Clinical Predictive Factors in Patients with Prostate Cancer Diagnosed by Repeat Prostate Biopsy

Kwan Joong Joo; Chil Hun Kwon

doi:10.5534/kja.2011.29.1.62

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Joo and Kwon: Clinical Predictive Factors in Patients with Prostate Cancer Diagnosed by Repeat Prostate Biopsy

Original Article

Korean J Androl 2011;29(1):62-68.

Published online: 22 April 2011

DOI: https://doi.org/10.5534/kja.2011.29.1.62

Clinical Predictive Factors in Patients with Prostate Cancer Diagnosed by Repeat Prostate Biopsy

Kwan Joong Joo, Chil Hun Kwon

Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea

Received 3 December 201124 March 2011 Accepted 31 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated the predictive factors in patient with prostate cancer diagnosed by repeat prostate biopsy, where initial prostate biopsy results were negative for malignancy.

Materials and Methods

Between March 2000 and June 2007, 1280 men with suspected prostatic cancer underwent transrectal ultrasound guided needle biopsy of the prostate, with 148 (11.6%) diagnosed as having prostate cancer. Of 1132 men whose biopsy results were negative for malignancy, 655 whose prostate specific antigen (PSA) was elevated persistently underwent second biopsy, and 462 underwent third biopsy as the same course. Twelve core biopsies were performed in the majority of patients. To determine predictive factors, we evaluated prostate volume, serum PSA, percent free PSA, PSA density (PSAD), transition zone PSAD, PSA velocity (PSAV) and pathological report of previous biopsy between the men with cancer detection and the men with negative biopsy in second and third biopsy.

Results

Overall cancer detection rate was 16.3% (208/1280). From the first, second and third biopsies, the cancer detection rate were 11.6, 5.5 and 5.2%, respectively. There were significant differences in percent free PSA, transition zone PSAD, PSAV between cancer and negative biopsy groups after serial repeat biopsies (p＜0.05). Multivariate logistic regression analysis revealed that the transition zone PSAD, PSAV, and presence of either atypical small acinar proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN) in initial biopsy specimen were significant predictors for prostate cancer diagnosed by repeat biopsy.

Conclusions

Of the men with negative results on the first biopsy, 60 (5.4%) were diagnosed prostate cancer after serial biopsies. The transition zone PSAD, PSAV, and presence of either ASAP or HGPIN in initial biopsy specimen are predictable factors for prostate cancer detection on repeat biopsy.

Keywords: Prostate neoplasm, Needle biopsy, Prostate specific antigen, Prostatic intraepithelial neoplasia

REFERENCES

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Table 1.

Patients characteristics of repeat biopsy group (mean±SD)

	Initial biopsy		Second biopsy		Third biopsy
	Non Ca	CaP	Non Ca	CaP	Non Ca	CaP
No. of patients	1,132	148	619	36	438	24
Age (years)	68.1±6.7	67.9±7.1	68.5±7.0	68.3±6.8	68.4±6.3	69.0±5.8
Prostate volume (ml)	44.1±9.8	45.7±10.6	46.2±11.6	45.6±10.8	47.0±8.3	48.3±11.4
TZ volume (ml)	24.7±6.9	22.4±7.3	24.6±7.8	22.1±5.5	25.1±6.6	22.7±7.4
Serum PSA (ng/ml)	7.73 (median)	8.25 (median)	8.94±2.52	9.18±3.11	8.97±2.96	9.21±3.24
Percent free PSA	22.5±3.2∗	15.8±2.8∗	20.9±3.3^†	16.3±1.8^†	21.7±3.0^‡	14.6±1.7^‡
PSAD (ng/ml/cc)	0.19±0.03	0.21±0.05	0.20±0.04	0.21±0.02	0.20±0.04	0.19±0.04
PSAD_TZ (ng/ml/cc)	0.32±0.07∗	0.45±0.06∗	0.33±0.07^†	0.48±0.10^†	0.31±0.07^‡	0.42±0.10^‡
PSAV (ng/ml/yr)	0.97±0.27∗	1.96±0.34∗	1.23±0.28^†	2.07±0.51^†	0.83±0.31^‡	2.03±0.63^‡

SD: standard deviation, Non Ca: non cancer, CaP: prostate cancer, TZ: transition zone, PSA: prostate specific antigen, PSAD: prostate specific antigen density, PSAD_TZ: transition zone prostate specific antigen density, PSAV: prostate specific antigen velocity. ∗p＜0.01,

^† p＜0.01,

^‡ p＜0.01.

Table 2.

Results of biopsies in patients with prostate cancer diagnosed by initial and repeat biopsy

	Initial biopsy	Second biopsy	Third biopsy
No. of patients (%)	148 (11.6)	36 (5.5)	24 (5.2)
Biopsy cores
Sextant	4	0	0
Sextant＋2 cores	7	0	0
Twelve cores	137	36	24
Previous pathologic report
BPH	N/A	33	22
HGPIN	N/A	2	2
ASAP	N/A	1	0
Gleason score (%)
6	81 (54.7)	17 (47.2)	13 (54.1)
7	56 (37.9)	14 (38.9)	9 (37.5)
8	7 (4.7)	3 (8.3)	1 (4.2)
9	3 (2.0)	2 (5.6)	1 (4.2)
10	1 (0.7)	0 (0.0)	0 (0.0)

BPH: benign prostatic hyperplasia, HGPIN: high grade prostatic intraepithelial neoplasia, ASAP: atypical small acinar proliferation, N/A: not applicable.

Table 3.

Multivariate logistic regression analysis of potential predictors for prostate cancer diagnosed by repeat biopsy

Variables	Odds ratio	95% CI	p-value
Second biopsy
Age	0.988	0.939-1.040	0.650
PSAD_TZ (0.36 ng/ml/cc)	4.968	2.218-11.129	0.000
PSAV (1.32 ng/ml/yr)	9.467	3.577-25.057	0.000
ASAP or HGPIN	7.732	1.435-45.667	0.017
Third biopsy
Age	1.016	0.939-1.100	0.691
PSAD_TZ (0.33 ng/ml/cc)	4.377	1.565-12.242	0.005
PSAV (1.16 ng/ml/yr)	47.984	15.113-152.351	0.000
HGPIN	7.873	1.446-42.873	0.046

CI: confidence interval, PSAD_TZ: transition zone prostate specific antigen density, PSAV: prostate specific antigen velocity, ASAP: atypical small acinar proliferation, HGPIN: high grade prostatic intraepithelial neoplasia.

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