Diagnosis Of Prostatic Carcinoma Research Articles

Prostate Carcinoma: Urologist's Perspective

AbstractProstate cancer management has undergone radical changes in recent times, due to early diagnosis in localized stage and availability of multiple treatment modalities. But the onus of selecting appropriate treatment rests with the urologist. Radiological investigations are immensely important in these patients. Measurement of prostate-specific antigen and its derivatives is the primary investigation in the diagnosis of prostate carcinoma. Ultrasonogram is of limited utility in prostate carcinoma. Magnetic resonance imaging provides extensive information to the treating physician regarding the approach and the treatment modality to be used in the management of prostate carcinoma. Radiological investigations are the cornerstones for efficient management of prostate carcinoma.

A current role status of micro-ultrasound imaging in prostate cancer diagnosis.

Recently diagnostic field in medicine was enriched by advances in ultrasonography (US) technology, which led to establishment of novel modalities, one of which is micro-ultrasound. Results demonstrated by early studies have been promising, simultaneously rising a question if those new modalities could become an alternative in diagnosis of prostatic carcinoma (PCa). To answer this question, several studies have been conducted where micro-ultrasound have been compared to standard diagnostic tools, such as conventional TRUS or mpMRI. Nevertheless, new technology presents with some limitations, which include inconsistent results, necessity for specialized equipment, need of training for investigators to understand the findings, and external validation. In this publication, we have identified studies that provided evaluation of the accuracy and efficiency of the micro-ultrasound technology. Additionally, analysis of the results provided a better understanding of the novel imaging tool when compared standard modalities in diagnosis of PCa. Increasing number of studies demonstrated that micro-ultrasound carries high detection rate of PCa and clinically significant prostatic cancer (csPCa), suggesting a similar performance to mpMRI and even showing superiority over conventional TRUS. Recent studies have also showed that micro-ultrasound takes active role in improving the detection of csPCa and guidance for prostate biopsy (PBx) as well as further treatment. Moreover, certain practical aspects such as lower costs, decreased waiting time, real-time imaging and application of the imaging tool for patients that are not suitable for mpMRI (contrast allergy, prosthetics etc.) are significant advantages. Analysis of the results still does not provide clear answer whether micro-ultrasound outperforms mpMRI. Further studies are necessary in order to completely understand the potential of this new technology.

Diagnostic accuracy of the different pulse sequences of multi-parametric prostate MRI in the diagnosis of prostate cancer in the peripheral and transitional zones

BackgroundOne of the most prevalent malignancies among males is prostate carcinoma (PCa). For the diagnosis of PCa, multiparametric magnetic resonance imaging (mpMRI) constitutes by far the most accurate imaging technique. The PI-RADS v2.1 indications for dynamic contrast enhanced (DCE) sequence include identifying PI-RADS score 3 lesions, as clinically significant prostate carcinoma, aiding evaluation of examinations having poor quality of T2 as well as diffusion weighted imaging (DWI), and helping readers having relatively reduced expertise. Most articles don't provide outcomes pertaining to these indications, which weakens their conclusions. All MRI scans, even those with low quality T2 or DWI, were included in our study. Additionally, special emphasis on assessing peripheral zone lesions was made. Our objective was to assess the diagnostic accuracy of the various mpMRI pulse sequences, including the T2 sequence, diffusion and apparent diffusion coefficient (ADC) sequences, both T2 and diffusion sequences (biparametric (bp) MRI), DCE sequence, and the entire examination (mpMRI), in the diagnosis of PCa in the peripheral as well as the transitional zone using PI-RADS version 2.1 scoring system, once when malignant lesions are considered as those having PI-RADS scores 4 and 5 and once when PI-RADS categories 3, 4 and 5 were regarded as malignant.ResultsIn the assessment of peripheral zone lesions, when PI-RADS categories 3, 4, and 5 were considered malignant, both bpMRI and mpMRI showed similar sensitivity (94.29%) and diagnostic accuracy (77.78%) while when considering scores 4 and 5 malignant, mpMRI demonstrated increased diagnostic accuracy and sensitivity but lower specificity (sensitivity was 82.86%/60%, specificity was 80%/100%, and diagnostic accuracy was 82.22%/68.89% for mpMRI/bpMRI test comparaison). Both bpMRI and mpMRI had similar sensitivity (95.83%) and diagnostic accuracy (71.05%) when PI-RADS categories 3, 4, and 5 were regarded as malignant; however, mpMRI demonstrated better diagnostic accuracy and sensitivity considering scores 4 and 5 malignant (sensitivity was 77.08% for mpMRI compared to 60.42% for bpMRI and diagnostic accuracy was 82.89% for mpMRI compared to 75% for bpMRI).ConclusionsBoth bpMRI and mpMRI demonstrated similar diagnostic accuracy when PI-RADS categories 3, 4, and 5 were taken into account as malignant while mpMRI had higher diagnostic accuracy considering categories 4 and 5 malignant.

MRI-Guided Targeted and Systematic Prostate Biopsies as Prognostic Indicators for Prostate Cancer Treatment Decisions.

