Can prostate cancer be predilected in BHP patients with elevated serum PSA negative initial sextant biopsy? A multivariate analysis study

ABSTRACT

Objective To define a predictor of prostate cancer in BPH patients with an intermediate PSA (4.1-10 ng/ml) and a negative initial sextant biopsy. Patients and Methods During 1999; 193 BPH patients with an intermediate PSA (4.1-10 ng/ml) underwent TRUS and sextant biopsy. The patients whose initial biopsies were negative for prostate cancer were re-evaluated by serum PSA every 6 months. A total of 76 patients were subjected to an extended 11-core biopsy in view of (1) PSA velocity ? 1 ng/ml/year; (2) a PSA rise to 10 ng/ml and (3) suspicious biopsy findings (atypical adenomatous hyperplasia or high-grade prostatic intraepithelial neoplasia). Overall; 160 patients were subjected either to TURP (n=127) or open prostatectomy (n=33). Results On initial sextant biopsy; prostate cancer was diagnosed in 22 out of 193 patients (11.4). The specificity of the sextant biopsy was 91.8and its positive predictive value (PPV) was 61.1. A repeat 11-core biopsy revealed prostate cancer in 11 out of 76 patients (14.5). The specificity of the 11-core biopsy was 95.4and its PPV was 78.6. Three cancers out of 160 (2) were discovered on definitive pathology. The PSA velocity cut-off point at 1.4 ng/ml/year and the PSA density cut-off point at 0.12 were optimal for the prediction of cancer using receiver operating characteristic curves. The multivariate analysis (stepwise logistic regression) revealed that PSA density (p=0.011); PSA velocity (p=0.002) and age (p=0.021) were the most significant predictors of cancer when the data were inserted as a continuous format. The sensitivity; specificity and overall accuracy of the model were 80; 98.7and 95.9; respectively. When the data were re-inserted as a coded format; PSA velocity and PSA density were the only predictors. All the analyzed risk factors (age; PSA; DRE; prostate echogenicity and PSA/TZ index) were excluded from the model. Conclusion PSA velocity and PSA density were the most significant predictors of prostate cancer in BPH patients with an intermediate PSA (4.1-10 ng/ml) and a negative initial sextant biopsy