253 FINASTERIDE PROSTATE 10 NGiML
BE USED AS A DIAGNOSTIC MEANS FOR IN MEN WITH SERUM PSA LEVELS OF 4 TO
AS A DIAGNOSTIC
Staedt. Krankenhaus PaDadoDoulos G., Kalantzis Doumas K., Lykourinas M. General
S. Kiel H.J. Miinchen-Harlaching,
INTRODUCTION & OBJECTIVES: Prostatic biopsies are the “golden standard” for PCs diagnostics. PSA is not a cancer specific antigen. Distribution of PCs within the gland is not homogenous. Therefore a TURP is often performed as diagnostic tool in cases with negative random biopsies but elevated PSA. Nevertheless the validity of the diagnostic TURP is subject to controversies.
MATERIAL & METHODS: Thirty-five patients with irritative and/or obstructive voiding symptoms and a mean age of 63.4 years were enrolled in this study during the period 1996-2002. All of them had serum PSA levels of 4 to 10 tigi ml, mean prostate volume of 42 cm3, as this had been delineated by TRUS, and had undergone at least two negative biopsies (12 cores taken). Exclusion criteria included urinary retention, acute inflammation of the prostate gland and previous therapy with Finasteride. PSA levels were remeasured at 6 and 9 months. Moreover, a TRUS-guided biopsy was performed at the end of the ninth month. RESULTS: Patients were divided into three groups in accordance with PSA reduction. None of them who demonstrated PSA decrease of more than 50% (11 men) was proved to have positive biopsy. CaP was detected in 4 of the 13 patients (30.1 %) with PSA decrease between 30-50%, while 6 of the 11 (54.5 %) who presented a PSA reduction of less than 30% revealed cancer. Furthermore, no statistically significant difference was noticed in terms of Gleason sum between the two groups in which prostate cancer was detected. after 9-month therapy can be CaP. Our results should be
MATERIAL & METHODS: 356 patients with prostate cancer underwent combined TURP before local HIFU treatment. All patients had positive biopsies. TURP chips were histologically examined. Two groups (localized PCs: n=195, and not localized PCs: n=161) were considered. The localized PCs was defined through: Tl-2 NO-x MO-x, PSAi ~15 rig/ml, Gleason score 15 with Gleason sum 4 7, positive biopsy cores < 5. Cancer presence in TURP chips was determined and quantified (~10% / ll-40% / >40%). Positive PCs determination of the chips was related to tumour stage, the himour location according to biopsy findings, and the prostate size. The mean resection weight was llg (range: l-110). In 55.8% of the localized and in 74.5% of the not localized PCs patients, the TURP chips evidenced the presence of cancer. No correlation was found between the proportion of positive chips and the positive biopsy cores location. The proportion ofpositive TURP chips according to the prostate size is described in the following table:
CONCLUSIONS: TURP as a diagnostic tool for PCs has a detection rate of 55.8% only in patients with biopsy proven and localized PCs, and is only up to 50% in bigger prostates (>25cc). Even in advanced cases, the detection rate was less than 75%. There was no correlation
chips and the intraprostatic
of the positive
biopsies. This shows that the TURP is not effective as a diagnostic approach: negative TURP chips without biopsy control of the residual gland in patients suspected for prostate cancer are less specific than a toss-up.
255 THE IMPACT OF PROSTATE GLAND DETECTION BY MEANS OF EXTENDED
VOLUME ON PROSTATE CANCER NEEDLE BIOPSY AND RE-BIOPSY
Scattoni V., Roscigno M., Freschi M., Raber M., Deh(, F., Montorsi mG., Rigatti P. Scientific Institute H San Raffaele, Pathology, Milan, Italy
F., Salonia A., Briganti A., of Urology
INTRODUCTION & OBJECTIVES: We investigated the relationship between prostate volume and cancer detection by needle biopsy and determined the effect of a x-biopsy on the sampling error of needle biopsy. MATERIAL & METHODS: The study cohort included 3 150 consecutive patients submitted to a first extended systematic TRUS-guided biopsy (mean cores 12.2) and 343 patients who underwent a second set of extended biopsies of the prostate within a 12 months time span. At least five biopsies were performed in each lobe: in addition to sextant biopsies, cores were taken from the far lateral and mid region (transition zone) of the gland according to gland volume (ten cores for prostate ~50 gr; 12 cores in prostate >=50 gr.). The two sets of biopsies were processed and analyzed by the same pathologist. Patients with a PSA higher than 100 ngiml were excluded in this analysis. RESULTS:
Prostate volumes were divided into quartiles as shown in the following Total
38% 1.5% 7.9
50.0% 7.8% 9.0
45.1% 611% 11.0
21.6% 7.6% 11.9
26% 8.5% 12.3
< 0.001 < 0.001 0.002
18% 6.5% 7.9
30.5% 5.5% 9.5
12.9% 6.4% 10.0
12.7% 5.3% 8.4
6.6% 4.9% 14.5
co.05 co.05 NS
P First biopsy Positive HGPIN or ASAP Median PSA (rig/ml) Second biopsy Positive HGPIN or ASAP Median PSA @g/ml)
256 PSA IS NOT A PREDICTIVE COURSE OF HIGH NEOPLASIA Tune M., &t&CL.,
INTRODUCTION & OBJECTIVES: To determine the possibility of detecting prostate cancer(CaP) by assessing PSA reduction in men with serum PSA levels between 4 and 10 ngiml and at least two negative biopsies during the previous 6 months, who underwent therapy with Finasteride 5 mg daily for 9 months.
CONCLUSIONS: The magnitude of PSA reduction exploited as a remarkable means of “suspecting” confirmed with a larger cohort of patients.
FOR ESTIMATING THE NATURAL PROSTATIC INTRAEPITHELIAL
M., Kandirali E., Oktar T., Orsoy C.
Istanbul University, Istanbul Medical Faculty, Departnxnt of Urology, Istanbul, Turkey INTRODUCTION & OBJECTIVES: There is no clinical parameter for estimating the detection of CaP in patxnts with high grade intraepithelial neoplasia (HPIN). In this study, the role of PSA was evaluated for predicting the natural course of HPIN. MATERIAL & METHODS: A total of 655 patients undewent TRUS guided prostate needle biopsy due to abnormality in dlgital rectal examination and/or elevated PSA. Of these patients, 150(24.7%), 393(59%) and 112(17%) had CaP, BPH and HPIN without concurrent prostate carcinoma respectively. Overall, patients related with HPIN were evaluated in 5 categories as follows: Groupl: Pts with HPW and Cap detected in the subsequent biopsies, Gm~p 2: Patients who were followed-up with recurrent HPIN, Group 3: Pts with a final diagnosis of BPH after a variable number of biopsies, Group 4: Pts with HPrN in RRP specimen without an initial diagnosis of HPIN, Group 5: Pts with HPDJ in the final RRF’ specimen and also in the prostate biopsy revealing CaP. For the follow-up, first and second biopsies were performed in the 3rd and 6th months of diagnosis of HPIN. PSA measuements were obtained in every 6 months and rebiopsy was considered if an elevation in PSA occurred. Regardless of the pathology and PSA, other biopsies were performed once a year if the patients were willing to. Statistical analyses were done with Mann-Whitney U test and Wilcoxon log-rank test. RESULTS: A closed follow-up was achieved in only 63 of the 112 pts with a diagnosis of HPIN. After a mean number of 2.9OAO.94 repeated TRUS guided biopsies, during 15.7-tl3.3 months follow-up, adenocarcinoma was detected in 19% (n=12). Other final diagnosis were HPIN in 19% (n=12) and BPH in 62% (n=39) afier a mean follow-up of 31.6A13.96 and 37.119.6 months respectively. In the latter group, the final biopsy revealed a nunber of benign prostatic patterns such as chronic prostatitis, but no coexistence of HPIN. Mean age of the patients, initial and average PSA values of each of the groups and mean number of repeated biopsies was given in the table.
PSA was significantly higher with increasing quartiles both in patients submitted to first biopsy and x-biopsy. Similarly, PSA density was significantly lower with increasing quartiles in both groups. Decreasing cancer detection rates were seen with increasing prostate volume for both groups @=O.OOl and p=O.OOS, respectively). PSA and PSA density levels were significantly higher only in patients with a positive first biopsy for each quartile, but not in patients submitted to a second biopsy. CONCLUSIONS: Patients with larger prostate are more likely to undergo increased PSA than those with smaller prostates, but have a lower risk of result. Despite an extensive first negative biopsy, sampling error may be more smaller prostate since patients wth smaller prostate have a higher risk of having second biopsy.
No. 2, pp. 66
biopsy for a positive frequent in a positive
CONCLUSIONS: Our preliminary results indicate that, the natural outcome of HPlN can not be predicted with PSA like the other currently used parameters. Another point to be underhned is that, in the majority of the cases (80.9%) CaP can not be detected on repeated sextant TRUS guided biopsies.