Repeat prostate biopsy--when, where, and how

Urol Oncol. May-Jun 2009;27(3):312-4. doi: 10.1016/j.urolonc.2008.10.029.


Patients who have a persistently elevated or a rising PSA level following a prior negative prostate biopsy can be a stressful situation for both the urologist and the patient. This will be a brief review of the indications and techniques in patients undergoing a repeat biopsy. In patients with a prior negative biopsy, assessing the adequacy of the initial biopsy is important. F/T PSA is currently the most useful marker in predicting cancer on repeat biopsy although newer markers, such as PCA3, are promising. 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. In patients for whom repeat biopsies fail to identify cancer, yet the clinical suspicion remains high, consideration for a saturation biopsy approach seems warranted.

MeSH terms

  • Biomarkers, Tumor / blood
  • Biopsy / methods*
  • Biopsy / standards
  • Humans
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Prostate / pathology*
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / pathology*
  • Time Factors


  • Biomarkers, Tumor
  • Prostate-Specific Antigen