Are prostate biopsies mandatory in patients with prostate‐specific antigen increase during intravesical immuno‐ or chemotherapy for superficial bladder cancer?

Beltrami, P.; Ruggera, Lorenzo; Cazzoletti, Lucia; Schiavone, D.; Zattoni, Filiberto

doi:10.1002/pros.20790

Cited by 16 publications

(18 citation statements)

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“…It is most often asymptomatic, and the granulomas cannot be distinguished from prostate malignancy by digital rectal examination. It raises the serum PSA level in almost half of the patients [12,13], and the image features are similar to those of prostate malignancy as the lesion can appear as a hypoechoic region within the peripheral zone of the prostate on transrectal ultrasound [14] or as low signal intensity on T2-weighted imaging on magnetic resonance imaging (MRI) [15].…”

Section: Discussionmentioning

confidence: 97%

Granulomatous Prostatitis After Intravesical Bacillus Calmette-Guérin Instillation Therapy: A Potential Cause of Incidental F-18 FDG Uptake in the Prostate Gland on F-18 FDG PET/CT in Patients with Bladder Cancer

Kim

Lee

Choi

et al. 2015

Nucl Med Mol Imaging

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Purpose This study aimed to evaluate the possibility that Bacillus Calmette-Guérin (BCG)-induced granulomatous prostatitis can be a potential cause of benign F-18 FDG uptake. Methods A total of 395 bladder cancer patients who underwent F-18 FDG PET/CT (PET/CT) were retrospectively evaluated. Patients were divided into two groups according to BCG therapy status. Elapsed time after BCG therapy, serum PSA level, results of prostate biopsy, and the SUVmax and uptake pattern in the prostate gland were reviewed. For patients who underwent follow-up PET/CT, the changes in SUVmax were calculated. Results While 35 % of patients showed prostate uptake in the BCG therapy group, only 1 % showed prostate uptake in the non-BCG therapy group (p<0.001). Among 49 patients with FDG-avid prostate lesions, none had suspected malignancy during the follow-up period (median: 16 months). Five patients revealed granulomatous prostatitis on biopsy. The incidence of FDG-avid prostate lesions was significantly higher if the elapsed time after BCG therapy was less than 1 year compared to more than 1 year (p<0.001). Serum PSA was normal in 88 % of patients. All patients with incidental F-18 FDG uptake in the prostate gland showed focal or multifocal prostate uptake, and median SUVmax was 4.7. In 16 patients who underwent follow-up PET/CT, SUVmax was decreased in 14 patients (88 %) without treatment, and no patients demonstrated further increased prostate uptake (p<0.001). Conclusions BCG-induced granulomatous prostatitis can be a potential cause of benign F-18 FDG uptake, especially in those with a history of bladder cancer treated with BCG. In BCG-induced granulomatous prostatitis, focal or multifocal prostate uptake is frequently seen within 1 year after BCG therapy, and the intensity of prostate uptake is decreased on the follow-up PET/CT without any treatment.

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Section: Discussionmentioning

confidence: 97%

Granulomatous Prostatitis After Intravesical Bacillus Calmette-Guérin Instillation Therapy: A Potential Cause of Incidental F-18 FDG Uptake in the Prostate Gland on F-18 FDG PET/CT in Patients with Bladder Cancer

Kim

Lee

Choi

et al. 2015

Nucl Med Mol Imaging

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“…The best way to differentiate between these two entities is to measure PSA levels before initiation of therapy, and digital rectal examination (DRE). In a study performed by Beltrami et al [10] in the year 2008, 106 male patients who had undergone intravesical therapy, following BCG induction therapy, BCG levels increased in 41.6% of the patients, and PSA levels dropped to normal values 12 months after termination of the therapy.Ten patients had undergone prostate biopsies, and the results of the prostatic biopsy were reported as prostate cancer (n=1), and inflammatory process (n=9). In a study by Leibovici et al [11] performed in the year 2000, in 41.6% of the patients who had received 36 sessions of intravesical therapy PSA levels increased.…”

