Management of Rising Prostate-specific Antigen After a Negative Biopsy.
Summary of "Management of Rising Prostate-specific Antigen After a Negative Biopsy."
Prostate biopsy remains one of the most commonly performed urologic office procedures. A significant percentage of men with a negative result may have unrecognized disease. Inadequate biopsy strategies or findings of high-grade prostatic intraepithelial neoplasia or atypia increase this likelihood. The term "negative biopsy" may be misleading. Traditional sextant biopsy is inaccurate and extended- or saturation-biopsy protocols miss small cancers. A rising prostate-specific antigen (PSA) after a negative prostate biopsy may indicate undiagnosed cancer. Magnetic resonance imaging (MRI) and template-guided biopsy have been proposed as diagnostic adjuncts in this setting. Medical manipulation has met with limited acceptance in this setting. In the presence of a rising PSA after a negative biopsy a low threshold for repeat biopsy should be entertained. Saturation biopsy increases cancer detection, especially in patients with more than two prior biopsies. Adjuncts to improve cancer detection, such as administration of 5-α-reductase inhibitors and MRI, are promising.
Affiliation
Cleveland Clinic, Department of Regional Urology, Glickman Urological Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, Levyd3@ccf.org.
Journal Details
This article was published in the following journal.
Name: Current urology reports
ISSN: 1534-6285
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21344195
- DOI: http://dx.doi.org/10.1007/s11934-011-0177-1
Medical and Biotech [MESH] Definitions
Prostatic Secretory Proteins
Proteins secreted by the prostate gland. The major secretory proteins from the human prostate gland include PROSTATE-SPECIFIC ANTIGEN, prostate-specific acid phosphatase, prostate-specific membrane antigen, and prostate-specific protein-94.
Prostate-specific Antigen
A glycoprotein that is a kallikrein-like serine proteinase and an esterase, produced by epithelial cells of both normal and malignant prostate tissue. It is an important marker for the diagnosis of prostate cancer.
Seminal Plasma Proteins
Proteins found in SEMEN. Major seminal plasma proteins are secretory proteins from the male sex accessory glands, such as the SEMINAL VESICLES and the PROSTATE. They include the seminal vesicle-specific antigen, an ejaculate clotting protein; and the PROSTATE-SPECIFIC ANTIGEN, a protease and an esterase.
Tissue Kallikreins
A family of trypsin-like SERINE ENDOPEPTIDASES that are expressed in a variety of cell types including human prostate epithelial cells. They are formed from tissue prokallikrein by action with TRYPSIN. They are highly similar to PROSTATE-SPECIFIC ANTIGEN. EC 3.4.21.35.
Seminal Vesicle Secretory Proteins
The secretory proteins of the seminal vesicles are proteins and enzymes that are important in the rapid clotting of the ejaculate. The major clotting protein is seminal vesicle-specific antigen. Many of these seminal vesicle proteins are under androgen regulation, and are substrates for the prostatic enzymes, such as the PROSTATE-SPECIFIC ANTIGEN, a protease and an esterase.
PubMed Articles
PURPOSE: Prostate specific antigen velocity has been proposed as a marker to aid in prostate cancer detection. We determined whether prostate specific antigen velocity could predict repeat biopsy resu...
Indication for prostate biopsy is presently mainly based on prostate-specific antigen (PSA) serum levels and digital-rectal examination (DRE). In view of the unsatisfactory accuracy of these two diagn...
Objectives: To assess the effects of a 4-week levofloxacin course on PSA in asymptomatic men with elevated prostate-specific antigen (PSA) and on prostate biopsy decision. Methods: Fifty asymptomatic...
Objectives: Obese men with benign prostate hyperplasia might have lower serum prostate-specific antigen because of hemodilution, resulting in underestimation of total prostate volume by serum prost...
Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b OBJECTIVE To investigate the relationships between the 2nd to 4th digit ratio (digit ratio) and prostate volume, prostate-specific ant...
Clinical Trials
A Trial of PROSCAR (Finasteride) Versus Placebo in Men With an Initial Negative Prostate Biopsy
The purpose of this study is to assess whether six months of daily finasteride (PROSCAR), following an initial negative prostate biopsy, will improve the detection of prostate cancer on re...
This is a multicenter phase 2 open-label single-arm study that will evaluate the safety and efficacy of TAK-700 in patients with castration-resistant prostate cancer (CRPC) without radiogr...
RATIONALE: Pomegranate extract may keep prostate cancer from growing in patients with rising prostate-specific antigen (PSA) levels after surgery or radiation therapy for localized prostat...
Prostate specific antigen (PSA) and digital rectal exam (DRE) are used to screen for prostate cancer. Patients with abnormal DRE or elevated PSA undergo transrectal ultrasound guided biops...
Trial of Iressa in Prostate Cancer Patients
This study is being carried out to see if ZD1839 is effective in treating prostate cancer after being diagnosed with an early rising PSA (prostate specific antigen) following surgery.
