title: The chances of subsequent cancer detection in patients with a PSA > 20 ng/ml and an initial negative biopsy.
abstract: Transrectal ultrasound (TRUS)-guided prostate biopsy is known to carry a significant false-negative rate, leading some patients to have multiple biopsies. We investigated cancer detection rates in patients with a PSA > 20 ng/ml and a negative initial biopsy. We reviewed our database of 2396 TRUS-guided biopsies done between 1997 and 2002 in order to give a follow-up of at least 6 years. PSA, PSA density (PSAD), PSA velocity (PSAV), prostate volume, and DRE findings were analysed in relation to cancer status. Of the patients, 388 (16%) had a PSA > 20 ng/ml, including 99 (26%) with benign biopsies. Of those, 67 were rebiopsied, including 19 (28%) with cancer on the first rebiopsy and four (6%) on further biopsies. PSAD, DRE, and volume significantly differed between rebiopsied patients with and without cancer (p < 0.05). Patients who present with a PSA > 20 ng/ml and have an initial negative biopsy have a high chance of malignancy being detected on a second biopsy. However, if a second biopsy is also negative, then the chances of subsequent biopsies showing signs of cancer are very low if the DRE is normal and particularly if the PSAD is >0.35 ng/ml/cm3.
authors.affiliation: Harold Hopkins Department of Urology, Royal Berkshire Foundation NHS Trust, London Road, Reading, RG1 5AN, UK. nadeemshaida@doctors.org.uk
authors.forename: Nadeem
authors.initials: N
authors.lastname: Shaida
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Jones
authors.forename: Navin
authors.initials: N
authors.lastname: Ravindranath
authors.forename: Peter R
authors.initials: PR
authors.lastname: Malone
mesh_terms: D001706:Biopsy / Q000379:methods*; D016208:Databases, Factual / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D006113:United Kingdom
chemical_list: D017430:Prostate-Specific Antigen