Avoid unnecessary repetition of biopsies
Which test can best predict whether a repeat biopsy will be positive, if not precluded by the initial biopsy prostate cancer? On this issue, a new work was presented at the German Association of Urology congress.
Is in a prostate biopsy, no tumor detectable (negative biopsy), but is still suspected prostate cancer, so usually there is a first or further Rebiopsie (repeat biopsy; details on sampling seeprostate biopsy ). It is detected prostate cancer in 11-41% of cases (positive biopsy), depending on how many samples were taken and the umpteenth Rebiopsie as it was. Most men thus undergoing surgery "in vain".
In order to assess the need for biopsy and to reduce the number of "unnecessary" procedures, you can see the digital rectal examination ( DRE use) and laboratory tests, such as the PSA level (t-PSA), the proportion of free PSA (f -%-PSA), PSA density (PSA-D) and the increase in PSA velocity (PSA-V, on the tests see PSA test ). Unfortunately, takes its significance from the number of Rebiopsien, so that the cancer risk is more difficult to estimate beforehand. Which test here provides the best prediction has now been examined in more detail:
Included in the study were 127 men under 70 years, who underwent due to an abnormal DRE, elevated PSA level or a suspicious previous biopsy of a Rebiopsie. For PSA,% f-PSA, PSA-V and PCA3 (for the latter see more PCA3 in the diagnosis of prostate cancer ) different ratios for the explanatory power of each test were calculated based on the biopsy results. Here, you had to appreciate the recognition rate of the biopsy, it was assumed this referred to as sensitivity of 75%, 85% and 95%.
Overall, it was discovered at just 35% of men develop prostate cancer. In the first Rebiopsie PCA3 had 80%, the largest prediction accuracy, followed by% f-PSA at 74% and the PSA-V with 57% compared to PSA would have up to 73% and 56% and 0% these interventions can save. In the second, however Rebiopsie% f-PSA was 82% prediction accuracy before the PSA-V with 72% and PCA3 with 70%, with a share of savings interventions of up to 67% and 17% and 33% respectively. Three or more Rebiopsien the prediction accuracy of f-PSA% was 70%, 62% of PCA3 and PSA-V 55%, the proportion of saved procedures up to 45% and 5% and 40% respectively.
Conclusion of the authors
The validity of laboratory tests depends strongly on the number of previous biopsies. The PSA value was not significant enough in the whole analysis. The free PSA (f-PSA%) was superior to the PCA3 and PSA-V from the second Rebiopsie. Only in the first Rebiopsie PCA3 was better, and there would thus compared to PSA can save up to 73% of these interventions.
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