Bahlburg H.a· Tully K.a· Hoffmann V.a· Hanske J.b· von Landenberg N.a· Roghmann F.a· Palisaar R.-J.a· Noldus J.a· Berg S.a· Brock M.b

Author affiliations

aDepartment of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
bDepartment of Urology, Stiftungsklinikum PROSELIS, Prosper-Hospital Recklinghausen, Recklinghausen, Germany

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Article / Publication Details

Received: November 22, 2022
Accepted: February 22, 2023
Published online: April 14, 2023

Number of Print Pages: 6
Number of Figures: 2
Number of Tables: 1

ISSN: 0042-1138 (Print)
eISSN: 1423-0399 (Online)

For additional information: https://www.karger.com/UIN

Abstract

Introduction and Objectives: Decision-making to perform prostate biopsy should include individual risk assessment. Patients classified as low risk by the Rotterdam Prostate Cancer Risk Calculator are advised to forego biopsy (PBx). There is concern about missing clinically significant prostate cancer (csPCa). A clear pathway for follow-up is needed. Material and Methods: Data for 111 consecutive patients were collected. Patients were encouraged to adhere to a PSA-density-based safety net after PBx was omitted. Cut off values indicating a re-evaluation were PSA density >0.15 ng/mL/ccm in PBx-naïve patients and >0.2 ng/mL/ccm in men with past-PBx. Primary endpoint was whether men had their PSA taken regularly. Secondary endpoint was whether a new multiparametric MRI was performed when PSA-density increased. Tertiary endpoint was whether biopsy was performed when risk stratification revealed an increased risk. Results: Median follow-up was 12 months (IQR 9–15 months). The primary endpoint was reached by 97.2% (n = 106). The secondary endpoint was reached by 30% (n = 3). The tertiary endpoint was reached by 50% (n = 2). Histopathologic analyses revealed csPCa in none of these cases. Risk stratification did not change (p = 0.187) with the majority of patients (89.2%, n = 99). Conclusion: The concern of missing csPCa when omitting PBx in the risk-stratified pathway may be negated. Changes in risk stratification during follow-up should lead to subsequent PBx. We suggest implementing a safety net based on PSA density and digital rectal examination (DRE).

© 2023 S. Karger AG, Basel

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Received: November 22, 2022
Accepted: February 22, 2023
Published online: April 14, 2023

Number of Print Pages: 6
Number of Figures: 2
Number of Tables: 1

ISSN: 0042-1138 (Print)
eISSN: 1423-0399 (Online)

For additional information: https://www.karger.com/UIN

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