PSA, digital rectal examination and the indication of prostate biopsy

Abstract

Background: Despite it is an invasive procedure with a limited detection efficiency, prostate biopsies remain the "gold standard" for prostate cancer diagnosis. Digital rectal examination (DRE) and prostate specific antigen (PSA) may be helpful to better indicate the biopsy. Objective: We studied the contribution of Digital rectal examination, prostate specific antigen and their combination with the indication of the biopsy. Patients and methods: Our retrospective study included 122 patients aged between 52 and 95 years who underwent between 2010 and 2012, prostate biopsy because they presented clinical signs of prostate disease, a suspect Digital rectal examination (DRE+) and/or a total prostate specific antigen (tPSA)≥4 ng/ml. Outcome measurements and statistical analysis: Every patient underwent a transrectal ultrasound-guided 12-core prostate biopsy. Total prostate specific antigen was analyzed by microparticle enzyme immunoassay technique. Results: Only 69 of the 122 biopsies (56.55%) were positive. Digital rectal examination is more effective in predicting positive biopsy results with fewer false negatives than that of total prostate specific antigen. The combination between Digital rectal examination and total prostate specific antigen improves the biopsy efficiency but does not reduce false negatives. Prostate biopsies were negative in four cases with (DRE-) and Total prostate specific antigen<4 ng/ml. Conclusion: Digital rectal examination and prostate specific antigen could, in some cases, limit the indication for prostate biopsy.