Comparison in the follow-up of two patients with persistent elevated PSA and negative prostate biopsy

Abstract

Purpose To compare two clinical cases on the follow-up of patients with benign prostatic hyperplasia at risck of progression, negative prostate biopsy and persistent elevated PSA levels. Materials After a first negative prostate biopsy for elevated PSA levels, Case A received dutasteride therapy for benign prostatic hyperplasia, whereas Case B continued his therapy without dutasteride. In both cases, other diagnostic procedures or other biopsies were decided on the basis of PSA level modifications. Results Case A showed a stabilization of PSA levels with a new nadir; the patient did not undergo new biopsies or other diagnostic procedures till the presence (24 months of follow-up) of a PSA elevation despite dutasteride therapy. A new biopsy, then, showed a prostate adenocarcinoma. Case B showed persistent and progressive PSA elevation; the patient underwent other diagnostic procedures and 2 new negative biopsies. Only after 26 months of follow-up a further biopsy showed a prostate adenocarcinoma. Conclusions 5-alpha-reductase inhibitors can reduce the number of unnecessary prostate biopsies.