Total Prostate-specific Antigen Values Research Articles

Prostate Biopsies and the Vienna Nomograms

Introduction and objective Discordant data still persists regarding the optimal prostate biopsy scheme to be used, the correct timing for performing repeat biopsy in high risk patients as well as the ability of clinical variables to predict prostate cancer. The aim of this review is to provide a comprehensive assessment of different prostate biopsy approaches and to evaluate the role of clinical variables in predicting the presence of prostate cancer (PCa) at biopsy. Methods Analysis of published full-length papers that were identified through Medline search from January 1980 through January 2006. Abstracts published in peer-reviewed journals from the same period were also considered. Results Several groups have proposed new biopsy strategies, often increasing the number of biopsies and the sectors to be sampled or performing biopsies more laterally. However, controversial data have been reported about the real advantage of these new techniques. Moreover, several studies report that sextant biopsies still do not represent an appropriate tool for PCa detection, especially in large prostates. Our nomogram based on patient age and gland volume provides the minimum number of cores needed to accurately detect cancer and it is associated with a 90% sensistivity of PCa detection. Furthermore, several evidences report that, in case of negative initial biopsy, cancers detected on repeat biopsy have similar stage, grade distribution and total PSA values compared to cancers found on initial biopsy. On the contrary, cancers detected on third and fourth systematic biopsy show characteristics of “insignificant” cancers. Among the available clinical predictors, % free PSA and PSA-Transition Zone showed to be the best markers for repeat prostate biopsy, increasing sensitivity and specificity for prostate cancer detection. Conclusions Traditional sextant biopsies might become obsolete in future designed trials since a body of evidence supports the findings that this technique is far from optimal in patients with large prostates. The combination of prostate size and patient age can help physicians in determining the most appropriate prostate biopsy sampling for PCa detection. Due to the high rate of insignificant prostate cancer detected, a systematic repeat biopsy after the second negative biopsy in a PSA range of 2.5–10 ng/ml is not indicated and PSA based watchful waiting should be advocated. Finally, % free PSA and PSA-Transition Zone should be included in predicting models for prostate cancer detection at repeat biopsy.

Comparison of the effects of on‐pump versus off‐pump coronary artery bypass surgery on serum prostate‐specific antigen levels

To compare the effects of coronary artery bypass operation with or without extracorporeal circulation on serum total prostate-specific antigen levels. Seventy-six men with a mean age of 57.04+/-9.27 years (range 44-77 years), who underwent coronary artery bypass surgery were enrolled to the study. In 50 patients (Group I), coronary revascularization was performed using extracorporeal circulation, and in 26 patients (Group II) coronary bypass grafting was performed on the beating heart without using extracorporeal circulation. All the patients had serum total prostate-specific antigen levels measured preoperatively and twice postoperatively in the first and fifth postoperative days. Differences in mean total prostate-specific antigen levels between the two groups in the postoperative period were analysed. The mean preoperative total prostate-specific antigen levels in Group I and Group II were 1.28+/-1.13 ng/mL and 1.11+/-0.93 ng/mL, respectively, and there was no significant difference in the preoperative total prostate-specific antigen values between the two groups (P=0.519). In Group I, postoperative means were 4.96+/-6.29 ng/mL and 5.86+/-9.09 ng/mL in the first and fifth days, respectively (P=0.0001, P=0.0001). Total prostate-specific antigen means in the same postoperative period for Group II were 2.13+/-2.72 ng/mL and 2.00+/-2.20 ng/mL, respectively (P=0.014, P=0.024). The comparison of total postoperative prostate-specific antigen levels between the groups showed significantly higher elevation in Group I (postoperative day 1: P=0.013; day 5: P=0.05). Coronary revascularization can cause a statistically significant rise in serum total prostate-specific antigen levels. This rise is more marked in patients undergoing conventional coronary revascularization.

