Repeat prostate biopsy: who, when, how?

Abstract

Aim: Patients who have a persistently elevated or a rising PSA level following a prior negative biopsy can be a stressful situation for both the urologist and the patient. We reviewed indications of repeat biopsy. Findings: The indications for a repeat biopsy are rising and/or persistent PSA, suspicious digital rectal examination (DRE), atypical small aciner proliferation (ASAP) in biopsy and extensive high grade prostatic intraepithelial neoplasia (HGPIN) in biopsy. Result: Repeat biopsies should include a minimum of 14 cores, the 12 cores recommended for an initial biopsy and 2 additional cores obtained form the right and left anterior apex. Saturation biopsy must be performed in patients with persistently elevated PSA despite multiple negative prior biopsies. Repeat biopsy can be performed 6 weeks later with no significant difference in morbidity.