Abstract

Objective: In this study, we investigated the relationship between prostate size and age with prognostic factors in patients who underwent transrectal ultrasonography-guided (TRUSG) prostate biopsy because of high prostate specific antigen (PSA) values. 

Materials and methods: A total of 1133 patients underwent 10-quadrant TRUSG-guided prostate biopsy due to high PSA values at our clinic between 2001-2012. Cases with prostate cancer were divided by age and prostate size. Patients were classified into 3 groups according to age (<60, 60-70 and >70 years) and prostate size (<40 cc, 40-70 cc and >70 cc). We evaluated the relationship between prostate size and age with prognostic factors in patients with diagnosed prostate cancer. Cases with prostate cancer classified according to age were compared in terms of PSA, PSA density, Gleason score, positive core percentage, average highest positive core tumor percentage and perineural invasion. Cases classified according to prostate size were compared in terms of PSA, Gleason score, positive core percentage, average highest positive core tumor percentage and perineural invasion. 

Results: A total of 1133 patients underwent prostate biopsy. Prostate adenocarcinoma was detected in 326 patients (28.7%), and benign prostate hyperplasia was detected in 808 (71.3%) patients. The detection rate of prostate cancer in patients <60 years of age and >70 years of age was 18.2% and 40.7%, respectively (p<0.001). The prostate cancer detection rate in patients with a prostate size <40 cc and >70 cc was 39.2% and 16.1%, respectively (p<0.001). PSA, PSA density, Gleason score, positive core percentage, average highest positive core tumor percentage and perineural invasion were increased significantly in older prostate cancer patients (p<0.05). Although PSA increased with prostate size (p<0.001), Gleason score, positive core percentage, average highest positive core tumor percentage and perineural invasion were not correlated with prostate size.

Conclusion: While the detection rate of prostate cancer increased with age, a negative correlation was observed with prostate size in patients who underwent prostate biopsy due to high PSA values. It was clear that poor prognostic factors were related to age, but that was not shown with prostate size except for PSA. Prostate cancer detection rate was lower in younger patients who underwent prostate biopsy due to high PSA levels. Therefore, non-cancer causes of elevated PSA and the use of PSA derivatives should be considered to increase the detection rate of cancer in these patients.