Analysis of repeated biopsy results within 1 year after a noncancer diagnosis

• Published in: Urology (Ridgewood, N.J.) N.J.), 2000-04, Vol.55 (4), p.553-558
• Main Authors: O’dowd, Gerard J, Miller, M.Craig, Orozco, Roberto, Veltri, Robert W
• Format: Article
• Language: English
• Subjects: Aged; Biopsy; Cell Transformation, Neoplastic - pathology; Follow-Up Studies; Humans; Likelihood Functions; Male; Middle Aged; Prostate - pathology; Prostatic Hyperplasia - pathology; Prostatic Intraepithelial Neoplasia - pathology; Prostatic Neoplasms - pathology; Reoperation; Retrospective Studies
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(00)00447-7

Objectives. A prostate biopsy data base derived from patients referred to private practice urologists was analyzed for the cancer diagnosis rates of the “initial” biopsy and the repeated biopsy performed within 1 year for those patients with a noncancer diagnosis. Methods. A retrospective analysis assessed 132,426 prostate biopsies received and processed by a single pathology laboratory between March 1994 and September 1998; none had had a previous biopsy processed at this laboratory. Prostate cancer was diagnosed in 50,521 of the patients (38.2%). The remaining 81,905 patients (61.8%) had a noncancer diagnosis of either no evidence of malignancy (NEM), high-grade prostatic intraepithelial neoplasia (HGPIN), small acinar glands suspicious for cancer (suspicious), or suspicious with HGPIN (Susp-HGPIN). We identified 6380 (7.8%) of these “noncancer” patients who underwent a repeated biopsy within 1 year. Results. The incidence of NEM, HGPIN, suspicious, and Susp-HGPIN biopsy diagnoses in the “noncancer” patients (81,905) was 55.3%, 3.7%, 2.5%, and 0.3%, respectively. The rate at which these “noncancer” patients (81,905) underwent a repeated biopsy was 4.8% for patients with a diagnosis of NEM, 26.6% for HGPIN, 40.4% for suspicious, and 47.5% for Susp-HGPIN. The overall cancer diagnosis rate in the repeated biopsy patient sample (6380) was 25.7%. When stratified by the initial biopsy diagnosis, the cancer diagnosis rate for the repeated biopsies was 19.8%, 22.6%, 40.0%, and 53.1%, for the patients with NEM, HGPIN, suspicious, and Susp-HGPIN, respectively. The repeated biopsy diagnosis rates did not vary dramatically when analyzed at 3-month intervals during the 1-year period. Also, a strong correlation (79%) was observed between the number of tissue samples obtained at the initial and repeated biopsy procedures. In a subset of patients with free and total prostate-specific antigen (PSA) results obtained before the repeated biopsy (n = 813), we were able to construct a multivariate logistic regression algorithm using the patients’ age, initial biopsy diagnosis, total PSA, and free/total PSA ratio that could predict the likelihood of cancer on the repeated biopsy with an accuracy of 70%. Conclusions. Men who have an initial noncancerous biopsy diagnosis remain at risk of prostate cancer, especially if the initial diagnosis was suspicious or Susp-HGPIN. These data suggest that the initial biopsy strategy needs to be improved and/or expanded to increase the overa