Elevated Prostate-specific Antigen Levels Research Articles

Vitamin D status: ready for guiding prostate cancer diagnosis and treatment?

Vitamin D deficiency is associated with increased risk of prostate cancer for those with elevated prostate-specific antigen (PSA) level or abnormal digital rectal examination. Vitamin D deficiency is also associated with aggressive prostate cancer. Vitamin D level could be added as an additional factor to consider before ordering a biopsy. Clin Cancer Res; 20(9); 2241-3. ©2014 AACR.

Fluctuation in prostate cancer gene 3 (PCA3) score in men undergoing first or repeat prostate biopsies

To evaluate the variability in prostate cancer gene 3 (PCA3) score over time in men with elevated serum prostate-specific antigen (PSA) levels who are undergoing first or repeat prostate biopsy. A total of 360 men from two Italian institutions who had undergone at least two PCA3 assessments were selected. Of these, 97.5% were scheduled for first or repeat prostate biopsy because of elevated PSA level and/or positive digital rectal examination (DRE). We compared the PCA3 scores in men with a negative biopsy (normal parenchyma, benign prostatic hyperplasia [BPH], chronic prostatitis, high-grade prostate intraepithelial neoplasia [HG-PIN]) with those in men with a positive biopsy. We evaluated PCA3 repeated measures biological variability and its possible association with basic patient characteristics (age, family history of prostate cancer, DRE, prostate volume, BPH, prostatitis and HG-PIN). Three different thresholds were used to evaluate the possible changes in risk class: the standard threshold (a PCA3 score of 35), a US Food and Drug Administation-approved PCA3 threshold of 25 and a threshold selected based on our previous research which was a PCA3 score of 50. The PCA3 scores varied significantly (P < 0.001) when comparing men with a negative biopsy with those with a positive biopsy (median [range] PCA3 score: 25 [2-276] vs 43 [7-331]). There was no significant difference in PCA3 scores in men with chronic prostatitis and HG-PIN compared with other men with negative biopsies. The median (range) time between the two PCA3 assessments was 16.2 (3-53.7) months. No association was found between PCA3 repeated measures modifications and age, family history of prostate cancer, DRE, BPH, prostatitis, HG-PIN and use of 5-α-reductase inhibitors. The variability of PCA3 scores on repeated measures confirmed the risk class for about 80% of patients; of the remaining 20% of patients, the risk class was upgraded in two thirds and downgraded in one third. PCA3 score can be considered a stable marker over time in most cases but there is a group of men among whom there is clinically notable risk class change. Further investigation is required to determine the genesis of this phenomenon.

Prostate Cancer Prognostic Factors Among Asian Patients Born in the US Compared to Those Born Abroad

US surveillance data indicate that incidence of prostate cancer differs by place of birth among Asian men. However, it is less clear if the prognostic factors for prostate cancer also differ by place of birth. The study included 7,824 Asian prostate cancer patients diagnosed between 2004 and 2009 and reported to the Surveillance Epidemiology and End Results (SEER) program. Logistic regression models were used to evaluate the relation of place of birth (foreign born vs. US born) to three outcomes: prostate specific antigen (PSA) level, Gleason score, and T classification, adjusting for age, marital status, Rural-Urban Continuum Code, and SEER registry. All outcome variables were binary using different cutoffs: ≥ 4, ≥ 10 and ≥ 20 ng/ml for PSA; ≥ 7 and ≥ 8 for Gleason score; and ≥ T2 and ≥ T3 for T classification. Elevated PSA was more common among foreign born Asian men regardless of the cut point used. In the analysis comparing foreign born versus US born patients by ethnic group, the association with PSA was most pronounced at cut point of ≥ 20 ng/ml for Chinese men (OR 1.68, 95% CI 1.02-2.75), and at cut point of ≥ 4 ng/ml for Japanese men (OR 2.73, 95% CI 1.20-6.21). A statistically significant association with Gleason score was only found for Japanese men and only for the cutoff ≥ 7 (OR 1.71, 95% CI 1.12-2.61). There was no difference in clinical T classification between foreign-born and US-born Asian men. Inclusion of cases with missing place of birth or restriction of data to those who underwent radical prostatectomy did not substantially change the results. The data suggest that foreign-born Asian prostate cancer patients may have moderately elevated PSA levels at diagnosis compared with their US born counterparts. For the other prognostic markers, the associations were less consistent and did not form a discernible pattern.

Association between obesity, prostate-specific antigen level and prostate-specific antigen density in men with a negative prostate biopsy.

To determine the association between body mass index (BMI), serum prostate-specific antigen (PSA) level and PSA density (PSAD) in patients with an elevated serum PSA level but a negative prostate biopsy. This retrospective study enrolled men with a negative prostate biopsy but a serum PSA level of 3.0-10 ng/ml. All men underwent anthropometric measurements, serum PSA determination and transrectal ultrasound examination. BMI was grouped according to the Asia-Pacific obesity criteria: nonobese (<25 kg/m(2)) versus obese (≥ 25 kg/m(2)). Partial correlation and linear regression models between PSA, PSAD and BMI were conducted after adjusting for age. A total of 907 men were enrolled in this study. On multivariate analyses, PSA showed no significant correlation with age or BMI, whereas PSAD had a negative correlation with age and BMI. Similar results were obtained when patients were categorized as having low (3.0 < PSA ≤ 6.5 ng/ml) or high PSA (6.5 < PSA ≤ 10.0 ng/ml) levels. PSAD, but not PSA, demonstrated a significant negative correlation with BMI. This indicates that a new strategy including PSAD rather than simple PSA levels should be adopted in the study of obesity-adjusted PSA cut-offs.

Transperineal Sector Prostate Biopsies: A Local Anesthetic Outpatient Technique

To describe our technique and determine the feasibility and tolerability of transperineal template prostate (TP) biopsies under local anesthesia (LA). Fifty consecutive patients underwent TP biopsies under LA for investigation of an elevated prostate-specific antigen level or risk stratification as part of our active surveillance protocol. Tolerability was evaluated with a visual analog scale assessing probe discomfort, LA infiltration, and the biopsy procurement. Patients were also asked if they would have the procedure again, and in those who had undergone previous transrectal biopsies, how the TP technique compared. Pathologic data, clinical outcomes, and complications were recorded at 2 weeks. Mean age was 62.8 years (standard deviation [SD], 6.34 years) and the mean prostate-specific antigen level was 8.49 ng/mL (SD, 6.36 ng/mL). Mean prostate volume was 48.2 mL (SD, 19.4 mL). Mean visual analog scale scores for discomfort caused by the ultrasound probe, LA injections, and biopsies were 3.08 (SD, 1.64), 3.29 (SD, 1.13), and 2.88 (SD, 1.28), respectively. Thirty-four of 50 men (68%) had positive histology, 26 men had Gleason score≤3+4, 5 men had Gleason score≥4+3, and 3 had recurrent adenocarcinoma after radiotherapy. There were 2 complications: 1 Clavien score 1 and 1 Clavien score 3a. LA TP biopsies are well tolerated, acceptable, and feasible when carried out within an outpatient setting.

The Value of Magnetic Resonance Imaging in the Detection of Prostate Cancer in Patients with Previous Negative Biopsies and Elevated Prostate-specific Antigen Levels: A Meta-analysis

To assess the diagnostic performance of magnetic resonance imaging (MRI) for targeting prostate cancer in patients with previous negative biopsies and elevated prostate-specific antigen (PSA) levels. Pubmed, Scopus, and Cochrane Library databases were searched to identify suitable studies published from January 2001 to October 2013. Polled estimation and subgroup analysis data were obtained using a random effect model. Summary receiver operating characteristic curves were used to summarize overall test performance. Fourteen studies involving 698 patients met the included criteria. The mean prostate cancer detection rate was 37.5%. Twelve studies had a pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of 88%, 69%, and 16.84 by patient analysis, respectively. In the subgroup analysis, magnetic resonance imaging spectroscopy (MRSI) provided higher pooled sensitivity (91%) and specificity (69%) compared with T2-weighted imaging (T2WI). MRSI combined with MRI had the highest pooled specificity (73%). By site analysis, the pooled sensitivity, specificity, and DOR in nine studies were 57%, 90%, and 14.34, respectively. In the subgroup analysis, MRSI combined with MRI showed higher pooled sensitivity (58%) and specificity (93%) compared with T2WI. Diffusion-weighted MRI (DWI) showed the highest pooled specificity: 95% but the lowest pooled sensitivity: 38%. A limited number of studies suggest that the value of MRI to target prostate cancer in patients with previous negative biopsies and elevated PSA levels appears significant. MRI combined with MRSI is particularly accurate. Further studies are necessary to confirm the eventual role of DWI in this field.

948 Comparison of targeted in-bore MRI–guided biopsy and conventional transrectal ultrasound (TRUS) – guided biopsy in biopsy-naïve patients with elevated prostate specific antigen (PSA) level

948 Comparison of targeted in-bore MRI–guided biopsy and conventional transrectal ultrasound (TRUS) – guided biopsy in biopsy-naïve patients with elevated prostate specific antigen (PSA) level

MP67-08 IDENTIFICATION OF PATIENTS WHO CAN AVOID REPEAT BIOPSY USING MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING

INTRODUCTION AND OBJECTIVES: The aim of our study is to determine if multiparametric magnetic resonance imaging (MRI) and/or clinical variables can discriminate between significant cancer and others (indolent or no cancers) before repeat biopsy and to identify men who can avoid repeat biopsy with low risk of missing significant cancer. METHODS: Between 2007 and 2010, 137 consecutive men who underwent repeat biopsy because of elevated or continuous high prostate-specific antigen (PSA) level after initial biopsy (n 1⁄4 88), atypical gland or prostatic intraductal neoplasia at previous biopsy (n 1⁄4 39), positive digital rectal findings (n 1⁄4 1), or patient desire (n 1⁄4 9) were prospectively evaluated. All men underwent 1.5T MRI, including T2-weighted, diffusion-weighted, and/or dynamic contrastenhanced imaging in the prebiopsy setting. Repeat biopsy protocol was 14to 28-core biopsy, including at least 4-core anterior samplings under transrectal ultrasound. Pathological specimens were evaluated according to the 2005 modified Gleason grading. Biopsy results were categorized into biopsy no cancer (BNC), biopsy indolent cancer (BIC), and biopsy significant cancer (BSC). We defined BIC as biopsy GS 3+4, clinical stage T1-T2a based on digital rectal findings (DRE), percent positive core 20%, and maximum cancer length < 5 mm. Cancer other than BIC was defined as BSC. Frequency of biopsy results according to MRI was evaluated. We also assessed clinical variables as predictors for BSC using logistic regression analysis in men with negative MRI. Clinical variables included age, PSA, free PSA, PSA at initial biopsy, rate of increase in PSA, DRE, prostate volume, number of days since initial biopsy, and pathology at previous biopsy. RESULTS: Median age and PSA were 66 years (range: 44e80) and 8.7 ng/ml (range: 1.1e58.6), respectively. The negative and positive MRI group included 84 and 53 men, respectively. The frequency of BNC/BIC/BSC was 76/19/5% in men with negative MRI and 36/19/45% in men with positive MRI. In men with negative MRI, multivariate analysis revealed that DRE was the only significant predictor of BSC. The frequency of BSC in men with negative MRI was 25% (2/8) in abnormal DRE and 3% (2/76) in normal DRE. CONCLUSIONS: Our results suggest that in repeat prostate biopsy setting, men with prebiopsy-negative MRI and normal DRE can avoid biopsy with a very low risk of missing significant cancer.

PP-262 Factors that Can Affect the Prostate Specific Antigen Levels in Patients with Cardiovascular Disease

In recent years, a growing interest has been directed towards the elevated prostate-specific antigen (PSA) levels in patients with cardiovascular conditions. However, there is conflicting data about the exact relationship between PSA level and cardiovascular disease. In this context, we investigated the factors that can affect the level of PSA in those with cardiovascular disease.

Evaluating the Use of Prostate-Specific Antigen as an Instrument for Early Detection of Prostate Cancer beyond Urologists: Results of a Representative Cross-Sectional Questionnaire Study of General Practitioners and Internal Specialists

Objectives: The aim of this cross-sectional study was to evaluate the value of prostate-specific antigen (PSA) testing as a tool for early detection of prostate cancer (PCa) applied by general practitioners (GPs) and internal specialists (ISs) as well as to assess criteria leading to the application of PSA-based early PCa detection. Methods: Between May and December 2012, a questionnaire containing 16 items was sent to 600 GPs and ISs in the federal state Brandenburg and in Berlin (Germany). The independent influence of several criteria on the decision of GPs and ISs to apply PSA-based early PCa detection was assessed by multivariate logistic regression analysis (MLRA). Results: 392 evaluable questionnaires were collected (return rate 65%). 81% of the physicians declared that they apply PSA testing for early PCa detection; of these, 58 and 15% would screen patients until the age of 80 and 90 years, respectively. In case of a pathological PSA level, 77% would immediately refer the patient to a urologist, while 13% would re-assess elevated PSA levels after 3-12 months. Based on MLRA, the following criteria were independently associated with a positive attitude towards PSA-based early PCa detection: specialisation (application of early detection more frequent for GPs and hospital-based ISs) (OR 3.12; p < 0.001), physicians who use exclusively GP or IS education (OR 3.95; p = 0.002), and physicians who recommend yearly PSA assessment after the age of 50 (OR 6.85; p < 0.001). Conclusions: GPs and ISs frequently apply PSA-based early PCa detection. In doing so, 13% would initiate specific referral to a urologist in case of pathological PSA values too late. Improvement of this situation could possibly result from specific educational activities for non-urological physicians active in fields of urological core capabilities, which should be guided by joint boards of the national associations of urology and general medicine.

Holmium Laser Enucleation of the Prostate and Perioperative Diagnosis of Prostate Cancer: An Outcomes Analysis

Our objective is to assess the outcomes of patients with prostate cancer (PCa) diagnoses undergoing holmium laser enucleation of the prostate (HoLEP). From 2009 to 2012, 450 patients underwent HoLEP at our institution. We performed a retrospective review of these patients to identify those with PCa. PCa was diagnosed in 57 (12.7%) HoLEP patients: 11 (19.2%) preoperatively, 43 (75.4%) in the operative specimen, and 3 (5.4%) during follow-up. Mean time to PCa development in the postoperative group was 16 months (9-23). There was no difference in patient characteristics for those diagnosed with PCa at the time of HoLEP or in the postoperative period. There were 5 patients with a Gleason score (GS)>8 and 52 with GS<8 PCa. In the operative group, 39 (91%) elected for active surveillance and 4 (9%) elected to have cancer treatment. In subgroup analysis, men diagnosed with GS>8 intraoperatively or postoperatively had significantly elevated preoperative, postoperative, and percent change prostate-specific antigen (PSA) levels when compared to patients diagnosed GS ≤ 7 (P=0.01, 0.02, and 0.01, respectively). There were no complications, all voided spontaneously, and one patient had persistent incontinence. HoLEP for the treatment of lower urinary tract symptoms (LUTS) in selectively chosen men with known PCa can safely improve urination. Furthermore, PCa is diagnosed at the time of or post HoLEP in nearly 12% of patients. Those patients with persistently elevated post HoLEP PSA levels or low percent change PSA levels should raise suspicion for high GS PCa. Finally, HoLEP does not preclude active surveillance or treatment for PCa when appropriate.

Prostate Cancer Contribution to Elevated PSA Levels : A Screening Study

Objective: To investigate the causes of elevated prostate specific antigen (PSA) levels in patients with lower urinary tract symptoms (LUTS) through transrectal ultrasound guided biopsy (TRUS biopsy), regardless of prostate volume. Methods: Retrospective study was conducted between January 2008 and December 2009 to find the cause of elevated PSA levels in sixty six (N=66) patients from the outpatient department in Guryyte General Hospital, Aljouf. Age of the patients was between 52 and 90 years and PSA level ranged between 5 ng/ml and 26 ng/ml. All patients were presented with some degree of lower urinary tract symptoms (LUTS) and high PSA levels for age. They underwent TRUS biopsies performed by a Radiologist and Urologist Results: Out of the total sixty six patients, twenty two (33%) of them with a PSA range between 5.1ng/ml and 26 ng/ml were found to have Benign Prostatic Hyperplasia (BPH) and Prostatitis. Eighteen patients (29.5%) with a PSA level between 9.3 ng/ml and 25.6 ng/ml were diagnosed as adenocarcinoma of the prostate. Sixteen patients with PSA between 12ng/ ml and 26 ng/ml were diagnosed as BPH. Ten patients with PSA between 9.3ng/ml and 16 ng/ml were found to have Prostatitis (15.15%). Conclusion: Benign prostate hyperplasia and chronic prostatitis are the two major causes of elevated serum PSA in our cohort followed by prostate cancer. With regards to the PSA level in chronic prostatitis and in prostate cancer, no significant difference was noted. The conclusion reached is that TRUS biopsy is mandatory to determine the exact cause of an elevated PSA level.

Integrin-free tetraspanin CD151 can inhibit tumor cell motility upon clustering and is a clinical indicator of prostate cancer progression.

Normal physiology relies on the organization of transmembrane proteins by molecular scaffolds, such as tetraspanins. Oncogenesis frequently involves changes in their organization or expression. The tetraspanin CD151 is thought to contribute to cancer progression through direct interaction with the laminin-binding integrins α3β1 and α6β1. However, this interaction cannot explain the ability of CD151 to control migration in the absence of these integrins or on non-laminin substrates. We demonstrate that CD151 can regulate tumor cell migration without direct integrin binding and that integrin-free CD151 (CD151(free)) correlates clinically with tumor progression and metastasis. Clustering CD151(free) through its integrin-binding domain promotes accumulation in areas of cell-cell contact, leading to enhanced adhesion and inhibition of tumor cell motility in vitro and in vivo. CD151(free) clustering is a strong regulator of motility even in the absence of α3 expression but requires PKCα, suggesting that CD151 can control migration independent of its integrin associations. The histologic detection of CD151(free) in prostate cancer correlates with poor patient outcome. When CD151(free) is present, patients are more likely to recur after radical prostatectomy and progression to metastatic disease is accelerated. Multivariable analysis identifies CD151(free) as an independent predictor of survival. Moreover, the detection of CD151(free) can stratify survival among patients with elevated prostate-specific antigen levels. Cumulatively, these studies demonstrate that a subpopulation of CD151 exists on the surface of tumor cells that can regulate migration independent of its integrin partner. The clinical correlation of CD151(free) with prostate cancer progression suggests that it may contribute to the disease and predict cancer progression.

Advanced carcinoma of the prostate presenting as a supraclavicular mass: Case report

Advanced carcinoma of the prostate presenting initially with supraclavicular lymphadenopathy is uncommon. These are 2 cases of advanced prostate cancer that presented initially with persistent painless left supraclavicular mass. Both patients had elevated prostate specific antigen (PSA) level. This as well as histological finding of metastatic adenocarcinoma following biopsy of the neck masses necessitated referral to the urologists. Urological review revealed enlarged hard nodular prostate and transrectal prostate biopsy findings in keeping with high grade adenocarcinoma in both cases. The patients had initial clinical and biochemical response to androgen deprivation therapy with resolution of neck masses within 4-8 weeks of treatment. The authors advocate that men presenting with persistent supraclavicular masses should have a digital rectal examination (DRE) and a PSA test as part of their initial assessment.

