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Cancer diagnosis with prostate specific antigen greater than 10 ng./ml. and negative peripheral zone prostate biopsy
J E Fowler1, M A Condon, F L Terrell
1Division of Urology, University of Mississippi Medical Center, Jackson, USA.
Purpose:
We assessed the results of additional diagnostic procedures in men with prostate specific antigen (PSA) more than 10 ng./ml. and a peripheral zone prostate biopsy negative for cancer.
Materials And Methods:
A total of 68 men with PSA more than 10 ng./ml. and a peripheral zone biopsy negative for cancer was investigated with 1 or more peripheral zone biopsies (17), prostatectomy (18), or 1 or more peripheral zone biopsies and needle biopsy of the transition zone or prostatectomy (33).
Results:
Cancer was detected in 20 of 68 patients (29%) with 1 or more additional diagnostic procedures. Of 51 patients whose transition zone was biopsied or who underwent prostatectomy 16 had cancer, and in 8 the malignancy appeared to be isolated to the transition zone. Mean PSA density and proportion of patients with PSA density more than 0.15 were significantly greater and mean prostate volume was significantly less in the 20 patients with compared to 31 without identifiable cancer.
Conclusions:
At least 30% of men with PSA more than 10 ng./ml. and a negative peripheral zone biopsy have prostate cancer. In approximately 50% of cases the cancer appears to reside in the transition zone, and transition zone biopsy or prostatectomy is required for diagnosis.