title: Histopathological findings in extended prostate biopsy with PSA < or = 4 ng/mL.
abstract: OBJECTIVE
  Cancer detection has been reported in up to 27% of patients when lowering the PSA cutoff to 2.5 ng/mL. Although this practice could increase the number of biopsies performed, it also could lead to more frequent detection of significant prostate cancers at an organ-confined stage and/or a less aggressive state. This study describes the incidence of malignancy and tumor characteristics in extended prostate biopsies with PSA <or= 4 ng/mL.
  
  
  METHODS
  Prostate biopsies from 1081 patients where examined, 275 (25.4%) patients had PSA level <or= 4 ng/mL.
  
  
  RESULTS
  Cancer was diagnosed in 32.0% and 35.7% of patients with PSA <or= 4 ng/mL and >4 ng/mL, respectively (p=0.906). The median Gleason score was 7 independent of PSA > or <or= 4 ng/mL (p=0.078). The median number of cores positive for tumor was 4 and 3, respectively, for PSA >4 ng/mL and PSA <or= 4 ng/mL (p=0.627). There was a difference in the total percent of tumors involving all cores, 11% and 7% for PSA > or <or= 4 ng/mL (p=0.042). Fifty-six patients underwent radical prostatectomy, 12 had PSA <or= 4 ng/mL. In both groups, a diagnosis of cancer was accurate with no differences in Gleason score, tumor volume or staging for both groups.
  
  
  CONCLUSIONS
  When PSA is below 4 ng/mL, cancer is detected in a proportion equal to the proportion diagnosed with a PSA >4 ng/mL, and tumor characteristics are similar between the two groups. Only clinically significant tumors were diagnosed following radical prostatectomy.
authors.affiliation: Laboratory of Medical Investigation-LIM55 University of Sao Paulo, USP, SP, Brazil. katiaramos@uol.com.br
authors.forename: Katia R
authors.initials: KR
authors.lastname: Leite
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Dall'Oglio
authors.forename: Adriana
authors.initials: A
authors.lastname: Sanudo
authors.forename: Luiz H
authors.initials: LH
authors.lastname: Camara-Lopes
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D016009:Chi-Square Distribution; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D018709:Statistics, Nonparametric; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D017430:Prostate-Specific Antigen