TY - JOUR
T1 - The optimal rebiopsy prostatic scheme depends on patient clinical characteristics
T2 - Results of a recursive partitioning analysis based on a 24-core systematic scheme
AU - Scattoni, Vincenzo
AU - Raber, Marco
AU - Capitanio, Umberto
AU - Abdollah, Firas
AU - Roscigno, Marco
AU - Angiolilli, Diego
AU - MacCagnano, Carmen
AU - Gallina, Andrea
AU - Sacc, Antonio
AU - Freschi, Massimo
AU - Doglioni, Claudio
AU - Rigatti, Patrizio
AU - Montorsi, Francesco
PY - 2011/10
Y1 - 2011/10
N2 - Background: The most beneficial number and the location of prostate biopsies remain matters of debate, especially after an initial negative biopsy. Objective: To identify the optimal combination of sampling sites (number and location) to detect prostate cancer (PCa) in patients previously submitted to an initial negative prostatic biopsy. Design, setting, and participants: A transrectal ultrasound-guided systematic 24-core prostate biopsy (24PBx) was performed prospectively in 340 consecutive patients after a first negative biopsy (at least 12 cores). Measurements: We relied on a classification and regression tree analysis to identify three clinically different subgroups of patients at dissimilar risk of harboring PCa at second biopsy. Subsequently, we set the cancer-positive rate of the 24PBx at 100% and calculated PCa detection rates for 255 possible combinations of sampling sites. We selected the optimal biopsy scheme (defined as the combination of sampling sites that detected 95% of all the cancers with the minimal number of biopsy cores) for each patient subgroup. Results and limitations: After an initial negative biopsy, cancer was detected at rebiopsy in 95 men (27.9%). At a given number of cores, the cancer detection rates varied significantly according to the different combination of sites considered. Three different PCa risk groups were identified: (1) previous report of atypical small acinar proliferation of the prostate (ASAP), (2) no previous ASAP and ratio of free prostate-specific antigen (fPSA) to total PSA (%fPSA) ≤10%, and (3) no previous ASAP and %fPSA >10%. For patients with previous ASAP or patients with no previous ASAP and %fPSA ≤10%, two schemes with different combinations of 14 cores were most favorable. The optimal sampling in patients with no previous ASAP and %fPSA >10% was a scheme with a combination of 20 cores. Conclusions: Both the number and the location of biopsy cores taken affect cancer detection rates in a repeated biopsy setting. We developed an internally validated flowchart to identify the most advantageous set of sampling sites according to patient characteristics.
AB - Background: The most beneficial number and the location of prostate biopsies remain matters of debate, especially after an initial negative biopsy. Objective: To identify the optimal combination of sampling sites (number and location) to detect prostate cancer (PCa) in patients previously submitted to an initial negative prostatic biopsy. Design, setting, and participants: A transrectal ultrasound-guided systematic 24-core prostate biopsy (24PBx) was performed prospectively in 340 consecutive patients after a first negative biopsy (at least 12 cores). Measurements: We relied on a classification and regression tree analysis to identify three clinically different subgroups of patients at dissimilar risk of harboring PCa at second biopsy. Subsequently, we set the cancer-positive rate of the 24PBx at 100% and calculated PCa detection rates for 255 possible combinations of sampling sites. We selected the optimal biopsy scheme (defined as the combination of sampling sites that detected 95% of all the cancers with the minimal number of biopsy cores) for each patient subgroup. Results and limitations: After an initial negative biopsy, cancer was detected at rebiopsy in 95 men (27.9%). At a given number of cores, the cancer detection rates varied significantly according to the different combination of sites considered. Three different PCa risk groups were identified: (1) previous report of atypical small acinar proliferation of the prostate (ASAP), (2) no previous ASAP and ratio of free prostate-specific antigen (fPSA) to total PSA (%fPSA) ≤10%, and (3) no previous ASAP and %fPSA >10%. For patients with previous ASAP or patients with no previous ASAP and %fPSA ≤10%, two schemes with different combinations of 14 cores were most favorable. The optimal sampling in patients with no previous ASAP and %fPSA >10% was a scheme with a combination of 20 cores. Conclusions: Both the number and the location of biopsy cores taken affect cancer detection rates in a repeated biopsy setting. We developed an internally validated flowchart to identify the most advantageous set of sampling sites according to patient characteristics.
KW - Diagnosis
KW - Prostate biopsy
KW - Prostatic neoplasms
KW - Transrectal ultrasound
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U2 - 10.1016/j.eururo.2011.07.036
DO - 10.1016/j.eururo.2011.07.036
M3 - Article
C2 - 21820797
AN - SCOPUS:80052261103
VL - 60
SP - 834
EP - 841
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 4
ER -