The correlation between serum PSA level and prostate cancer risk is well described in the literature.
We know that urologists commonly accept the quite higher PSA levels, especially more than 100 ng/mL, as an indicator of prostate cancer. Moreover, sometimes, only one or two core sampling is performed in clinical practice by urologists for histopathological confirmation of clinically explicit prostate cancer. Consequently, it is not surprising that serum PSA levels have a significant impact on prostate biopsy outcomes.
Our results demonstrated that prostate volume had no effect on prostate cancer detection rates during TRUS-Bx in patients with PSA level more than 10 ng/mL. It seems that increased tumor volume related to higher PSA levels masks the negative effects of prostate volume on the cancer detection rates. We can think that increased PSA levels even in the larger prostates may indicate the existence of underlying prostate cancer and the effect of prostate volume on biopsy outcomes may be insignificant at these PSA levels. In our opinion, extended biopsy templates may be recommended in patients with PSA level ≤10 ng/mL and large prostate gland, but not in patients with PSA levels more than 10 ng/mL.
Written by: Mustafa Zafer Temiz, MD, FEBU, and Engin Kandirali, MD, FECSM, Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey.
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