Predictive Factors for Detection of Clinically Significant Cancer in Repeat Prostate Biopsy

Somalia Turkiye Medical Journal (STMJ), cilt.2, sa.4, ss.1-7, 2023 (Hakemli Dergi)

Abstract Introduction: This study aims to identify predictive factors for detecting clinically significant cancer in the second

biopsy among patients who underwent two prostate biopsies. Materials and Methods: Between 2016 and 2022,

our clinic conducted prostate biopsies in response to elevated prostate-specific antigen (PSA) levels. When the

initial pathology did not reveal cancer, patients who subsequently underwent a second biopsy due to the detection

of atypical small acinar proliferation (ASAP) and persistent PSA elevation were included in this study. Data from

103 patients were retrospectively evaluated. The initial biopsy followed a 12-quadrant routine protocol. The

second biopsy was performed within three months for ASAP cases and six months later for cases with persistent

PSA elevation. Pathological staging utilized the Gleason scoring system, with scores of 7 and above indicating

clinically significant cancer. Patients were stratified by age (under 65 and 65 and over), and whether their PSA

values six months post-initial biopsy exceeded 20%. Statistical analysis employed Fisher’s exact test, with a

significance threshold set at p<0.05. Results: Of the 103 patients included in the study, cancer was detected in 13

(12.6%) during the second biopsy. Among these, 5 (4.8%) exhibited clinically insignificant cancers meeting active

surveillance criteria, while 8 (7.8%) demonstrated a Gleason score of 7 or higher. No significant difference in

cancer detection or identification of clinically significant cancer was observed between patients with ASAP at the

first biopsy and those without (p=0.982). However, the rate of clinically significant cancer was notably higher at

15.4% in patients with a PSA increase of over 20%, compared to 3.1% in those without an increase (p=0.024).

Furthermore, clinically significant cancer was identified in 14.2% of patients aged 65 and over, as opposed to

1.9% in those under 65 (p=0.019). Conclusions: This study highlights a higher detection rate of clinically

significant cancer in patients with a PSA value increase of more than 20% compared to their initial PSA, as well

as in individuals aged 65 and over, among those who underwent a prostate biopsy due to elevated PSA levels

initially deemed benign. Timely consideration of a second biopsy is crucial for these patient cohorts.