Serial Prostatic Biopsies in Men with Persistently Elevated Serum Prostate Specific Antigen Values

Abstract

The objective of this study was to determine the need for repeat prostatic biopsies in men whose initial biopsy results revealed no evidence of cancer or atypia. We evaluated 1,136 men who underwent 1 or more prostatic biopsies in a longitudinal prostate specific antigen (PSA) based prostate cancer screening study that called for biopsy if the serum PSA level was greater than 4.0 ng./ml. (Hybritech assay) and findings on rectal examination or ultrasonography were abnormal or suspicious for cancer. Of the 1,136 men who underwent prostatic biopsy 391 (34%) had prostate cancer on the initial biopsy. Of 427 men who had negative initial biopsy results, a persistent serum PSA level of greater than 4.0 ng./ml. and abnormal rectal or ultrasound examination findings 82 (19%) had cancer on biopsy 2. Of 203 men with persistent abnormalities 16 (8%) had cancer on biopsy 3 and 6 of 91 (7%) had cancer on biopsy 4 or later. Thus, 96% of the cancers were detected through either biopsy 1 or 2. The median initial PSA level, followup PSA levels and the yearly rate of change in PSA were significantly greater in men whose cancer was detected compared with those of men whose cancer was not detected (6.4 versus 5.4 ng./ml., 7.4 versus 6.6 ng./ml. and 1.1 versus 0.7 ng./ml. per year, respectively). There was a trend for a higher percentage of tumors detected through serial screening to be pathologically organ confined with those detected through initial screening (73% versus 62%, p = 0.07). We conclude that men with a persistently elevated serum PSA value after an initial negative prostatic biopsy should routinely undergo at least 1 repeat biopsy to exclude adequately the presence of detectable prostate cancer.

Influence of dioxin exposure upon levels of prostate-specific antigen and steroid hormones in Vietnamese men

“…Previous phases of the Vietnam Veterans Study suggested that exposure to Agent Orange is associated with an increased risk of prostate cancer (Zafar MB et al 2001;Justine L et al 2006;Chamie K et al 2008). A positive family history is also an important risk factor for prostate cancer and, therefore, increases PSA levels (Keetch DW et al 1994). …”

“…Moreover, several epidemiologic studies have reported that low levels of testosterone have an adverse effect on men with newly diagnosed prostate cancer (Messengill JC et al 2003;Schatzl G et al 2003). It is known that prostate cancer can elevate PSA levels (Keetch DW et al 1994). In addition, one study demonstrated that PSA production is associated with steroid hormone receptors (Yu H et al 1994).…”

The effect of finasteride on the prostate gland in men with elevated serum prostate-specific antigen levels

“…and to establish a model for the study of late-stage efficacy of potential chemopreventive agents for prostate carcinoma. We chose men with elevated serum PSA but no histological evidence of prostate cancer, as these men are at increased risk for the development of prostate carcinoma (Keetch et al 1994). These men also have a high incidence of high-grade PIN (Brawer.…”

“…Routine follow-up of these patients includes biannual PSA and annual repeat biopsy. The risk of finding cancer on repeat biopsy in these men has been estimated to be 15% (in a selected group of men with persistently elevated PSA) (Keetch et al, 1994).…”

“…we randomized a group of men at high risk for the development of prostate cancer. as evidenced by an elevated serum PSA (Keetch et al 1994). either to receive finasteride or simply be observed for 12 months.…”