The Pursuit of Prostate Cancer in Patients with a Rising Prostate-Specific Antigen and Multiple Negative Transrectal Ultrasound-Guided Prostate Biopsies

Abstract

To determine if patients with persistently elevated prostate-specific antigen (PSA) levels who have had transrectal ultrasound (TRUS)-guided prostate biopsies negative for carcinoma will benefit from additional saturation (≥ 14 cores) TRUS biopsies with or without transurethral (TUR) biopsies. A retrospective review of 35 men between ages 51–74 with PSA values between 4.5–46 ng/mL, normal digital rectal examinations, and ≥ 2 previously negative sextant TRUS biopsies. Seventeen patients had TUR biopsies in addition to saturation TRUS biopsies. Eighteen patients had saturation TRUS biopsies only (median 20 cores). Seven patients who had no cancer detected with the combined TRUS/TUR biopsies had an additional saturation biopsy performed (median 20 cores). Seven (20%) of the 35 patients who had a saturation biopsy had cancer detected, and one (5.9%) cancer was detected in the 17 men that had a TUR biopsy. Five (71.4%) of the seven patients who had an additional TRUS biopsy had cancer detected (total core range 45–60). The overall yield of prostate cancer was therefore 37.1%, with 1–9 cores positive (median 5 cores). For patients with a rising PSA and ≥ 2 negative sextant TRUS biopsies, the cancer yield of the initial saturation TRUS biopsies was 20%. Furthermore, a significant proportion of patients with negative initial saturation biopsies had cancer detected on repeat TRUS biopsy. The cancer yield of adding TUR biopsies in this same group of patients is < 6%.