Positive Rate Of Prostate Biopsy Research Articles

The learning curve and experience of a novel multi-modal image fusion targeted transperineal prostate biopsy technique using electromagnetic needle tracking under local anesthesia.

Prostate cancer is the most common malignant tumor of male genitourinary system, and the gold standard for its diagnosis is prostate biopsy. Focusing on the methods and skills of prostate biopsy, we explored the learning curve and experience of a novel magnetic resonance imaging and transrectal ultrasound (mpMRI-TRUS) image fusion transperineal biopsy (TPB) technique using electromagnetic needle tracking under local anesthesia. The clinical and pathological data of 92 patients who underwent targeted TPB from January 2023 to July 2023 in our center were prospectively collected. The cumulative sum (CUSUM) analysis method and the best fitting curve were used to analyze the learning curve of this novel technique, and the clinical characteristics, perioperative data and tumor positive rate of prostate biopsy of patients at different stages of the learning curve were compared. With the increase of the number of surgical cases, the overall operative time showed a downward trend. The best fitting curve of CUSUM reached its peak at the twelfth case, which is the minimum cumulative number of surgical cases needed to cross the learning curve of the operation. Taking this as the boundary, the learning curve is divided into two stages: learning improvement stage (group A, 12 cases) and proficiency stage (group B, 80 cases). The surgical time and visual analog scale score during prostate biopsy in group A were significantly higher than those in group B. The visual numerical scale score during prostate biopsy in group A was significantly lower than that in group B. There was no statistically significant difference between group A and group B in the detection rate of csPCa and the incidence of perioperative complications. The novel targeted TPB technique is divided into learning improvement stage and proficiency stage, and 12 cases may be the least cumulative number.

Application value of multi-parameter magnetic resonance image-transrectal ultrasound cognitive fusion in prostate biopsy.

To investigate the effect of three-dimensional (3D) reconstruction-assisted cognitive fusion in targeted prostate biopsy. There was no significant difference in the detection rate of prostate cancer (PCa) between targeted biopsy and systematic biopsy, and there was significant difference in the detection rate of clinically significant prostate cancer (csPCa) between targeted biopsy and systematic biopsy. In the low prostate total specific antigen (tPSA) group, there was no statistically significant difference in the detection rate of prostate cancer between the two biopsy modalities. However, compared with systematic puncture, targeted puncture had a higher detection rate for csPCa and a lower detection rate for clinically insignificant prostate cancer (ciPCa), and the difference was statistically significant. In the high tPSA group, there was no significant difference in the detection rate of PCa, csPCa, and ciPCa between the two biopsy types. Single needle positive rate of targeted puncture (29.77%) was significantly higher than that of systematic puncture (10.28%). The detection rate of csPCa in 3D reconstruction-assisted cognitive fusion targeted prostate biopsy is better than that of 12-needle systematic biopsy, which markedly improved the positive rate of prostate biopsy.

Application of single-point prostate biopsy in elderly patients with highly suspected prostate cancer.

ObjectiveTo explore the feasibility of single-point prostate biopsy in elderly patients with highly suspected prostate cancer.MethodsForty-three patients with a prostate imaging reporting and data system score (PI-RADS) of 5, age ≥ 80 years and/or PSA ≥ 100 ng/ml and/or Eastern Cooperative Oncology Group score ≥ 2 were enrolled in our hospital from March 2020 to June 2022. Targeted surgery of these patients was performed using only precise local anesthesia in the biopsy area. The biopsy tissues were examined by intraoperative frozen section examination (IFSE). If the result of IFSE was negative, traditional systematic biopsy and further routine pathological examination were performed. The positive rate of biopsy, operation time, complications and pain score were recorded.ResultsThe positive rate of prostate biopsy was 94.7%. The results of IFSE in two patients were negative, and the routine pathological results of further systematic biopsy of those patients were also negative. The visual analog scale and visual numeric scale were 2 (2-4) and 3 (2-3), respectively, during the biopsy procedure. The mean time of operation was 8.5 ± 2.1 min from the beginning of anesthesia to the end of biopsy. It took 35.3 ± 18.7 minutes to obtain the pathological report of IFSE. The incidences of complication hematuria and urinary retention were 10.5% and 2.6%, respectively.ConclusionFor elderly patients with highly suspected prostate cancer, single-point prostate biopsy can be used to quickly and safely obtain pathological results.

Establishing a novel prediction model for improving the positive rate of prostate biopsy.

