The Necessity of Prostate Biopsy for Patient of LUTS/BPH with Elevated Serum Prostate Specific Antigen

Chung, Young Chur; Chang, Hyuk Soo; Kim, Chun Il

Abstract

PURPOSE: To determine the criteria that can be used to safely reduce unnecessary biopsies for patient found to be lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) negative on digital rectal examination (DRE) and transrectal ultrasound (TRUS), with a prostate specific antigen (PSA) level over 4.0ng/ml.
MATERIALS AND METHODS
A retrospective data analysis of 157 patients, with a raised serum PSA level, over 4.0ng/ml, and negative DRE and TRUS findings was performed. The detection rates of prostate cancer according to the prostate volume were also investigated. All patients with one benign biopsy were followed with PSA determination over a 2 year period, and in the cases of men with a persistently elevated PSA, a re-biopsy was suggested. Patients were also classified according to the results of the first biopsy and the follow up PSA level.
RESULTS
Of the 157 patients, the rate of prostate cancer was 14.6% (23 of 157), and that for a benign disease, including BPH, was 85.4% (134 of 157). The rates of prostate cancer according to prostate volume (PV) were 20.6 (22 of 107) and 2.0% (1 of 50) in those with a PV80ml, respectively. In the men with one benign biopsy, cancer was not found in 61 (23 with a prostatectomy and 38 with a re-biopsy) and 112/134 (83.6%) had normalized PSA after 1 year.
CONCLUSIONS
A statistically significant difference was noted in the profile of a prostate biopsy for cancer according to the prostate volume. We concluded that the majority of LUTS/BPH men with a prostate volume over 80ml have PSA elevation due to BPH or another benign prostate disease, not related to cancer. For patients with negative DRE and TRUS findings, a large prostate (>80ml) and elevated prostate-specific antigen (PSA), over 4ng/ml, watchful waiting, with PSA follow up and BPH treatment, may be a suitable option.