UROLOGICAL ONCOLOGY

A seven-year follow-up of men following a benign prostate biopsy
Boddy JL, Pike DJ, Malone PR
Department of Urology, Royal Berkshire and Battle Hospitals, Oxford Road, Reading RG30 1AG, UK
Eur Urol. 2003; 44: 17-20

• Objectives: To determine the incidence and clinical relevance of newly diagnosed cases of prostate cancer in a group of men who had an elevated PSA and benign prostate biopsy 7 years previously.
• Patients and Method: Patients under the age of 80 years with an elevated PSA who had had a benign prostate biopsy in the 12 months between March 1, 1994 and February 28, 1995 were studied. One hundred and sixty four patients with a mean age of 66.8 years (range 47 - 79 years) were identified. The mean PSA for this group was 10.3 ng/ml (range 4.1 - 81 ng/ml). One hundred and fifty nine of the 164 (97%) hospital records were available for review and all but 21 (12.8%) of the General Practitioners were contacted.
• Results: Eighteen (11%) of the original 164 patients were subsequently diagnosed with prostate cancer, 2 died from their disease.
• Conclusions: In a population where the follow-up of patients with a benign biopsy was arranged on clinical grounds alone, 11% of the study group was diagnosed with prostate cancer during a seven-year follow-up. Although some of these cancers appear to be slow growing, most of those diagnosed in the initial follow-up period were deemed to be clinically significant and a small proportion progressed rapidly to metastases. All patients who have an elevated PSA, but benign biopsy, should undergo a period of PSA monitoring until it is clear that their PSA is not rising. We propose an initial intensive monitoring period to avoid missing those with clinically aggressive disease.
  
  
• Editorial Comment
  Transrectal ultrasound guided biopsy of the prostate is not 100% sensitive and the false negative biopsy rate is estimated at 20 - 30 %. Only few papers address these missed cases and therefore, this contribution is worthwhile reading. 164 patients had negative biopsy of their prostate. 40% underwent TURP, and of these 69 underwent 1 or 2 TURPs. 7 of these patients had cancer. 53 patients had one or more TRUS biopsies, 13 were found with cancer. Interestingly, of the 18 patients diagnosed with prostate cancer, 3 were diagnosed within 12 months of their initial biopsy. 3 patients were found to have bone metastasis at this time, indicating an aggressive disease.
  With these results in background the authors concluded correctly, that all patients, who have a suspicious PSA, but a negative biopsy should undergo an intensive monitoring period and PSA monitoring until it is clear that PSA is not rising.

Dr. Andreas Böhle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany