DIAGNOSTIC YIELD OF REPEATED TRANSRECTAL ULTRASOUND-GUIDED BIOPSIES STRATIFIED BY SPECIFIC HISTOPATHOLOGIC DIAGNOSES AND PROSTATE-SPECIFIC ANTIGEN LEVELS

Objectives. To determine the diagnostic yield of secondary and tertiar y transrectal ultrasound (TRUS)-guided biopsies of the prostate in men suspected of having carcinoma of the prostate because of an elevated serum prostate-specific antigen (PSA) level or an abnormal digital rec tal examination (DRE). Methods. The pathology database at the Dallas V eterans Affairs Medical Center was retrospectively searched for patien ts who had undergone at least two TRUS-guided biopsies of the prostate within a 6-month time span. Pertinent demographic data, serum PSA, ou tcomes of the two (or more) biopsies stratified in six distinct histop athologic diagnoses, and Gleason grade if carcinoma of the prostate wa s identified, were entered into a database and analyzed. Results. A to tal of 123 men had at least two TRUS-guided biopsies, of which 22 had three biopsies. Mean age of this group was 68.5 +/- 0.51 (SE), and mea n PSA was 11.5 +/- 1.07 (SE). Of 123 patients, 28 had a positive secon d biopsy following a negative first biopsy, for a positive biopsy rate of 23%. Only 2 of 22 patients who underwent a third biopsy were found to have carcinoma of the prostate, for a positive biopsy rate of 9%. The positive biopsy rate for the second biopsy was 19% (3 of 16) if th e PSA was 4.0 ng/mL or less, 15% (10 of 66) if the PSA was between 4 a nd 10.0 ng/mL independent of the DRE findings, and 37% (15 of 41) if t he PSA was 10.0 ng/mL or higher. Benign prostatic hyperplasia (59 of 1 23 [48%]) and atypia (38 of 123 [31%]) were the most common histopatho logic diagnoses on the first biopsy, and the positive re-biopsy rates were similar for these two groups (25% versus 21%). Conclusions. An ov erall positive biopsy rate of 23% in our retrospective series of 123 m en with a mean PSA of 11.5 ng/mL warrants the performance of a second biopsy independent of the histopathologic diagnosis made on the first (negative) biopsy, if the outcome of such biopsy would have therapeuti c consequences for the patient. This policy should not be restricted t o men with a PSA above the cutoff level of 4.0 ng/mL alone. Patients w ith atypia should be pursued aggressively, as even on a third biopsy t he positive biopsy rate was 29%.