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Delaying a Biopsy With Serial Prostate-Specific Antigen Checkup Helps to Identify a Significant Prostate Cancer: A Strategy to Evade Unnecessary Procedures

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Author(s)
Young Hwii KoByung-Hoon KimWonho JungJi Yong HaTeak Jun ShinSe Yun KwonHyun Jin JungYoon Soo HahTae Hyo Kim
Keimyung Author(s)
Kim, Byung HoonJung, Won HoHa, Ji YongShin, Teak Jun
Department
Dept. of Urology (비뇨의학)
Journal Title
The Korean Journal of Urological Oncology
Issued Date
2022
Volume
20
Issue
3
Keyword
Prostate cancerProstate biopsySignificant prostate cancer
Abstract
Purpose:
To differentiate a non-cancer-related temporary increase in prostate-specific antigen (PSA) triggering unnecessary biopsy, we intentionally delayed biopsy with a serial follow-up, then investigated the efficacy of this strategy in identifying a significant prostate cancer (PCa).

Materials and Methods:
Retrospective data of patients who initially presented with a suspicious level of serum PSA (3–20 ng/mL), managed using the delayed strategy, and then eventually underwent biopsy were obtained from 4 tertiary centers between 2018–2020.

Results:
The collected 271 subjects had a median (interquartile range) PSA, age, and prostate volume of 5.03 ng/mL (4.46–7.79 ng/mL), 67 years (61–73 years), and 38 g (28–50 g), respectively. During the delay period of 8 weeks (4–19 weeks), most were managed with alpha-blockers (85.6%, n=232). Ninety-four (34.7%) experienced a PSA decrease of 20.53% (8.82–38.16). Eventual biopsy revealed 115 PCa cases (42.5%) including 82 significant ones and 46 high-risk diseases. Men with a PSA decrease had a lower probability of PCa (31.9% vs. 48%, p=0.014), a significant disease (21.3% vs. 35.0%, p=0.026), and high-risk PCa (7.4% vs. 22.0%, p=0.002) than the PSA-elevated counterparts. However, the degree of PSA decrease was not associated with the presence or the severity of PCa. In patients with PSA normalization (≤3 ng/mL), though 4 patients of them (66%) had PCa including a single significant disease, none had high-risk disease.

Conclusions:
About one-third of individuals initially indicated for transrectal biopsy experienced a decrease in PSA, and their chance for significant PCa was diminished. This retrospective study suggests PSA normalization could be an acceptable notion, though requires further investigation.
Keimyung Author(s)(Kor)
김병훈
정원호
하지용
신택준
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
2234-4977
Source
https://www.kjuo.or.kr/journal/view.php?doi=10.22465/kjuo.2022.20.3.177
DOI
10.22465/kjuo.2022.20.3.177
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44418
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Urology (비뇨의학)
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