Patients with Persistently Elevated PSA and Negative Results of TRUS-Biopsy: Does 6-Month Treatment with Dutasteride can Indicate Candidates for Re-Biopsy. What is the Best of Saturation Schemes: Transrectal or Transperineal Approach?

摘要

To identify patients who actually need a re - biopsy, based on alterations in PSA readings after 6-month treatment with Dutasteride. We also sought to bring out the most beneficial re-biopsy scheme. We have reviewed the records of patients with persistently elevated PSA and at least one set of TRUS biopsies. Patients who were treated with alpha -blockers/Dutasteride combination were considered as the study group, while patients in control received alpha-blockers alone. Patients in both groups underwent re-biopsy 6?months later. The two protocols of re-biopsies were used at that time: 20-24 cores saturation transrectal (ST)) and ≥40 cores saturation transperineal template-guided (STT) biopsies. One hundred thirty-three patients were included in this study. In 86.7?% of the patients in the study group mean PSA decreased from 7.4?±?2.69 to 4.037?±?1.53 (p-0.001). The overall cancer detection rate was 29?% (n-39: 19 v/s 20, control and study groups, respectively). In the study group PSA decreased to 26.73?±?11.26?% in patients with cancer, compared with 40.54?±?13.3?% in patients without. It must be emphasized that STT-biopsies detected significantly more cancers (38.46 v/s 20.59?%, p- 0.005). Mean cores number got to 21?±?2.45 and 45?±?5.65 in ST and STT biopsies, respectively. Six-month treatment with Dutasteride decreases PSA readings in 86.7?% of the patients. A PSA decline of less than 40% (cutoff) should be considered as an indicator for re-biopsy. Transperineal template-guided biopsies had a higher cancer detection rate.