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The initial
biopsies of men with elevated prostate specific antigen (PSA)
levels or suspicious digital rectal examination results appear
to miss prostate cancer almost one-quarter of the time, according
to researchers at the Washington University School of Medicing
in St. Louis.
The researchers
studied 2,526 volunteers 40 years old or older who underwent
1 or more prostate biopsies for serum PSA concentrations greater
than 4.0 ng./ml. (before May 1995) or greater than 2.5 ng./ml.
(after May 1995), or who had a digital rectal examination
that raised suspicions of cancer.
They reported
in the Journal of Urology that of the 962 prostate cancers
detected, 77 percent were detected by the first biopsy, but
that the total number of cancers detected rose to 91 percent
when patients had a seond biopsy, 97 percent with a third
biopsy, and 99 percent with 4 biopsy procedures.
They reported
that cancers detected through serial screening also were more
likely to be confined to the prostate than cancers detected
by the initial biopsy.
"Serial
biopsies detect more organ confined cancers without over detecting
clinically unimportant tumors," the researchers concluded.
"Future studies are needed to determine whether obtaining
more biopsy cores initially would provide earlier prostate
cancer detection and avoid unnecessary repeat biopsies. "
Source:
Prostate Cancer
Week of May 12, 2002
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