Yearly Prostate Specific Antigen And Digital Rectal Examination Fluctuations In A Screened Population

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 12 Jul 2009 - 0:00 PDT

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UroToday.com - A group of investigators from the University of Texas, San Antonio reported their findings on PSA fluctuations in the May, 2009 issue of the Journal of Urology. Their objective was to evaluate the year-to-year changes in serum PSA and DRE findings in a prospectively studied cohort based on biopsy recommendations and biopsy findings.

The study cohort analyzed 2,578 men with 2 or more PSA values. They were offered prostate biopsy for a PSA >2.5ng/ml or an abnormal DRE. The participants were divided into 3 groups according to whether they had undergone prostate biopsy during the followup of

1) no biopsy (88.1%),

2) 1 or more negative biopsies (8.6%), or

3) prostate cancer diagnosis (3.3%).

Men without prostate biopsy were significantly younger, had lower rates of a family history of CaP and were ethnically more diverse.

In most cases the incidences of an increased PSA was followed by consecutive increased PSAs 1, 2, and 3 consecutive years later. However, in some cases the next consecutive PSA was not increased. Regarding men who never had a biopsy performed during the study, in 23.3%, the next PSA was not increased, in 19.5% the next 2 consecutive PSAs were not increased, and in 17.5% the next 3 consecutive PSAs were not increased. Persistence of an increased PSA during the ensuing 1 to 3 years more commonly occurred in men with 1 or more negative biopsies performed during the study or with an eventual CaP diagnosis. Median increased PSAs among the groups 1, 2, and 3 were 3.3, 4.1, and 3,2ng/ml, respectively. PSA decreased by a median of 3.1% at the next annual visit in group 1, and by 3.6% in group 2. However, in group 3 PSA increased by a median of 13.6% at the next annual visit. Approximately 70% of abnormal DREs were normal the following year. This was even true in group 3 men, who were eventually diagnosed with CaP.

The authors conclude that occurrences of reversed PSA cut point or abnormal DRE based decisions to biopsy 1 or more years after the initial test are common and suggest that repetition of these tests should be performed.

Ankerst DP, Miyamoto R, Nair PV, Pollock BH, Thompson IM, Parekh DJ
J Urol. 2009 Mar 13. Epub ahead of print.
doi:10.1016/j.juro.2009.01.029

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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