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: It is usual to identify patients with a negative prostate biopsy who are still at risk of prostate cancer. We try to analyse if the classical variables used in the prostate cancer screening are useful for those patients with a previous negative prostate biopsy, and if there is a possibility for making a nomogram witch would help us in the decision to repeat the biopsy. We studied 179 patients with at least 1 initial negative biopsy. At each biopsy session we recorded: Patient age, serum prostate specific antigen (PSA), free PSA/total PSA, PSA slope, digital rectal examination, prostate volume, PSA density, cancer suspicion in previous transrectal ultrasounds findings, number of negative cores previously obtained, history of precarcinomatous lesions and time between biopsies. Through Logistic regression analysis we determined the association of each variable a positive biopsy. A nomogram was constructed using all variables and discrimination was calculated as the concordance index. Overall 46% of patients had cancer at the repeated biopsy session. In the univariate analysis: Age, digital rectal examination, prostate volume, PSA density, cancer suspicion in ultrasounds findings, and precarcinomatous lesions were associated with repeat positive biopsy for cancer (all p <0.05). In the multivariate study, age, digital rectal examination, prostate volume and history of precarcinomatous lesions were associated with repeat positive biopsy. A nomogram was constructed that had a concordance index of 0.80.Actas urologicas españolas 04/2008; 32(3):281-7. · 1.14 Impact Factor
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ABSTRACT: Prostatic intraepithelial neoplasia (PIN) and atypical small acinar proliferation (ASAP) in the setting of prostatic needle biopsies are considered premalignant although questions still remain. In this paper, we have studied the clinical relevance of these histologic findings. We collected 138 subjects (108 PIN, 30 ASAP); in 67% we performed a second biopsy and the rate of cancer in this late biopsy were 19% and 27% respectively. We cannot identify any clinical factor to predict the finding of cancer in the re-biopsy (PSA, age, digital rectal examination, prostatic volume). In the follow-up, we observed higher rates of cancer for the ASAP; the finding of ASAP was the single clinical or histopathological factor that was an independent predictor of cancer. We observed that the finding of ASAP was an indication for re-biopsy because of the higher rates of cancer; on the contrary, the paper of PIN in the prostatic needle biopsy still requires further investigation.Actas urologicas españolas 01/2008; 32(7):680-5. · 1.14 Impact Factor
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ABSTRACT: To validate the performance of percentage of free prostate-specific antigen (%fPSA) in men undergoing extended scheme biopsy. The current cutoff values for %fPSA were chosen using data from sextant biopsies, which have been known to miss a significant number of prostate cancer cases. Additionally, we sought to validate the use of %fPSA in men with a total PSA < 4.0 ng/mL or > 10.0 ng/mL. We evaluated %fPSA performance in 1077 men who had undergone initial extended prostate biopsy. The men were categorized according to their PSA level into 2 groups (>4.0 and ≤4.0) ng/mL. The overall cancer detection rate was 42.1%. The mean PSA level was 7.6 ng/mL, and the mean %fPSA was 18.0%. The area under the curve for %fPSA was 0.59 (95% confidence interval 0.57-0.61) for all PSA levels, comparable to previous reports from sextant biopsy series. The performance of %fPSA in predicting prostate cancer on initial extended biopsy was improved with a PSA level of ≤4.0 ng/mL (area under the curve 0.66, 95% confidence interval 0.62-0.70) compared with a PSA level >4.0 ng/mL (area under the curve 0.57, 95% confidence interval 0.55-0.59; P < .001). A specificity of 85% was achieved for a %fPSA cutoff of 11% for the ≤4.0-ng/mL group and 10% for the >4.0-ng/mL group. The performance of %fPSA in predicting the presence of prostate cancer was not altered when an extended biopsy scheme was used. Although a %fPSA level greater than our cutoffs would not rule out prostate cancer, a low %fPSA would be particularly useful in predicting prostate cancer, especially in men with normal digital rectal examination findings and a PSA level <4 ng/mL.Urology 12/2010; 77(4):899-903. · 2.42 Impact Factor