Almost one quarter of men who have a single negative prostate biopsy are eventually diagnosed with prostate cancer (PCa) within 20 years, according to investigators.

The finding is from a study of 95,675 men who had a negative first transrectal ultrasound (TRUS)-guided prostate biopsy from January 1994 to October 2014. The 5-, 10-, 15, and 20-year cumulative rates of PCa diagnosis were 12.7%, 18.4%, 21.7%, and 23.7% respectively, Rashid K. Sayyid, MD, of the University Health Network and University of Toronto in Toronto, and colleagues reported in Urologic Oncology. The 5-, 10-, 15, and 20-year cumulative rates of PCa-specific mortality were 0.16%, .057%, 1.3%, and 1.8%, respectively.

In addition, men aged 70 to 79 and 80 to 84 years at initial biopsy had 20-year PCa-specific mortality cumulative rates of 3.2% and 6.4%, respectively. The 20-year cumulative rates of undergoing radical prostatectomy, definitive radiotherapy, and androgen deprivation therapy were 7.6%, 6.1%, and 7.2%, respectively.

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Given the significantly higher PCa mortality rates in older men, more aggressive follow-up and treatment approaches may be warranted in medically fit older individuals with a history of a negative TRUS-guided biopsy, according to the investigators.

The study also showed that increasing socioeconomic status was associated with a higher risk of PCa diagnosis, but a lower PCa-specific mortality risk, Dr Sayyid and colleagues reported. Patients living in an urban area had a significant 11% increased risk of PCa diagnosis compared with those living in a rural area, but a significant 31% decreased risk of PCa-specific mortality.

The authors said their investigation is the first population-based study to assess long-term cancer outcomes in North American men with a single negative TRUS-guided prostate biopsy. The study included the largest patient series to date, and had the longest median follow-up (8.1 years), they stated.

Study limitations included the lack of prebiopsy PSA values, clinical stage, ethnicity, family history, biopsy-derived Gleason score, number of sampled cores, and imaging findings, Dr Sayyid and his colleagues stated. In addition, as their study inclusion period extended back to 1994, “it is likely that a significant proportion of men in our cohort underwent a sextant biopsy as opposed to the currently used systematic 12-core biopsy protocol.”


Sayyid RK, Alibhai SMH, Sutradhar R, et al. Population-based outcomes of men with a single negative prostate biopsy: Importance of continued follow-up among older adults. Urol Oncol. 2019; published online ahead of print.