosed on IPBx demonstrated a higher median maximum cancer % per single core (p < 0. 001) and higher median % of positive cores (p < 0. 001). Compared to RPBx, men diagnosed on IPBx had a higher GS upgrade (≥7) (57. 7% vs. 42. 1%, p = 0. 005) and EPE (14. 1 % vs. 5. 4 %, p = 0. 01). On stratified analysis comparing IPBx to RPBx, very-low risk disease was associated with GS upgrade (49. 3% vs. 31. 8%, p=0. 02) and low-risk disease demonstrated higher rates of extraprostatic extension (19. 9 % vs. 6. 0 %, p = 0. 02).

The likelihood of adverse pathologic outcomes at the time of RP is lower among men diagnosed with favorable-risk PCa on RPBx compared to men diagnosed on IPBx and may represent an important consideration in risk stratifying men with favorable-risk PCa.

The Journal of urology. 2015 Dec 24 [Epub ahead of print]

Ahmed ElShafei, Yaw Nyame, Onder Kara, Atef Badawy, Ifeanyi Amujiogu, Khaled Fareed, Eric Klein, J Stephen Jones

Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, United States; Urology department, Al Kasr Al Aini Hospital, Cairo University, Giza, Egypt. , Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, United States. , Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, United States. , Urology department, Faculty of Medicine, Menofiya University, Menofiya, Egypt. , Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, United States. , Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, United States. , Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, United States. , Glickman Urological & Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, United States.