[Repeat prostate biopsies following a first negative biopsy in a context of an elevated prostate specific antigen]

Introduction: An elevated PSA and a negative prostate biopsy (PB) can be a false negative PB that ignores a prostate cancer (PCa) or a false positive PSA not related to PCa. The objective of this study was to analyze a group of patients who had a negative first BP for a PSA superior to 4 ng/mL and at least one additional PB and to compare these cases with controls who had the diagnosis PCa from the first PB.

Methods: Retrospective single-center study comparing patients with an elevated PSA and repeat biopsy following a first negative PB and patients with PCa diagnosed from the first PB.

Results: The 63 cases were younger than the 75 controls and had more often a normal digital rectal examination. Their prostate volume was larger and their number of PSA before the first PB lower: this corresponded to a lower PSA in the second (7/64), third (6/31), fourth (3/9) and sixth (1/1) PB. Among these cases with PCa, the length of core invaded by cancer and the total length of cancer of the entire PB were smaller than controls. In 76% of cases, the Gleason score among cases was 6 or less.

Conclusion: PCa discovered on repeat biopsy had features of better prognosis than those of controls. We propose an algorithm for management of patients with elevated PSA and negative first PB.