Purpose: In men with persistently elevated serum prostate specific antigen (PSA) concentrations and prostatic biopsies that show no cancer an important question is whether the PSA elevation is caused by undetected cancer in the transition zone of the prostate gland. Materials and Methods: To evaluate this issue further we examined 166 men age 50 years or older who participated in a PSA based screening trial for prostate cancer. All men had an initially elevated serum PSA concentration of 4.1 ng./ml. or greater. They had undergone 1 or 2 sets of negative peripheral zone biopsies of the prostate but elevated serum PSA concentrations persisted. They underwent repeat biopsy of the peripheral zone as well as 2 core biopsies from the right and 2 from the left transition zone region of the prostate. Results: Peripheral and transition zone biopsies revealed cancer in 3 of 19 cases (16 percent). Cancer was present in the peripheral zone only biopsy in 14 of 19 cases (74 percent). Two of 19 cancers (10 percent) were detected only in the transition zone. Overall 17 of the 19 cancers (89 percent) were detected by peripheral zone biopsy. Conclusions: Transition zone biopsy detects few additional prostate cancers in men with persistent serum PSA elevations and previous negative biopsies.
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