The incidence of prostate cancer in a screening population with a serum prostate specific antigen between 2.5 and 4.0 ng./ml. Relation to biopsy strategy

Richard J. Babaian, Dennis A. Johnston, William Naccarato, Alberto Ayala, Vijaya A. Bhadkamkar, Herbert A. Fritsche

Research output: Contribution to journalArticle

130 Scopus citations

Abstract

Purpose: It has recently been suggested that the diagnostic threshold for the prostate specific antigen (PSA) assay be lowered to enhance prostate cancer detection. A 22% incidence of prostate cancer has been reported in men with PSA between 2.5 and 4.0 ng./ml. We designed a study to confirm this observation. Materials and Methods: Men who participated in our free early detection program and who had serum PSA between 2.5 and 4.0 ng./ml. were asked to undergo prostate biopsy. Of 268 eligible men 151 (56%) agreed to participate in this free trial. All men underwent biopsy using an 11-core multisite directed biopsy scheme. All biopsy cores were color coded for location specificity and examined by 1 pathologist. Results: Cancer was identified in 24.5% (37 of 151) of the men biopsied. The median age of men with cancer was 62 years (range 43 to 74). Conventional systematic sextant biopsies, which accounted for 6 of the 11 cores, detected 73.0% (27 of 37) of the cancers and the alternate site biopsies identified the remaining 10. Gleason score was 6 in 25 men, 3 + 4 in 5, 4 + 3 in 4 and 8 or greater in 3 (median Gleason score 6). There were 14 men who had 1 core positive for cancer, 9 had 2 and 14 had more than 2 (median number of positive cores 2). Of the 14 men with 1 positive core 11 had a less than 3 mm. focus of cancer and 8 had only a positive alternate site biopsy. There were 11 cases of abnormal results on digital rectal examination, 5 of which were cancer, and 31 cases of abnormal results on ultrasonography, 13 of which were cancer. Median biological variability in PSA was ± 15% (range 0.4% to 440.0%). Conclusions: We found a significant incidence of cancer (24.5%, 37 of 51) in men with serum PSA between 2.5 and 4.0 ng./ml. In our study 67.6% of the detected cancers were significant based on the biopsy data. If the PSA threshold is lowered the conventional systematic sextant technique may be preferable to an extended strategy.

Original languageEnglish (US)
Pages (from-to)757-760
Number of pages4
JournalJournal of Urology
Volume165
Issue number3
DOIs
StatePublished - 2001

Keywords

  • Biopsy
  • Incidence
  • Mass screening
  • Prostate-specific antigen

ASJC Scopus subject areas

  • Urology

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