Systematic TRUS-biopsies Identify Men with Palpable Tumors and High PSA

A study published in Urology evaluated the use of systematic transrectal ultrasound-guided biopsies (TRUS-biopsies) to identify clinically significant prostate cancer (csPCa) in combination with age, prostate-specific antigen (PSA)-value, and clinical tumor category (cT).

The researchers collected data from the Danish Prostate Cancer Registry (DaPCaR) who underwent TRUS-biopsies from 1995 through 2016. Risk of histological findings were stratified as non-malignant, insignificant PCa, or csPCa, defined as a Gleason score 3+4 or above.

Final analysis included 39,886 men, with a diagnostic hit rate for csPCa of 40.8%. The researchers discovered that in the first TRUS-biopsy set, men who had PSA >20 ng/mL and ≥cT2 had more than a 75% risk of csPCa. Men with PSA <20 ng/mL and cT1 tumors had at least a 58% risk of non-malignant histology.

“The likelihood of diagnosing csPCa on systematic TRUS-biopsies is high, especially in men with high PSA or clinically locally advanced PCa on digital rectal examination. Our data suggest that not all men need a pre-biopsy MRI and the optimal candidate should still be debated. According to this study, MRI seems optimal in men age < 75 years, cT1, and PSA < 20 ng/ml to reduce the number of unnecessary biopsies,” the study authors wrote in their conclusion.

A high rate of exclusions due to missing information was cited as a study limitation.