title: Follow-up of men with elevated prostate-specific antigen and one set of benign biopsies at prostate cancer screening.
abstract: 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.
authors.affiliation: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. bjorn.zackrisson@lundbysjukhus.se
authors.forename: Björn
authors.initials: B
authors.lastname: Zackrisson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Aus
authors.forename: Hans
authors.initials: H
authors.lastname: Lilja
authors.forename: Pär
authors.initials: P
authors.lastname: Lodding
authors.forename: Carl-Gustaf
authors.initials: CG
authors.lastname: Pihl
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen