Histopathological findings in extended prostate biopsy with PSA ≤ 4 ng/mL

OBJECTIVE: Cancer detection has been reported in up to 27% of patients when lowering the PSA cutoff to 2.5 ng/mL. Although this practice could increase the number of biopsies performed, it also could lead to more frequent detection of significant prostate cancers at an organ-confined stage and/or a less aggressive state. This study describes the incidence of malignancy and tumor characteristics in extended prostate biopsies with PSA ≤ 4 ng/mL. MATERIALS AND METHODS: Prostate biopsies from 1081 patients where examined, 275 (25.4%) patients had PSA level ≤ 4 ng/mL. RESULTS: Cancer was diagnosed in 32.0% and 35.7% of patients with PSA ≤ 4 ng/mL and > 4 ng/mL, respectively (p = 0.906). The median Gleason score was 7 independent of PSA > or ≤ 4 ng/mL (p = 0.078). The median number of cores positive for tumor was 4 and 3, respectively, for PSA > 4 ng/mL and PSA ≤ 4 ng/mL (p = 0.627). There was a difference in the total percent of tumors involving all cores, 11% and 7% for PSA > or ≤ 4 ng/mL (p = 0.042). Fifty-six patients underwent radical prostatectomy, 12 had PSA ≤ 4 ng/mL. In both groups, a diagnosis of cancer was accurate with no differences in Gleason score, tumor volume or staging for both groups. CONCLUSION: When PSA is below 4 ng/mL, cancer is detected in a proportion equal to the proportion diagnosed with a PSA > 4 ng/mL, and tumor characteristics are similar between the two groups. Only clinically significant tumors were diagnosed following radical prostatectomy.