Predictors of first repeat biopsy cancer detection with suspected local stage prostate cancer
ABSTRACT We determine demographic and tumor related predictors of repeat biopsy cancer detection in men with suspected stage T1c-2 prostate cancer.
The study population included 298 consecutive men with suspected stage T1c-2 prostate cancer who had a benign prostate biopsy at 1 institution between January 1, 1992 and April 1, 1999 and underwent 1 repeat biopsy. Mean age plus or minus standard deviation was 66.8+/-6.7 years for 133 black (55%) and 165 white (45%) patients. Clinical measures included determination of high grade prostatic intraepithelial neoplasia in benign biopsy specimens, Gleason score of malignant biopsy specimens, prostate specific antigen (PSA), PSA density, annualized interbiopsy PSA change, percent free PSA (201 cases) and PSA velocity (171).
Cancer was detected on repeat biopsy in 80 cases (27%). Significant differences between patients with benign and malignant repeat biopsies included age (p = 0.001), PSA density (p = 0.0001), percent free PSA (p = 0.0001) and PSA velocity (p = 0.009). High grade prostatic intraepithelial neoplasia in an initial benign biopsy was not predictive of cancer in repeat biopsy (p = 0.12). Multiple logistic regression analysis of all cases showed that age (p = 0.002) and PSA density (p = 0.0002) were independent predictors of cancer. Subset multiple logistic regression analysis modeled with age, PSA density and percent free PSA demonstrated that age (p = 0.002) and percent free PSA (p = 0.0001) were significant independent predictors of malignancy. Subset multiple logistic regression analysis modeled with age, PSA density, percent free PSA and PSA velocity revealed that age (p = 0.02) and percent free PSA (p = 0.0003) were significant independent predictors of cancer. There were no significant differences between the Gleason scores of cancers detected on repeat biopsy compared to 587 stage T1c-2 cancers detected on initial biopsy during the study period (p = 0.09). PSA, PSA density, percent free PSA and PSA velocity were not significantly different among men without a cancer diagnosis who had high grade neoplasia in 1 or 2 benign biopsies.
Greater than 25% of this population of select patients with suspected stage T1c-2 prostate cancer had malignancy detected on repeat biopsy. Percent free PSA was the most powerful predictor of cancer. High grade prostatic intraepithelial neoplasia was not a predictor of repeat biopsy cancer detection and PSA functions were similar among men without cancer who did and did not have high grade neoplasia in 1 or more benign biopsies. This finding suggests that high grade prostatic intraepithelial neoplasia may not be a reliable indicator of clinically significant existing prostate cancer.
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ABSTRACT: Objectives To determine what clinical, analytic and ultrasound parameters, are more effective to predict the result of a second biopsy in patient with high PSA and a first prostate biopsy negative.Material and methodsIt was carried out a longitudinal study in a series of 435 cases with negative prostate biopsy. In 59 of these cases it was practiced a second biopsy due to a permanent or sudden high PSA levels with or without a suspicious digital rectal examination. Of the 31 cases with a negative second biopsy, in 4 cases it was carried out a third biopsy. The biopsy was made in all the occasions by transrectal ultrasound guided sextant biopsy. It were also valued the ultrasound characteristic of the prostate, the prostate volume and the proportion of free PSA.ResultsIt was demonstrated statistically significant differences among the patients with a second biopsy negative and positive regarding: the age, proportion of free PSA, abnormal digital rectal examination and presence of hipoechogenic areas in the prostate. The multivariate analysis demonstrated that the only significant parameters were the proportion of free PSA and the existence of an abnormal digital rectal examination. Based on the data of multivariate analysis, we settled down for the patients with normal digital rectal examination a cut-off point of 0,23 of proportion of free PSA as indication for the realization of a second biopsy, and of 0,59 for the patients with abnormal digital rectal examination. This protocol applied to our series would avoid the realization of a second biopsy in 8 patients, and a third biopsy in 1 patient, diagnosing all the cases of prostate cancer.Conclusions The digital rectal examination associated with the proportion of free PSA constitutes a reliable parameter to indicate the realization of a second prostate biopsy in patient with high PSA and previous negative biopsy.Actas urologicas españolas 01/2002; 26(3):196–203. DOI:10.1016/S0210-4806(02)72757-5 · 1.15 Impact Factor
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ABSTRACT: Prostate cancer is nowadays the most common non-cutaneous cancer in men in the Western world. Since the introduction of Prostate Specific Antigen (PSA) testing in the last decade, prostate cancer incidence increased dramatically. In addition, the population is aging, and prostate cancer incidence increases with higher age. The dilemma of prostate cancer is that more men die with prostate cancer than from prostate cancer, as reflected by the observation that in 70% of men who are 80 years or older prostate cancer is diagnosed histologically on autopsy. As a consequence of this high incidence on autopsy, it may be anticipated that a large proportion of old men are diagnosed with prostate cancer when undergoing prostate biopsy and a great proportion of prostate cancers detected in screening programs may be over-diagnosed. It is as yet unclear whether PSA based screening reduces prostate cancer mortality. Due to screening with PSA most cancers are diagnosed in an early stage and therefore possibly in a curable stage. As a result, cancer is removed in an early stage, before the tumor is able to metastasize. It is conceivable that population-based early prostate cancer screening will reduce prostate cancer mortality. In order to investigate this further, randomized clinical trials have been introduced. In the USA the Prostate Lung Colorectal and Ovary cancer (PLCO) study investigates if prostate cancer screening is justified. In Europe the European Randomized Study of Screening for Prostate Cancer (ERSPC) is conducted in 8 European countries to study whether prostate cancer screening can reduce prostate cancer specific mortality at affordable costs and quality of life. The European screening centers differ with regard to the screening procedure but they share PSA testing and most other features (Table 1). At the Rotterdam section of the ERSPC the screening protocol comprises serum PSA testing followed – in case of an elevated serum PSA level- by six lateralized needle biopsies, three from each side of the prostate (systematic sextant biopsy) in men aged between 55 and 75 years. Every four years the same cohort of men is screenend. Men are excluded from screening in the 2nd round if a previous diagnosis of prostate cancer is made and those with interval carcinoma (i.e. cancers detected after the 1st round, but during the 4-year screening interval period. Unfortunately, the final outcome of the ERSPC will not be here until the end of 2008 or later. This thesis is restricted to an analysis of the data from first and second screening rounds at the Rotterdam section of the ERSPC. Awaiting the final outcome of the ERSPC, the investigations collected in this thesis are aimed to provide insight in 1) intermediate endpoints, concerning stage and grade of prostate cancer in subsequent screening rounds and the forthcoming therapy choices, 2) the efficiency of the screening protocol employed at the Rotterdam section of the ERSPC and 3) the natural biology of prostate cancer and its possible premalignant lesions.
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ABSTRACT: Prostate cancer is known for its heterogeneous histological appearance. It is currently not clear whether this histological heterogeneity is also reflected in the genomic composition of a tumor. The cancer DNA's were retrieved from the European Randomized Study of Screening for Prostate Cancer section Rotterdam (ERSPC). Tumors with volumes 1.0-1.5 ml and a Gleason score of 3+3 or 3+4 were selected. Comparative genomic hybridization with a 3500-element BAC array was used to detect differences in the genetic content of Gleason patterns 3 and 4. A total of 1155 gains and 583 losses were discriminated in 10 G3 areas; 768 gains and 497 losses were detected in 7 G4 regions. Frequent losses included chromosome arms 6q, 8p and 13q, while frequent gains were seen on 7q and 8q. There were no significant differences between Gleason patterns 3 and 4, or between Gleason grades within one cancer. Histological heterogeneity, defined by Gleason grades 3 and 4, does not have a genomic counterpart. Furthermore, these asymptomatic screen-detected prostate carcinomas have genetic signatures comparable with those commonly seen in symptomatic cancers.Anticancer research 26(2A):1193-200. · 1.87 Impact Factor