Section: Discussionmentioning

confidence: 97%

Granulomatous prostatitis diagnosed during intravesical BCG treatment

Okçelik

Soydan

Yılmaz

et al. 2014

Turkish Journal of Urology

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The histopathological report of the biopsy material retrieved from hyperemic areas of the bladder during control cystoscopy of a 70-year-old man who had a bladder cancer diagnosis three years previously, indicated the presence of a carcinoma in situ (CIS). Intravesical immunotherapy treatment was initiated. After severe symptoms of dysuria emerging during intravesical immunotherapy with BCG, the immunotherapy treatment dosage was lowered. His treatment was then discontinued due to the progression of symptoms. A biopsy was performed due to higher prostate spesific antigen (PSA) and digital rectal examination abnormalities which indicated granulomatous prostatitis. An antituberculosis treatment was initiated because the PPD test result was 25 mm and the QuantiFERON test was positive. After one month, the patient's PSA levels were reduced, and his clinical status improved. The symptoms of severe dysuria, sterile pyuria, abnormal digital rectal examination findings and high PSA levels during intravesical BCG treatment should remind us diagnosis of granulomatous prostatitis. It should not be forgotten that diagnosis of granulomatous prostatitis was established histopathologically, and the patient benefited from medical treatment.

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“…Beltrami et al [10] reported a progressive increase in serum PSA during early intravesical BCG instillations and a return to basal levels after several months. In the present study, 53 patients (89.8%) experienced an increase in serum PSA of 0.1–18.1 ng/ml after intravesical BCG instillation.…”

Section: Discussionmentioning

confidence: 99%

“…Adverse events are generally due to intravasation of live bacteria. Although clinically symptomatic granulomatous prostatitis (GP) reportedly affects 10% of patients after intravesical BCG instillation [9], it has been shown that levels of serum prostate-specific antigen (PSA) increase in up to 40% of BCG-treated patients, and return to baseline by 3–12 months post-treatment [10], [11]. Therefore, Beltrami et al reported that biopsy did not appear mandatory in patients with PSA increase after BCG instillation, even if a positive digital rectal exam (DRE) was detected [10].…”

Section: Introductionmentioning

confidence: 99%

Is Bladder Tumor Location Associated with Prostate Cancer Detection after Intravesical Bacillus Calmette-Guérin Instillation?

et al. 2014

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ObjectivesThe aim of this study was to evaluate the effect of bladder tumor (BT) location on prostate cancer (PCa) detection in patients with elevated PSA levels after intravesical BCG instillation.MethodsBetween February 2004 and January 2013 prostate biopsies were performed in 59 non-muscle invasive bladder cancer (NMIBC) patients whose PSA level were elevated (≥3 ng/ml) after a 6 week course of intravesical BCG (Oncotice, 12.5 mg in 50 ml normal saline). Differences in PCa detection according to the BT location [bladder neck and/or trigone (Group 1, n = 22) vs. other locations (Group 2, n = 37)] were evaluated. The Fisher's exact test and the Mann-Whitney U test were used to evaluate the association between categorical and continuous variables, respectively.ResultsA total of 14 patients (23.7%) were diagnosed with PCa. The mean ± standard deviation (SD) PSA before intravesical BCG instillation and prostate biopsy were 1.36±1.04 ng/ml in Group 1 and 1.09±1.12 ng/ml in Group 2 (P = 0.633), and 6.05±3.57 ng/ml in Group 1 and 5.13±3.88 ng/ml in Group 2 (P = 0.378), respectively. Interestingly, whereas PCa was detected upon biopsy in only one patient in Group 1 (4.5%), 13 cases were detected in Group 2 (35.1%) (P = 0.009).ConclusionsPCa detection after intravesical BCG was highly associated with BT location. Prostate biopsy should therefore be considered when PSA level is elevated after BCG instillation and his BT is located far from the bladder neck.

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Are prostate biopsies mandatory in patients with prostate‐specific antigen increase during intravesical immuno‐ or chemotherapy for superficial bladder cancer?

Cited by 16 publications

References 18 publications

Granulomatous Prostatitis After Intravesical Bacillus Calmette-Guérin Instillation Therapy: A Potential Cause of Incidental F-18 FDG Uptake in the Prostate Gland on F-18 FDG PET/CT in Patients with Bladder Cancer

Granulomatous Prostatitis After Intravesical Bacillus Calmette-Guérin Instillation Therapy: A Potential Cause of Incidental F-18 FDG Uptake in the Prostate Gland on F-18 FDG PET/CT in Patients with Bladder Cancer

Granulomatous prostatitis diagnosed during intravesical BCG treatment

Is Bladder Tumor Location Associated with Prostate Cancer Detection after Intravesical Bacillus Calmette-Guérin Instillation?

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