Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Lowering the PSA threshold for prostate biopsy from 4 to 2.5 ng/ml : influence on cancer characteristics and number of men needed to biopt
Authors: Müntener, Michael
Kunz, Urs
Eichler, Klaus
Puhan, Milo
Schmid, D M
Sulser, T
Strebel, R T
DOI: 10.1159/000277589
Published in: Urologia
Volume(Issue): 84
Issue: 2
Pages: 141
Pages to: 146
Issue Date: 2010
Publisher / Ed. Institution: Wichtig
ISSN: 0391-5603
Language: English
Subjects: Prostate biopsy; Evidence-based-medicine; Prostate cancer; Prostate-specific antigen
Subject (DDC): 616: Internal medicine and diseases
Abstract: Objective: In 1999 we lowered the prostate-specific antigen (PSA) threshold for prostate biopsy at our institution from 4 to 2.5 ng/ml. The aim of this study was to compare the differences in tumor characteristics of the detected prostate cancers (PCAs) and the detection rate for the two different PSA thresholds and to evaluate if lowering the threshold was justified by any of the detected differences. Patients and Methods: We retrospectively analyzed the records of all patients who underwent an 8-core prostate biopsy between January 1999 and December 2004 and had a PSA between 2.5 and 10 ng/ml. Patients with a PSA between 2.5 and 4 ng/ml (group 1, n = 214, mean age 62.0 years) were compared to patients whose PSA was between 4 and 10 ng/ml (group 2, n = 292, mean age 63.2 years). Patients who were older than 75 years or had a suspicious rectal examination were excluded from this study. Results: Overall, we detected 120 can-cers in 506 patients (cancer yield 23.7%). The cancer yield in group 1 was significantly lower than in group 2 (17 vs. 28%, p < 0.01). In group 1 significantly less Gleason score ≧7 (p = 0.04) and significantly more potentially insignificant cancers (p = 0.03) were identified. In 80 patients who subsequently underwent radical prostatectomy, final pathology revealed no significant differences between the two PSA groups with regard to high pT stages, Gleason score ≧7 PCA or positive surgical margins, respectively. The difference in the absolute risk of being diagnosed with high-grade PCA between a PSA threshold of 2.5 ng/ml and a PSA threshold of 4 ng/ml was 1%. Conclusion: Lowering the PSA threshold for prostate biopsy from 4 to 2.5 ng/ml results in a substantial increase in the number of men who undergo biopsy and may result in an increased detection of potentially insignificant cancers. If total PSA alone is used to determine the need for prostate biopsy, the disadvantages of this lower threshold probably outweigh its potential benefits.
Fulltext version: Published version
License (according to publishing contract): Licence according to publishing contract
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Appears in Collections:Publikationen School of Management and Law

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