The Effectiveness of Prostate Biopsy in Patients with Negative Digital Rectal Examination and Serum Prostate Specific Antigen Concentration between 4 and 10ng/ml

Min, Young Ki; Kim, Jong Sung; Rim, Joung Sik

Abstract

PURPOSE: Most urologists, to our knowledge, recommend prostatic biopsy if serum prostate specific antigen(PSA) concentrations are between 4 and 10ng/ml(gray zone), even in the abscence of abnormal digital rectal examination(DRE). But the detection of prostate cancer has not been frequent in patients with negative DRE and gray zone of serum PSA. So, we investigated the detection rate of prostate cancer to evaluate the effectiveness of biopsy, and provide the clinical data which is needed to make an appropriate guideline for management in those patients in Korea.
MATERIALS AND METHODS
We retrospectively reviewed 58 patients with negative DRE and serum PSA greater than 4ng/ml, in whom transrectal systemic biopsy was done between January 1, 1996 and July 31, 1998. Additionally we analysed 38 patients with negative DRE and serum PSA more than 4ng/ml in a Korean literature. We calculated the detection rate of prostate cancer in patients with gray zone of serum PSA and serum PSA greater than 10ng/ml, respectively.
RESULTS
Prostate cancer was detected in 5 patients out of the 58 patients(8.6%), including 1 patient(3.7%) out of 27 patients with gray zone of serum PSA and 4(12.9%) out of 31 patients with serum PSA greater than 10ng/ml. Prostate cancer was detected in 4 patients out of the 38 patients in the literature(10.5%), including 1 patient(5.0%) out of 20 patients with gray zone of serum and 3 patients(16.7%) out of 18 patients with serum PSA greater than 10ng/ml. Combining the results of our current study with that of other Korean literature, total number of patients was 96, and 9(9.4%) of them proved to harbor prostate cancer, including 2 patients(4.3%) out of 47 patients with gray zone of serum PSA and 7 patients(14.3%) out of 49 patients with serum PSA greater than 10ng/ml.
CONCLUSIONS
The detection rate of prostate cancer in Korean with negative DRE and gray zone of serum PSA is significantly lower than that in North American. Therefore it may not be effective to perform biopsy in all of those patients in Korea. Needed are Korean criteria of prostatic biopsy to detect prostate carcinoma in those patients, which can be acceptable in Korean.