Relation of the prostate specific antigen level with the outcome of analgesic transrectal ultrasound-guided prostate biopsy by intravenous anesthesia in the older men

Abstract

Objective To investigate the relation of the prostate specific antigen (PSA) level with the outcome of analgesic transrectal ultrasound-guided prostate biopsy(ATUGPB) by intravenous anesthesia and clinical parameters in the older men with evaluated PSA. Methods The AUGPB with twelve cores by intravenous anesthesia were completed in 106 patients from September 2008 to August 2010 induding our outpatient and inpatient [mean age(68±7)years] with evaluated PSA(>4 ng/ml). According to the PSA level, the patients were divided into low-risk group(4 ng/ml20 ng/ml，24 cases). The parameters were recorded including biopsy time, visual analog pain scale score(VAS), prostate volume(PV), PSA density(PSAD), pathological outcome, anesthetic adverse events and complications. Results The mean biopsy time was(5.9±2.0)min, ninety eight cases(92%) had no pain(VAS=0)and no case occurred anesthetic adverse event. There were total 164 positive cores in 1272 cores, of which 36 cases were prostate cancer(Pca), 4 cases were prostate atypical hyperplasia and 4 cases were prostate intraepithelial neoplasia. The detection rate of Pca from low-risk group to high-risk group were respectively 10.9%, 33.3% and 87.5%, and that of benign prostatic hyperplasia(BPH) were 81.8%, 59.2% and 4.2%, the difference of them was significant(P<0.05). The PV and mean age [(48±11)cm3 and(65±7) years]of the cases with BPH in low-risk group were significantly lower than those in moderate-risk group [(87±14）cm3 and(73±5) years]. Moreover, the PSAD was significantly increasing in the cases with Pca from low-risk group to high-risk group [(0.18±0.05) ng/(ml·cm3), (0.21±0.04) ng/(ml·cm3) and(0.49±0.04) ng/(ml·cm3)]. Furthermore, the PSAD of the cases with Pca was significantly higher than that of the cases with BPH, however, PV was significantly lower than that of the cases with BPH from both low-risk group and moderate-risk group. Conclusions It is suggested that it is painless, accurate and safe for ATUGPB by intravenous anesthesia in the older men with evaluated PSA. The PSA level is well relation with pathological outcome and PSAD could serve as an effetive predictive parameter. Key words: Prostate biopsy; Prostate specific antigen; Anethesia; Pain; Ultrasound