[Incidence of prostatic cancer in symptomatic patients with non-suspicious rectal palpation and PSA levels greater than 10 ng/ml].

Objective: To evaluate the overall incidence of prostate cancer in patients with symptoms of prostatism, no suspicious DRE and PSA > 10 ng/ml.

Material And Method: 397 eligible patients based on the above criteria, mean age 69.3 +/- 7.7 years and mean PSA level of 21.3 +/- 29.3 ng/ml, underwent ultrasound-guided transrectal biopsy of the peripheral and central areas. Patients with no cancer in the biopsy and surgery indication underwent prostate surgery. Incidence of cancer in the transitional area was evaluated in these patients.

Results: Biopsy was found to be positive for cancer in 15.4% patients. Patients with prostate cancer had PSA concentrations (p = 0.06) and PSAD (p < 0.0001) lower than cancer-free patients. Thirteen (21%) of these patients underwent radical prostatectomy; an extracapsular tumour was found in 46% of the surgical specimens. Of the 336 patients with benign histology in the biopsy, 94 (28%) underwent prostate surgery. Cancer in the transitional zone was found in 15% cases (5 T1a and 8 T1b), with significant differences between PSA (0.03) and PSAD (0.04) concentrations between patients with BPH or T1b tumour in the surgical specimen but not among patients with BPH and T1a cancer.

Conclusions: Approximately 30% of these patients had prostate cancer, half of them found in the transitional area. PSA and PSAD did not show enough diagnostic strength to identify these patients. Most patients with cancer had clinically significant tumours. Therefore, we believe that prior to deciding the course of therapy these patients should undergo another series of biopsies including the transitional area, mainly in those with long-term life expectancy.