Follow-up of men with elevated prostate-specific antigen and one set of benign biopsies at prostate cancer screening.
OBJECTIVE
To study the follow-up of men with elevated prostate-specific antigen (PSA) (>3 ng/ml) after one benign set of sextant biopsies. From the Göteborg branch of the European Randomised Study of Screening for Prostate Cancer (ERSPC).


METHODS
456 men with one set of benign sextant biopsies were followed every second year for 4 years with PSA determinations. In cases of elevated PSA, transrectal ultrasound (TRUS) guided sextant biopsies were suggested. Digital rectal examination (DRE), prostate volume, PSA, PSA density (PSAD) and the ratio between free and total PSA (PSA F/T) were recorded.


RESULTS
Complete data were available for 322 men. 3 groups were identified. In 84/322 (26%) men cancer was found ("cancer" group). 182/322 (56%) had benign biopsies ("benign" group) and 56/322 (17%) had normalised PSA ("normalised PSA" group). Median prostate volumes were 36, 46, and 33 cc respectively in the three groups. DRE and/or TRUS were abnormal in only 30% of the men in all groups. Cancer was not found in any prostate >70 cc volume. In prostates of <20 cc either cancer was found or PSA was normalised. The "normalised PSA" group had initial PSA, PSAD and PSA F/T similar to cancer, normalising during follow-up.


CONCLUSIONS
Patients with one negative sextant biopsy still have a high likelihood of cancer, especially men with persistently elevated PSA and small prostates (<20 cc) while the majority of men with large prostates (>70 cc) have PSA elevation due to benign prostate hyperplasia (BPH) and not to cancer.
Zackrisson
Björn
B
Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. bjorn.zackrisson@lundbysjukhus.se
Aus
Gunnar
G
Lilja
Hans
H
Lodding
Pär
P
Pihl
Carl-Gustaf
CG
Hugosson
Jonas
J
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001707:Biopsy, Needle; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D010173:Palpation / Q000379:methods; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D012680:Sensitivity and Specificity; D013548:Sweden / Q000453:epidemiology
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen