Introduction:

INTRODUCTION:

              Prostate cancer is the second most common cancer diagnosed in men with an estimated 1.2 million diagnoses worldwide. The incidence of Prostate cancer is higher in western countries and low in Asian countries.  The need for prostate biopsy is based on PSA levels. The general cut-off PSA value for the Indian population is 4.0 ng/mL. The reported cancer detection rate of TRUS-guided biopsies is around 30 percent in western countries and lesser in Asian countries, including India, particularly for serum PSA values less than 20 ng/mL indicating that many of the Indian patients are subjected to an unnecessary biopsy which adds up to temporary distress to these patients.

Methods:

The aim of our study is to determine the cancer detection rate of TRUS-guided prostate biopsy in the Indian population at different serum Prostate-Specific Antigen levels and determine a PSA cut-off level to avoid unnecessary biopsies. All symptomatic patients between the age group of 45 to 80 who underwent TRUS guided biopsy for raised serum PSA levels between 4 ng/mL and 20 ng/mL from August 2018 to August 2020 were included. Standard 12-core biopsies were taken in all patients.  The patients were categorized into four groups corresponding to the PSA levels ranging between 4-6 ng/mL, 6- 8 ng/mL, 8-10 ng/mL, and 10-20 ng/mL respectively, and cancer detection rate and other characteristics in each group were statistically analyzed.

Results:

The overall cancer detection rate of TRUS-guided biopsy in our study was 18.4%. The cancer detection rates in groups A, B, C, and D were found to be 0%, 0%, 4.76%, and 43.47% respectively, implying that 49.43% of the patients underwent unnecessary biopsy in our study. The PSA cut-off to do biopsy was derived by ROC curve as 8.9 ng/ml for all men.

Conclusion:

Currently, a single demarcation between normal and elevated PSA values, 4.0 ng/mL, is used as an indication for biopsy among men of all ages in the Indian population. Our study concludes that using the PSA cut-off value of 4 ng/mL derived from western literature has a lower positive predictive value in the Indian population as compared to western counterparts. Hence, we recommend that the cut-off be raised to 8.9 ng/mL to curb the burden of unnecessary TRUS-guided biopsies in the Indian population.

Funding: N/A