title: PSA repeatedly fluctuating levels are reassuring enough to avoid biopsy?
abstract: 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.
authors.affiliation: Department of Urology Service, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy. gianluigi.taverna@humanitas.it
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Taverna
authors.forename: Fabio
authors.initials: F
authors.lastname: Grizzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Minuti
authors.forename: Mauro
authors.initials: M
authors.lastname: Seveso
authors.forename: Alessandro
authors.initials: A
authors.lastname: Piccinelli
authors.forename: Guido
authors.initials: G
authors.lastname: Giusti
authors.forename: Alessio
authors.initials: A
authors.lastname: Benetti
authors.forename: Orazio
authors.initials: O
authors.lastname: Maugeri
authors.forename: Luisa
authors.initials: L
authors.lastname: Pasini
authors.forename: Silvia
authors.initials: S
authors.lastname: Zandegiacomo
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Colombo
authors.forename: Sonia
authors.initials: S
authors.lastname: Di Biccari
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Graziotti
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen