[Systematic ultrasound guided transrectal core prostate biopsy based on serum level of prostate-specific antigen]

Between August 1995 and June 1996, a total of eighty Japanese men underwent ultrasound guided systematic biopsy of the prostate. Sixty-six men were clinically suspected of having prostatic cancer by elevated serum PSA (Tandem-R kit) value or digital rectal examination (DRE). Overall, 63 of the 80 (78.8%) men had elevated serum PSA with normal DRE and 30 of the 80 men (37.5%) had prostatic cancer. In patients with PSA values of 0 to 4.0 ng/ml, 4.1 to 10.0 ng/ml and 10.1 ng/ml or more, the positive predictive value of PSA was 33.3%, 23.3% and 66.7%, respectively. In patients with PSA levels of 4.1-10.0 ng/ml, the positive predictive values of digital rectal examination, transrectal ultrasonography and PSA density were 30.0%, 28.0% and 31.8%, and the false-negative rates were 20.0%, 0% and 0%, respectively. Along with the findings of transrectal ultrasonography and PSA density, estimation of PSA value and abnormal findings of digital rectal examination may help minimize the number of biopsies in patients with PSA values of 4.1-10.0 ng/ml. Systematic biopsies were performed without major complications. The biopsy missed the cancer in 4.6%.