Repeat Prostate Biopsy: Rationale, Indications, and Strategies

Background: The inaccuracy of prostate biopsy in detecting and characterising prostate cancer (PCa) has led to a widespread use of repeat biopsy (RB). Objective: To summarise the most recent data regarding indication, techniques, and clinical implications of RB. Evidence acquisition: A search of Medline, PubMed, and Scopus identified articles published in the last 7 yr (2008-2014) addressing the role of RB in the PCa setting. Abstracts deemed relevant to the defined review question were screened, and the data were extracted, analysed, and summarised. Evidence synthesis: RB can be considered either in patients with persistent PCa suspicion after a first negative systematic biopsy or during active surveillance (AS), either to confirm patient enrolment or to monitor the natural progression of the disease. Indication and biopsy techniques differ according to each PCa scenario. Magnetic resonance imaging (MRI)-guided RB has been gaining popularity because of its accuracy in detecting and characterising PCa. Indications for multiple RBs (eg, AS setting) should be carefully evaluated because of the cumulative risk of complications, especially infection. In the next few years, clinical and genetic markers are expected to further improve the ability to determine the need for RB. Conclusions: RB indications and techniques in persistent PCa suspicion and AS should take into account the evolving field of imaging, management options, and the risk of possible complications. In an RB setting, the introduction in daily clinical practice of MRI-guided targeted biopsy has improved the accuracy in detecting PCa without significantly increasing the risk of finding indolent, low-risk PCa. Referral to specialised care centres should be considered in patients with persistent PCa suspicion to provide the most rationalised management in terms of indication, biopsy technique, complications, pathologic assessment, and, finally, clinical implications of the findings. Patient summary: A man may require a second prostatic biopsy for a number of reasons. In the current report, we describe why, when, and how a patient should undergo rebiopsy of the prostate. Until future findings and more accurate biomarkers are available, repeated biopsy indication and techniques should be considered carefully to maximise the clinical utility of the procedure.