Abnormal Digital Rectal Examination Findings Research Articles

The Clinical Predictors of Malignancy in the Prostate Gland and Their Correlation With Prostate-Specific Antigen (PSA) Levels.

Background and objective The prostate gland, which plays a crucial role in the male reproductive system, has a complex structure and function. Prostate enlargement, often benign but occasionally malignant, poses significant health concerns, particularly in aging populations. Prostate-specific antigen (PSA) serves as a vital biomarker, reflecting changes in prostate architecture and aiding diagnostic stratification. Elevated PSA levels correlate with prostate pathology and standard grading systems such asGleasongrading help guide treatment decisions. This study aimed to investigate the correlation between prostate enlargement, PSA levels, and Gleasongrades, particularly within the Indian context. Materials and methods This study was conducted over one and a half years at the Department of Pathology, Rajendra Institute of Medical Sciences, Ranchi, and involved 100 cases of clinically enlarged prostates. Clinical data, including age, symptoms, and relevant features, were collected, and histopathological analysis was performed on biopsy specimens. Statistical analysis was conducted using Microsoft Excel and SPSS Statisticsversion 20.0 (IBM Corp., Armonk, NY). Results Our study identified possible links between several factors and prostate conditions. Non-vegetarian diets showed a potential association with increased adenocarcinoma prevalence (p = 0.179). Urinary symptoms like hesitancy, incomplete voiding, retention, frequency, and urgency were significantly more common in men with adenocarcinoma (p<0.05). Additionally, bone pain and abnormal digital rectal examination (DRE) findings strongly correlated with adenocarcinoma (p<0.001). As expected, age showed a positive correlation with prostate weight and PSA levels (p<0.01). Interestingly, bone pain was associated with a lower likelihood of other prostate symptoms (p = 0.023). Conclusions Our findings provide key insights into the clinical factors associated with prostate pathology and highlight the need fora comprehensive approach to diagnosis in these patients, integrating clinical evaluation and histopathological assessment.

The role of multiparametric magnetic resonance ımaging in the diagnosis of granulomatous prostatitis mimicking prostate cancer.

Aimed to investigate the role of multiparametric magnetic resonance imaging (mp-MRI) in the diagnosis of granulomatous prostatitis caused by intravesical Bacillus Calmette-Guérin (BCG). In this prospective, single-center study, 10 male patients who were given intravesical BCG due to intermediate- and high-risk bladder cancer were included. Before transurethral resection of bladder tumors (TURB), all patients were evaluated by mp-MRI, serum prostate-specific antigen (PSA), and digital rectal examination (DRE). Serum PSA levels and DRE findings were evaluated before and after intravesical BCG treatment. Prostate mp-MRI was performed for patients with elevated levels of serum PSA and/or with abnormal DRE findings. Then, MRI fusion + systematic prostate biopsy was performed. Demographic data of the patients before and after intravesical BCG were compared. The average age of the patients was 66.9years (55-87years). While PSA was 1.7ng/ml before intravesical BCG treatment, it was 4.3ng/ml after intravesical BCG treatment (p = 0.005). PSA density (PSAD) was 0.04 and 0.10 before and after the treatment, respectively (p = 0.012). DRE findings of all patients were normal before the treatment. However, abnormal findings were detected in 80% of them after the treatment (p = 0.008). PI-RADS ≥ 3 lesions were found to be significantly higher in all patients after intravesical BCG (p = 0.004). Granulomatous prostatitis is a rare complication of intravesical BCG. High PSA, abnormal DRE, and PI-RADS ≥ 3 lesions detected after intravesical BCG should suggest granulomatous prostatitis and unnecessary biopsies may be avoided.

