Patients undergoing multiple prostate biopsies before radical prostatectomy (RP) are more likely to harbor clinically insignificant prostate cancer (PCa) than those who only undergo only one biopsy before surgery, according to researchers.
Matthew Resnick, MD, of the University of Pennsylvania in Philadelphia, and colleagues, reviewed their institutional RP database containing information from 2,411 consecutive patients undergoing RP. They stratified patients by the prostate biopsy on which their cancer was diagnosed and correlated the biopsy number with the risk of clinically insignificant disease and adverse pathology at RP.
Prior to RP, 1,867 men (77.4%) underwent one prostate biopsy, 281 (11.9%) underwent two biopsies, and 175 (7.3%) underwent three or more prostate biopsies. An increasing number of prostate biopsies was associated with increasing prostate volume, PSA, and an increased likelihood of clinical Gleason 6 or less disease.
Pathologic analysis revealed that an increasing number of prostate biopsies was associated with increased likelihood of low-volume, organ-confined disease, the researchers reported in Urology (2011;77:548-552). The risk of clinically insignificant disease was 31.1% for men who had one prostate biopsy, 43.8% for those who had two biopsies, and 46.8% for men who had three or more biopsies prior to surgery. The risk of adverse pathology was 64.6%, 53%, and 52% for men who had one, two, or three or more biopsies prior to RP.
Dr. Resnick’s group concluded that “the risk of overdiagnosis and overtreatment of prostate cancer must be balanced with the continued risk of clinical significant disease when counseling men regarding repeat prostate biopsy.”