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.
Cleveland Clinic, Department of Regional Urology, Glickman Urological Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA, Levyd3@ccf.org.
This article was published in the following journal.
Name: Current urology reports
- 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.
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.
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 18.104.22.168.
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.
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