Low Serum Neutrophil Count Predicts a Positive Prostate Biopsy

K Fujita; R Imamura; G Tanigawa; M Nakagawa; T Hayashi; N Kishimoto; M Hosomi; S Yamaguchi


Prostate Cancer Prostatic Dis. 2012;15(4):386-390. 

In This Article

Abstract and Introduction


Background: Asymptomatic prostatic inflammation may cause increased PSA in some men, leading to unnecessary prostate biopsy. We investigated whether the differential white cell count could predict the result of prostate biopsy.

Methods: Prostate needle biopsy was carried out in 323 Japanese men with elevated PSA levels or abnormal digital rectal findings. White blood cell count (WBC), differential white cell count (neutrophils, lymphocytes, basophils, eosinophils, and monocytes), and serum C-reactive protein level were assessed for associations with biopsy findings.

Results: In all, 203 (62.1%) were positive for prostate cancer. WBC, neutrophil count, age, PSA, prostate volume, and PSA density (PSAD) were associated with the results of biopsy (P<0.05). Multivariate analysis showed that neutrophil count, age, PSA, prostate volume and PSAD were independent predictors. When the cut-off neutrophil count was set at 2900 μl−1, 78 of 104 men (75.0%) with a count below this value had a positive biopsy, while 125 of 219 (57.0%) men with a count above this value were positive. The area under the receiver-operator characteristics curve (AUC) for the predicted probability of a positive biopsy for prostate cancer according to the optimum logistic model was 0.83 (95% confidence interval (CI) 0.78–0.87), while the AUC for PSA was 0.70 (95% CI 0.64–0.76) and that for PSAD was 0.79 (95% CI 0.74–0.84).

Conclusions: An elevated neutrophil count may be a good indicator of a benign prostate biopsy. Men with a low neutrophil count and an increase of serum PSA should strongly be considered for biopsy.


PSA is secreted from prostate luminal cells, and serum PSA level is used for detection of prostate cancer. If elevation of serum PSA is found, prostate biopsy is performed next. Biopsy is currently the only way to confirm the diagnosis of prostate cancer in a patient with an abnormal PSA level and/or abnormal findings on digital rectal examination, but biopsy is associated with significant morbidity. It is also well recognized that PSA lacks sufficient sensitivity and specificity for detecting prostate cancer, leading to numerous unnecessary biopsies. In addition to cancer, prostatic inflammation and benign prostatic hypertrophy can cause an increase of the serum PSA level. Many models have been proposed to predict the results of biopsy that use the age, the findings on digital rectal examination, and the PSA, PSA density (PSAD), PSA velocity, and prostate cancer antigen 3.[1,2] Prostatic inflammation is detected in most biopsy specimens and subclinical prostatitis is known to increase the serum PSA level.[3,4] Acute and chronic inflammation in biopsy specimens is a significant predictor of the serum PSA level. Histological inflammation in needle biopsy specimens and infiltration of polymorphonuclear leukocytes are correlated with an increase of serum PSA and with the results of repeat biopsy.[5,6] However, information of histological inflammation is not utilized before initial biopsy. Chronic inflammation may also have an important role in prostate cancer carcinogenesis.[7] Only a few markers related with inflammation have been reported to be possible serum markers of prostate cancer. Serum interleukin-7 levels, a cytokine important for B- and T-cell development, is increased in patient with localized prostate cancer as compared with patients with BPH,[8] and C-reactive protein (CRP) is associated with poor survival in men with metastatic prostate cancer.[9]

The purpose of this study was to assess whether the white blood cell count (WBC) or the differential white cell count (neutrophils, lymphocytes, basophils, eosinophils, and monocytes) was correlated with the results of prostate biopsy and/or with various prostatic parameters.