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KMID : 1001020220200030177
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Journal of Urologic Oncology
2022 Volume.20 No. 3 p.177 ~ p.185
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Delaying a Biopsy With Serial Prostate-Specific Antigen Checkup Helps to Identify a Significant Prostate Cancer: A Strategy to Evade Unnecessary Procedures
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Ko Young-Hwii
Kim Byung-Hoon
Jung Won-Ho
Ha Ji-Yong
Shin Teak-Jun
Kwon Se-Yun
Jung Hyun-Jin
Hah Yoon-Soo
Kim Tae-Hyo
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Abstract
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Purpose: To differentiate a non-cancer-related temporary increase in prostate-specific antigen (PSA) triggering unnecessary biopsy, we intentionally delayed biopsy with a serial follow-up, then investigated the efficacy of this strategy in identifying a significant prostate cancer (PCa).
Materials and Methods: Retrospective data of patients who initially presented with a suspicious level of serum PSA (3?20 ng/mL), managed using the delayed strategy, and then eventually underwent biopsy were obtained from 4 tertiary centers between 2018?2020.
Results: The collected 271 subjects had a median (interquartile range) PSA, age, and prostate volume of 5.03 ng/mL (4.46?7.79 ng/mL), 67 years (61?73 years), and 38 g (28?50 g), respectively. During the delay period of 8 weeks (4?19 weeks), most were managed with alpha-blockers (85.6%, n=232). Ninety-four (34.7%) experienced a PSA decrease of 20.53% (8.82?38.16). Eventual biopsy revealed 115 PCa cases (42.5%) including 82 significant ones and 46 high-risk diseases. Men with a PSA decrease had a lower probability of PCa (31.9% vs. 48%, p=0.014), a significant disease (21.3% vs. 35.0%, p=0.026), and high-risk PCa (7.4% vs. 22.0%, p=0.002) than the PSA-elevated counterparts. However, the degree of PSA decrease was not associated with the presence or the severity of PCa. In patients with PSA normalization (≤3 ng/mL), though 4 patients of them (66%) had PCa including a single significant disease, none had high-risk disease.
Conclusions: About one-third of individuals initially indicated for transrectal biopsy experienced a decrease in PSA, and their chance for significant PCa was diminished. This retrospective study suggests PSA normalization could be an acceptable notion, though requires further investigation.
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KEYWORD
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Prostate cancer, Prostate biopsy, Significant prostate cancer
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