What is the Approach to Negative Prostate Biopsies?

Today, the golden standard in diagnosis of prostate cancer is extended transrectal ultrasound guided prostate biopsy. However we often come across with undiagnosed patients at the first biopsy and we might need to decide a repeat prostate biopsy in these patients. If the Prostate Specific Antigen (PSA) elevation and suspicious prostate examination persists in the patient, if the first biopsy pathology reports atypical small acinar proliferation or multiple focus high grade prostatic intraepithelial neoplasia, we can decide a repeat prostate biopsy. In patients with previous negative biopsy, because of the possibility of missing sampling at the anterior or apex regions of prostate, repeating the transrectal or transperineal saturation needle biopsy with sampling from anterior and apex of prostate and multiparametric magnetic resonance imaging guided prostate biopsies are suggested.