Korean J Urol.  2012 Jul;53(7):467-471. 10.4111/kju.2012.53.7.467.

Role of Prostate-Specific Antigen Change Ratio at Initial Biopsy as a Novel Decision-Making Marker for Repeat Prostate Biopsy

• Lee JG
• Bae SH
• Choi SH
• Kwon TG
• Kim TH

• KMID: 1988757
• DOI: http://doi.org/10.4111/kju.2012.53.7.467

Abstract

PURPOSE
Prostate biopsy is used to confirm the prostate cancer. Although first biopsy result was benign, repeat biopsy is recommended for the patient who has higher risk of prostate cancer. In this study, we investigated the PSA change ratio (post-biopsy PSA to baseline PSA) whether it could be predictive factor of prostate cancer and helpful when decided to perform repeat biopsy.
MATERIALS AND METHODS
151 patients, first diagnosed as benign, but underwent repeat biopsy due to clinical suspicion of prostate cancer were included. Post-biopsy PSA was checked 60 minutes later after biopsy. PSA change ratio was defined as post-biopsy PSA to baseline PSA. According to results of repeat biopsy, patients were divided into benign group (group A) and cancer groups (group B). Between two group baseline PSA, PSA density, post-biopsy PSA and PSA change ratio were compared, and most effective cut-off value was analyzed using receiver operating characteristic (ROC).
RESULTS
129 men were benign, 22 men were prostate cancer according to results of repeat biopsy. Between two groups, post-biopsy PSA and PSA change ratio were statically significant differences. (p<0.001, <0.001) The effective cut-off value was 3.0, 3.5 and 4.0 according to ROC. At ROC curve, PSA change ratio was statistically significant for diagnosis of prostate cancer. (AUC 0.800, p<0.001).
CONCLUSIONS
PSA change ratio is thought be a predictive factor for prostate cancer. If the PSA change ratio was less than 3.0-4.0, repeat biopsy should be considered to confirm the diagnosis.

Keyword

Prostate-specific antigen; Prostatic hyperplasia; Prostatic neoplasms

MeSH Terms

Biopsy
Humans
Male
Prostate
Prostate-Specific Antigen
Prostatic Hyperplasia
Prostatic Neoplasms
ROC Curve
Prostate-Specific Antigen

Figure

• 

  FIG. 1 Receiver operating characteristics (ROC) curve using multiple cutoff values of the prostate-specific antigen (PSA) ratio (AUC 0.800, p<0.01).

Reference

1. Catalona WJ, Partin AW, Slawin KM, Brawer MK, Flanigan RC, Patel A, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998. 279:1542–1547.

2. Lin TP, Huang WJ, Chen KK. Differentiation of benign prostatic hyperplasia from prostate cancer using prostate specific antigen dynamic profile after transrectal prostate biopsy. J Urol. 2004. 171(6 Pt 1):2226–2229.

3. Choi SH, Yoo ES, Park YI. The significance of prostate-specific antigen after transrectal prostate biopsy. Korean J Urol. 2006. 47:958–962.

4. Song C, Ahn H, Lee MS, Park J, Kwon TG, Kim HJ, et al. Mass screening for prostate cancer in Korea: a population based study. J Urol. 2008. 180:1949–1952.

5. Postma R, Schroder FH. Screening for prostate cancer. Eur J Cancer. 2005. 41:825–833.

6. Oesterling JE. Prostate specific antigen: a critical assessment of the most useful tumor marker for adenocarcinoma of the prostate. J Urol. 1991. 145:907–923.

7. Devonec M, Fendler JP, Monsallier M, Mouriquand P, Mestas JL, Dutrieux-Berger N, et al. Prostatic cancer diagnosis with ultrasonically guided prostatic biopsy: results in 226 cases. Prog Clin Biol Res. 1989. 303:35–40.

8. Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ, et al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med. 1991. 324:1156–1161.

9. Gilbert SM, Cavallo CB, Kahane H, Lowe FC. Evidence suggesting PSA cutpoint of 2.5 ng/ml for prompting prostate biopsy: review of 36,316 biopsies. Urology. 2005. 65:549–553.

10. Matlaga BR, Eskew LA, McCullough DL. Prostate biopsy: indications and technique. J Urol. 2003. 169:12–19.

11. Polascik TJ, Oesterling JE, Partin AW. Prostate specific antigen: a decade of discovery--what we have learned and where we are going. J Urol. 1999. 162:293–306.

12. Partin AW, Oesterling JE. The clinical usefulness of percent free-PSA. Urology. 1996. 48:6A Suppl. 1–3.

13. Schroder FH, Roobol MJ, van der Kwast TH, Kranse R, Bangma CH. Does PSA velocity predict prostate cancer in pre-screened populations? Eur Urol. 2006. 49:460–465.

14. Filella X, Alcover J, Molina R, Rodriguez A, Carretero P, Ballesta AM. Clinical evaluation of free PSA/total PSA (prostate-specific antigen) ratio in the diagnosis of prostate cancer. Eur J Cancer. 1997. 33:1226–1229.

15. Djavan B, Zlotta A, Kratzik C, Remzi M, Seitz C, Schulman CC, et al. PSA, PSA density, PSA density of transition zone, free/total PSA ratio, and PSA velocity for early detection of prostate cancer in men with serum PSA 2.5 to 4.0 ng/ml. Urology. 1999. 54:517–522.

16. Rabbani F, Stroumbakis N, Kava BR, Cookson MS, Fair WR. Incidence and clinical significance of false-negative sextant prostate biopsies. J Urol. 1998. 159:1247–1250.

17. Gore JL, Shariat SF, Miles BJ, Kadmon D, Jiang N, Wheeler TM, et al. Optimal combinations of systematic sextant and laterally directed biopsies for the detection of prostate cancer. J Urol. 2001. 165:1554–1559.

18. Chon CH, Lai FC, McNeal JE, Presti JC Jr. Use of extended systematic sampling in patients with a prior negative prostate needle biopsy. J Urol. 2002. 167:2457–2460.

19. Djavan B, Zlotta A, Remzi M, Ghawidel K, Basharkhah A, Schulman CC, et al. Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men. J Urol. 2000. 163:1144–1148.

20. Borboroglu PG, Sur RL, Roberts JL, Amling CL. Repeat biopsy strategy in patients with atypical small acinar proliferation or high grade prostatic intraepithelial neoplasia on initial prostate needle biopsy. J Urol. 2001. 166:866–870.

21. Horinaga M, Nakashima J, Ishibashi M, Oya M, Ohigashi T, Marumo K, et al. Clinical value of prostate specific antigen based parameters for the detection of prostate cancer on repeat biopsy: the usefulness of complexed prostate specific antigen adjusted for transition zone volume. J Urol. 2002. 168:986–990.

22. Charrie A, Fleury-Goyon MC, Dutey P, Perrin P. The effect of prostate aspiration biopsy on serum levels of prostatic acid phosphatase and prostate-specific antigen. JAMA. 1986. 256:474.

23. Yuan JJ, Coplen DE, Petros JA, Figenshau RS, Ratliff TL, Smith DS, et al. Effects of rectal examination, prostatic massage, ultrasonography and needle biopsy on serum prostate specific antigen levels. J Urol. 1992. 147(3 Pt 2):810–814.

24. Ornstein DK, Rao GS, Smith DS, Ratliff TL, Basler JW, Catalona WJ. Effect of digital rectal examination and needle biopsy on serum total and percentage of free prostate specific antigen levels. J Urol. 1997. 157:195–198.