Diagnosis of high-grade XXXX : the impact of the number of biopsy cores at initial sampling on cancer detection after a saturation re-biopsy.

@entity1 @entity263 @entity5436
OBJECTIVES: To evaluate factors that may predict @entity263 ( @entity263 ) detection after initial diagnosis of high-grade @entity5436 (HGPIN) on 6-24 cores prostatic biopsies (PBx). MATERIAL AND METHODS: We retrospectively evaluated 193 @entity1 submitted from 1998 to 2007 to prostate re-biopsy after initial HGPIN diagnosis in three urologic departments. HGPIN diagnosis was obtained on initial systematic PBx with 6 to 24 random cores. All @entity1 were re-biopsied with a "saturation" PBx with 18-26 cores with a median time to re-biopsy of 12 months. All slides were reviewed by expert uro-pathologists. RESULTS: Plurifocal HGPIN (pHGPIN) was found in 103 @entity1 and monofocal HGPIN (mHGPIN) in 90. Seventy-two and 121 @entity1 were submitted to > 12-core initial biopsy and < or = 12-core, respectively. Overall @entity263 detection at re-biopsy was 28.4%. PSA (6.7 vs 8.5 ng/ml; p = 0.029) and age (64 vs 68 years; p = 0.005) were significantly higher in @entity1 with @entity263 at re-biopsy. @entity263 detection was significantly higher in @entity1 who underwent a < or = 12-core initial PBx than in those with > 12-core (35.5% vs 16.8%; p = 0.03), and in @entity1 with pHGPIN than in those with mHGPIN (34.9% vs 21%; p = 0.035). At multivariable analysis, PSA value (p = 0.007; HR:1.18), prostate volume (p = 0.01; HR:0.966), age (p < 0.001; HR:1.15), pHGPIN (p = 0.003; HR:2.97) and < or = 12-core initial biopsy (p = 0.012; HR:3.62) were independent predictors of PC detection. We further analysed the 2 groups of @entity1 submitted to < or = 12-core and > 12-core initial PBx. Plurifocal HGPIN and older age at biopsy were independent predictors in @entity1 with < or = 12-core initial PBx. On the contrary, in @entity1 with > 12-core initial biopsy, higher PSA values and lower prostate volume were independent predictors of PC detection. CONCLUSIONS: @entity263 detection on saturation re-biopsy after initial diagnosis of HGPIN is significantly higher in @entity1 submitted to < or = 12-core than those submitted to > 12-core initial PBx. In @entity1 with < or = 12-core initial biopsy pHGPIN and older age were predictors of @entity263 detection at re-biopsy. In @entity1 with > 12-core initial biopsy, higher PSA values and lower prostate volume was associated to an increased risk of @entity263 detection at re-biopsy.
