Editorial Comment

Abstract

The current study by Billis et al is intriguing, suggesting that there is a correlation between serum PSA levels and the extent of atrophy on needle biopsy, although not the type of atrophy. While this may be true, other confounding factors should be excluded. Atrophy is commonly associated with inflammation, which could lead to elevated serum PSA levels. The extent of inflammation on the biopsies in this study and whether the inflammation was acute or chronic should be correlated with serum PSA levels. Similarly, prostate size is also correlated with elevated serum PSA values, such that it too should be analyzed in the current study. The number of cores sampled could also be a confounding factor. Cases with fewer cores sampling the prostate could be associated with unsampled cancer and higher serum PSA levels. Ultimately, extent of atrophy, extent of inflammation, type of inflammation, size of prostate, and number of cores should be correlated with serum PSA levels in a multivariate analysis to determine the independent predictors of PSA levels. ReplyUrologyVol. 74Issue 5PreviewWe were particularly aware of the confounding factors associated to the correlation between serum PSA levels and the extent of atrophy on needle biopsy. For the present study, we selected from the previous cohort of patients only the cases with extended biopsies. The number of cores examined for each biopsy ranged from 7-18 (mean and median, 9.4 and 8 cores, respectively). We clearly informed in the discussion that extent of atrophy was associated with increasing age (P = .04) but not to increasing volume of the prostate (P = .25). Full-Text PDF Does the Type of Prostatic Atrophy Influence the Association of Extent of Atrophy in Needle Biopsies and Serum Prostate-specific Antigen Levels?UrologyVol. 74Issue 5PreviewTo consider the possibility that a positive and significant association between extent of atrophy and serum total or free prostate-specific antigen (PSA) elevation in patients with biopsies showing no cancer, high-grade prostatic intra-epithelial neoplasia or areas suspicious for cancer found in a previous study may be related to the type of atrophy. Full-Text PDF