title: Patients with Persistently Elevated PSA and Negative Results of TRUS-Biopsy: Does 6-Month Treatment with Dutasteride can Indicate Candidates for Re-Biopsy. What is the Best of Saturation Schemes: Transrectal or Transperineal Approach?
abstract: To identify patients who actually need a re - biopsy, based on alterations in PSA readings after 6-month treatment with Dutasteride. We also sought to bring out the most beneficial re-biopsy scheme. We have reviewed the records of patients with persistently elevated PSA and at least one set of TRUS biopsies. Patients who were treated with alpha -blockers/Dutasteride combination were considered as the study group, while patients in control received alpha-blockers alone. Patients in both groups underwent re-biopsy 6 months later. The two protocols of re-biopsies were used at that time: 20-24 cores saturation transrectal (ST)) and ≥ 40 cores saturation transperineal template-guided (STT) biopsies. One hundred thirty-three patients were included in this study. In 86.7 % of the patients in the study group mean PSA decreased from 7.4 ± 2.69 to 4.037 ± 1.53 (p-0.001). The overall cancer detection rate was 29 % (n-39: 19 v/s 20, control and study groups, respectively). In the study group PSA decreased to 26.73 ± 11.26 % in patients with cancer, compared with 40.54 ± 13.3 % in patients without. It must be emphasized that STT-biopsies detected significantly more cancers (38.46 v/s 20.59 %, p- 0.005). Mean cores number got to 21 ± 2.45 and 45 ± 5.65 in ST and STT biopsies, respectively. Six-month treatment with Dutasteride decreases PSA readings in 86.7 % of the patients. A PSA decline of less than 40% (cutoff) should be considered as an indicator for re-biopsy. Transperineal template-guided biopsies had a higher cancer detection rate.
authors.affiliation: Barziali Medical Center, Urology Department, Ashkelon, Israel, kravchick.sergey@gmail.com.
authors.forename: Sergey
authors.initials: S
authors.lastname: Kravchick
authors.forename: Leonid
authors.initials: L
authors.lastname: Lobik
authors.forename: Shmuel
authors.initials: S
authors.lastname: Cytron
authors.forename: Yakov
authors.initials: Y
authors.lastname: Kravchenko
authors.forename: David Ben
authors.initials: DB
authors.lastname: Dor
authors.forename: Ronit
authors.initials: R
authors.lastname: Peled
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D000368:Aged; D014408:Biomarkers, Tumor; D001707:Biopsy, Needle; D000068538:Dutasteride / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D058891:5-alpha Reductase Inhibitors; D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen; D000068538:Dutasteride