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    • This study was supported by the

    2019-04-28

    This study was supported by the Ministry of Education, Science and Technological Development of Serbia (grant# 175083).
    Introduction In the United States, PCa was the most commonly found cancer among all males, according to the US Centers for Disease Control and Prevention (CDC). In Taiwan, PCa was the fifth most common and the sixth most lethal cancer found in that country\'s population. The incidence of PCa in Taiwanese men (30 per 100,000 person-year in 2010) was significantly lower than its American and European counterparts. Though not as prevalent as in Western countries, the incidence rate of PCa in Taiwan has continued to increase for more than 10 years. Young men 40–50 years of age in Taiwan had a very low 10-year cumulative incidence of PCa, unless their PSA was greater than the 99th percentile (4.07 ng/mL). However, little was known about the PCa features detected by TRUSP biopsy, as well as the side effects of TRUSP biopsy in young patients (under 50 years old) especially in Taiwan. Several recent studies indicated that overzealous diagnosis and overtreatment of PCa might be induced by PSA screening, particularly in young men. This elevated level of diagnosis and overtreatment has also led to increased economic costs, added social burdens, and unnecessary compromise of both the quality of life and psychological wellness. According to the EAU guideline and several other recent studies, a baseline PSA determination for men 40 years of age was suggested to identify a high-risk group for PCa. Such testing to identify a baseline PSA not only provides beneficial risk stratification, but also has helped to guide screening protocols. The 2013 American Urological Association (AUA) guideline discourages screening for men younger than 40 years of age, considering the relatively low prevalence of PCa in this bcr-abl inhibitor age group and the lack of sufficient evidence demonstrating the benefits. Several studies suggested that for young males, the risk of TRUSP biopsy may outweigh its benefit. Yoo et al. reported that in Korean subjects younger than 40 years of age who received TRUSP biopsy, febrile urinary tract infections occurred in 3 patients (6%), 2 (4%) of whom needed hospitalization. Hematuria persisting longer than 1 week was noted in 2 (4%) patients, and hematospermia was noted in 1 (2%). In Unequal crossing-over cohort, only one patient (2%) was found to have low risk PCa. However, major guidelines suggested a baseline PSA at 40 years of age, which are based on studies performed on western populations. Thus, we set out to study the clinical efficacy of TRUSP biopsy, and the features of cancer detected in men younger than 50 years of age. To this end, we retrospectively reviewed the records of TRUSP biopsy in men younger than 50 years of age, with high PSA (>4.0 ng/mL) in Taipei Veterans General Hospital (TPEVGH).
    Methods All prostate biopsies were guided by ultrasonography (Type 2202, BK medical, Herlev, Denmark) in two-dimensional planes [sagittal and axial]. The TRUSP biopsy procedure followed the standard template including parasagittal medial and lateral plane, with each plane comprising the apical, middle, and basal regions of bilateral prostate. Each region was sampled with a biopty gun for a total of 12 cores. The needle cores were submitted separately. The Gleason score, percentage of the tissue involved by the tumor, and presence or absence of perineural invasion were reported for each core. Patients with a biopsy finding of atypical prostatic gland, prostatic intraepithelial neoplasia (PIN), and atypical small acinar proliferation (ASAP) were not included in the malignancy group. We specified the total percentage of cancer in each individual biopsy core, which was a percentage of a single focus of carcinoma or a sum of separate tumor foci percentages if extensive distance was seen between them. The Epstein criteria was applied to determine insignificant PCa and to see if any of these cancers were eligible for active surveillance. A generally accepted definition of the Epstein criteria was as follows: (1) PSA density (PSAD) ≦0.15; (2) biopsy Gleason score ≦6; (3) ≦2 positive cores; and (4) ≦50% involvement in any single core.