Poster 16 - Is digital rectal examination in the community of value in prostate cancer detection? A retrospective review of prostate cancer rates among patients referred to rapid access prostate clinic services with abnormal primary care digital rectal examination findings

Poster 16 - Is digital rectal examination in the community of value in prostate cancer detection? A retrospective review of prostate cancer rates among patients referred to rapid access prostate clinic services with abnormal primary care digital rectal examination findings

Results of Transrectal Ultrasound-Guided Prostate Biopsy by the Method of 12 Cores at Can Tho University Hospital

Background: Prostate cancer is a common disease in men, with the second-highest incidence rate and the fifth-highest mortality rate worldwide. Diagnoses to determine prostate cancer need to be based on factors such as rectal examination, total PSA in serum, and the result of a prostate biopsy. Our study aimed to evaluate the results of rectal prostate biopsies of 12 cores under the direction of ultrasound. Objectives: Assess results of transrectal ultrasound-guided prostate biopsy by the method of 12 cores. Methods: This was cross-sectional research of 60 patients with prostate tumors with indications for biopsy from 5/2021 to 5/2022 at the Can Tho University of Medicine and Pharmacy Hospital. Our research conducts medical history and patient history to score 2 points on IPSS (International Prostate Syndrome Score) and QoL (Quality of Life Index), and we use the descriptive statistic method to analyze data. The indications for the prostate biopsy were abnormal digital rectal examination findings and/or an elevated serum total prostate-specific antigen (PSA) level (greater than 10 ng/mL). The participants received prophylactic vein bacsulfo (1000 mg) and oral metronidazol (500 mg) before and maintained continued after about 3 days. A Fleet enema was self-administered the night before the procedure for rectal cleansing. Results: The average age of patients was 68.72, and the most common reason for hospitalization was dysuria at 80%. The average IPSS was 26.21 ± 4.49, the average QoL was 3.38 ± 0.67, and the average total PSA was 26.11 ng/mL. The prostate cancer detection rate after the biopsy was 40% (24/60). Gleason’s scores determined accounted for 45.83% (11/24) from 8 points or more. There were two cases of strong rectal bleeding (3.33%) and one case of strong hematuria (1.67%). Conclusions: Transrectal ultrasound-guided prostate biopsy is valuable in the diagnosis of prostate cancer and feasible at our hospital.

Transperineal vs transrectal magnetic resonance and ultrasound image fusion prostate biopsy: a pair-matched comparison

The objective of this study was to compare transperineal (TP) versus transrectal (TR) magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion prostate biopsy (PBx). Consecutive men who underwent prostate MRI followed by a systematic biopsy. Additional target biopsies were performed from Prostate Imaging Reporting & Data System (PIRADS) 3–5 lesions. Men who underwent TP PBx were matched 1:2 with a synchronous cohort undergoing TR PBx by PSA, Prostate volume (PV) and PIRADS score. Endpoint of the study was the detection of clinically significant prostate cancer (CSPCa; Grade Group ≥ 2). Univariate and multivariable analyses were performed. Results were considered statistically significant if p < 0.05. Overall, 504 patients met the inclusion criteria. A total of 168 TP PBx were pair-matched to 336 TR PBx patients. Baseline demographics and imaging characteristics were similar between the groups. Per patient, the CSPCa detection was 2.1% vs 6.3% (p = 0.4) for PIRADS 1–2, and 59% vs 60% (p = 0.9) for PIRADS 3–5, on TP vs TR PBx, respectively. Per lesion, the CSPCa detection for PIRADS 3 (21% vs 16%; p = 0.4), PIRADS 4 (51% vs 44%; p = 0.8) and PIRADS 5 (76% vs 84%; p = 0.3) was similar for TP vs TR PBx, respectively. However, the TP PBx showed a longer maximum cancer core length (11 vs 9 mm; p = 0.02) and higher cancer core involvement (83% vs 65%; p < 0.001) than TR PBx. Independent predictors for CSPCa detection were age, PSA, PV, abnormal digital rectal examination findings, and PIRADS 3–5. Our study demonstrated transperineal MRI/TRUS fusion PBx provides similar CSPCa detection, with larger prostate cancer core length and percent of core involvement, than transrectal PBx.

