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Repeat Prostate-Specific Antigen Tests Before Prostate Biopsy Decisions.

Tobias Nordström1, Jan Adolfsson1, Henrik Grönberg1

  • 1Department of Medical Epidemiology and Biostatistics (TN, HG, ME), Department of Clinical Sciences at Danderyd Hospital (TN), and Department of Clinical Science, Intervention and Technology (JA), Karolinska Institutet, Stockholm, Sweden; Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden (JA).

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Summary
This summary is machine-generated.

A repeat prostate-specific antigen (PSA) test before biopsy can reduce unnecessary procedures. However, omitting biopsies based on decreasing PSA may miss aggressive cancers, highlighting the need for careful consideration in prostate cancer screening.

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Area of Science:

  • Urology
  • Oncology
  • Medical Diagnostics

Background:

  • Prostate-specific antigen (PSA) testing is a common tool for prostate cancer screening.
  • Repeat PSA testing before biopsy decisions is frequently performed, despite limited evidence supporting its efficacy.
  • The STHLM3 study provides a valuable dataset for analyzing PSA dynamics and biopsy outcomes.

Purpose of the Study:

  • To evaluate the impact of repeat PSA testing on prostate biopsy decisions.
  • To determine the diagnostic yield and potential risks associated with omitting biopsies based on PSA changes.
  • To analyze the relationship between PSA kinetics and cancer aggressiveness (Gleason Score).

Main Methods:

  • Analysis of biopsy outcomes in 1686 men from the STHLM3 study with initial PSA levels between 3-10 ng/mL.
  • Inclusion of men with two PSA tests taken within eight weeks prior to prostate biopsy.
  • Utilized percentages and multinomial logistic regression to analyze PSA values and changes in relation to biopsy results.

Main Results:

  • Omitting biopsies for men with PSA decreasing to ≤3 ng/mL could save 16.8% of procedures but miss 5.4% of high-grade (GS ≥7) cancers.
  • The proportion of low-grade (GS ≤6) cancers was independent of initial PSA and PSA change.
  • The risk of high-grade tumors (GS ≥7) decreased with both increasing and decreasing PSA levels (e.g., 6.6% for PSA decrease ≥20%).

Conclusions:

  • Repeat PSA testing can help reduce unnecessary prostate biopsies, but careful interpretation is needed.
  • A significant proportion of high-grade prostate cancers could be missed by omitting biopsies solely based on decreasing PSA levels.
  • PSA kinetics, including both increases and decreases, are associated with the risk of aggressive prostate cancer, warranting further investigation in clinical decision-making.