BackgroundAt present, prostate-specific antigen (PSA) is the primary evaluation index for judging the necessity of prostate cancer (PCa) biopsy. However, there is a high false-positive rate and a low predictive value due to many interference factors. In this study, we tried to find a novel prediction model that could improve the positive rate of prostate biopsy and reduce unnecessary biopsy.MethodsWe retrospectively studied 237 patients, including their age, body mass index (BMI), PSA, prostate volume (PV), prostate imaging-reporting and data system (PI-RADS) v2 score, neutrophil-lymphocyte ratio (NLR), biopsy Gleason score (BGS), and other information. The univariate and multivariate logistic analyses were used to screen out indicators related to PCa. After establishing a prediction formula model, we used receiver operating characteristic (ROC) curves to assess its prediction performance.ResultsOur study found that age, PSA, PI-RADS v2 score, and diabetes significantly correlated with PCa. Based on multivariate logistic regression analysis results, we created the following prediction formula: Y = 2.599 × PI-RADS v2 score + 1.766 × diabetes + 0.052 × age + 1.005 × PSAD – 9.119. ROC curves showed the formula’s threshold was 0.3543. The composite formula had an excellent capacity to detect PCa with the area under the curve (AUC) of 0.91. In addition, the composite formula also achieved significantly better sensitivity, specificity, and diagnostic accuracy than PSA, PSA density (PSAD), and PI-RADS v2 score alone.ConclusionsOur predictive formula predicted performance better than PSA, PSAD, and PI-RADS v2 score. It can thus contribute to the diagnosis of PCa and be used as an indicator for prostate biopsy, thereby reducing unnecessary biopsy.

Research on the correlation between prostate volume and the detection of prostate cancer in prostate biopsy

Objective To investigate interactions between prostate volume (PV) and the detection of prostate cancer in prostate biopsy. Methods We performed a review of a cohort of 145 biopsy patients, because of increased prostate-specific antigen (PSA) serum levels (≥10 ng/mL, or 4 ng/mL≤tPSA<10 ng/mL and f/t≤0.16), and suspicious findings on digital rectal examination , or/and suspected MRI signals on prostate in the years between Jan 2014 and July 2017. Clinic data was summarized including ages, tPSA, PV and PSAD. Results The cancer positive rates of prostate biopsy were 53%, 33% and 17% in PV groups of <25 mL (Ⅰdegree), 25~55 mL (Ⅱ degree)and ≥55 mL (Ⅲ degree), which showed statistic different (χ2= 9.1653, P= 0.010) by chi-square test. There was a trend that positive rates of prostate biopsy were decreased with increasing prostate volume proven by Cochran-Armitage test (Z=2.9948, P=0.003). Multipule logistic analysis that PV was an independent risk factor for prostate cancer in prostate biopsy that Odds ratios were 6.268(95%CI, 1.802-21.805, P=0.004)and 2.444(95%CI: 0.962-6.205, P=0.060)on Ⅰ/Ⅲ and Ⅱ/Ⅲ degree prostate. Conclusions The positive rate of prostate biopsy is elevated with smaller prostate volume which is a disk factor for prostate cancer in patients with tPSA<100 ng/mL. Key words: Prostatic Neoplasms; Punctures; Risk Factors

Application of transperineal prostate projection supersaturated needle in prostate biopsy

Objective To explore diagnostic value of transperineal prostate projection supersaturated needle (TPPSN) after initial negative biopsy result and to assess the efficacy and safety. Methods A total of 218 patients were enrolled in this study. These patients were diagnosed with benign prostatic hyperplasia by transperineal template biopsy but were suspected to have prostate cancer through the abnormal prostate specific antigen(PSA) and digital rectal examination (DRE). All patients were divided into the observation group (TPPSN) and the control group (traditional transperineal template saturated biopsies) according to different way of puncture. According to the prostate volume different interval ( 80 mL), the positive rates of two groups were contrasted. The incidence of postoperative complications such as gross hematuria, fever, retention of urine and perineum discomfort of two groups were compared. Results The total cancer detection rate of the observation group was higher than that of the control group (P=0.044), the improvement of cancer detection rate was higher only when the prostate volume was greater than 80 mL (P=0.041). Compared to the control group, the incidence of complication such as gross hematuria, fever, retention of urine and perineum discomfort by TPPSN was low, but there was no significant difference (P>0.05 ). Conclusions For the patients who are initial negative biopsy but highly suspected with prostate cancer, the TPPSN can improve the positive rate of prostate biopsy. It can more accurate positioning the prostate cancer and is a safe and effective diagnostic method for prostate cancer. TPPSN can be a safe and reliable way to prostate biopsy. Key words: Prostate; Biopsy, Needle; Perineum

Prostate biopsy results and clinicopathological characteristics of the 55 years or younger patients

Objective: To explore the clinical features, biopsy results and risk factors of patients underwent prostate biopsy with age≤55, and to help make the proper treatment strategies of this cohort of patients. Methods: The data of patients with age≤55 underwent prostate biopsy between Jan 2011 and Nov 2013 was retrospectively reviewed. Clinical factors including prostate-specific antigen, digital rectal examination, ultrasonography and magnetic resonance imaging were recorded. Biopsy positive results were defined as the presence of prostate cancer and high-grade prostate cancer (Gleason score≥7). Results: There were all together 82 patients in this cohort, with the median age of 51 years old and median prostate-specific antigen of 8.62 μg/L. Among them 71 patients (86.6%) underwent pre-biopsy magnetic resonance imaging test, with 25 positive (35.2%), 18 suspicious (25.4%) and 28 negative results (39.4%). Pathology confirmed prostate cancer in 26 patients (31.7%), including 23 (28.0%) high-grade prostate cancer. Higher prostate-specific antigen, positive ultrasonography and positive magnetic resonance imaging were risk factors for prostate cancer and high-grade prostate cancer. For patients with prostate-specific antigen between 4 and 10 μg/L, 15.0% were diagnosed with prostate cancer, and positive ultrasound and magnetic resonance imaging were predictive for biopsy results. Conclusions: The positive rate of prostate biopsy in men younger than 55 years old is 31.7%, and the risk for prostate cancer of this cohort of patients shouldn't be neglected. Prostate-specific antigen value, ultrasonography and magnetic resonance imaging could help predict biopsy results.

The davantages of transrectal ultrasound-guided 12+ X-core biopsy in the diagnosis of prostate cancer

Objective To summarize the experience in transrectal ultrasound-guided 12+ X-core biopsy and analyze the influencing factors of the biopsy results. Methods Totally, 622 consecutive patients who had a transrectal ultrasonography (TRUS)-guided 12+ X-core biopsy were retrospectively analyzed in the study from Jan. 2010 to Mar. 2016 .The age ranged from 46 to 88 years[mean(68.1±6.8)years], age≤60y (116), age 61-70y (251), age 71-80y (230), age>80y (25). Prostate specific antigen (PSA) ranged from 0.35 to 264ng/ml[mean (28.15±31.42)ng/ml], PSA<4ng/ml(26), 4-9ng/ml(182), 10-19ng/ml(194), 20-39ng/ml(93), 40-59ng/ml( 34), 60-79ng/ml(32), 80-99ng/ml(66), ≥100 ng/ml(5). Every core positive rate, lateral zone and contralateral zone positive rate were analyzed. The biopsy positive rates were also analyzed, adjusted to the age and PSA. The complications were analyzed. The Logistic regression analysis were used for data analysis a. Results Among the 622 patients who underwent 12+ X core prostate biopsy, the pathological result included BPH(314), PIN(31), doubtful-PCa(26) and PCa(231). The positive biopsy rate was 37.1%(231/622). The contralateral zone and lateral zone positive rate was 21.6%(807/3 735)and 21.3%(796/3 736)(P>0.05), respectively. The positive rate of 1-12 core was (21.6±1.6)%(P>0.05)and the positive rate of X core was 34.8%(P 80y (64.0%)(P 38℃), and the complication rate were 13.7%, 5.2%, 4.2%, 9.2%, respectively. Conclusions The age and serum PSA were both related to the positive rate of prostate biopsy and could be used as a prediction to guide the prostate biopsy. The combination of sextant and lateral peripheral zone biopsies (12+ X biopsy scheme) could have an advantage over 6 systematic biopsy and saturate biopsy scheme. Key words: Transrectal ultrasound; Prostate biopsy; Prostate cancer

Clinical significance of serum high sensitive C-reactive protein in patients undergone prostate biopsy

