Most men who undergo prostate biopsy will not be found to have cancer. Nevertheless, a significant number of those men may harbor cancer that was simply not identified during biopsy because the biopsy needle missed its location. It is widely assumed that rising PSA following a negative prostate biopsy is more likely to indicate cancer, so this is the most common indication for repeat biopsy. By contrast, most men with stable PSA levels are more often observed without further investigation. However, no data support that approach, and multiple studies indicate that approximately one fourth of all patients undergoing a second biopsy will be found to have prostate cancer (PCa). There is no consensus on how to manage this heterogeneous growing population, so this article addresses the issues that must be understood to navigate the scenario posed by patients that have had a prior negative biopsy.
After taking part in this educational activity, participants should be better able to:
- Define all relevant parameters in the decision to repeat biopsy.
- Discuss the threshold for rebiopsy in patients found to have high-grade prostatic intraepithelial neoplasia and/or atypia on first biopsy.
- Assess whether or not PSA dynamics after a negative biopsy should drive the decision for repeat biopsy.
- Identify optimal strategies for secondary and tertiary biopsy of the prostate.
AMA PRA Category 1 Credit(s)TM
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Medical Education Resources (MER) and Haymarket Media, Inc. MER is accredited by the ACCME to provide continuing medical education for physicians.
Medical Education Resources designates this educational activity for a maximum of 2.0 AMA PRA Category 1 creditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
J. Stephen Jones, MD, FACS
Chairman, Department of Regional Urology
Glickman Urological and Kidney Institute,
Professor of Surgery,
Lerner College of Medicine
Disclosure of Conflicts of Interest:
Medical Education Resources insures balance, independence, objectivity, and scientific rigor in all our educational programs. In accordance with this policy, MER identifies conflicts of interest with its instructors, content managers, and other individuals who are in a position to control the content of an activity. Conflicts are resolved by MER to ensure all scientific research referred to, reported, or used in a CME activity conforms to the generally accepted standards of experimental design, data collection, and analysis. MER is committed to providing its learners with high-quality CME activities that promote improvements or quality in health care and not the business interest of a commercial interest.
J. Stephen Jones, MD, FACS, has reported relationships with GlaxoSmithKline, Pfizer, Abbott, and Endocare.
Publishing Staff Disclosures
Jody A. Charnow and Marina Galanakis, Haymarket Media Group, have nothing to disclose with regard to commercial support.
Victoria Smith, MD, Medical Education Resources, Inc., has nothing to disclose with regard to commercial support.
Disclosure of Unlabeled Use:
This educational activity may contain discussion of approved and/or investigational uses of agents that are not indicated by the FDA. Medical Education Resources, Inc. (MER), and Haymarket Medical Education (HME) do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of MER and HME. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Medical Education Resources or Haymarket Media, Inc. The authors have disclosed if there is any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Medical Education Resources, or Haymarket Media, Inc. Before prescribing any medicine, primary references and full prescribing information should be consulted. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management.
This program is sponsored by Medical Education Resources, Inc. and produced by Haymarket Medical Education.
If you have any questions relating to the accreditation of this activity, please contact:
Medical Education Resources, Inc.
1500 West Canal Court
Littleton, CO 80120-5615
To obtain credit, a score of 70% or better is required. This CME is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the posttest survey, and have received your digital copy of your credit certificate. Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.
WINDOWS PC SYSTEM REQUIREMENTS:
266-MHz Pentium II; Windows 98 or higher; 64 MB RAM; 800 x 600 screen resolution
set for “High Color (16-Bit)”; Macromedia Flash Player 6 or higher.
MACINTOSH® SYSTEM REQUIREMENTS:
Power Mac g3 at 300 MHz; System 8.5 or higher (excluding Mac OSX); 96 MB RAM; 20
MB minimum hard disk space available; 800 x 600 screen resolution set to “Thousands
of Colors”; Macromedia Flash Player 6 or higher.