PSA repeatedly fluctuating levels are reassuring enough to avoid biopsy?

Area of Science:

• Urology
• Oncology
• Biomarker Research

Background:

• Prostate-specific antigen (PSA) levels exhibit variability during repeated measurements.
• Understanding PSA fluctuations is crucial for accurate prostate cancer (PC) detection.

Purpose of the Study:

• To compare PC detection rates in patients with fluctuating PSA (flu-PSA) versus steadily increasing PSA (si-PSA).
• To assess if PSA slope predicts cancer risk in flu-PSA patients.
• To investigate topographical differences in PC development and disease characteristics based on PSA behavior.

Main Methods:

• Analyzed data from 211 patients undergoing a second biopsy after an initial negative result.
• Estimated PSA Slope, PSA velocity (PSAV), and PSA doubling time (PSADT).
• Defined flu-PSA as a series with at least one value lower than the preceding one.

Main Results:

• Identified 82 patients with flu-PSA and 129 with si-PSA.
• No significant differences in cancer detection, clinical, or pathological stage between flu-PSA and si-PSA groups.
• The si-PSA group with cancer showed a higher Gleason score; PSA Slope did not differ between flu-PSA patients with or without cancer.

Conclusions:

• Repeat biopsy PC detection rates are similar for patients with flu-PSA and si-PSA.
• PSA Slope, PSAV, and PSADT are not reliable predictors for PC detection in this context.