Objective To assess the clinical significance of serum high sensitive C-reactive protein (hs-CRP) in patients undergone prostate biopsy.Methods A total of 273 consecutive patients were enrolled,aged 44-95 years (mean,69 years).All the patients underwent prostate biopsy.The pathological findings showed 96 cases with prostate cancer (PCa) and 177 cases with benign prostate hyperplasia (BPH).The difference of hs-CRP level between patients with PCa and those with BPH was analyzed.The positive prostate biopsy rate was compared between the patients with high hs-CRP level and those with normal hs-CRP level.Logistic regression was used to evaluate the effect of factors such as hs-CRP,tPSA,PSA density,prostate volume and age on prostate biopsy.Results The medians (interquartile range) of hs-CRP were 3.22 mg/L (1.22-9.84 mg/L) in patients with PCa and 1.24 mg/L (0.55-2.76 mg/L) in those with BPH,respectively,with significant difference(P＜0.05).The positive prostate biopsy rate in patients with high hs-CRP (＞ 3 mg/L)was 55％ (51/92),higher than that in those with normal hs-CRP (≤ 3 mg/L).The odds ratio of hs-CRP was larger than that of all other factors analyzed including tPSA,prostate volume and age according to the Logistic regression analysis.Conclusions Elevated serum hs-CRP level is associated with increased positive prostate biopsy.Serum hs-CRP acts as an independent factor increasing the positive prostate biopsy rate in patients undergone prostate biopsy. Key words: High sensitive C-reactive protein; Prostatic neoplasms; Prostatic hyperplasia; Prostate biopsy

Use of PSA in prostate cancer screening in male physical examination population over 50 years in Beijing

Objective To study the role of using PSA in prostate cancer screening in the male physical examination population over 50yrs in Beijing.Methods From January 2010 to December 2010,in Physical Examination Center of Beijing Hospital and Beijing MeiZhao Health Screening Center,men over 50years with PSA records in the past three years (from 2007 to 2009) were selected.The exclusion criteria included history of prostate cancer,severe diseases of the heart,brain,lung,liver and kidney,and mental or neurological disorders.People who couldn't cooperate with the investigation due to any reasons were excluded as well.The number of recruited cases was 2862.Among the cases,males with PSA over 4 μμg/L received prostate biopsy after singing the informed consent form.The average age was 67.2 ± 9.3 years.Results In the 2862 males,2621 cases (91.5％) had normal PSA levels and 241 cases (8.5％) had abnormal PSA levels.With the age increasing from 50 to 89 years,the proportion of abnormal PSA levels increased significantly from 2.7％ to 10.9％,P ＜ O.001.86 patients (33.2％) received prostate biopsy in the group of abnormal PSA levels; The positive prostate biopsy rate was 41.4％ (39/86).In PSA ＜4 μg/Lgroup,the positive rate was 25.0％ ; in 4 μg/L≤PSA ＜ 10 μg/L group,the positive rate was 29.8％ ; in PSA ≥ 10 μg/L group,the positive rate was 68.9％,P ＜ 0.001.With the PSA level increasing,the proportion of the localized cancer decreased from 100％ to 70％,and the ratio of locally advanced and distant metastatic tumor increased from 0 to 30％ ; the proportion of Gleason≤6 fell from 100％ to 30％,the proportion of Gleason ≥ 8 increased from 0 to 50％.The differences above did not show statistical significance.Conclusions Use of PSA in prostate cancer screening for men over 50 years could increase the detection rate of prostate cancer. Key words: Physical examination population; PSA; Screening

Utilization and cancer detection by U.S. prostate biopsies (2005-2011).

e16076 Background: To assess the positive biopsy rate and core sampling pattern in patients undergoing prostate biopsy in the US at a national reference laboratory and pathology laboratories integrated into urology group practices and analyze the relationship between positive biopsy rates and number of specimen vials per biopsy (v/b). Methods: For the years 2005-11, we collected pathology data from a national reference laboratory (NRL) including number of urologists and urology practices referring samples, total specimen vials submitted per prostate biopsy, and final diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia or atypical small acinar proliferation. Over the same period, similar data was gathered from urology practices with in-house laboratories performing global pathology services (urology practice labs, UPL) identified by a member survey of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials/biopsy were calculated in aggregate and separately for each site of service. Results: From 2005-11, 437,937 biopsies were submitted in 4,230,129 vials (9.4 v/b); overall positive biopsy rate was 40.3%, identical at both the NRL and UPL (p=0.97). Nationally, the number of specimen vials/biopsy increased sharply from a mean of 8.8 during 2005-8 to 10.3 from 2009-11 (difference 1.5 v/b, p=0.03). For the most recent 3 year period (2009-11), there was no significant difference between the NRL (10.0 v/b) and UPL (10.6 v/b) (p=0.08). Positive biopsy rate correlated strongly (p&lt;0.01) with number of specimen vials/biopsy. Conclusions: The positive prostate biopsy rate of 40.3% is identical across sites of service. Although there was a national trend towards increased specimen vials/biopsy from 2005-11, from 2009-11 there was no significant difference in specimen vials/biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10-12 unique specimen vials has been adopted by urologists across sites of service and can be considered the de facto national standard of care.

Utilization and cancer detection by U.S. prostate biopsies (2005-2011).

107 Background: To assess the positive biopsy rate and core sampling pattern in patients undergoing prostate biopsy in the US at a national reference laboratory and pathology laboratories integrated into urology group practices and analyze the relationship between positive biopsy rates and number of specimen vials per biopsy (sv/b). Methods: For the years 2005-11, we collected pathology data from a national reference laboratory (NRL) including number of urologists and urology practices referring samples, total specimen vials submitted per prostate biopsy, and final diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia or atypical small acinar proliferation. Over the same period, similar data was gathered from urology practices with in-house laboratories performing global pathology services (urology practice labs, UPL) identified by a member survey of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials/biopsy were calculated in aggregate and separately for each site of service. Results: From 2005-11, 437,937 biopsies were submitted in 4,230,129 vials (9.4 sv/b); overall positive biopsy rate was 40.3%, identical at both the NRL and UPL (p=0.97). Nationally, the number of specimen vials/biopsy increased sharply from a mean of 8.8 during 2005-8 to 10.3 from 2009-11 (difference 1.5 sv/b, p=0.03). For the most recent 3 year period (2009-11), there was no significant difference between the NRL (10.0 sv/b) and UPL (10.6 sv/b) (p=0.08). Positive biopsy rate correlated strongly (p&lt;0.01) with number of specimen vials/biopsy. Conclusions: The positive prostate biopsy rate of 40.3% is identical across sites of service. Although there was a national trend towards increased specimen vials/biopsy from 2005-11, from 2009-11 there was no significant difference in specimen vials/biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10-12 unique specimen vials has been adopted by urologists across sites of service and can be considered the de facto national standard of care.

Outcomes and Trends of Prostate Biopsy for Prostate Cancer in Chinese Men from 2003 to 2011

BackgroundProstate-specific antigen (PSA) screening is growing in popularity in China, but its impact on biopsy characteristics and outcomes are poorly understood.ObjectiveOur objective was to characterize prostate biopsy outcomes and trends in Chinese men over a 10-year period, since the increasing use of PSA tests.MethodsAll men (n = 1,650) who underwent prostate biopsy for PCa at Huashan Hospital, Shanghai, China from 2003–2011 were evaluated. Demographic and clinical information was collected for each patient, including age, digital rectal examination (DRE), transrectal ultrasound (prostate volume and nodule), total prostate-specific antigen (tPSA) levels and free PSA ratio (fPSA/tPSA) prior to biopsy. Prostate biopsy was performed using six cores before October 2007 or ten cores thereafter. Logistic regression and multivariate analysis were used to evaluate our data.ResultsThe overall positive rate of prostate biopsy for PCa was 47% and the rate decreased significantly over the years from 74% in 2003 to 33% in 2011 (P-trend = 0.004) . Age at diagnosis was slightly increased (P-trend = 0.04) while fPSA/tPSA was significantly decreased (P-trend = 1.11×10-5). A statistically significant trend was not observed for tPSA levels, prostate volume, or proportion of positive nodule. The model including multiple demographic and clinical variables (i.e., age, DRE, tPSA, fPSA/tPSA and transrectal ultrasound results) (AUC = 0.93) statistically outperformed models that included only PSA (AUC = 0.85) or fPSA/tPSA (AUC = 0.66) to predict PCa risks (P<0.05). Similar results were observed in a subgroup of men whose tPSA levels were lower than 20 ng/mL (AUC = 0.87, vs. AUC of tPSA = 0.62, P<0.05).ConclusionsDetection rates of PCa and high-grade PCa among men that underwent prostate biopsy at the institution has decreased significantly in the past 10 years, likely due to increasing use of PSA tests. Predictive performance of demographic and clinical variables of PCa was excellent. These variables should be used in clinics to determine the need for prostate biopsy.

