2126 PROSTATIC INFLAMMATION IN FIRST BIOPSY SPECIMENS AND URINARY PYURIA ARE PREDICTORS FOR NEGATIVE REPEAT PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20112126 PROSTATIC INFLAMMATION IN FIRST BIOPSY SPECIMENS AND URINARY PYURIA ARE PREDICTORS FOR NEGATIVE REPEAT PROSTATE BIOPSY Kazutoshi Fujita, Masahiro Hosomi, Shigeaki Nakazawa, Yoshiyuki Yamamoto, Takuji Hayashi, Go Tanigawa, Ryoichi Imamura, Hiroaki Fushimi, and Seiji Yamaguchi Kazutoshi FujitaKazutoshi Fujita Osaka, Japan More articles by this author , Masahiro HosomiMasahiro Hosomi Osaka, Japan More articles by this author , Shigeaki NakazawaShigeaki Nakazawa Osaka, Japan More articles by this author , Yoshiyuki YamamotoYoshiyuki Yamamoto Osaka, Japan More articles by this author , Takuji HayashiTakuji Hayashi Osaka, Japan More articles by this author , Go TanigawaGo Tanigawa Osaka, Japan More articles by this author , Ryoichi ImamuraRyoichi Imamura Osaka, Japan More articles by this author , Hiroaki FushimiHiroaki Fushimi Osaka, Japan More articles by this author , and Seiji YamaguchiSeiji Yamaguchi Osaka, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2323AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Asymptomatic prostatic inflammation may cause PSA elevation and lead to unnecessary repeat prostate biopsies. We determine whether histological findings of inflammation in first biopsy specimens or clinical parameters of inflammation could predict the outcome of repeat biopsy in men with negative first biopsy. METHODS Repeat biopsy of the prostate was carried out in 105 men who were diagnosed as having no malignancy at first biopsy. Of these, 45 (42.8%) were positive for prostate cancer at repeat biopsy. We evaluated histological inflammation by mononuclear (MN) and polymorphonuclear leukocytes (PMN) in the first needle biopsy specimens, serum white blood cell count (S-WBC), serum C-reactive protein, and urinary white blood cell count (U-WBC) to study associations with outcome of the repeat biopsy. RESULTS PMN infiltrates, U-WBC, age, PSA at repeat biopsy, prostate volume, PSAV and PSAD were associated with repeat biopsy outcome (p < 0.05). Multivariate analysis showed that age, PSAD and U-WBC were independent predictors. The area under the receiver-operator characteristics curve (AUC) for the predicted probability of cancer detection by the optimum logistic model was 0.82 (95% CI 0.74 – 0.90), in contrast to the AUC for PSA of 0.72 (95% CI 0.62 – 0.81) and PSAD of 0.75 (95% CI 0.65 – 0.85) for cancer detection in all patient cohort (fig A). In subgroup analysis of 63 men with PSA < 10ng/ml at first biopsy, PMN and MN inflammation, age, PSA at repeat biopsy, PSA volume, PSAV, and PSAD were associated with the outcome of the repeat biopsy (p < 0.05). Multivariate analysis showed that PMN infiltrates, PSAD, and age were independent predictors. AUC for the predicted probability of cancer detection by the optimum logistic model was 0.89 (95% CI 0.81 – 0.97), in contrast to the AUC for PSA at repeat biopsy of 0.69 (95% CI 0.56 – 0.82) and PSAD of 0.73 (95% CI 0.59 – 0.87) for cancer detection in this cohort (fig B). CONCLUSIONS PMN inflammation in first biopsy specimens and/or urinary pyuria are possible indicators of benign PSA elevation and may help avoid unnecessary repeat biopsies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e851 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazutoshi Fujita Osaka, Japan More articles by this author Masahiro Hosomi Osaka, Japan More articles by this author Shigeaki Nakazawa Osaka, Japan More articles by this author Yoshiyuki Yamamoto Osaka, Japan More articles by this author Takuji Hayashi Osaka, Japan More articles by this author Go Tanigawa Osaka, Japan More articles by this author Ryoichi Imamura Osaka, Japan More articles by this author Hiroaki Fushimi Osaka, Japan More articles by this author Seiji Yamaguchi Osaka, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...