Rising PSA in patients with minor LUTS without evidence of prostatic carcinoma: a missing link?

Renterghem, Koenraad van; Koeveringe, Gommert van; Kerrebroeck, Philip Van

doi:10.1007/s11255-007-9209-7

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…It has subsequently been shown that patients with minor or no LUTS undergoing PBx because of an elevated serum PSA and being diagnosed with benign prostate all had BOO on pressure uroflowmetry. 11 …”

Section: Introductionmentioning

confidence: 99%

Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy

et al. 2016

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The purpose of this study was to investigate the relationship between bladder outlet obstruction (BOO) and the risk of being diagnosed with prostate cancer (PCa).Study population consisted of 2673 patients scheduled for the first prostate biopsy (PBx). All patients underwent uroflowmetry before PBx; those with a peak flow rate (PFR) <10 mL/s were considered to have BOO.The incidence of PCa was 41.3% (1104/2673) in the overall population and 34.1% (659/1905) in patients with serum prostate-specific antigen (PSA) ≤ 10 ng/mL. Univariate and multivariate logistic regression analyses showed that patients with BOO had a significantly (P < 0.0001) lower risk than those without BOO of being diagnosed with PCa (33.1% vs 66.9% in the overall population; 30% vs 70% in patients with PSA ≤ 10 ng/mL). As the presence of BOO was significantly correlated to a large prostate volume, another independent predictor of PBx outcome, we tested whether these parameters could be used to identify, in the subset of patients with PSA≤10 ng/mL, those who could potentially be spared from a PBx. If we would have not biopsied patients with BOO and prostate volume ≥60 mL, 14.5% of biopsies could have been avoided while missing only 6% of tumors. Only 10% of the tumors that would have been missed were high-risk cancers.In conclusion, in men undergoing PBx, the absence of BOO, as determined by a PFR ≥10 mL/s, is an independent risk factor for PCa. Our study provides ground for this simple, noninvasive, objective parameter being used, alone or in combination with prostate volume, in the decision-making process of men potentially facing a PBx.

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Section: Introductionmentioning

confidence: 99%

Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy

et al. 2016

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“…In our study, a suspicious PSA velocity ranging between 1.1 and 7.0 ng/ml/ year (with a mean of 3.0 ng/ml/year) was measured in 20 patients in both groups, but the subsequent biopsies were negative. This implies that, in addition to the PSA levels [3] , the PSA velocity can be a parameter for BOO. Altogether, when the PSA level is elevated or rising, and/or the PSA density is elevated and/or the PSA velocity is pathological, negative extended (multi-site) biopsies suggest the presence of BOO.…”

Section: Discussionmentioning

confidence: 99%

“…We have shown that in those patients, bladder outlet obstruction (BOO) can be the reason for elevated and/or rising PSA levels [3] . We also demonstrated that after performing a diagnostic transurethral resection of the prostate (TURP), BPH is encountered in most of these patients (90.2%) [4] .…”

Section: Introductionmentioning

confidence: 99%

Long-Term Clinical Outcome of Diagnostic Transurethral Resection of the Prostate in Patients with Elevated Prostate-Specific Antigen Level and Minor Lower Urinary Tract Symptoms

Renterghem

Koeveringe²,

Achten³

et al. 2009

Urol Int

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Introduction: In patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels and (multiple) negative multi-site biopsies, therapy decision is complex. Long-term outcome of a diagnostic transurethral resection of the prostate (TURP) in these patients needs to be determined. Methods: We retrospectively evaluated patients with minor LUTS, elevated PSA levels (≥4 ng/ml) and no signs of prostate cancer. Patients with bladder outlet obstruction (BOO) underwent TURP. When TURP showed no malignancy, patients were annually evaluated by PSA testing and the International Prostate Symptom Score (IPSS). Results: The study included 82 consecutive patients satisfying the inclusion criteria. All patients underwent TURP. No malignancy was encountered in 74 patients (90.2%). Of this group, 36 patients were followed >3 years (mean 62.1 months). One patient (2.8%) showed a persistently rising PSA level with positive extended multi-site biopsies 4 years after TURP, implying further treatment. 35 patients (97.2%) had a permanent complete normalization of PSA levels (<4 ng/ml) together with normalized IPSS. Conclusions: We consider an elevated PSA level in patients with minor LUTS and (multiple) negative multi-site biopsies as a sign of BOO. If these patients receive a diagnostic TURP, long-term outcome is excellent.

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“…In our series of studies [4, 70–72], we included a population with very specific characteristics that are notwithstanding regularly encountered in a urological practice. Therefore, we investigated patients with elevated and/or rising PSA, minor LUTS, negative DRE and TRUS, and (multiple) negative extended prostate biopsies.…”

Section: What Has Been Suggested So Far To Deal With Those Patients?mentioning

confidence: 99%

“…More specifically, this will be the case if the patient suffers only minor LUTS. We have previously shown that this group of patients (patients with elevated/and or rising PSA levels, minor LUTS and no signs of prostate cancer) are likely to have bladder outlet obstruction (BOO) on pressure flowmetry according to Abram–Griffiths definition [3, 4]. Despite minor to no LUTS, transurethral resection of prostate (TURP) is a therapeutic option that can be offered to patients resulting in (super)normalisation of PSA levels, symptomatic benefit, and improvement of the quality of life.…”

Section: Introductionmentioning

confidence: 99%

A new algorithm in patients with elevated and/or rising prostate-specific antigen level, minor lower urinary tract symptoms, and negative multisite prostate biopsies

et al. 2009

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Patients with elevated and/or rising prostate-specific antigen (PSA), minor lower urinary tract symptoms (LUTS), and no evidence for prostate cancer on (multiple) extended prostate biopsies are a regularly encountered problem in urological practice. Even now, patients are seen with no objective explanation of this persistent elevated and/or rising PSA. So far, many strategic proposals have been elaborated and published to deal with this specific population including the use of different PSA derivates; applying different biopsy schemes—strategies—biopsy target imaging; diagnostic use of prostate cancer genes; and many more. In this review, we propose a new algorithm in which an urodynamic evaluation should be included since bladder outlet obstruction (BOO) can be expected. Once BOO is confirmed, a transurethral resection of the prostate (TURP) can be offered to these patients. This procedure will result in subjective and biochemical improvement and allows extensive histological examination. Current literature was reviewed with regard to this specific population. This research was performed using the commercially available Medline online search tools and applying the following search terms: “diagnostic TURP”; “elevated PSA”; and “prostate biopsy”. Furthermore, subsequent reference search was executed on retrieved articles.

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Rising PSA in patients with minor LUTS without evidence of prostatic carcinoma: a missing link?

Abstract: An increased PSA in patients with minor or no LUTS, clinical BPH and negative extended multi-site prostate biopsy is strongly correlated to bladder outlet obstruction. Therefore, patients with these characteristics should be treated with TURP.

Cited by 5 publications

References 31 publications

Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy

Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy

Long-Term Clinical Outcome of Diagnostic Transurethral Resection of the Prostate in Patients with Elevated Prostate-Specific Antigen Level and Minor Lower Urinary Tract Symptoms

A new algorithm in patients with elevated and/or rising prostate-specific antigen level, minor lower urinary tract symptoms, and negative multisite prostate biopsies

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