Evaluation of an Aggressive Prostate Biopsy Strategy in Men Younger than 50 Years

Hanan Goldberg, Zachary Klaassen, Thenappan Chandrasekar, Christopher J.D. Wallis, Ants Toi, Rashid Sayyid, Bimal Bhindi, Michael Nesbitt, Andrew Evans, Theo van der Kwast, Joan Sweet, Nathan Perlis, Robert J. Hamilton, Girish S. Kulkarni, Antonio Finelli, Alexandre Zlotta, Neil Fleshner

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Purpose: Longitudinal cohort studies and guidelines demonstrate that prostate specific antigen 1 ng/ml or greater in younger patients confers an increased risk of delayed prostate cancer death. At our institution we have used an aggressive biopsy strategy in younger patients with prostate specific antigen 1 ng/ml or greater. Our objective was to determine the proportion of detected cancer and specifically clinically significant cancer by this strategy. Materials and Methods: The prostate biopsy database at Princess Margaret Cancer Centre was queried for patients younger than 50 years who underwent a first prostate biopsy between 2000 and 2016. We included only patients who underwent prostate biopsy due to prostate specific antigen 1 ng/ml or greater and those with a suspicious digital rectal examination, a positive family history or a suspicious lesion on transrectal ultrasound. All clinical and pathological parameters were analyzed. Patients were stratified according to specific prostate specific antigen values. Multivariable logistic regression was performed to ascertain predictors of any prostate cancer diagnosis and of clinically significant prostate cancer. Results: Of the 199 patients who met study inclusion criteria 37 (19%) were diagnosed with prostate cancer and 8 (22%) had a Gleason score of 7 or greater. Of those diagnosed with prostate cancer 25 (68%) had prostate specific antigen 1.5 ng/ml or greater and all men with a Gleason score of 7 or greater had prostate specific antigen 1.5 ng/ml or greater. Notably 19 patients (51%) had prostate cancer exceeding the Epstein criteria for active surveillance. Factors predicting prostate cancer included a positive family history, rising prostate specific antigen and lower prostate volume. Conclusions: Our results justify adopting an aggressive prostate biopsy strategy in men younger than 50 years with prostate specific antigen 1.5 ng/ml or greater while patients with prostate specific antigen less than 1.5 ng/ml are unlikely to have significant cancer. Special attention should be given to patients with a smaller prostate and a positive family history.

Original languageEnglish (US)
Pages (from-to)1056-1061
Number of pages6
JournalJournal of Urology
Volume200
Issue number5
DOIs
StatePublished - Nov 2018
Externally publishedYes

Keywords

  • age groups
  • biopsy
  • neoplasm grading
  • prostate-specific antigen
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

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    Goldberg, H., Klaassen, Z., Chandrasekar, T., Wallis, C. J. D., Toi, A., Sayyid, R., Bhindi, B., Nesbitt, M., Evans, A., van der Kwast, T., Sweet, J., Perlis, N., Hamilton, R. J., Kulkarni, G. S., Finelli, A., Zlotta, A., & Fleshner, N. (2018). Evaluation of an Aggressive Prostate Biopsy Strategy in Men Younger than 50 Years. Journal of Urology, 200(5), 1056-1061. https://doi.org/10.1016/j.juro.2018.05.017