title: Rising PSA in patients with minor LUTS without evidence of prostatic carcinoma: a missing link?
abstract: OBJECTIVE
  To determine the role of pressure flowmetry in patients without bothersome lower urinary tract symptoms (LUTS), rising prostate-specific antigen (PSA) levels and diagnosed as having clinical benign prostatic hyperplasia (BPH) after negative (multiple) extended multi-site biopsy.
  
  
  METHODS
  The study enrolled patients with minor LUTS who were referred to our urological practice by their general practitioner because of a rising PSA level (>/=4 ng/ml). After exclusion of clinical prostatic carcinoma by digital rectal examination and transrectal ultrasound, all patients underwent at least one set of extended multi-site biopsies to exclude T1c prostate cancer. Patients with negative biopsies (clinical BPH) were subjected to pressure flowmetry whereafter those with bladder outlet obstruction underwent TURP.
  
  
  RESULTS
  The study included 82 patients, with a mean age of 64.8 years (50.2-78.2 years), satisfying the inclusion criteria. Urodynamic analysis showed that all patients had bladder outlet obstruction. After TURP, eight patients (9.8%) were diagnosed as having histologically proven prostate cancer; 74 patients (90.2%) were diagnosed as having BPH. Patients of the BPH group had a mean preoperative PSA level of 8.8 ng/ml (4.3-25.8 ng/ml) and a mean international prostate symptom score of 8.8 (2-18). The mean detrusor pressure at maximum flow in BPH patients was 89.5 cmH(2)O (20-200 cmH(2)O).
  
  
  CONCLUSIONS
  An increased PSA in patients with minor or no LUTS, clinical BPH and negative extended multi-site prostate biopsy is strongly correlated to bladder outlet obstruction. Therefore, patients with these characteristics should be treated with TURP.
authors.affiliation: Department of Urology, Virga Jesse Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium. koenraad.van.renterghem@ageingmaleclinic.be
authors.forename: Koenraad
authors.initials: K
authors.lastname: van Renterghem
authors.forename: Gommert
authors.initials: G
authors.lastname: Van Koeveringe
authors.forename: Philip
authors.initials: P
authors.lastname: Van Kerrebroeck
mesh_terms: D000368:Aged; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000601:surgery; D011471:Prostatic Neoplasms / Q000097:blood; D012189:Retrospective Studies; D020728:Transurethral Resection of Prostate; D014563:Urodynamics
chemical_list: D017430:Prostate-Specific Antigen