br Results There were patients younger than years
Results There were 81 patients younger than 50 years of age who received 12 cores TRUSP biopsy at TPEVGH from January 2008 to December 2013. Four patients who received TRUSP biopsy for abnormal DRE or prostate sonography findings were excluded for PSA <4 ng/ml. A total of 77 patients were included for analysis. The baseline characteristics of the study cohort are shown in Table 1. 5 Patients had positive family history and none of them were diagnosed as being PCa patients. Also, 11 of 77 (14.3%) patients had abnormal DRE findings; for all patients, the average PSA was 9.07 (±11.52) ng/ml. The average total prostate volume was 29.83 (±13.92) mm3. The overall cancer detection rate was 11.69% (9/77). There were 20 patient who were younger than 40 years of age (the younger group). All of the patients were informed of their elevated PSA levels by means of health checkups at other hospitals. Of these subjects, 57 patients were between 40 and 50 years of age (the elder group) and PCa were all in this smoothened agonist group. There was no significant difference between the younger and elder groups in terms of PSA level, %fPSA, prostate volume, PSAD, DRE, family history and PCa detection rate. The only significant difference was the incidence of moderate to severe LUTS (Table 2). According to the pathology results, the patients were divided into PCa and benign groups. However, there was no significant difference in terms of PSA level, %fPSA, prostate volume, PSAD, DRE and family history (Table 3). Table 4 showed the clinic-pathologic results of the 9 patients with PCa. All PCa were clinically significant according to the Epstein criteria. There were 4 patients who received radical prostatectomy, and 1 patient was currently stage IV, and died of disease after castration therapy. Free-form PSA (fPSA) was available in 4 of them, and all of the %fPSA were less than 25% (Table 4).
Discussion Despite several retrospective analyses of the TRUSPBx in young male, there has not been a purposefully designed prospective trial. Current guidelines published by major organizations such as the American Urology Association, the European Association of Urology, the American Cancer Society, and the National Comprehensive Cancer Network do not recommend screening for patients <40 years of age for the following reasons: (1) low prevalence of PCa; (2) no evidence of benefit (population subset not represented in randomized trials); and (3) potential harms of screening. According to recent reports, the incidence of PCa in men younger than 50 years of age accounts for 3–4% of the total PCa. Sun et al. reported that the detection rate of PCa by PSA triggered TRUSP biopsy is 4.4% in men younger than 50 years of age, compared to 14.2% of men older than 50 years of age in US. In minimum viable population (MVP) study, the investigator suggested a PSA velocity threshold of 0.60 ng/mL/year for men younger than 50 years of age. This is lower than the traditional 0.75 ng/mL/year. However, The PSA velocity (PSAV), and PSA doubling time (PSADT) are of limited use in the diagnosis of PCa due to background noise (total volume of prostate, BPH), the variations in interval between PSA determinations, and acceleration/deceleration of PSAV and PSADT over time. Moreover, some prospective studies have shown that these predictors do not provide additional benefit compared to PSA alone. Also in the US, Kosaka et al. investigated clinical characteristics of men younger than 50 years of age. In that study, 106 patients were included and PCa was noted in 15 patients (12.3%); Gleason score was 6 or lower in 9 patients, and 7 in the other 6 patients. There were no significant differences between non-PCa and PCa patients with regard to PSA value, prostate volume, and PSAD, which are consistent with our study. The Kosaka et al. study proposed a cut value of PSAD <0.32 to predict clinical insignificant PCa, a number which we did not validate. The rationale for this discrepancy does merit further study.