Simple Test Identifies Men Needing Second Prostate Biopsy

A new test identifies which men need a second prostate biopsy because they may be harboring life-threatening prostate cancer even though they were given a clean bill of health after their first biopsy. The key is prostate-specific antigen (PSA) density, which compares the size of a man's prostate with his levels of the cancer-related protein PSA.

Mark Garzotto, M.D., assistant professor of surgery (urology) in the Oregon Health & Sciences University School of Medicine (OHSU; Portland, OR, USA), presented his findings on Thursday, Feb. 22, 2007, at the Multidisciplinary Prostate Cancer Symposium in Orlando (FL, USA).

Until now we've really had no clear and consistent method to recommend further follow up or diagnostic procedures for men who have a negative biopsy. We have derived a simple marker so urologists can identify who is at risk for high-grade prostate cancer, Dr. Garzotto said.

Dr Garzotto studied a large group of 511 men at the Portland Veterans Affairs Medical Center (OR, USA) from 1992 to 2006. All had been referred to urology clinics for suspicion of prostate cancer. All patients had one prior negative prostate biopsy. In all, the study included 1,319 biopsies. He found that the indicator for a repeat biopsy was a high prostate-specific antigen (PSA) adjusted for prostate size. A Gleason score of seven or above was indicative that life-threatening prostate cancer may be present and a repeat biopsy is advised.

A Gleason score is a system of grading prostate cancer tissue based on how it looks under a microscope. Gleason scores range from two to 10 and indicate how likely it is that a tumor will spread. A low Gleason score means the cancer tissue is similar to normal prostate tissue and the cancer is less likely to spread; a high Gleason score means the cancer tissue is very different from normal tissue and the tumor is more likely to spread. A high grade of cancer results in a higher PSA. Dr. Garzotto also stressed that the size of the prostate has to be taken into account when measuring PSA.

What we worry about is which men may have high-grade cancer. Now we can prescribe a second biopsy for a few months later. We know that this is a judicious use for a biopsy, Dr. Garzotto said.

Besides identifying which men may have a deadly form of prostate cancer this new finding could also reduce the rate of overtreatment, unnecessary biopsies, and overdiagnosis.

Prostate biopsies can cause patient anxiety, pain, bleeding, and infection, and can lead to a significant increase in medical and non-medical costs to health care systems and patients. This study is particularly meaningful because of the large sample size of patient cases, and it is longitudinal, which means researchers were able to study the patients for many years.

More than 1 million prostate biopsies are performed each year. Of those, only about 25 % test positive for cancer. However, another 25 % are given a false-negative, meaning that no cancer is detected even when later it is found that the patient does have cancer.


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