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Clinical Considerations after a Negative Prostate Biopsy

E David Crawford, Neal Shore, Matthew Cooperberg, Marc Dall'Era and Francisco G La Rosa

Accurate diagnosis and follow-up of prostate cancer (PCa) remains a challenge and comes at a considerable cost to the US healthcare system. Over one million US men receive a negative biopsy result each year; however, approximately 25% or more may harbor a cancer that was missed on the biopsy. Unfortunately, many men will have a number of repeat biopsies to satisfy the concern for the presence of cancer. The current standard for prostate biopsy procedure collects samples of <1% of the gland, leaving patients who have persistent risk factors in fear of having occult cancer and leading to a high rate of, often unnecessary, additional repeat biopsy procedures. Concerns over missed cancer due to false-negative biopsy results, coupled with the high rate of clinically significant cancer detected upon repeat biopsy, pose a diagnostic dilemma for urologists. Actionable diagnostic tests could reduce the number of unnecessary repeat biopsies.

This manuscript provides an overview of the current state of affairs in the repeat biopsy setting and highlights available tools to help urologists ‘rule-out’ otherwise cancer-free men from undergoing unnecessary repeat biopsies while ‘ruling-in’ men at increased risk for clinically significant PCa.