However, there are patients with two negative biopsies who continue with a high suspicion of cancer, with a persistently elevated PSA or pre-malignant histology report such as prostate intraepithelial neoplasia grade 3 or atypical microacinar proliferation. The evidence suggests that cancers diagnosed with the third or fourth biopsy are those of low grade and volume (Djavan, 2001). The key question is how often is it justified to re-biopsy the patient that perhaps does not have a cancer that is life threatening. The diagnosis of a prostate cancer not clinically significant implies an overdiagnosis and over-treatment. However, there are no predictive factors, clinical or laboratorial that help to.
