Role of Prostate-Specific Antigen Change Ratio at Initial Biopsy as a Novel Decision-Making Marker for Repeat Prostate Biopsy

Abstract

PurposeProstate biopsy is used to confirm the prostate cancer. Although first biopsy result was benign, repeat biopsy is recommended for the patient who has higher risk of prostate cancer. In this study, we investigated the PSA change ratio (post-biopsy PSA to baseline PSA) whether it could be predictive factor of prostate cancer and helpful when decided to perform repeat biopsy.Materials and Methods151 patients, first diagnosed as benign, but underwent repeat biopsy due to clinical suspicion of prostate cancer were included. Post-biopsy PSA was checked 60 minutes later after biopsy. PSA change ratio was defined as post-biopsy PSA to baseline PSA. According to results of repeat biopsy, patients were divided into benign group (group A) and cancer groups (group B). Between two group baseline PSA, PSA density, post-biopsy PSA and PSA change ratio were compared, and most effective cut-off value was analyzed using receiver operating characteristic (ROC).Results129 men were benign, 22 men were prostate cancer according to results of repeat biopsy. Between two groups, post-biopsy PSA and PSA change ratio were statically significant differences. (p<0.001, <0.001) The effective cut-off value was 3.0, 3.5 and 4.0 according to ROC. At ROC curve, PSA change ratio was statistically significant for diagnosis of prostate cancer. (AUC 0.800, p<0.001).ConclusionsPSA change ratio is thought be a predictive factor for prostate cancer. If the PSA change ratio was less than 3.0-4.0, repeat biopsy should be considered to confirm the diagnosis.

A Clinicopathological Analysis of 120 Cases of Prostate Biopsies and Their Correlation with Prostate Specific Antigen levels

“…Benign prostatic tissue has been known to secrete PSA and their levels have been found to increase in non-malignant lesions of prostate such as BPH [3] . In the present study, the range of PSA observed in BPH was between 0.04-64.6ng/ mL and the mean PSA was 7.21 which is comparable with Lee et al [8] The probable reason for such a wide range in PSA could be due to the association with prostatitis which can raise PSA levels. Also, 19 cases (20.6%) had PSA levels >10ng/mL which is higher compared to the study done by Lakhey et al [9] where it was only 3 cases (3.28%).…”

What is the Prostate-Specific Antigen Cut-Off Value to Detect Clinically Significant Prostate Cancer According to Age in Turkey?

“…We determined a free/total PSA ratio threshold value of 18% for the 70-79 year age group. (12), and 0.80 by Lee et al (13). No previous studies have examined the ROC area under the curve based on age.…”

Is histological prostate inflammation in an initial prostate biopsy a predictor of prostate cancer on repeat biopsy?

“…Indications for repeat prostate biopsy include rising or persistent PSA levels, suspicious DRE results, atypical small acinar proliferation, and extensive high-grade prostatic intraepithelial neoplasia (i.e., in multiple biopsy sites) [13]. To reduce the number of unnecessary repeat prostate biopsy procedures performed, many prostate-related parameters utilizing PSA, such as PSAD, %fPSA, and PSAV, have been developed and can provide some information for the detection of prostate cancer, although not enough to be clinically definitive [14][15][16]. Despite the relatively high prevalence of prostate cancer, only family history, ethnicity, and age are universally recognized as risk factors, none of which is modifiable [17].…”