Morbidity of transrectal ultrasonography-guided prostate biopsies in patients after the continued use of low-dose aspirin.

OBJECTIVE: To determine whether low-dose aspirin increases morbidity after transrectal ultrasonography-guided sextant prostate biopsy. PATIENTS AND METHODS: In a single-centre prospective cohort study of 200 patients who underwent sextant prostate biopsies, those routinely taking low-dose aspirin were encouraged to continue to do so before and after biopsy. The morbidity in each case was assessed using a standardized questionnaire that patients completed in the 7 days after biopsy. The presence of haematuria, rectal bleeding and haematospermia were recorded. The questionnaire also directed the patient to record fevers, use of analgesia and any further treatment received. RESULTS: In all, 36 patients took aspirin whilst the other 141 did not. There were no major complications in either group. Of the patients on aspirin, 20 (56%) had haematuria, compared with 83 (59%) of those not taking aspirin (difference 3%, 95% confidence interval, CI, -15 to 21). Overall bleeding (haematuria, rectal bleeding and haematospermia) occurred in 22 patients (61%) of the aspirin group and 105 (74%) of the other group (difference 13%, 95% CI -4 to 31). Comparisons of other morbidities between the groups are also discussed. CONCLUSIONS: There was no statistically significant difference in the incidence of haematuria or overall bleeding after biopsy between the groups. There is no evidence that aspirin needs to be discontinued before sextant prostate biopsy.

Serum insulin-like growth factor-1 is not a useful marker of prostate cancer.

OBJECTIVE: To determine whether the use of serum insulin-like growth factor 1 (IGF-1) levels is more efficient than serum prostate specific antigen (PSA) levels in predicting prostate cancer in patients undergoing prostatic biopsy. PATIENTS AND METHODS: The study included 94 consecutive patients who required transrectal ultrasonography (TRUS)-guided biopsies of their prostate and who had blood samples taken before their biopsies. These samples were then analysed for IGF-1 and PSA concentrations. Six prostatic biopsies were taken from each patient; they were assessed and a diagnosis made of prostate cancer or no malignancy. RESULTS: Thirty-seven patients were found to have prostate cancer and 57 had no evidence of malignancy. There was no statistical difference in serum IGF-1 levels between these groups. The PSA level and age of the patients differed significantly between the groups (both P<0.001). There was no correlation between IGF-1 and PSA levels, and even when the age difference in the groups was considered, there was still no significant relationship between IGF-1 levels and the incidence of prostate cancer. In patients with a PSA level of 4-20 microg/L there was no statistically significant difference in IGF-1 levels between the groups. CONCLUSION: Serum IGF-1 as a tumour marker does not help to predict patients with prostate cancer. PSA level and even age were better predictors of the presence of prostate cancer than were serum IGF-1 levels.