Initial Biopsies Miss Many Prostate Cancers
by William J. Catalona, M.D.
The need for repeat prostate biopsies is a common occurrence in men with elevated PSA levels or a suspicious digital examination whose initial biopsies do not show prostate cancer.
Dr. Catalona suggested that with the recent ability to perform a local anesthetic block of the prostate, more biopsy cores could be obtained with less discomfort to the patient.
Using this technique, it is likely that fewer cancers would be missed on initial biopsy sessions and the need for repeat biopsies would decrease.
Dr. Catalona's research team recently reported on serial biopsy results on 2,527 consecutive men in the PSA study who had abnormal screening results and underwent one or more biopsy sessions.
In these men, six biopsy cores were usually obtained per session and the biopsies were performed without anesthesia. Of these men, 960 (38%) were diagnosed with prostate cancer.
Of the cancers detected, 76% were detected during the first biopsy session, 91% during the first two sessions, 97% during the first three sessions and 99% during the first four sessions. No cancer was detected beyond the sixth biopsy session.
Thus, almost 25% of the cancers were missed on the first biopsy session.