Prostate Volume Effect on Cancer Detection Rate in Prostate Biopsy, Additional Role of Prostate - Specific Antigen Levels - Beyond the Abstract

We performed a retrospective analysis of our data regarding the outcomes of transrectal ultrasound guided prostate biopsy (TRUS-Bx) in a large-scale cohort study. Our primary aim was to determine whether prostate volume had a constant impact on cancer detection rates during TRUS-Bx, focusing on the role of serum PSA levels. During the recent years, magnetic resonance imaging (MRI)-guided transrectal prostate biopsies are in vogue but the current standard technique for prostate cancer diagnosis in men with a high PSA level or an abnormal finding on digital rectal examination is a 10–12 core TRUS-Bx, especially at first diagnostic attempts. During the TRUS-Bx, the most controversial issue has been the number of biopsy cores. The most accepted attitude is that a greater number of core biopsies are needed with larger prostate glands. But, the role of PSA about this topic has been commonly ignored. 

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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