Effects of Chronic Bacterial Prostatitis on Prostate Specific Antigen Levels Total and Free in Patients with Benign Prostatic Hyperplasia and Prostate Cancer

Prostatic-specific antigen (PSA), a tumor marker helpful in the diagnosis and follow-up of prostate cancer, may rise due to causes such as prostatitis, chronic benign prostatic hyperplasia (BHP), etc. The aim of this study was to investigate the relationship between prostatitis and the level of total and free prostate-specific antigen in patients with no clinical evidence of prostate cancer. A comprehensive urological examination was performed on 156 patients aged 35-61 years old. All patients have symptoms of prostatitis. Prostate fluid culture was preformed. All patients underwent a course of antibacterial treatment after which the levels of total prostate specific antigen (TPSA) and free prostate specific antigen (FPSA) were evaluated. An increase in TPSA (> 4 ng/ml) was observed in 14/24 (58.3%) patients with acute prostatitis and in 7/45 (15.5%) and 4/44 (9.1%) in patients with chronic bacterial prostatitis (CBP) and a bacterial prostatitis, respectively. Low blood concentration of TPSA and FPSA were observed after effective antibacterial and anti-inflammatory treatment therapy in most cases. These data suggested that prostatitis must be considered when interpretation of TPSA and FPSA values as tumor marker.

Complexed PSA improves prostate cancer detection: Results from a multicenter Japanese clinical trial

Objectives To compare the distribution of total and complexed prostate-specific antigen (cPSA) in men with and without prostate cancer with another studied population and to ascertain whether cPSA could enhance the detection of prostate cancer in Japanese men. Methods A total of 760 men whose serum total PSA (tPSA) values ranged from 1.0 to 100 ng/mL were enrolled. Serum samples for tPSA and cPSA (ADVIA Centaur) were obtained in all cases. The area under the curve was calculated for comparison of the tPSA and cPSA values. We calculated the number of cancers missed and false-positive results at various cutoff values of cPSA compared with the conventional tPSA threshold of 4.0 ng/mL. Results Prostate cancer was detected in 268 (35.3%) of 760 patients. cPSA was greater than 8.3 ng/mL (equivalent to 10.0 ng/mL tPSA) in 46.6% of the men with cancer. The area under the curve for cPSA (0.741) was significantly better than that for tPSA (0.721, P <0.001). At a sensitivity of 85% to 95%, significant differences were found in the corresponding specificity between tPSA and cPSA. cPSA at a 3.0-ng/mL threshold detected an identical number of cancers as a tPSA cutoff of 4.0 ng/mL; however, it decreased the false-positive results by 28 cases. Conclusions To our knowledge, this is the first report of the distribution of cPSA in Japanese men using a urologic referral population. cPSA can be an alternative to tPSA as the first screening test. A substantial number of men in Japan with prostate cancer are currently diagnosed with a tPSA value greater than 10.0 ng/mL.

Needle Core Length is a Quality Indicator of Systematic Transperineal Prostate Biopsy

ObjectiveTo analyse the length of needle cores sampled as a quality indicator in systematic transperineal prostate biopsy. We assessed the correlation of core length with the other clinical and topographic parameters. Material and methodsWe prospectively evaluated data from 509 consecutive patients who underwent a first set of transrectal ultrasound-guided transperineal prostate biopsy for suspected prostate cancer. Fourteen cores were sampled from each patient. Needle cores were stretched and placed in tissue cassettes between two nylon meshes according to the pre-embedding methods of prostate needle biopsy specimens. For single biopsy core, the measurement of length (in millimetres) and any percentage of cancer in the biopsy specimen were reported. ResultsThe mean length of 7,126 analysed cores was 14.14±4.35mm. All cores were longer than 10mm. The mean length of needle cores sampled did not correlate with patient age, total prostate-specific antigen value, digital rectal examination, and prostate volume. The whole mean length of the six samples from the peripheral zone of the right lobe was higher than the mean corresponding value of the six samples from the left lobe peripheral zone (p<0.001). The transperineal approach allows a greater sampling of the prostate apex than of the midgland and prostate base (p<0.001). ConclusionsThe length of the needle cores sampled during transperineal prostate biopsy fulfils the parameters of quality required by pathologists for an appropriate evaluation of the biopsy specimen.

Free PSA estimation substituted by calculation where total PSA value is up to 4 ng/ml

Free PSA estimation substituted by calculation where total PSA value is up to 4 ng/ml

Total and Percent Free Prostate-Specific Antigen Levels among U.S. Men, 2001-2002

Because total prostate-specific antigen (PSA) and, more recently, the percent free PSA are used to screen men for prostate cancer, population-based, age- and race-specific distributions are needed of both PSA tests among American men to estimate the effect of lowering the PSA threshold or widespread introduction of the free PSA test as an additional screening test. We did PSA assays on serum samples from men of ages 40 years and older (n = 1,320) who participated in the 2001-2002 National Health and Nutrition Examination Survey. About 6.1% (95% confidence interval, 4.7-7.7%), corresponding to an estimated 3.4 million (range, 2.7-4.3 million) men nationwide, ages 40 years and older, had a total PSA of >4.0 ng/mL. Among men ages 50 to 69 years old, the age group for which PSA testing is most prevalent, 5.4% or an estimated 900,000 to 2 million men had a total PSA of >4.0 ng/mL. An equal number had a total PSA between 2.5 and 4.0 ng/mL and a percent free PSA of <25%. Approximately 27% of men in this age group, corresponding to a range of 5.7 to 8.1 million men, had a total PSA <2.5 ng/mL and a percent free PSA of <25%. The effect of lowering the total PSA threshold or introducing another screening test is significant. Provision of the number of U.S. men with certain total PSA and percent free PSA values may help guide prostate cancer public health policy and screening practices.

Resultados de una serie de 6000 pacientes con biopsia transrectal ecodirigida de próstata: Parte II: Parámetros derivados de PSA

We review the results of 6000 patients with the clinical suspect of prostate cancer who underwent one or more prostate, biopsies, analyzing the role of PSA derived parameters in the probability of having prostate cancer in the TRUS biopsy. We selected 6000 patients who under- went TRUS biopsy between 1994 and 2002. 861 of them underwent more than one is biopsy, adding up to a total of 7127 biopsies. For the study of PSA derived indexes we established ranges based on the 10th percentile for the first biopsy for all patients and also for those with PSA between 4 and 10 ng/ml. Several predictive models were determined by logistic regression of the variables related with presence/no presence of cancer. For first biopsies the ranges of PSAD established showed a diagnostic effectiveness below 8% with PSA densities lower than 0.11 ng/ml/cc. The free/total PSA ratio is less discriminant in the ranges obtained with a 13.7% incidence of prostate cancer for values above 0.24. In the case of second biopsies the group of patients with PSAD below 0.12 had only a 5.3% incidence, and only one patient with F/T PSA ratio higher than 0.24 had a prostate cancer (2.9%). All studied parameters but F/T PSA ratio showed statistical significance in the multivariant analysis. Although the establishment of a cut point for PSAD diminishes sensitivity, prostate biopsy habits should be modified assuming the loss of tumors in patients with low PSAD and increasing the number of biopsies in patients with total PSA values below 4 ng/ml with higher densities.

Is serum prostate-specific antigen level affected by fasting and nonfasting?

Objectives To determine whether the level of serum prostate-specific antigen (PSA) varies with fasting and nonfasting. Methods The study involved 80 male patients with normal digital rectal examination who were hospitalized for benign urologic problems. The patients with active urinary tract infection, urologic cancer, urethral catheterization, diabetes mellitus, or acute or chronic renal failure and those who had undergone urologic manipulations within the past 45 days were excluded from the study. All the patients were asked to fast between 12:00 am and 8:00 am. The next morning, 10-mL venous blood samples were obtained at 8:00 am. Then each patient was provided with breakfast, which was followed by additional serial venous serum sampling during the first and second hour. The patients ate lunch at 12:00 pm. The final venous serum sampling was conducted at 2:00 pm. The serum PSA levels were determined for all the serum samples. Results The mean patient age was 62.42 ± 8.75 years (range 46 to 82). The mean serum total PSA value at fasting and the first, second, and sixth hour was 2.78 ± 2.19, 2.7 ± 2.0, 2.7 ± 2.1, and 2.78 ± 2.10 ng/mL, respectively. In the comparisons of the fasting values and first, second, and sixth hour values and the values at each hour with those at the other hours, no significant differences were observed ( P >0.05). Conclusions According to our results, blood samples can be obtained for serum PSA measurement at any time of the day, regardless of whether the patient has fasted or not.

Urinary/serum prostate-specific antigen ratio: Comparison with free/total serum prostate-specific antigen ratio in improving prostate cancer detection

Objectives To test the previously reported hypothesis, that the urinary/total serum (U/S) prostate-specific antigen (PSA) ratio improves the detection of prostate cancer, by evaluating the clinical usefulness of the U/S PSA ratio and comparing it with the free/total (F/T) serum PSA ratio. Methods A total of 165 patients undergoing transrectal ultrasound-guided prostate biopsy were prospectively included in this multicenter study. In all patients, PSA was measured from preoperative serum and 12-hour urine specimens in a centralized laboratory. Results Prostate cancer was identified in 83 of 165 patients. The differences between patients with and without prostate cancer were statistically significant ( P <0.001) when considering the total PSA value (median, 10.2 ng/mL and 6.6 ng/mL respectively), F/T serum PSA ratio (0.11 and 0.18), and U/S PSA ratio (1.2 and 4.2). In the group of 79 patients with a PSA level between 4 and 10 ng/mL, receiver operating characteristic curves showed that the U/S PSA ratio was associated with a larger area under the curve (0.63; 95% confidence interval, 0.51 to 0.73) than the total PSA value (0.55; 95% confidence interval, 0.43 to 0.66) or F/T serum PSA ratio (0.60; 95% confidence interval, 0.49 to 0.71). The U/S PSA ratio did not correlate with patient age or prostate volume. Conclusions Our results confirmed that the U/S PSA ratio may be a useful test in prostate cancer detection when the total serum PSA level is between 4 and 10 ng/mL. The F/T serum PSA ratio and U/S PSA ratio did not correlate. This suggests that these two tests could complement each other.

Effect of extracorporeal shockwave lithotripsy on serum prostate specific antigen concentration.

We investigated the effect of extracorporeal shockwave lithotripsy (SWL) on the serum prostate specific antigen (PSA) concentration. A total of 22 male patients with a mean age of 52.9 years (range 37-67 years) were treated with SWL for distal ureteral calculi close to the ureteral orifice. Serum samples were drawn for measurement of PSA values just before (PSA-1) and 45 minutes (PSA-2) and 7 days (PSA-3) after the session. None of the patients had urinary tract infection or any abnormal finding on digital rectal examination. The SWL sessions were performed with the Wolf piezoelectric 2300 lithotripter that has a therapeutic focus of 3 x 11 mm. The mean number of shockwaves per patient was 2204. Student's t-test was used for statistical analysis. At 1 year, all patients completed a questionnaire concerning recent diagnosis of prostate cancer. The mean total PSA concentration before SWL was 3.13 ng/mL and rose to 3.91 ng/mL 45 minutes after the session. The mean PSA-3 value was 3.76 ng/mL. The mean free PSA values were 0.80, 0.83, and 0.77 ng/mL, respectively. The difference between PSA-1 and PSA-2 was statistically significant; all of the other differences were not significant. None of the patients reported prostate cancer at 1 year. Shockwave lithotripsy affects prostate epithelial cells and may cause a minor rise in total serum PSA values. However, this rise does seem to impair the value of PSA in patients with undiagnosed prostate cancer.

Prostate specific antigen in Africans: a study in Nigerian men

Background: Since the reference range of prostate specific antigen (PSA) that are used for the screening, diagnosis and management of prostate disease are based on studies of PSA range in Caucasians and African-Americas, they may not be applicable to other ethnicities, especially indigenous African populations. Methods: In a hospital-based study, we measured total PSA levels using an immunoassay (DSL-10-9700 Active Enzyme-Linked Immunosorbent Assay, Webster, TX) in patients with prostate disease (n = 48) and age-matched controls (n = 64). Results: The mean total PSA value for healthy Nigerians was significantly lower than the established values for African-Americans (2.22+/- 2.90 ng/ml versus 7.56+/- 1.11 ng/ml, respectively). PSA values in the controls did not increase with age. Severity of symptoms was not age-dependent; however, PSA levels did increase with severity of symptoms (p = 0.002). Conclusion: The PSA range of healthy Nigerian men were significantly lower than those of African-American or Caucasian men. This underscores the need for a population-specific reference range for African men. Key Words: Prostate specific antigen, benign prostatic hyperplasia, prostate cancer Nigerian Journal of Surgical Research Vol.5(1&2) 2003: 114-119

Predictors of random sextant biopsy outcome in screened men with PSA > 4 ng/mL and a negative sextant biopsy at previous screening. Experience in a population-based screening program in Florence.

The aim of this study was to evaluate possible pedictors of the outcome of repeat random sextant biopsy of the prostate prompted by a rise in prostate-specific antigen (PSA). Random biopsies performed for PSA elevation (>4 ng/mL) in the course of a randomized study of screening efficacy were reviewed, and 87 consecutive biopsies (carcinoma = 13, high-grade prostatic intraepithelial neoplasia = 6, negative = 68) performed in subjects with a negative random biopsy at the previous screening round were considered. Findings at digital rectal examination or transrectal ultrasonography and total PSA value were not useful predictors of repeat biopsy outcome, whereas PSA velocity was significantly associated with biopsy outcome. The positive predictive value for a cancer biopsy was 2.7% (1/36), 28.5% (2/7), and 22.7% (10/44) for PSA velocity values of <0.1, 0.1-0.19, and >0.19 ng/mL/yr, respectively. A cutoff of 0.1 ng/mL/yr for PSA velocity would have allowed to avoid approximately half (35/74 = 47.2%) of the benign biopsies while decreasing the sensitivity by 7.6% (1/13), and is thus suggested as a possible criterion for the indication of repeat random biopsy for persistent PSA elevation.

Value of various PSA parameters for diagnosing prostate cancer in men with normal digital rectal examination

The risks of identifying prostate cancer (PCa) in patients with serum total PSA (tPSA) between 4 and 10 ng/dl are between 25 and 35%. There are no data in Brazil showing the incidence of disease when all variables for PSA assessment are considered altogether, specifically tPSA, free fraction, PSA velocity and PSA stratified by age. The objective in this work was to define the incidence of disease in a population of men with abnormal values of PSA variables and normal digital rectal examination. Between 1998 and 2003, 273 prostate biopsies were performed by the same radiologist and analyzed by the same pathologist. All patients had a normal digital rectal examination and biopsy had been indicated due to tPSA above 4 ng/dl or free-to-total PSA ratio (F/T PSA) below 15% or PSA velocity higher than 25% per year or a PSA level regarded as high for the age range. The relationship between these parameters and the positivity for prostate caner was determined. Patients' mean age was 63.8 years, and PCa was identified in 135 cases (49.5%). The incidence of PCa, related to unitary variations in tPSA, ranged from the limits of 33 to 80%, respectively, in tPSA < 3 and PSA between 15.1 to 20. When the other PSA parameters were assessed (free PSA, PSA according to age, rise velocity) PCa was detected in more than 25.3% of cases. When patients with normal digital rectal examination are selected for prostate biopsy due to tPSA levels above 4 or F/T PSA ratio lower than 15% or PSA velocity higher than 25% per year or high PSA for the age range, the incidence of PCa is quite higher than that observed in a population selected exclusively with basis on total PSA value.

Ganglionar metastization on radical prostatectomy

To analyze retrospectively 19 patients with positive pelvic lymph node disease obtained with a radical prostatectomy. To discuss the actual role of pelvic lymphadenectomy and evaluate the results obtained using one treatment protocol. Between January 1993 and December 2001 450 patients underwent radical prostatectomy for localized prostate cancer. Nineteen patients were identified as having positive ganglionar disease (4.2%). The mean PSA value of the 450 patients was 11.8 ng/ml (ranging 1.9 - 40 ng/ml). We analyzed the survival curves using the method of Kaplan-Meier, based on non recurrence of elevated biochemical total PSA values. The mean follow up time was 37.7 months. The recurrence of disease was defined by two consecutive determinations of PSA values greater than 0.2 ng/ml. the mean age of the nineteen patients was 66 years, varying between 56 and 74. The specific survival curve for these patients shows a survival probability of 60.9%, after 5 years. The survival curve of biochemical free recurrence shows a probability of 37.5%, after 5 years. A progressive decrease in the incidence of patients with ganglionar disease was observed after radical prostatectomy. It is therefore disputable the role of routine lymphadenectomy, its advantages, disadvantages and indications. The scientific analysis have permited great controversy regarding treatment. Our results with a treatment protocol which utilizes preventive adjuvant radiotherapy together with hormone treatment, initially differed and actually systematic, shows a survival rate similar to other studies. The actual indication of lymphadenectomy is maintained in radical retropubic prostatectomy and in patients with a risk of extracapsular disease in perineal prostatectomy or laparoscopy prostatectomy. The monotherapy offers a limited potential of cure. An extensive disease needs an aggressive therapy. A combination of adjuvant radiation therapy and simultaneous hormone treatment is indicated until there exists a randomized study, with an adequate follow up time, to determine which treatment strategy is the best.

Probability of prostate cancer as a function of the percentage of free prostate-specific antigen in patients with a non-suspicious rectal examination and total prostate-specific antigen of 4-10 ng/ml.

Our aim was to assess the usefulness of measuring the percentage of free prostate specific antigen (PSA) in serum in relation to reducing the number of prostate biopsies in men with benign prostate examinations and serum PSA levels between 4 and 10 ng/ml. The percentage of free PSA (Immulite) in serum was analyzed prospectively in 500 men, all of whom underwent ultrasound-guided sextant prostate biopsies. Cancer was detected in 21.4% (107/500) of the patients. Using a free PSA cutoff of < or = 23% as a criterion for performing prostate biopsy would have detected 94.4% of cancers, avoided 18.8% of benign biopsies and yielded a positive predictive value of 25.3%. The percentage of free PSA increased with prostate volume. Mean total PSA and mean free percent PSA values increased as patient age increased, influencing the calculation of cutoff values, sensitivity and specificity. PSA density had a sensitivity and specificity not significantly different than the percentage of free PSA. Measurement of the percentage of free serum PSA improves the specificity of prostate cancer detection in patients with elevated total serum PSA levels and benign prostate examinations.

Detection of telomerase activity in prostate massage samples improves differentiating prostate cancer from benign prostatic hyperplasia.

We performed a case-control study in which we tested the ability of a non-invasive assay to detect telomerase activity and to distinguish between prostatic cancer (Pca) and benign prostatic hyperplasia (BPH) on samples of epithelial cells obtained after prostatic massage. Telomerase activity was determined by a telomeric repeat amplification protocol (TRAP) assay. We selected 60 patients with histologically proven Pca (30 cases) or BPH (30 cases). Specimens included in this study were from patients who had no suspicious findings on digital rectal examination for cancer, had clinical evidence of lower urinary tract symptoms, had no sonographic signs of Pca at the transrectal ultrasound evaluation, had total PSA values moderately elevated (2.6-15 ng/ml), and had no evidence of other urological cancers. The whole procedure was conducted in double blind between pathologists and molecular biology operators. Telomerase activity was detected in 90% of Pca cases and in 13% of BPH cases. The sensitivity (90%) and specificity (76%) of this method were calculated. The positive predictive value, negative predictive value, and diagnostic efficiency were 87%, 90%, and 88% respectively. Our data indicate that telomerase activity detected by TRAP assay on prostate epithelial cells collected by prostate massage can substantially improve the distinction between Pca and BPH conditions. One of the clinical benefits resulting from the use of this new assay would be to refine the biopsy indication and to avoid for several patients without Pca the unnecessary cost and the complications of prostate biopsy.

Can Complexed Prostate Specific Antigen Enhance Prostate Cancer Detection in Japanese Men?

The aim of this study is to ascertain whether Bayer complexed PSA (cPSA) and volume referenced cPSA could enhance the detection of prostate cancer in Japanese men. A total of 214 Japanese men whose serum total PSA (tPSA) values ranged from 1.2 ng/ml to 4600 ng/ml were enrolled from two institutions. Serum samples for tPSA, free PSA, PSA-alpha-1-antichymotripsin (PSA-ACT) and cPSA (ADVIA-Centaur) were obtained in all cases. In addition, total gland (TGV) as well as transition zone volume (TZV) were determined in all cases who underwent untrasound guided prostate biopsy (sextant and two additional transition zone biopsies). Biopsy outcome was correlated to the following parameters: tPSA, cPSA, PSA-ACT, free to total (F/T) PSA ratio, 2 complex to total (C/T) PSA ratios and 6 volume referenced parameters. Prostate cancer was detected in 85 of 214 patients (40%). The area under the receiver operating characteristic curve in non-volume referenced variables was highest for cPSA (0.736), followed by PSA-ACT (0.735), tPSA (0.722), F/T PSA ratio (0.613) and C/T PSA ratio (0.591). Comparing tPSA with the cutoff value of 4.0 ng/ml, the cutoff value with a 2.8 ng/ml of cPSA detected one more positive biopsy patient, decreasing one more cancer missed case and 8 more false positive cases. At sensitivities of 85% to 95% in men with tPSA between 4.00 and 10.00 ng/ml (n = 116), there were no significant differences in the corresponding specificities between tPSA and cPSA, or between cPSA and PSA-ACT. At sensitivities of 90% to 95%, the corresponding specificities of PSA-ACT adjusted for transition zone volume revealed best performance. As for the performance in men with a tPSA less than 4.0 ng/ml, the specificities of cPSA performed best, and differed significantly from PSA-ACT and F/T PSA at sensitivities of 80% to 90%. Bayer cPSA could replace the first screening test by total PSA and can enhance cancer detection, compared with PSA-ACT. However, cPSA did not provide additional value in differentiating cancer from non-cancer cases in men with a tPSA between 4.00 and 10.00 ng/ml.

Pain assessment after original transperineal prostate biopsy using a coaxial needle

Objectives To assess whether the use of a coaxial needle reduces discomfort in patients undergoing multiple-core transperineal prostate biopsy to detect prostate cancer. Methods From October 2002 to January 2003, we enrolled 102 consecutive patients with a suspicion of prostate cancer. In every case, we performed a 14-core transperineal prostate biopsy under transrectal ultrasound guidance. The patients were randomized into two groups: group 1 (n = 51) in which we used the 17-gauge coaxial TruGuide needle, and group 2 (n = 51) in which the conventional transperineal technique was used. At the end of the procedure, patients were asked to complete a questionnaire regarding the level of pain experienced. Results The studied groups were comparable in age, total prostate-specific antigen value, and prostate volume. The whole procedure was significantly less painful in group 1 (2.20 ± 1.20 versus 2.90 ± 1.73, P = 0.01). We failed to show any significant pain score differences during rectal probe insertion ( P = 0.10), transrectal ultrasonography ( P = 0.16), and execution of local anesthesia ( P = 0.11). The pain score recorded during the multiple-core prostate sampling was significantly lower in group 1 (1.53 ± 1.5 versus 2.43 ± 1.86, P = 0.009). No statistically significant differences were found in the complication rates between the two groups. Conclusions The use of a coaxial needle reduces the procedure's invasiveness and patient's pain compared with the conventional transperineal prostate biopsy.

Early detection of prostate cancer with low PSA cut-off values leads to significant stage migration in radical prostatectomy specimens.

The introduction of prostate-specific antigen (PSA) contributed to a shift in tumor stage at diagnosis in patients with prostate cancer. The aim of the present study was to evaluate the effects of PSA screening with low PSA cut-off values on mean total and percent-free PSA levels in patients with prostate cancers at the time of diagnosis as well as on pathologic stage and mean Gleason scores in positive biopsies and radical prostatectomy specimens. Data of 875 patients who were diagnosed with prostate cancers between 1996 and 2001 were analyzed. Patients were stratified into six groups according to the year of biopsy. Annual changes in total and percent-free PSA values, in Gleason scores of biopsies and radical prostatectomy specimens, and in pathologic stages of radical prostatectomy specimens were assessed. Mean PSA of patients diagnosed with prostate cancer decreased from 13.11 ng/ml (percent-free PSA: 11.89%) in 1996 to 7.33 ng/ml (percent-free PSA: 12.58%) in 2001 (P < 0.05). The percentage of organ-confined prostatectomy specimens increased from 64.3% in 1996 to 81.5% in 2001 (P < 0.05). However, mean Gleason scores increased from 5.23 to 6.33 over the 6 years (P < 0.05). The percentage of patients with biopsy-proven prostate cancers and PSA values below 4 ng/ml increased from 14.0% in 1996 to 39.2% in 2001. In the group with PSA values below 4 ng/ml organ-confined cancers were found in 80.0-95.2% of patients. PSAg screening with low cut-off levels has led to a significant reduction of mean baseline PSA levels in prostate cancer patients and to a significant increase in the percentage of organ-confined radical prostatectomy specimens, whereas mean Gleason scores have remained relatively constant.