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Patients with Persistently Elevated PSA and Negative Results of TRUS-Biopsy: Does 6-Month Treatment with Dutasteride can Indicate Candidates for Re-Biopsy. What is the Best of Saturation Schemes: Transrectal or Transperineal Approach?

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Pathology & Oncology Research

Abstract

To identify patients who actually need a re - biopsy, based on alterations in PSA readings after 6-month treatment with Dutasteride. We also sought to bring out the most beneficial re-biopsy scheme. We have reviewed the records of patients with persistently elevated PSA and at least one set of TRUS biopsies. Patients who were treated with alpha -blockers/Dutasteride combination were considered as the study group, while patients in control received alpha-blockers alone. Patients in both groups underwent re-biopsy 6 months later. The two protocols of re-biopsies were used at that time: 20-24 cores saturation transrectal (ST)) and ≥40 cores saturation transperineal template-guided (STT) biopsies. One hundred thirty-three patients were included in this study. In 86.7 % of the patients in the study group mean PSA decreased from 7.4 ± 2.69 to 4.037 ± 1.53 (p-0.001). The overall cancer detection rate was 29 % (n-39: 19 v/s 20, control and study groups, respectively). In the study group PSA decreased to 26.73 ± 11.26 % in patients with cancer, compared with 40.54 ± 13.3 % in patients without. It must be emphasized that STT-biopsies detected significantly more cancers (38.46 v/s 20.59 %, p- 0.005). Mean cores number got to 21 ± 2.45 and 45 ± 5.65 in ST and STT biopsies, respectively. Six-month treatment with Dutasteride decreases PSA readings in 86.7 % of the patients. A PSA decline of less than 40% (cutoff) should be considered as an indicator for re-biopsy. Transperineal template-guided biopsies had a higher cancer detection rate.

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Ethical Statement

This retrospective study was approved by ethical committee of our hospital: 0077-13 BRZ. Only after obtaining this authorization we reviewed in a retrospective manner the records of patients who were treated in our outpatient clinics for LUTS from 2009 to 2013.

Conflict of Interest

The authors declare that they have no conflict of interest.

Authors’ Contribution

Kravchick - project development, data collection/management and manuscript writing.

Lobik - project development, data management and manuscript editing.

Cytron – project editing.

Kravchenko – data collection.

Ben Dor – manuscript editing.

Peled – data analysis and manuscript writing.

Author information

Authors and Affiliations

  1. Barziali Medical Center, Urology Department, Ashkelon, Israel

    Sergey Kravchick, Leonid Lobik & Shmuel Cytron

  2. Barziali Medical Center, Pathology Department, Ashkelon, Israel

    Yakov Kravchenko & David Ben Dor

  3. Epidemiology and Statistics, Ben Gurion University, Beer Sheva, Israel

    Ronit Peled

Authors
  1. Sergey Kravchick
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  2. Leonid Lobik
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  3. Shmuel Cytron
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  4. Yakov Kravchenko
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  5. David Ben Dor
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  6. Ronit Peled
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Corresponding author

Correspondence to Sergey Kravchick.

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Kravchick, S., Lobik, L., Cytron, S. et al. Patients with Persistently Elevated PSA and Negative Results of TRUS-Biopsy: Does 6-Month Treatment with Dutasteride can Indicate Candidates for Re-Biopsy. What is the Best of Saturation Schemes: Transrectal or Transperineal Approach?. Pathol. Oncol. Res. 21, 985–989 (2015). https://doi.org/10.1007/s12253-015-9910-2

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  • DOI: https://doi.org/10.1007/s12253-015-9910-2

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