Follow-up of atypical prostate needle biopsies suspicious for cancer

Objectives. To determine both how the diagnosis of an atypical biopsy influ ences a urologist's decision to repeat the biopsy and the outcome of rebiop sy. Methods. Of 200 atypical biopsies that we confirmed from outside consultati ons to the Johns Hopkins Hospital from 1992 to 1993, we were able to retrie ve follow-up information for 144 cases. Each atypical biopsy was evaluated for the reason for atypia (atrophic glands, rule out [r/o] adenosis, atypic al not otherwise specified [NOS; insufficient cytologic and/or architectura l atypia], r/o prostatic intraepithelial neoplasia [PIN], inflammation, cru sh artifact) and a favored diagnosis (cancerous, benign, and undetermined). Results. Of the 144 atypical biopsies, 92 were rebiopsied (63.9%). The time from the initial atypical biopsy to rebiopsy ranged from 0.5 months to 3 y ears (63% less than 6 months; 39% less than 3 months). Rebiopsy revealed ca rcinoma in 48.9%, benign in 38%, atypical in 8.7%, and PIN in 4.4%. The med ian prostate-specific antigen (PSA) value was lower in men who did not unde rgo a repeat biopsy (6 versus 7.8) (rank sum analysis, P = 0.04). No correl ation was found between PSA level and results of the rebiopsy. Of the atypi cal biopsies in which cancer was favored, 61% were cancerous on rebiopsy ve rsus 33% where a benign process was favored. The three reasons for atypical biopsies that seemed to correlate with outcome of rebiopsy were atypical N OS (68% cancer on rebiopsy); inflammation (63% cancer on rebiopsy); and r/o adenosis (36% cancer on rebiopsy). Conclusions. Although 48.9% of the rebiopsied cases were cancerous, only 63 % of men underwent rebiopsy, raising a concern that cancers are being misse d in those cases not rebiopsied after an atypical diagnosis. Although there was a trend for serum PSA to correlate with outcome of rebiopsy, this corr elation was not significant, and even men with serum PSA less than 4 ng/mL had a 33% risk of cancer on rebiopsy. Although histologic features of the a typical foci may be useful as factors in determining the urgency for rebiop sy, they also were not statistically significant in predicting outcome. Men with atypical diagnoses should undergo rebiopsy regardless of serum PSA le vels and regardless of why the lesions were atypical. (C) 1999, Elsevier Sc ience Inc. All rights reserved.