Optimal Predictors of Prostate Cancer on Repeat Prostate Biopsy: A Prospective Study of 1,051 Men

Hemospermia is known to be associated with transrectal ultrasound-guided prostate biopsy (TRUS-PB). The true incidence of hemospermia, its duration and implications are not well established. We performed a prospective observational study involving patients undergoing TRUS-PB for suspected prostate cancer at our institution. Sixty-three eligible men were included in the study. Most men (84%) undergoing TRUS-PB, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 3.5 (71.7) weeks. The number of ejaculations before the complete resolution of hemospermia was 8 (76.7). None of the clinical and pathological factors was a significant predictor of the duration of hemospermia. Patients should be adequately counseled before TRUS-PB to avoid undue anxiety and alterations in sexual activity.

Section: Discussionmentioning

confidence: 99%

Hemospermia following transrectal ultrasound-guided prostate biopsy: a prospective study

Manoharan

Ayyathurai

Nieder

et al. 2007

“…Additionally, several other prostate cancer markers including percent free PSA, PSA velocity and PSAD of the transition zone have been suggested as highly sensitive and specific for prostate cancer. [19][20][21][22] These values were unavailable in these data, but addition of these factors to the nomogram may have further improved its diagnostic accuracy. Additionally, validation of our nomogram in the same cohort in which it was developed may be problematic with regard to overfit bias, and the need for external validation is clear.…”

Section: Discussionmentioning

confidence: 99%

Utility of PCA3 in patients undergoing repeat biopsy for prostate cancer

Reese

Cooperberg

et al. 2011

BACKGROUND: Men with persistently elevated and/or rising PSA levels after negative prostate biopsy often undergo multiple repeat biopsies. Prostate cancer antigen 3 (PCA3) has emerged as a predictor of prostate cancer. METHODS:We sought to define the utility of PCA3 in combination with other clinical data in predicting the risk of prostate cancer on repeat biopsy. We retrospectively obtained PCA3, PSA, PSA density (PSAD), digital rectal examination (DRE) and transrectal ultrasound (TRUS) findings from 103 patients at a single institution who had at least one prior negative prostate biopsy. The sensitivity and specificity of PCA3 in detecting prostate cancer was determined. Receiver operating characteristics curves were produced for each variable individually and in multivariable analysis, controlling for PCA3, PSAD, TRUS, PSA and DRE. A nomogram was created, internally validated and compared to another recently published nomogram. RESULTS:Of the 103 patients, 37 (31%) had prostate cancer on repeat biopsy. The sensitivity and specificity of PCA3 (using a cut point of 25) was 0.67 and 0.64, respectively. In multivariable analyses, PCA3 was independently associated with prostate cancer (odds ratio: 1.02, 95% confidence interval: 1.01-1.04), with area under the curve (AUC) of 0.64. A multivariable model containing PCA3, PSAD, PSA, DRE and TRUS findings showed the most diagnostic accuracy (AUC: 0.82). CONCLUSIONS:In the setting of prior negative biopsies, PCA3 was independently associated with prostate cancer in a multivariable model. In combination with other clinical data, PCA3 is a valuable tool in assessing the risk of prostate cancer on repeat biopsy.

“…15 indirectly demonstrated the problem of not performing laterally directed biopsies. In their study of 1051 men, eight biopsies were obtained including six of the sextant format and two of the TZ.…”

Section: Biopsy Techniquementioning

confidence: 99%

“…While initial evaluation of this issue revealed an increased false-negative rate in biopsies for those with increased volumes, further studies have yielded mixed results. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] These studies have also addressed the need for extended biopsy schemas in larger volume prostates. Ung et al 18 demonstrated no statistical difference in CaP detection rates in patients undergoing increased numbers of biopsies beyond nine cores.…”

Section: Biopsy Techniquementioning

confidence: 99%

Determining variables for repeat prostate biopsy

Busby

Evans

2004

During the evaluation of prostate cancer, men who have undergone transrectal ultrasound-guided biopsy with negative results present a dilemma as to what further follow-up is required. Multiple variables have been proposed throughout the literature to improve cancer detection rates not only in initial biopsy results, but also on repeat evaluation. These variables include prostate-specific antigen (PSA) velocity, PSA density, free-percent PSA, and histological findings, each of which may singly or collectively dictate the need for further biopsy. After performing a Medline literature search using specific Medical Subject Headings (prostate biopsy, repeat prostate biopsy, PSA velocity, PSA density, free-percent PSA, prostate inflammation), we critically evaluated pertinent articles. Using this accumulated data and information, we composed an algorithm to assist in the decision process for repeat biopsy.