Strategies for repeat prostate biopsies

Urologists are routinely faced with the dilemma of a persistently worrisome clinical picture for prostate cancer in patients who have undergone prior negative ultrasound-guided prostate biopsies. Indications for repeat biopsy include sustained or worsening of the findings that prompted the initial biopsy; various derivations of prostate-specific antigen; and the histology from the initial biopsy (ie, high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation is identified). Large prostate volume or inflammation can confound the decision to perform repeat biopsies. Repeat biopsies should include a combination of standard sextant, lateral, anterior apical, and possibly transition zone biopsies. Repeat biopsies should consist of at least 14 cores but may include more than 36 samples. In patients who are not at high risk for prostate cancer, more than two sets of repeat biopsies have a very low yield.