<p><strong>After a negative initial biopsy in patients with low probability for harboring GG2+ prostate cancer, clinicians should not reflexively perform biomarker testing. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>The goal of early detection is to identify patients at high risk for harboring GG2+ prostate cancer. While biomarkers may improve the capacity to identify patients at risk for high-grade disease, these tests generally provide the probability of disease or high-grade disease as discussed previously (<strong>see Statement 17</strong>). In patients with a negative biopsy, with low probability for GG2+ disease, it is unlikely that additional biomarker tests will be informative. For example, a low PSA density (≤ 0.10 ng/mL<sup>2</sup>) at the time of initial prostate biopsy is associated with a low likelihood of harboring GG2+, including in the setting of negative or equivocal mpMRI.<sup>251, 252</sup> It is unlikely a biomarker test will provide any additional clinically actionable information in this scenario. Thus, clinicians should not implement reflex biomarker testing without prior consideration to the utility of the test or how the information gathered will impact the decision to undergo repeat biopsy.</p>