Is There a Role for Medications to Reduce the Need for Prostate Biopsy?

Abstract

The widespread use of prostate-specific antigen (PSA) screening has led to an increased incidence of prostate cancer, and the majority of prostate cancer cases are now detected at an early stage (Cooperberg et al. J Urol 170: S21–5, 2003). PSA can be elevated due to a number of noncancer-related conditions including benign prostatic hyperplasia (BPH), inflammation, infection, and trauma. Also, the PSA value fluctuates, and an elevated PSA can normalize on subsequent measurements (Eastham et al. JAMA 289(20): 2695–700, 2003). The lack of PSA specificity becomes especially apparent when evaluating patients with a mildly elevated PSA. Only 25–35 % of men undergoing prostate biopsy in the PSA “gray zone” of 4–10 ng/ml are found to have prostate cancer, leaving behind a significant portion of patients who undergo potentially unnecessary biopsy (Brawer et al. J Urol 150(1): 106–9, 1993; Catalona et al. J Urol 151(5):1283–90, 1994). Though prostate biopsy is generally safe, it is an invasive procedure invoking patient anxiety and can be associated with complications such as pain, bleeding, sepsis, and possibly impotence (Aus et al. Br J Urol 77(6): 851–5, 1996; Rietbergen et al. Urology 49(6): 875–80, 1997; Fujita et al. J Urol 182(6): 2664–9, 2009). Furthermore, infectious complications from prostate biopsy are increasing in prevalence due to fluoroquinolone resistance (Feliciano et al. J Urol 179(3):952–5, 2008). Hence, the challenge facing the referring physician or urologist is to determine the most appropriate candidates for prostate biopsy among patients who present with an abnormal PSA.