Korean J Urol.  2012 Feb;53(2):82-86.

Is Prostate Biopsy Essential to Diagnose Prostate Cancer in the Older Patient with Extremely High Prostate-Specific Antigen?

• Jang JY
• Kim YS

Abstract

PURPOSE
The results of all prostate biopsies may be positive and suggestive of adenocarcinoma in patients with prostate-specific antigen (PSA) values higher than 100 ng/ml. We considered that the prostate cancer in patients with high PSA might be advanced disease and therefore that the treatment strategy should not be changed according to pathological reports. Thus, we assessed the role of prostate biopsy when diagnosing prostate cancer in patients with extremely high PSA levels.
MATERIALS AND METHODS
We reviewed the records of 1,150 cases undergoing prostate biopsies. Patients with urinary tract infection and acute urinary retention were excluded. According to the pre-biopsy PSA level, patients were divided into 6 groups (group A, 4 to 20 ng/ml; B, 20 to 40 ng/ml; C, 40 to 60 ng/ml; D, 60 to 80 ng/ml; E: 80 to 100 ng/ml; and F, above 100 ng/ml).
RESULTS
The calculated positive predictive value (PPV) for prostate cancer was 22% in group A, 54% in group B, 73% in group C, 75% in group D, 89% in group E, and 100% in group F, respectively. Pathological diagnosis was adenocarcinoma in all patients in group F (n=56). Among them, 38 patients (67.9%) had lymph node metastasis or extra-prostatic disease or both and 43 patients (76.8%) had bony metastasis. In group F, all cases were advanced prostate cancer (stage III or IV). All of them received hormonal therapy following diagnosis.
CONCLUSIONS
We suggest the possibility for biopsy-free diagnosis of prostate cancer in patients with extremely high levels of serum PSA and evidence of advanced disease in imaging studies, especially in older patients with comorbid medical problems.

Keyword

Adenocarcinoma; Biopsy-free diagnosis; Prostate; PSA

MeSH Terms

Adenocarcinoma
Biopsy
Humans
Lymph Nodes
Neoplasm Metastasis
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Urinary Retention
Urinary Tract Infections
Prostate-Specific Antigen

Figure

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  FIG. 1 Positive predictive values according to prostate-specific antigen (PSA) range.

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  FIG. 2 The percentage of high-grade cancers (Gleason score ≥8). PSA, prostate-specific antigen.

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