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Inverse Association Between Histologic Inflammation In Needle Biopsy Specimens And Prostate Cancer In Men With Serum PSA Of 10-50 Ng/ML

September 23, 2017

UroToday - In the online edition of Urology, Dr. Tomoaki Terakawa and associates reported on parameters that may help determine whether a man with a PSA between 10 and 50ng/ml with a negative prostate biopsy is likely to have prostate cancer (CaP) later on. Specifically, they evaluated the role of histological inflammation on the biopsy specimen as a cause of the elevated PSA.

The study cohort of 143 men with PSA levels of 10-50ng/ml had undergone initial TRUS/biopsy between 2003 and 2007. PSA density (PSAD) and PSAD of the transition zone (TZ) were calculated. Most patients had a 12-core biopsy and a single pathologist performed all pathologic examinations. The degree of inflammation was separated into 4 levels; none, mild, moderate or severe. Moderate and severe inflammation were the only 2 categories that were then considered as positive for histological inflammation in the biopsy specimen.

CaP was diagnosed in 86 men (60.1%) and 57 men (39.9%) had benign pathology. Gleason score was 7 in 21. The prostate volume and TZ volume in the CaP group were significantly smaller than in the benign group. The PSA level, PSAD and PSAD in the TZ were significantly greater in the CaP group compared to the benign group. Histologic inflammation was present in 35 (40.7%) and 42 (73.7%) patients with CaP and benign disease, respectively. This difference was significant. Only histologic inflammation and PSAD were independent variables indicating the prostate biopsy outcome. The optimal cutoff point for PSAD for predicting the prostate biopsy outcome was 0.43 (sensitivity 0.74 and specificity 0.84). When a PSAD cutoff of 0.43 and the presence or absence of histologic inflammation were combined, 86 and 57 specimens were judged to be positive and negative for CaP, respectively. CaP was detected in 75 of these 86 cases with no CaP present in 36 of these 57.

Thus, the sensitivity was 87.2%, specificity 63.2%, positive predictive value 78.1%, and negative predictive value 76.6%.

Terakawa T, Miyake H, Kanomata N, Kumano M, Takenaka A, Fujisawao M
Urology. 2008 Sep 29. Epub ahead of print

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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