[Clinical course of patients with negative initial prostate biopsy].
Of 227 men with a negative initial biopsy, the clinical course of 99 men who could be regularly followed using prostate specific antigen (PSA) determination was retrospectively analyzed. A repeat biopsy was recommended if the men showed persistent elevation of PSA > 10 ng/ml, PSA velocity (PSAV) > 0.75 ng/ml/year, or persistent abnormality on digital rectal examination and/or transrectal ultrasonography. A repeat biopsy was performed on 43 men. Because of the indication for a repeat biopsy, the PSAV of the 43 men who received a repeat biopsy was higher than that of the 56 men who did not. Clinically organ-confined cancer was detected in 18 patients (detection rate 41.9%). The patients having cancer had a higher PSAV (median 1.950) than those without the disease (median 0.900). Of 19 men aged 75 years and older at the initial biopsy, a repeat biopsy revealed organ-confined cancers in 4 out of 10 men. During follow-up of the 19 elderly men, 11 developed co-morbid illnesses such as cerebral infarction, ischemic heart diseases and other malignancies, and 4 died of the diseases. Thus, PSAV seems to be the best parameter for a repeat biopsy. Elderly men may not benefit from a repeat biopsy because they are unlikely to have lethal prostate cancer and highly likely to develop co-morbid illness that would affect their life-span.
Nishida
Sachiyo
S
Department of Urology, Sapporo Medical University School of Medicine.
Masumori
Naoya
N
Fukuta
Fumimasa
F
Takahashi
Atsushi
A
Itoh
Naoki
N
Tsukamoto
Taiji
T
D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D002423:Cause of Death; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D014463:Ultrasonography
D017430:Prostate-Specific Antigen