Negative influence of changing biopsy practice patterns on the predictive value of prostate-specific antigen for cancer detection on prostate biopsy

A correlation between prostate specific antigen (PSA) level and positive prostate biopsy rate was established in an era when biopsy practice patterns were different from what they are today. We evaluated if changes in biopsy practice patterns have affected the ability of PSA to predict cancer detection on prostate biopsy in the current era. Of 3634 prostate biopsies performed from 1993-2005, 1607 met criteria for analysis. Biopsy data were divided into 3 time-cohorts (1993-1997, 1998-2001, and 2002-2005) to assess for practice patterns shifts and correlation between PSA and biopsy results. Significant changes in biopsy practice patterns included an increase in biopsy cores and more frequent use of PSA 2.5-3.99 ng/mL as a biopsy indication. In men with normal DRE, a moderate correlation between PSA and positive biopsy rate did exist from 1993-1997, but was subsequently lost. On multivariate analysis, PSA was not a significant predictor of biopsy result in men with normal DRE. Early in the PSA era, the predictive power of PSA depended on multiple factors: high prevalence of disease, higher prevalence of high-grade disease, and low likelihood of prostate cancer diagnosis in men with low PSA. Now, beyond the culling effect of increased biopsy incidence and with shifted biopsy practice patterns, the correlation between PSA and biopsy result is lost in men with normal DRE. Diagnosing a higher proportion of tumors in men with a PSA between 2.0-4.0 ng/mL has negatively influenced the predictive value of PSA for cancer detection.

大阪府池田市での前立腺癌検診

Screening with prostate specific antigen (PSA) to detect prostate cancer was started in Ikeda City Osaka from 2003 as part of the city's health program. We evaluated the first year's result. Fifty-year-old or elder men living in Ikeda City who wanted to have their serum PSA level (Tandem-R) measured to screen for prostate cancer was entered into the screening program. Men whose PSA levels detected to exceed 4.1 ng/ml were told they should visit a urologist for further examinations to detect possible prostate cancer. These examinations included prostate biopsy. The results of further examinations were reported to Ikeda City and evaluated. The population of fifty-years-old or elder men in Ikeda City was 18,161. 3738 (21.0%) men had their serum PSA levels measured. 367 (9.81%) of the men were told they should undergo further examinations to detect possible prostate cancer. 263 (71.7%) men visited a urologist for further examinations, and prostate biopsy was performed in 138 (52.5%) of them. Among these 138, prostate cancer diagnosed in 91 (65.9%). The positive rate of prostate biopsy was 65.9% (91/138), The detection rate for prostate cancer was therefore 2.43% (91/3738). Patient's numbers for each clinical stage were 57 (62.6%) in B, 30 (32.9%) in C, 4 (4.4%) in D. Prostate cancer was diagnosed in 2.34% of 3738 men who had their serum PSA levels measured, and in stage B two thirds had a positive diagnosis. PSA screening to detect prostate cancer as one of the health checks in Ikeda City was useful in detecting early prostate cancer.

Positive Prostate Biopsy Rate Consistently Increases with Age at the Same Prostate-Specific Antigen Level in Patients with Normal Digital Rectal Examination

Objectives. To examine the relationship between positive prostate biopsy rates and age over the range of serum prostate-specific antigen (PSA) concentrations of 4 to 10 ng/mL. Methods. The rates for adenocarcinoma were calculated for prostate biopsy specimens received at UroCor Inc., Oklahoma City, Oklahoma between April 1995 and June 1997. The selection criteria were as follows: men between 50 and 79 years of age, normal digital rectal examination (DRE), prebiopsy PSA level between 4.01 and 10.0 ng/mL obtained within a 4-month period prior to receipt of biopsy, and no previous prostate biopsy. Five thousand six cases were selected out of 81,545 prostate biopsy specimens submitted by office-based urologists. The rates of positive prostate biopsies were stratified by age in decade increments and by PSA in increments of 1 ng/mL. The P values were calculated by the chi-square test. Results. The patient mean age was 65.8 years. An overall increase in the positive prostate biopsy rate for men between 50 and 79 years of age as serum PSA increases from 4.01 to 10.0 ng/mL ( P = 0.047) was found; however, this increase was less significant than the increase found in positive biopsy rates caused by age alone ( P <0.0001). Conclusions. Undetected prostate cancer appears to be a major cause of the increasing serum PSA seen with advancing age.