[Prognostic significance of "sawtooth" PSA and "stepwise" PSA].
OBJECTIVE
To evaluate the risk of diagnosing prostate cancer on repeated biopsies in patients with fluctuating PSA values compared to patients with stable or regularly increasing PSA values.


METHODS
Retrospective study conducted on the 2000-2003 databases of 2 French teaching hospitals. Selected patients had a first negative prostatic biopsy, then at least one other series of prostatic biopsies. "Sawtooth" PSA was defined by a PSA value less than that of the previous assay. Other cases were described as "stepwise" PSA.


RESULTS
191 patients were included: 79 in the "sawtooth" group and 112 in the "stepwise" group. Prostate cancer was diagnosed in 53 patients (27.7%), on the second prostatic biopsy 39 cases. Prostate cancer was detected in 17 (21.5%) of the 79 patients of the "sawtooth" group. This proportion was not significantly different (p = 0.14) from that observed in patients of the "stepwise" group: 36/112 (32.1%). No significant difference in terms of age, stage, Gleason score and initial PSA was observed between patients with a diagnosis of prostate cancer in the "sawtooth" and "stepwise" groups.


CONCLUSIONS
In our study, the risk of diagnosing prostate cancer on repeated prostatic biopsies was not greater in patients with "stepwise" PSA compared to patients with "sawtooth" PSA.
Celhay
Olivier
O
Service d'Urologie, CHU de Poitiers, France. olivecelhay@hotmail.com
De La Taille
Alexandre
A
Salomon
Laurent
L
Doré
Bertrand
B
Abbou
Claude Clément
CC
Irani
Jacques
J
D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies
D017430:Prostate-Specific Antigen