Korean J Urol.  2012 Jan;53(1):50-53. 10.4111/kju.2012.53.1.50.

A Prospective Study of Reducing Unnecessary Prostate Biopsy in Patients with High Serum Prostate-Specific Antigen with Consideration of Prostatic Inflammation

• Lee AG
• Choi YH
• Cho SY
• Cho IR

• KMID: 1988824
• DOI: http://doi.org/10.4111/kju.2012.53.1.50

Abstract

PURPOSE
We aimed to reduce unnecessary prostatic biopsy in patients with high prostate-specific antigen (PSA) by consideration of prostatic inflammation.
MATERIALS AND METHODS
The investigation was conducted prospectively in 413 patients with a PSA level of 4 to 10 ng/ml from January 2004 to December 2009. All patients underwent the expressed prostatic secretion (EPS) or voided bladder urine 3 (VB3) test to be classified into two groups: positive group and negative group. Patients with a positive result on the EPS or VB3 test were treated with antibiotics for 2 months, and in cases in which the PSA level remained high, we performed prostate biopsy. In patients with a negative result on the VB3 test, we performed prostate biopsy directly.
RESULTS
Of the 413 study patients, 215 (52%) patients had positive findings on the EPS or VB3 test. After 8 weeks of antibiotics therapy, 53 of the 215 men avoided prostate biopsy because their PSA level was normalized. The other patients (162 of 215) still had elevated PSA levels of more than 4 ng/ml, including 7 patients in whom the biopsy revealed cancer. Patients with negative findings (198 of 413) underwent prostate biopsy. Of the 198 patients, 41 were diagnosed with prostate cancer. The total prostate cancer detection rate was 11.6% in our subjects, where as it was 20.7% in the patients with negative findings on the EPS or VB3 and 3.3% in the patients with positive findings, respectively.
CONCLUSIONS
In cases in which the PSA level is increasing, if we first exclude prostatitis and carry out a serial diagnostic procedure, it may help to reduce unnecessary prostatic biopsy.

Keyword

Biopsy; Prostate-specific antigen; Prostatic neoplasms; Prostatitis

MeSH Terms

Anti-Bacterial Agents
Biopsy
Humans
Inflammation
Male
Prospective Studies
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Prostatitis
Urinary Bladder
Anti-Bacterial Agents
Prostate-Specific Antigen

Figure

• 

  FIG. 1 The process of prostate cancer detection considering PSA reduction after antibiotic treatment. PSA: prostate-specific antigen, EPS: expressed prostatic secretion, VB3: voided bladder urine 3.

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