PSA repeatedly fluctuating levels are reassuring enough to avoid biopsy?
BACKGROUND
Prostate-specific antigen (PSA) levels can show wide fluctuations when repeatedly measured. Here we investigatewd if: (a) biopsy timing influences the prostate cancer (PC) detection rate in patients with fluctuating PSA (flu-PSA) in comparison with patients with steadily increasing PSA (si-PSA); (b) PSA slope estimated in patients with flu-PSA predicts a different risk of cancer detection; (c) flu-PSA and si-PSA patients develop PC in topographically different sites; (d) the behaviour of pre-operative PSA is an expression of a disease with defferent characteristics to the following radical prostatectomy.


METHODS
The study involved 211 patients who underwent at least a second biopsy after a first negative prostate biopsy. PSA Slope, PSA velocity (PSAV) and PSA doubling time (PSADT) were estimated. Flu-PSA level was defined as a PSA series with at least one PSA value lower than the one immediately preceding it.


RESULTS
82 patients had flu-PSA levels and 129 si-PSA levels. There were no significant differences between the two groups in terms of cancer detection, clinical or pathological stage, but the si-PSA group with cancer had a higher Gleason score. No difference was found for PSA Slope between flu-PSA patients with cancer and those without.


CONCLUSIONS
Our study demonstrates no difference in PC detection rate at repeat biopsy between patients with flu or si-PSA levels. PSA Slope, PSAV and PSADT were not found helpful tools in cancer detection.
Taverna
Gianluigi
G
Department of Urology Service, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy. gianluigi.taverna@humanitas.it
Grizzi
Fabio
F
Minuti
Francesco
F
Seveso
Mauro
M
Piccinelli
Alessandro
A
Giusti
Guido
G
Benetti
Alessio
A
Maugeri
Orazio
O
Pasini
Luisa
L
Zandegiacomo
Silvia
S
Colombo
Piergiuseppe
P
Di Biccari
Sonia
S
Graziotti
Pierpaolo
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D015203:Reproducibility of Results
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen