Using a Saturation Biopsy Scheme Increases Cancer Detection During Repeat Biopsy in Men With High-grade Prostatic Intra-epithelial Neoplasia

ObjectiveTo determine the role of transrectal saturation biopsy for cancer detection in men with high-grade prostatic intra-epithelial neoplasia (HGPIN) diagnosed by extended biopsy. HGPIN was clearly associated with cancer risk in the sextant biopsy era, but this has not been clearly demonstrated in the extended biopsy era.Materials and MethodsFrom 1999 to 2009, 314 men had at least 1 or more repeat biopsy due to the presence of exclusive HGPIN (without any other pathologic finding) in a previous extended biopsy. They were divided into 2 groups according to the initial follow-up biopsy scheme, 178 men were followed up using a second standard extended biopsy scheme and 136 were followed up using the saturation biopsy scheme.ResultsIn the standard repeat biopsy group, 35 of 178 (19.7%) men had cancer on initial repeat biopsy. In the saturation biopsy group, 42 of 136 (30.9%) had cancer on initial repeat biopsy (overall, P = .04). Multivariate analysis demonstrates that the biopsy scheme on repeat biopsy is an independent predictor of prostate cancer detection (OR 1.85, (95% CI; 1.03, 3.29), exclusive of age, PSA, days from initial biopsy, DRE status and multifocal PIN. Furthermore, there appears to be no further increase in Gleason 6 disease with usage of saturation biopsy in this unique population.ConclusionCancer detection in men with HGPIN in the contemporary extended biopsy era is substantially improved using saturation technique.