REPEAT BIOPSY STRATEGIES FOR MEN WITH ATYPICAL DIAGNOSES ON INITIAL PROSTATE NEEDLE-BIOPSY

Objectives. To evaluate trends in prostate sampling and the efficacy o f different sampling methods to detect prostate cancer in subsequent b iopsies after an initial ''atypical'' biopsy. Methods. We searched Dia non Systems from March 1994 to June 1996 for cases with an initial aty pical diagnosis on biopsy and that had repeat biopsies. The files of D ianon and Johns Hopkins Hospital (JHH) were also analyzed for cases wi th an initial atypical diagnosis on sextant biopsy and for repeat sext ant biopsies showing cancer. Results. Of the 124 Dianon cases in which we knew the site (sextant, left, right) of the initial and subsequent biopsies, 56 cases (45.2%) were cancer on repeat biopsy; in cases wit h repeat sextant biopsies, cancer was detected 59.3% of the time. Ther e were 54 cases in which the initial biopsy was atypical and the repea t biopsy was cancer, where both sets of biopsies were sextants (44 Dia non, 10 JHH). Of the 46 cases with only one initial atypical site, the cancer was in the same sextant site as the previously atypical biopsy in 47.8% of cases; cancer was detected in 84.8% of the cases in eithe r the same sextant, adjacent ipsilateral, or adjacent contralateral si tes. Conclusions. Great variation exists in how urologists sample pros tates both initially and after an atypical diagnosis. Of the 149 Diano n cases, only 32 were sextant to sextant biopsies, and another 32 were consistently left and right to left and right. Our study shows that i n subsequent biopsies after an atypical biopsy, the chance of detectin g cancer greatly increases with biopsy not only of the atypical site, but adjacent contralateral and adjacent ipsilateral areas as well. We advocate the precise labeling of the initial biopsies so that rebiopsy of atypical cases can be directed in a more concentrated fashion into the region of the initial atypical biopsy. Other sites should be biop sied as well, which urologists did not always do, because cancer may a lso be found away from the initial atypical site. (C) 1998, Elsevier S cience Inc. All rights reserved.