Pathological features of prostate cancer detected on initial and repeat prostate biopsy: Results of the prospective European Prostate Cancer Detection Study

PURPOSE. We evaluated pathological features of prostate cancer detected on repeat prostate biopsy in men with a serum total prostate-specific antigen (PSA) level between 4 and 10 ng/ml who were diagnosed with benign prostatic tissue after an initial biopsy and compared them to those cancers detected on initial prostate biopsy. MATERIAL AND METHODS. In this prospective European prostate cancer detectio n study 1,051 men with a total PSA level between 4 and 10 ng/ml underwent t ransrectal ultrasound (TRUS)-guided sextant biopsy and two additional trans ition zone biopsies. All subjects whose biopsy samples were negative for pr ostate cancer (CaP) underwent a repeat biopsy after 6 weeks. Those with cli nically localized cancers underwent radical prostatectomy. Pathological and clinical features of patients diagnosed with cancer on either initial or r epeat biopsy and clinically organ confined disease who agreed to undergo ra dical prostatectomy were compared. RESULTS. Initial biopsy was positive (CaP) in 231 of 1,051 enrolled subject s and negative (benign histology) in 820 subjects. Of these 820 subjects, C aP was detected in 10% (83/820) upon repeat biopsy. Of cancers detected on initial and repeat biopsy, 148/231 (64%) and 56/83 (67.5%) had clinically l ocalized disease, respectively, and were offered radical prostatectomy. 10/ 148 (6.7%) and 3/56 (5.3%), respectively, opted for radiation therapy and t hus, 135/148 (93.3%) and 53/56 (94.7%), respectively, underwent radical ret ropubic prostatectomy. There were statistically significant differences wit h respect to multifocality (P = 0.009) and cancer location (P < 0.001) with cancers on repeat biopsy showing a lower rate of multifocality and a more apico-dorsal location. In contrast, there were no differences with respect to stage (P = 0.2), Gleason score (P = 0.36), percentage Gleason grade 4/5 (P = 0.1), serum PSA (P = 0.62), and patient age (P = 0.517). CONCLUSIONS. At least 10% of patients with negative prostatic biopsy result s will be diagnosed with CaP on repeat biopsy. Despite differences in locat ion and multifocality, pathological and biochemical features of cancers det ected on initial and repeat biopsy are similar, suggesting similar biologic al behavior and thus advocating for a repeat prostate biopsy in case of a n egative finding on initial biopsy. Cancers missed on initial biopsy and sub sequently detected on repeat biopsy are located in a more apico-dorsal loca tion. Repeat biopsies should thus be directed to this rather spared area il l order to improve cancer detection rates. Prostate 47:111-117, 2001. (C) 2 001 Wiley-Liss, Inc.