BJU Int. 2007;99:1028-1030
Contrary to what is commonly thought, the risk of having a positive repeat prostate biopsy is no lower for men with a fluctuating PSA level than it is for those with a steady or steadily increasing PSA level.

Jacques Irani, MD, of the Centre Hospitalier Universitaire La Milétrie, Poitiers, and his colleagues studied 191 men who had an initial negative prostate biopsy followed by one or more sets of biopsies and at least two PSA measurements.

The researchers defined a fluctuating PSA level as a PSA series including at least one PSA value lower than the one immediately preceding it. Prostate cancer eventually was detected in 53 men: 17 (22%) of 79 with a fluctuating PSA level and 36 (32%) of 112 with a steady or steadily increasing PSA level. The difference between the groups was not statistically significant.

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Prostate cancer patients with and without fluctuating PSA levels did not differ with respect to age, T stage, Gleason score, and first PSA level.
The median PSA level at the first biopsy was 7 ng/mL. It was 8.0, 8.0, and 8.7 ng/mL for the second, third, and fourth biopsies. Prostate cancer was found in 39 men at the second biopsy, 12 at the third, and two at the fourth.