Elevated serum PSA and abnormal prostatic echo pattern. Is prostate cancer a must?

ABSTRACT

To evaluate the distribution of malignant and non-malignant conditions in patients undergoing prostate needle biopsies and correlate the presence of malignancy to their sonographic pattern and PSA level. Over 3 years period from June 2006 till June 2009. 152 patients were included prospectively in the study. Their ages ranged between 57 years to 81 years with a mean age of 68.94 years +/- 8.41 years. Inclusion criteria for suspecting prostate cancer include abnormal digital rectal examination, increased total serum PSA level or abnormal suspicious sonographic echopattern. The prostate was evaluated with a high resolution 5-9 MHZ endorectal probe and TRUS guided core biopsies were taken. A total of 12 cores were sampled for every patient plus any suspicious lesion seen on TRUS examination. The presence of prostate cancer was correlated with the echo pattern of the biopsied areas and the PSA level. Statistical analysis was done. In our 152 cases, the serum PSA range was between 1.5 and 100 ng/ml with a median of 27.2 ng/ml. Prostate cancer was detected in 12 cases [28.57%] out of 42 cases with hypoechoic lesions while it was detected in 2 cases out of 16 cases with isoechoic lesions [37.53]. The difference between both groups was statistically significant [X2 = 16.48. P value < 0.001]. The pathological results of TRUS guided biopsies [n=152] showed adenocarcinoma in 18 cases [11.8%], benign prostatic hyperplasia [BPH] in 103 cases [67.8%]. BPH and prostatitis in 27 cases [17.8%]. BPH and high grade PIN in 4 cases [2.6%]. Any suspicious echo pattern lesion should undergo 12 core biopsy. The majority of pathology on biopsy in patients with suspected prostate cancer is nonmalignant with BPH being the most common [67%] followed by BPH and prostatitis [17.8%]. The higher the PSA above 10 ng/ml the higher the probability of prostate cancer