Standard 12-Core Transrectal Ultrasound-Guided Prostate Biopsy, a Useful Tool in Screening for Prostate Cancer: A Prospective Study in Uyo, Akwa Ibom State, Nigeria

Introduction: Guided prostate biopsy is still relevant in confirming the diagnosis of suspected prostate cancer. Objective: This study evaluated the role of Transrectal Ultrasound (TRUS) guided biopsy along with histopathological evaluation in the detection of prostate cancer on the basis of abnormal digital rectal examination (DRE) findings and elevated prostate specific antigen levels (PSA). Participants and Methods: This prospective study was undertaken among consenting men aged 40 years and above screened for prostate cancer at the University of Uyo Teaching Hospital using targeted, stepwise protocol including DRE, PSA and standard 12-core transrectal ultrasound guided biopsy technique. Biopsy samples were sent for histopathological evaluation. Findings were documented, analyzed and presented in tables and figures. Results: Among 437 participants, abnormal DRE findings, elevated PSA level above 4.0 ng/ml and abnormal TRUS findings were 17.2%, 21.1%, and 17.3% respectively. Of 44 participants who had prostate biopsies with histopathologic assessment, benign prostatic diseases were 24 cases (54.5%), slightly outnumbering malignant prostatic diseases seen in 20 (45.5%).The prostate cancer detection and prevalence rates were 45.5% and 4.6% respectively. Prostatic adenocarcinoma (45.5%), nodular hyperplasia (45.5%), basal cell hyperplasia (6.8%) and high grade prostatic intraepithelial neoplasia (2.2%) were identified histologic subtypes. Nodular hyperplasia was commonly associated with chronic prostatitis (80.0%). A significant association between DRE findings, outline of prostate, and tumour subtype was ascertained. Conclusion: Targeted screening protocol encompassing TRUS guided 12- core biopsy is a final arbiter in the diagnosis of prostate cancer and has a fairly high prostate cancer detection rate of 45.5%.

The Diagnostic Accuracy of Prostate-Specific Antigen and Digital Rectal Examination in the Diagnosis of Prostate Cancer at the University of Benin Teaching Hospital.

To assess and compare the diagnostic accuracy of prostate-specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of prostate cancer. It was a prospective, comparative study carried out over a period of 14 months at the University of Benin Teaching Hospital, Benin City. It involved male patients ≥50 years who presented at the urology clinic with lower urinary tract symptoms (due to prostatic disease), PSA > 4 ng/mL and or abnormal DRE findings. They had serum total PSA determined. Patients were recruited for prostate biopsy and samples sent for histopathological assessment. Histopathology was determined by a histopathologist dedicated to the study. Using a researcher-administered, structured proforma, data were collected, collated and subjected to statistical analysis for assessment and comparative analysis of the diagnostic accuracy of PSA and DRE. The study involved 94 patients; they were all Nigerians. The age range of the study population was 50-85 years, with a mean age of 70.4 ± 8.6 years. Most (89.4%) of the patients were exposed to formal education. PSA of the study population ranged between 2.5 and 840 ng/mL. For patients with carcinoma of the prostate (CaP), median PSA value was 79.2 ng/mL, whereas patients with benign prostatic disease had a median PSA value of 16.0 ng/mL. The difference in median PSA value between the two groups was statistically significant (P < 0.001). In this study, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of PSA was 97.2%, 12.1%, 40.7%, 87.5% and 44.7%, respectively. However, a sensitivity, specificity, PPV, NPV and diagnostic accuracy of DRE was 88.9%, 70.7%, 65.3%, 91.1% and 77.7%, respectively. Combination of PSA and DRE had sensitivity, specificity, PPV, NPV and diagnostic accuracy of 91.7%, 91.4%, 86.8%, 94.6% and 91.5%, respectively. In this study, 36 (38.3%) patients had CaP whereas 57 (60.6%) patients had benign prostatic disease and 1 (1.1%) patient had high-grade prostatic intraepithelial neoplasia. The study revealed a low specificity, high sensitivity and low diagnostic accuracy of PSA in diagnosis of CaP. However, sensitivity, specificity, and diagnostic accuracy of DRE were high but not sufficient in diagnosis of CaP. A combination of PSA and DRE had a higher sensitivity, specificity and diagnostic accuracy in diagnosis of prostate cancer.

Abstract A094: Ethnic differences in indicators of prostate health among Asian American men

Abstract Background: Prostate cancer (PCa) is the most diagnosed non-skin cancer in American men. While Asian Americans have lower incidence and mortality rates of PCa compared to other ethnicities, this cancer type nonetheless has a significant burden on this population. Specifically, population-based studies have shown that when data on PCa in Asian Americans are disaggregated based on ethnicity, several subgroups of Asian American men, in fact, are more likely to be diagnosed with advanced (i.e., more aggressive or metastatic) PCa than non-Hispanic Whites. The heightened rates of advanced PCa at diagnosis among Asian American subgroups highlights the importance of reducing modifiable risk factors, such as smoking and obesity, and promoting early detection in these subgroups. Objective: Accordingly, to better understand and improve prostate health among Asian American men, the present study investigated within group differences in obesity and smoking, two known risk factors for advanced PCa incidence, along with previous history of PCa screening, between three large Asian American ethnic groups: Vietnamese, South Asian (Asian Indian/Pakistani), and Chinese in Houston, Texas. Methods: From 2003 to 2008, the University of Texas MD Anderson Cancer Center conducted a prostate screening project targeting minority men with low income, in which over 500 Asian American men (142 Chinese, 251 Vietnamese, and 128 South Asians) participated. The community-based program provided an educational session on PCa and participants were offered free prostate screening using the prostate-specific antigen (PSA) test and/or digital rectal examination (DRE). Along with socio-demographic and clinical variables, risk factors for advanced PCa (smoking, and obesity), and previous PCa screening history were collected, and differences across the Asian subgroups were examined. Results: Vietnamese men had the highest smoking rate of the three Asian subgroups (52% reported as former/current smokers) and the lowest previous PCa screening rate (15.9% compared to 25.4% of Chinese and 18.8% of South Asian). South Asian men had the highest obesity rate of the three Asian subgroups (12.9% were obese compared to 3.4% of Vietnamese and 4.8% of Chinese). Chinese men had the highest mean PSA and the highest percentage (15.5%) of PSA results ≥ 4 compared to Vietnamese and South Asian men. Chinese men also had the highest percentage (22.4%) of abnormal findings in DRE, compared to Vietnamese (6.6%) and South Asian men (4.8%). Discussion: This study demonstrates that subgroups of Asian Americans may have different PCa risk profiles, nullifying the assumption that all Asian American men are at low risk for the disease. Thus, aggregation of Asian American subgroups may mask meaningful differences in their prostate health. Interventions may need to be tailored to specific Asian subgroups given the heterogeneity of the data based on Asian heritage. Citation Format: Dalnim Cho, Beverly Gor, Mike Hernandez, Curtis A. Pettaway. Ethnic differences in indicators of prostate health among Asian American men [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A094.

Diagnostic Efficacy of Transrectal Ultrasound vs Magnetic Resonance Imaging in the Diagnosis of Carcinoma Prostate: A Cross-sectional Study

Introduction: The high incidence and increasing awareness of prostate cancer, along with ongoing development of new and improved treatment methods have generated considerable need for imaging techniques that allow for accurate detection and staging of tumour prior to treatment. Aim: To compare the findings of Transrectal Ultrasound (TRUS) and Magnetic Resonance Imaging (MRI) in the diagnosis and localisation of carcinoma prostate. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Mysore Medical College, Mysore, Karnataka, India from April 2018 to June 2019. This study included 43 male patients, with age ranging from 49 to 76 years. They underwent TRUS, MRI and TRUS guided 12- core biopsies after being suspected with prostate cancer based on high Prostate Specific Antigen (PSA) values (greater than 4.0 ng/mL) or abnormal Digital Rectal Examination (DRE) findings. A cross table was used to compare the histopathology results, TRUS and MRI findings, from which sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated. Results: Total of 43 male patients were included with mean age of 64.8 years. The sensitivity, specificity, PPV and NPV of TRUS for detection of malignancy was 69.70, 80, 92 and 44.44 respectively and for MRI, it was 87.88%, 70%, 90.63% and 63.64% respectively. In addition, MRI detected lymphadenopathy in three patients and skeletal metastasis in four patients. Conclusion: MRI can improve the false negative biopsies resulting due to the inability of TRUS in the detection of abnormal areas, by showing the exact area of abnormality.

Clinicopathological features and prevalence of prostate cancer in Aseer, Saudi Arabia.

To determine the prevalence and characterize prostate cancer (PC) cases in Aseer, Saudi Arabia. This study involved 883 patients who consulted physicians in Aseer Central Hospital, Abha, Saudi Arabia, for prostate issues between the years 2008-2018. All patients underwent digital rectal examination and measurement of their serum prostate-specific antigen levels. For patients who presented abnormal digital rectal examination findings and elevated prostate-specific antigen levels, prostate biopsies were recommended. Specimens were histopathologically examined to differentiate between malignant and benign tumors. Among the 883 included patients, 132 (15%) underwent a prostate biopsy and were found to have a tumor. Histopathological examination confirmed malignancy (PC) in 77 (8.7%) patients. The absolute majority of the patients diagnosed with PC (96%) were aged >60 years and almost all of them (92%) were found to have a high prostate-specific antigen level of >4 ng/ml. Prostate cancer appears to be a serious disease in Aseer, Saudi Arabia. Further studies aimed at determining the causes of this type of cancer and understanding its mechanisms are warranted.

Individualised non-contrast MRI-based risk estimation and shared decision-making in men with a suspicion of prostate cancer: protocol for multicentre randomised controlled trial (multi-IMPROD V.2.0)

IntroductionEuropean Association of Urology and UK National Institute for Health and Care Excellence guidelines recommend that all men with suspicions of prostate cancer should undergo prebiopsy contrast enhanced, that is,...

Prostate Cancer: Risk Factors and Outcome Indicators

Background: Prostate cancer, which is the second most frequent cancer diagnosis made in men, more commonly occurs in the elderly. This disease is often diagnosed late in resource-limited settings, which results in people having advanced forms of the disease and a poor prognosis. This study aimed to identify factors indicative of prostate cancer aggressivity and a poor prognosis in patients with prostate cancer at a single center in Douala, Cameroon. Methods: We performed a retrospective study from 2015 to 2020 at the Centre medico-chirugical d’urologie in Douala, Cameroon, in which we included 203 patients aged 41 years to 85 years who had prostate cancer diagnosed via histopathology after either prostate biopsyor laparoscopic prostatectomy. Epi-info 7 was used for data analysis and logistic regression analyses were performed to identify factors associated with prostate cancer aggressivity and patients’ outcomes (survival or mortality). Results: The mean age of our study participants was 64.76 ± 7.48 years. Ten patients had a contributive family history of prostate cancer. The patients presented with lower urinary tract symptoms in 61.58% of cases. All patients had serum prostate-specific antigen (PSA) levels of >4 ng/ml, 100 patients were anemic, and 36 patients had aggressive forms of the disease. Eighty-eight patients had remarkable digital rectal examination (DRE) findings. The median prostate volume, as determined via transrectal ultrasonography (TRUS), was 59 [43 - 80] ml. Fifty-nine patients had abnormal prostate echostructures, and 33 patients died during follow-up. The presence of paraplegia and the practice of professions requiring unskilled labor were significantly associated with aggressive prostate cancer. The presence of lymphoedema, abnormal DRE findings, anemia, enlarged prostate glands (prostate volume >50 ml), and abnormal prostatic echostructures were significantly associated with both prostate cancer aggressivity and patients’ outcomes. Conclusion: The late diagnosis of prostate cancer is a major public health problem in Cameroon because of the complications and poor prognosis of the disease at an advanced stage. Certain clinical, biological, and imaging factors are associated with prostate cancer aggressivity and a poor prognosis, whose identification could help guide clinicians in making therapeutic choices for their patients.

Diffusion-weighted magnetic resonance imaging at 1.5 T for peripheral zone prostate cancer: the influence of the b-value combination on the diagnostic performance of apparent diffusion coefficient.

PurposeDiffusion-weighted imaging as a noninvasive functional modality plays a valuable role in the evaluation of prostate cancer. However, there is still no agreement on the number and range of b-values to be used. Therefore, the purpose of this study is to investigate the influence of b-value choice on the diagnostic performance of apparent diffusion coefficient (ADC) values for prostate cancer detection.Material and methodsFifty-nine consecutive patients with abnormal digital rectal examination findings and raised serum prostate-specific antigen were chosen for magnetic resonance imaging of the prostate before systematic 12-core trans-rectal ultrasound-guided prostate biopsies. ADC values for each ROI were calculated from different b-value combinations (0-1600 s/mm2) by a monoexponential model. Mann-Whitney and the paired-sample t-test were used to compare the mean ADC values for malignant lesions and noncancerous tissues. ROC curve analysis was used to evaluate the diagnostic performance of ADC values in distinguishing prostate cancer from normal-tissue ROIs.ResultsThe differences between mean ADC values of malignant lesions and contralateral healthy tissues were significant for all the pairs of b-value combinations. The pair of b-values 50 and 1200 provided the highest AUC (0.94), with a sensitivity of 90.2%, a specificity of 92.6%, and an accuracy of 91.2% at an ADC cut-off of 1.23 × 10-3 mm2/s.ConclusionsOur study showed that using a 1.5-Tesla MRI scanner the diagnostic performance of ADC values estimated from the b-value pair 50 and 1200 s/mm2 was highest. However, some other b-value pairs provided statically comparable diagnostic performance.

Hypoehoic lesions on Transrectal Ultrasound and its correlation to Gleason grade in the diagnosis of Clinically Significant Prostate Cancer: A Prospective Study.

Context The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing. Aims We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer. Settings and Design This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019. Methods and Material We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS. Statistical Analysis Used The statistical analysis for this study was performed using SPSS v20.0 software. Results Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion ( p <0.0001). Patients with hypoechoic lesion were more likely to have higher grade cancer. Abnormal DRE findings and hypoechoic lesion on TRUS were independent predictors of a clinically significant cancer ( p <0.05). Conclusion Hypoechoic lesion on TRUS can be considered as an indicator of clinically significant prostate cancer.

Platelet-to-lymphocyte ratio is not a predictor of clinically significant prostate cancer at the prostate biopsy: A large cohort study

Previous studies have reported conflicting results on the predictive role of the platelet-to-lymphocyte ratio (PLR) in detecting clinically significant prostate cancer (CSPCa) at the time of prostate biopsies. We explored the predictive value of pre-biopsy PLRs for CSPCa using our large-cohort database. Consecutive men with serum prostate-specific antigen (PSA) levels of ≥ 3.0 ng/mL or abnormal digital rectal examination (DRE) findings and who underwent prostate biopsies were included in the study. There was no significant difference in the pre-biopsy PLR between men with benign disease, clinically insignificant prostate cancer (CISPCa), and CSPCa. Only the subset of CSPCa patients with serum PSA levels of < 10 ng/mL showed lower PLRs than those with benign disease or CISPCa. In the entire patient cohort, multivariate analyses revealed that older age, diabetes mellitus, DRE abnormalities, higher serum PSA levels, and smaller prostate volume were predictors of CSPCa. However, the pre-biopsy PLR was not a significant predictor of CSPCa at the prostate biopsy in the entire patient cohort or the subset of patients with serum PSA levels of < 10 ng/mL. In summary, the pre-biopsy PLR is not an independent predictor of CSPCa at the prostate biopsy, regardless of the serum PSA level.

Clinical Significance of Caseating Granulomas Detected on Transrectal Ultrasound Biopsy of Prostate Gland: The Recommended Management

Introduction: The histopathological examination (HPE) findings of caseating granulomas from the transrectal ultrasound (TRUS) of prostate biopsy are rare. A high index of suspicion is necessary to diagnose a tuberculosis infection. Here, we present the clinical outcomes of patients and the practical management steps when encounter these findings. Methods: We conducted a retrospective analysis of three cases in a tertiary care centre and reviewed the available literature on the topic. Results: All patients were aged less than 55 years and were considered young adults. One patient presented with neurogenic systemic symptoms, and two patients presented with lower urinary tract symptoms. All patients had abnormal digital rectal examination findings that warranted a TRUS biopsy of the prostate. All biopsies reported caseating granuloma with multinucleated giant cells. Additional investigations led to the diagnosis of tuberculosis infections in two patients, and one patient was diagnosed as having non-specific granulomatous prostatitis. All patients were treated according to their specific diagnosis and recovered fully. Conclusion: The detection of caseating granuloma on prostate biopsy may lead to diagnoses of several conditions, either infective or non-infective in origin. Further investigation is mandatory to provide appropriate treatment.

