ORLANDO, FL (UroToday) - These investigators sought to determine both the risk of future prostate cancer in patients that undergo negative repeat saturation biopsies and the criteria that should be used in decision making whether to do follow-up biopsy in a patient with a previous negative repeat saturation or not.

They retrospectively evaluated a total of 576 patients with a repeat saturation prostate biopsy from April 2002 to March 2007. The definition of repeat saturation prostate biopsy was patients who had two biopsies or more with at least the last one being a saturation biopsy of 20 cores or more. Their PSA was repeated yearly and repeat biopsy was performed if PSA rose significantly after their last biopsy. They excluded all patients who had a previous positive biopsy for prostate cancer. They analyzed PSA, age, race, number of previous biopsies, number of cores taken, presence of PIN, inflammation, and atypia on pathology specimens, total prostate volume, and digital rectal exam (DRE) results of all patients involved. Differences between outcomes were examined with either the Wilcoxon ran-sum test for continuous variables or Fisher's exact test for categorical variables. The association between variables and the outcome were expressed as Hazard Ratios (HR) and their 95% confidence intervals (95% CI). Patients were followed for a mean of 3.7 months.

Of the 576 patients with repeat saturation biopsies, 386 was negative biopsies (67%). Mean follow-up was 3.8 months. The average age was 64. Out of those 386 patients with negative repeat saturation biopsies 18 (4.7%) developed prostate cancer at some point in the future (cases). However, the majority of patients (95.3%) remained prostate cancer free during our interval follow-up (control group). In a multivariate analysis, only atypia (HR=3.0, p=0.001) and increasing PSA of >1 ng/ml (HR=1.1, p=0.001) were predictors of a future risk of prostate cancer.

Patients with a history of negative saturation biopsy of > 20 cores have a 5% chance of developing prostate cancer in the future. Those patients with increasing PSA > 1 ng/ml and with atypia on their prostate biopsy should be followed more closely as they have a chance of developing future prostate cancer even with a negative repeat saturation biopsy. However, in those patients without these clinical predictors, a negative saturation biopsy decreases the likelihood of future development of prostate cancer. Furthermore, they conclude that saturation biopsy as a repeat biopsy detects almost all significant cancers and obviates the need for future biopsy in a vast majority of men.

Presented by Angelo A Baccala, MD, Ayman S Moussa, MD, Adrian V Hernandez, MD, J Stephen Jones, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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