The Management of the Patient with Elevated Prostate Specific Antigen and a Negative Initial Prostate Biopsy

Abstract

Background: The prostate cancer (PCa) is the second most common cancer amongst men. An elevated prostate specific antigen (PSA) level can lead to PCa suspition, thus the confirmation has to be a histopathological one. However, not all increased PSA level means prostate cancer. Material and Method: This retrospective study presents the results of 422 ultrasound guided prostate biopsy (PB) performed at the Clinic of Urology Târgu-Mureș, between 2011-2012. Inclusion criteria: patients with at least one negative PB and an elevated value of PSA. Results: In a two year period, from the total of 422 PB (100%), in 179 (42.42%) patients the histopathological result was "negative". In 154 (86%) of cases ultrasound guided biopsies were performed, mostly with an initial 6 core (98-54.74% of patients). Average PSA level was 13.45 ng/ml (0.49-100 ng/ml), the histological findings confirmed PCa in 52.58% cases, normal prostatic tissue in 141 cases (78.77%), atypical small acinar proliferation in 12 patients (6.70%), prostate atrophy in 11 males (6.14%), benign prostatic hyperplasia in 10 cases (5.59%) and prostatitis in 5 cases (2.80%). In 30 cases (16.75%) rebiopsy was performed with a number of 10-12 cores. Conclusions: In order to increase PCa detection we should perform more cores during PB. In "negative" histopathological cases PSA should be monitorised and the biopsy should be repeated after 6 to 8 weeks from the initial biopsy. Patient's compliance plays a vital role in the follow-up of the procedure. Introduction Despite the fact that prostate cancer is mostly a slow-growing cancer, still, thousands of men die of the disease each year and prostate cancer represents at the present moment the second most common cause of cancer death in males [1]. It is well-known that the incidence of prostate cancer increases with age and the highest rates are found in the seventh decade.The early and accurate detection of prostate cancer is critical for the appropriate management of the patients. In the detection of prostate cancer the first line of screening represents digital rectal examination and prostate specific antigen (PSA) determination [2][3][4][5][6][7]. Alone, the digital rectal examination has a low sensitivity and specificity in prostate cancer detection, having about 10% positive predictive value [1,4]. PSA is a kallikrein-like serine-protease, organ specific, produced almost exclusively by the epithelial cells of the prostate gland, it still remains the most used tumor marker for prostate cancer [2]. The standard PSA reference range in men's serum is 0,0-4,0 ng/ml [1]. The positive predictive value of digital rectal examination combined with determined serum PSA is about 30% in prostate cancer detection [1,2].Another useful diagnostic method in the prostate gland evaluation is the transrectal ultrasound of the prostate

Prognostic Value of Prostata Specific Antigen and Digital Rectal Examination at Prostate Biopsy

“…The golden standard in prostate cancer diagnosis is prostate biopsy with a variable number of prostate cores taken. 4 Findings such as abnormal digital rectal examination (DRE) and/or elevated serum prostate-specific antigen (PSA) level are the main indications for biopsy (5,6,7). Digital rectal examination is the oldest, non-invasive screening procedure for prostate cancer with a high specificity and a high negative predictive value.…”