Transrectal ultrasonography and biopsy of the prostate

When compared to other solid organ malignancies, the diagnosis of prostate cancer is not reliant on imaging findings alone. Men found to have abnormal digital rectal examination findings, raised serum prostate-specific antigen levels, or both are subjected to prostate biopsy to arrive at a diagnosis. Since its introduction in the 1970s, Transrectal ultrasonography (TRUS) plays a vital role in the diagnostic pathway to guide prostatic biopsy. However, many men are subjected to unnecessary biopsies, leading to a diagnosis of clinically-indolent cancer or occasionally missing a focus of clinically significant disease. Currently, TRUS-guided prostate biopsy performed under local anesthesia is in widespread use for the diagnosis of prostate cancer. The peripheral zone of the prostate showing a hypoechoic lesion is the most common finding consistent with prostate cancer. In this review, we aim to highlight the ultrasonographic anatomy of prostate, the technique, and associated complications along with a brief note on the recent advances in imaging technology for the diagnosis of prostate cancer.

Role of 68Ga-PSMA-PET/CT for the detection of primary prostate cancer prior to biopsy: a prospective study.

IntroductionProstate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET-CT) is widely used as a staging tool for patients with prostate cancer (PCa). The objective of the study is to assess the diagnostic accuracy of 68Ga-PSMA-PET/CT for PCa, which may help us avoid unnecessary biopsies in patients with intermediate prostate-specific antigen (PSA) levels.Material and methodsIn this prospective study, 81 patients suspected of PCa, with either raised PSA between 4–20 ng/ml or abnormal digital rectal examination (DRE) findings were included. 68Ga-PSMA-PET/CT was performed for all patients followed by transrectal ultrasound (TRUS) guided prostate biopsy. SUVmax (maximum standardized uptake value) was measured and correlated with biopsy results.ResultsOut of 81 patients, 31 (38.3%) patients were found to have malignancy on biopsy. Median SUVmax of biopsy positive patients was 10.4 (IQR 6.5–16.1) and biopsy negative patients (n=50) was 3.5 (IQR 1–4.9), (p <0.001). At a cut-off of 6.15, 68GA-PSMA-PET/CT demonstrated sensitivity of 84%, specificity of 80%, positive predictive value of 72.2%, negative predictive value of 88.9% and accuracy of 81.5% with an AUC of 0.876 (95% CI: 0.799–0.953, p <0.001).ConclusionsThe 68Ga-PSMA-PET/CT helps to localize suspicious lesions and improving the detection of primary prostate cancer. Our findings indicate a significant correlation of SUVmax values with biopsy results. We were also able to determine a cut-off value of SUVmax below which prostate biopsy can be avoided in selected patients.

Prostate cancer detection rate and Gleason score in relation to prostate volume as assessed by magnetic resonance imaging cognitive biopsy and standard biopsy

This study aimed to assess the relationship of the prostate cancer and Gleason scores (GSs) or ISUP Grade system with prostate volume (PV) as assessed by magnetic resonance imaging (MRI) cognitive biopsy and standard biopsy. Data were collected from 659 patients who underwent MRI cognitive biopsy and standard biopsy from January 2014 to January 2018. The biopsies were performed because of increased prostate-specific antigen (PSA) levels (>4 ng/mL) and/or abnormal digital rectal examination findings. Transrectal ultrasound was used to measure PV. Prostate cancer detection rates in patients with increased PVs of ≤40 cc and >40 cc were 68.8% and 51.6% (p<0.001), respectively. ISUP Grade group ≥2 (Gleason score ≥3+4) detection rates for increased PVs of ≤40 cc and >40 cc were 68% and 73%, and 22.3% and 37.8%, respectively, for those with ISUP Grade group ≥4 (Gleason score ≥8) (p=0.003). Among the patients with PV>40 cc, univariate logistic regression showed a significant relationship between ISUP Grade group ≥2 and PSA, free/total PSA, PSA density, and MRI (p<0.05). On multivariable logistic regression, MRI (p=0.014) and PSA (p=0.039) predicted ISUP Grade group ≥2 in patients with PV>40 cc. Although the detection rates of prostate cancer decreased as PV increased, the detection of prostate cancer aggressiveness increased as PV increased. This increase in high ISUP Grade lesions with the rise in PV is due to the use of MRI during prostate biopsy with standard biopsy.

Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer

Introduction: Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings. Methods: Prospective study was done in 66 males of age &gt;40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA &gt;4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings. Results: Twenty-three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%. Conclusion: TRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer.