Repeat prostate biopsy and the incremental risk of clinically insignificant XXXX .

@entity1 @entity263 @entity5 @entity1486 @entity5436
OBJECTIVES: To determine the incremental risk of diagnosis of clinically insignificant @entity263 with serial prostate biopsies. METHODS: We reviewed our institutional radical prostatectomy (RP) database comprising 2411 consecutive @entity1 undergoing RP. We then stratified @entity1 by the prostate biopsy on which their @entity5 was diagnosed and correlated biopsy number with the risk of clinically insignificant disease and adverse pathology at radical prostatectomy. RESULTS: A total of 1867 (77.4%), 281 (11.9%), and 175 (7.3%) @entity1 underwent 1, 2, and 3 or more prostate biopsies, respectively, before RP. Increasing number of prostate biopsies was associated with increasing prostate volume (P <.01), @entity1486 (P <.01), associated @entity5436 (P <.01), and increased likelihood of clinical Gleason 6 or less disease (P <.01). On pathologic analysis, increasing number of prostate biopsies was associated with increased risk of low-volume (P <.01), organ-confined (P <.01) disease. The risk of clinically insignificant disease was found to be 31.1%, 43.8%, and 46.8% in those undergoing 1, 2, and 3+ prostate biopsies, respectively. Conversely, the risk of adverse pathology was found to be 64.6%, 53.0%, and 52.0% in those undergoing 1, 2, and 3+ prostate biopsies, respectively. CONCLUSIONS: @entity1 undergoing multiple prostate biopsies before RP are more likely to harbor clinically insignificant @entity263 than those who only undergo 1 biopsy before resection. Nonetheless, the risk of adverse pathology in @entity1 undergoing serial biopsies remains significant. The increased risk of @entity263 overdiagnosis and overtreatment must be balanced with the continued risk of clinically significant disease when counseling @entity1 regarding serial biopsies.
