Diagnosis of Prostatic Carcinoma: Re-biopsy

A review of the literature on repeat prostate biopsy was performed. In the review, current knowledge on repeat prostate biopsies was evaluated. Cancer detection rate on repeat biopsy ranges betweeen 10% and 20%. In the repeat biopsy, percent free prostate specific antigen (f/t PSA) and PSA density of the transition zone (PSA-TZ) are the most accurate predictors. High-grade prostatic intraepithelial neoplasia (HG-PIN), especially when associated with high PSA or abnormal digital rectal examination (DRE), and atypical small aciner proliferation (ASAP) should be considered an indication for high probabilitiy of prostate cancer, and repeat biopsies should be performed. Repeat biopsies should be based on more extended or saturation biopsies and should include the transition zone. Recent reports suggest nomograms as more accurate than clinical parameters alone. It may improve clinical judgment before the decision to repeat biopsy. Cancer detection rates on the third and fourth sets of biopsies are very low and cancers detected are of lower grade stage and volume. Therefore, biopsies 3 and 4 should be indicated in selected cases only.