Editorial comment. Repeat prostate biopsy and the incremental risk of clinically insignificant prostate cancer.

摘要

This report reaffirms the intuitive conclusion that cancers missed on an initial prostate biopsy are likely to be smaller than those cancers identified on the first attempt. Although it might be tempting to assume that a negative biopsy rules out significant cancer, these data actually provide further evidence that a negative biopsy actually offers limited reassurance. Notably, more than half of the patients whose cancers were found after 2 prior negative biopsies still had adverse pathology, with 42% having Gleason score 7-10. Furthermore, these patients actually had a higher risk of upgrading at the time of radical prostatectomy compared with those diagnosed with 1 or 2 biopsies. Finally, there was no difference in biochemical failure after surgical intervention regardless of the number of prior biopsies, although the study was not designed for that purpose.