Prostate biopsy in subjects with abnormal transrectal ultrasonography but normal digital examination findings and prostate-specific antigen levels.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Shim
Hong Bang
HB
Department of Urology, Seoul Veterans Hospital, Seoul, Korea.
Lee
Sang Eun
SE
Park
Hyoung Keun
HK
Ku
Ja Hyeon
JH
D000328:Adult; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D019160:Endosonography; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012007:Rectum; D018709:Statistics, Nonparametric
D017430:Prostate-Specific Antigen