Naslov
Repeated biopsy: limitations of prognostic factors in everyday clinical practice

Autori
Šimunović, Dalibor ; Galić, Josip

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
European Urology Supplements / - , 2011

Skup
11th Central European Meeting

Mjesto i datum
Temišvar, Rumunjska, 28.10.2011. - 29.10.2011

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
biopsy; repeated; limitations; prognostic

Sažetak
Introduction Prostate biopsy is procedure for acquiring definite diagnosis of prostate cancer. If inconclusive, indications for repeated prostate biopsy are not so clear. Free to total PSA ratio, PSA velocity, PSA density, transition zone PSA density and some new markers are tested (PCA3 as most promising and widely used), but still waiting conformation as best add-on to PSA and rectal examination in decision when to repeat prostate biopsy. All mentioned plus extended biopsy, saturation biopsy or even prostate biopsy under MRI is recommended for repeated biopsy, with significant morbidity and black shadow of (over)diagnosing insignificant prostate cancer. Our study investigated results of our patients undergoing repeated biopsy. Patients Of 2583 prostate biopsies done from 2000 to 2010 in this study we included 102 patients from 2008 to 2010 in whom first or repeated prostate biopsy was done (241 biopsies total, up to 5 biopsies). Inclusion criteria were normal rectal examination and elevated PSA (age adjusted, family history considered). 12 core prostate biopsy was used for all biopsies, no MRI guidance, no saturation biopsies, and all biopsies as outpatient procedure without anesthesia. We analyzed PSA, PSA velocity, presence of high grade PIN (HgPIN), ASAP, presence of inflammation (chronic prostatitis - CP) and correlation of this variables to outcome of prostate biopsy. Results Prostate biopsy followed with repeated prostate biopsy was done in 103 patients, making total of 241 biopsies, or 2.3 biopsies per patient, up to 5 biopsies in 3 patients. In initial biopsy average PSA was 8.13 ng/ml, HgPIN was present in 54% of cases, ASAP in 9, 7% of cases and CP in 55% of cases. Results for second biopsy are as follows: of 103 patients 82 had benign prostate hyperplasia (BPH) with average PSA of 9.68 ng/ml, HgPIN in 26%, ASAP in 4% and CP in 65% of cases. PSA velocity for this group was 2.51 ng/ml/year. Prostate cancer was found in 20 patients (20% detection rate) with average PSA 9.13 ng/ml, PSA velocity 2.08 ng/ml/year. HgPIN was found in 43%, ASAP in 5%, no CP and 8 cases of prostate cancer were insignificant. Significantly more patients with BPH had CP (p=0.001), with no difference in rate of HgPIN (p=0.193) or ASAP (p=0.608). Third biopsy was done in 26 patients, with prostate cancer in 8.3% and fourth biopsy in 6 patients. Conclusion In our clinical experience from prostate biopsy patients referred to our Department we found that neither PSA, PSA velocity, nor presence of HgPIN or ASAP at first biopsy is associated with higher detection rate of prostate cancer on repeated biopsy. Chronic inflammation is present in higher proportion in BPH patients, as recent proposal on inflammation theory in evolution of BPH suggested, and could be predictor of BPH at repeated biopsy.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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