Dilemmas Over the Decision to Perform Repeat Prostate Biopsies

Regardless of age, patients with persistently elevated prostate-specific antigen (PSA) levels and/or a suspicious result on a digital rectal exam but with a previous history of a negative prostate biopsy result usually present a dilemma to urologists. Published reports have shown that the positive rate of repeat prostate biopsy in men suspected of having prostate cancer and at least 1 previous negative biopsy is around 10% to 35% [1,2]. Potential reasons for previous negative findings in men who have cancer detected in repeat biopsies include inadequacy of the initial biopsies (fewer cores taken) or the presence of precancerous lesions, such as atypical small acinar proliferation. As a result of concerns over missed cancer, urologists frequently resort to repeat biopsy. However, in reality, the aforementioned positive rates in repeat biopsies demonstrate that the results of most repeat biopsies will prove to be negative. In addition to causing significant anxiety, prostate biopsies can result in complications that can sometimes be severe. Some investigators have even reported that the rate of hospitalization for infection following prostate biopsies is on the rise [3]. Furthermore, in a Western series, it was shown that about 1 in 10 men refuse a repeat biopsy or require analgesia or sedation for the procedure [4]. Overall, it would be safe to say that the decision to recommend a repeat prostate biopsy is never an easy one for urologists to make. So how can urologists overcome such a dilemma? It may just be that we are digging a hole for us to be buried in by recommending PSA testing to the wrong group of men, specifically, younger men, in the first place. A recently published American Urological Association (AUA) guideline on prostate cancer detection recommends against PSA screening in men aged <40 years [5]. Also, despite causing some controversy, the same AUA guideline states that routine screening is not recommended in men aged 40 to 54 years and at average risk. Such statements may well have been made for the following reasons: a low prevalence of prostate cancer in younger men, absence of evidence for PSA screening in younger men, and risk of harm from biopsies and treatments. Accordingly, to avoid the dilemma of agonizing over the decision to perform repeat biopsy in younger men, we should be more judicious in recommending PSA testing initially. Although we should not actively discourage PSA testing in younger men on the whole (especially among those with a family history or other risk factors), a more careful approach in PSA screening would eventually prove beneficial in lessening the dilemma over repeat biopsies. Also, newly developed markers, such as PCA3, phi, and 4Kscore (although not yet available worldwide), will likely be helpful in decision-making for prostate biopsies. In addition, multiparametric magnetic resonance imaging has been frequently mentioned to increase the probability of a positive repeat biopsy. Applications of these tools would certainly be helpful in lessening urologists' burden over repeat biopsy decisions in the future. However, unless a breakthrough occurs in the detection of prostate cancer, which allows us to do away with PSA testing completely, we will never be 100% freed from the dilemma over repeat biopsies. Despite the current overall sentiment towards PSA testing, the fear of missed tumors will always linger.

The Xu′s chart for prostate biopsy: a visual presentation of the added value of biomarkers to prostate-specific antigen for estimating detection rates of prostate cancer

Elevated serum prostate-specific antigen (PSA) level is the primary indication for prostate biopsy for detection of prostate cancer (PCa) in the modern era. The detection rate of PCa from biopsy is typically below 30%, especially among patients with PSA levels at 4–10 ng ml−1. In the past several years, additional biomarkers, such as Prostate Health Index, PCA3 and genetic risk score (GRS) derived from multiple PCa risk-associated single nucleotide polymorphisms (SNPs) have been shown to provide added value to PSA in discriminating prostate biopsy outcomes. However, the adoption rate of these novel biomarkers in clinics is low, largely due to poor understanding of the added value of novel biomarkers. To address this matter, we developed a chart to visually present (i) expected detection rates of PCa from biopsy with respect to PSA levels, and more importantly, (ii) a range of PCa detection rates at the same PSA levels when novel biomarkers are considered. This chart, called the Xu's chart for prostate biopsy, is not a formal risk prediction model; rather, a simple visual tool for urologists to communicate with their patients an initial evaluation of PCa detection rate based on their PSA levels and a possible recommendation for additional biomarkers. A more comprehensive evaluation of PCa risk using existing risk assessment tools such as nomograms can be followed once additional biomarkers are measured. The current version of the chart is only a prototype and should be further developed to include the detection rate of aggressive PCa, and validated in larger studies.

Clinicopathologic differences between prostate cancers detected during initial and repeat transrectal ultrasound-guided biopsy in Korea.

PurposeThe aim of this study was to investigate clinicopathologic differences between prostate cancer (PCa) detected at initial and repeat transrectal ultrasound-guided prostate biopsy in a large Korean cohort.Materials and MethodsFrom 2000 through 2012, a total of 7,001 patients underwent transrectal ultrasound-guided prostate biopsy at 6 centers in Daegu and Gyeongbuk provinces. Of these 7,001 patients, the initial biopsy was positive for PCa in 2,118 patients. Repeat biopsy was performed in 374 of the 4,883 patients with an initial negative finding and a persistently elevated prostate-specific antigen (PSA) level, nodules or asymmetry by digital rectal examination (DRE), high-grade prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Numbers of biopsy cores varied from 6 to 12 according to center and biopsy date.ResultsCancer was diagnosed in 2,118 of the 7,001 patients (30.3%) at initial biopsy and in 86 of the 374 patients (23.0%) at repeat biopsy. The repeat biopsy rate was 5.3%. Mean PSA values were 68.7±289.5 ng/mL at initial biopsy and 18.0±55.4 ng/mL at repeat biopsy (p<0.001). The mean number of cancer-positive cores per biopsy was 5.5±3.5 for initial biopsy and 3.0±2.9 for repeat biopsy (p<0.001). Mean Gleason score was 7.5±1.4 at initial biopsy and 6.6±1.3 at repeat biopsy (p<0.001). For detected cancers, the low-stage rate was higher for repeat biopsy than for initial biopsy (p=0.001).ConclusionsCancers detected at repeat biopsy tend to have lower Gleason scores and stages than cancers detected at initial biopsy. The present study shows that repeat biopsy is needed in patients with a persistently high PSA or abnormal DRE findings.

3-T in-bore MR-guided prostate biopsy based on a scoring system for target lesions characterization

To estimate potential malignant lesions within the prostate gland, the usage of a scoring system has recently been proposed by a European consensus meeting. To prospectively investigate a scoring system for functional prostate magnetic resonance imaging (MRI) using in-bore MR-guided prostate biopsy at 3-T. Prostate MRI examinations of 59 patients (between February 2011 and May 2012) with no known prostate cancer, elevated prostate specific antigen (PSA) level, and unsuspicious digital rectal examination were included in the study. In each patient up to three lesions were defined and scored using a 5-point scoring system for each MR sequence (T2-weighted images, diffusion-weighted imaging, dynamic contrast-enhanced imaging). Following MRI-guided in-bore biopsy these lesions were correlated to the histopathological findings. A total number of 144 lesions were defined in 59 patients. In 28 patients (51 lesions) MR-guided in-bore biopsy was positive for tumor (Gleason grade 6 or higher). A cut-off limit of 10 or more points in summation of the individual scores of all three sequences was used, leading to a 90% sensitivity, 63% specificity, 58% positive predictive value, and 92% negative predictive value. A simple 5-point scoring system of functional prostate MRI achieves excellent sensitivity and moderate specificity for directing 3-T-guided prostate biopsy relative to the histopathological findings.

Adding Cyclooxygenase-2 inhibitor to alpha blocker for patients with benign prostate hyperplasia and elevated serum prostate specific antigen could not improve prostate biopsy detection rate but improve lower urinary tract symptoms

To investigate the impact of cyclooxygenase-2 (COX-2) inhibitor with α-adrenoceptor blocker (α-blocker) for men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) for detecting prostate cancer in men with elevated prostate specific antigen (PSA). Male patients with clinical BPH, elevated serum PSA (> 4ng/ml), and significant LUTS (International Prostate Symptom Score [IPSS]≥8) were randomly assigned to receive doxazosin 4mg daily plus celecoxib 200mg daily (study group) or doxazosin 4mg daily alone (control group) for 3months. Patients were investigated for the changes in IPSS, maximum flow rate (Qmax), voided volume, postvoid residual (PVR) volume and serum PSA from baseline to 3months after treatment. After the 3-month therapy, prostate biopsy was performed in the patients whose PSA were still higher than 4ng/ml. A total of 82 patients completed the study. The improvement in IPSS-voiding was significantly greater in the study group than control group (p=0.034). In the study group, patients with prostatic hyperplasia or inflammation on the prostate biopsy had a significantly better result than in patients with prostatic adenocarcinoma, typically in the changes of Qmax and voided volume (p=0.012 and p=0.005, respectively). The PSA level in the study group showed significant improvement after treatment (p<0.01). However, prostate cancer detection rate failed to show any significant difference between the patients whose PSA levels decreased or not (6/21=29% vs. 5/24=20%, respectively, p=0.447). Treatment with COX-2 inhibitor and α-blocker for 3months could not improve prostatic cancer detection rate. But it could increase therapeutic effectiveness of LUTS in men with BPH and elevated PSA levels. The changes in Qmax and voided volume after combination treatment were significantly greater in patients with prostatic hyperplasia or inflammation than adenocarcinoma.

The 6-item CAPRA-S score predicted cancer recurrence after radical prostatectomy

Source Citation Punnen S, Freedland SJ, Presti JC Jr, et al. Multi-institutional validation of the CAPRA-S score to predict disease recurrence and mortality after radical prostatectomy. Eur Urol. 2013;S0302-2838:00352-7. 23587869