Prostate biopsy in subjects with abnormal transrectal ultrasonography but normal digital examination findings and prostate-specific antigen levels |
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Authors: | Hong Bang Shim Sang Eun Lee Hyoung Keun Park Ja Hyeon Ku |
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Institution: | (1) Department of Urology, Seoul Veterans Hospital, Seoul, Korea;(2) Department of Urology, Seoul National University College of Medicine, Seoul, Korea;(3) Department of Urology, DongGuk University International Hospital, Goyang, Korea;(4) Department of Urology, Seoul National University Hospital, 28, Yongon dong, Jongno Ku, Seoul, 110-744, South Korea |
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Abstract: | Aim The aim of the present study was to evaluate the value of transrectal ultrasonography (TRUS) for prostate cancer diagnosis
in men with no other indication for biopsy, such as an abnormal digital rectal examination or abnormally high prostate-specific
antigen (PSA) levels.
Materials and methods The study cohort contained a total of 104 men aged 41–78 years (median 62.5 years) who had suspicious findings on TRUS. The
median prostate volume of the patients was 33.0 ml (range 15.0–90.9) and the serum PSA ranged from 0.2 to 4.0 ng/ml (median
2.5 ng/ml).
Results Of 104 men, 12 (11.5%) were diagnosed with prostate cancer on initial biopsy. The positive predictive value (PPV) was 3.7%
for PSA 0.1–1.0 ng/ml, 4.8% for PSA 1.1–2.0 ng/ml, 16.7% for PSA 2.1–3.0 ng/ml and 18.4% for PSA 3.1–4.0 ng/ml. The PPV for
cancer with Gleason score 7 or higher was 0.0%, 0.0%, 16.7% and 7.9%, respectively. No statistically significant differences
in patient characteristics and biopsy results were found between patients who received only systemic biopsy and those who
received systemic plus lesion-directed biopsies.
Conclusion The results of this study do not provide a rationale to recommend the additional use of lesion-directed biopsy in patients
with suspicious lesions at TRUS but with no other indication for biopsy. Furthermore, our data raise the question of whether
serum PSA levels lower than 4.0 ng/ml should be considered normal in Asian men. |
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Keywords: | Prostate biopsy Prostate-specific antigen Digital rectal examination Prostate cancer |
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