Rising PSA with a negative biopsy

The use of prostate-specific antigen (PSA) as a diagnostic and screening to ol has led to a significant rise in the numbers of patients undergoing pros tate biopsy. However, the specificity of the PSA test is low, and the major ity of patients in the diagnostically uncertain serum PSA range of 4-10 ng/ ml will be negative for prostate cancer on biopsy. In addition, current bio psy techniques are sub-optimal. Improvements in technique are needed to inc rease the tumour detection rate and reduce the number of repeat biopsies. S everal biopsy techniques have now been described that sample the prostate g land more effectively, by taking extra core samples in addition to the esta blished sextant biopsy core samples. Sampling of peripheral areas of the gl and results in significantly improved tumour detection rates while morbidit y to the patient is not increased. The presence of prostatic intraepithelia l neoplasia (PIN) is evidence that cancer is present, or is likely to appea r, in the prostate, but has not been sampled in the biopsy. In the event of a rising PSA and negative biopsy, serum free/total PSA (% free PSA) measur ement can be beneficial in discriminating between cancer and other possible causes of raised PSA, such as benign prostatic hyperplasia. PIN in associa tion with reduced % free PSA is a valuable indicator in the decision to car ry out a repeat biopsy. Copyright(C) 2001 S. Karger AG, Basel.