The standard procedure for the diagnosis of prostate carcinoma involves the collection of 10-12 systematic biopsies (SBx) from both lobes. MRI-guided targeted biopsies (TBx) from suspicious foci increase the detection rates of clinically significant (cs) PCa. We investigated the extent to which the results of the TBx predicted the tumor board treatment decisions. SBx and TBx were acquired from 150 patients. Risk stratifications and recommendations for interventional therapy (prostatectomy and radiotherapy) or active surveillance were established by interdisciplinary tumor boards. We analyzed how often TBx alone were enough to correctly classify the tumors as well as to indicate interventional therapy and how often the findings of SBx were crucial for therapy decisions. A total of 28/39 (72%) favorable risk tumors were detected in TBx, of which 11/26 (42%) very-low-risk tumors were not detected and 8/13 (62%) low-risk tumors were undergraded. A total of 36/44 (82%) intermediate-risk PCa were present in TBx, of which 4 (9%) were underdiagnosed as a favorable risk tumor. A total of 12/13 (92%) high-risk carcinomas were detected and correctly grouped in TBx. The majority of csPCa were identified by the sampling of TBx alone. The tumor size was underestimated in a proportion of ISUP grade 1 tumors. Systematic biopsy sampling is therefore indicated for the next AS follow-up in these cases.

RELATION BETWEEN LOW SERUM TESTOSTERONE AND PROSTATE CANCER BEHAVIOR

Objectives: Prostate cancer is intensifying globally, including Asian countries also. There are a numerous arguments is still going on in concerning the connection among endogenous testosterone levels and prostate ailments. The present research was performed to recognize the assessment of serum testosterone in identifying the threat and prostate cancer incidences. Methods: Hundred cases were registered in the research, among that, the cases showing low testosterone value (<250 ng/dL) was considered A Group and cases with normal testosterone value (>250 ng/dL) was considered B Group. All cases those went radical prostatectomy were followed for post-operatively with histopathological analysis and variables, namely, Post-operative Gleason grade, pathological tumor status, pathological node status, surgical margin status, extracapsular extension of tumor, seminal vesicle invasion, and matched among groups. Variables were completed with the Student’s t-test; p<0.05 was considered statistically significant. Results: Serum testosterone levels as found to be reduced among 74% and regular among 34% prostate cancer cases. Patients in Group A showed greater complete tumor stage, advanced nodal stage, and widespread metastases on scientific assessment associated with Group B. Conclusion: All the elderly men aged 60 and more should be screened of for serum testosterone levels for timely prostate carcinoma diagnosis and for better prognosis in the management.

ROLE OF EXPRESSION OF P63 AND CALPONIN IN PROSTATIC BIOPSIES

Background: An increased number of mortality and morbidity in elderly men is caused due to prostatic diseases all over the world. An increase in mass screening programmes conducted with the help of Prostate Specic Antigen (PSA) blood test along with Digital rectal examination (DRE) and imaging studies has resulted in an upsurge in the diagnosis of prostatic cancer which is markedly noted in the recent decades. Material And Methods: A total 100 cases of formalin xed parafn embedded histological sections of various prostatic lesions including benign prostatic hyperplasia, prostatic intraepithelial lesion and prostate carcinoma were studied. Out of 100 cases, 55 cases were benign prostatic hyperplasia, 10 cases of prostatic intraepithelial lesion and 35 cases were of prostate adenocarcinoma. All the sections were stained with Hematoxylin and Eosin stain and then immunohistochemical staining of p63 and Calponin was performed on all the cases (gure 6- 12). The parameters used to analyse the expression of both p63 and calponin were - Pattern of staining, Percentage of stained cell, Intensity of staining reaction. Total 100 cases i Results: ncluded in this study, out of which 55 (55%) cases were benign prostatic hyperplasia, 10 (10%) cases of prostatic intraepithelial neoplasia, and 35 (35%) cases were prostatic adenocarcinoma, majority of specimens (78%) were TURP followed by trucut biopsy (20%), Suprapubic prostatectomy (2%). The proportion of Transurethral resection of prostate (TURP) was signicantly higher as compared to the proportion of Trucut biopsy and supra pubic prostatectomy (SPP) (p<.001). Expression of calponin in various prostatic lesion. On analysing expression of proliferation marker calponin, in BPH it was expressed in only 52 cases out of 5 cases (94.5%) and 3 cases (8.6%) were negative. Our study concluded that the proportion of Benign prostatic Conclusion: hyperplasia was signicantly higher as compared to the Prostatic intraepithelial neoplasia and Prostatic adenocarcinoma. Immunohistochemical staining by p63 is diagnostically reliable in identifying basal cells in prostatic needle biopsies and TURP specimens. p63 is a valuable tool with high sensitivity in differentiating BPH from prostatic carcinoma. The decreased or absent stromal staining of calponin which indicates a reactive stroma in malignancy can be used alone or in conjunction with p63 for conrmation of diagnosis of prostatic carcinoma

Determination of sarcosine in urine as a predictor of prostate cancer using Enzyme linked immunosorbent method

Prostate cancer is a type of malignancy that is defined by abnormal development of cells in the prostate tissue. Prostate cancer needs early intervention since its incidence and prevalence is high across the world leading to high morbidity and mortality. Prostatic specific antigen test which is the commonly used screening test in Kenya and across the world is nonspecific, expensive and inaccessible to many people in rural setting who are in need. The definitive histological test is invasive and requires specialized facilities and personnel. This study sought to investigate sarcosine in urine as a predictor of prostate cancer to supplement prostatic specific antigen test in the diagnosis of prostate carcinoma. Cross sectional study design was employed in this study for all suspected prostate cancer identified according to clinical assessment during the study period. Midstream urine samples of about 30mls was collected in plastic tubes, centrifuged and supernatant collected and analyzed using ELISA method for sarcosine. Raw data obtained was tabulated in excel and transferred to statistical package for social science. Differences in means and standard deviation from various age groups was analyzed using one-way Anova and Independent t test. The Bonferroni was used as post Hoc to test the means that were significant from others. Significance level was set at 95%. The concentration of sarcosine (4.30±0.11nmol/ml) in prostate cancer participants was significantly higher than the concentration (0.47±0.06nmol/ml) of control participants using ELISA (p<0.001;). Hence Sarcosine in urine needs to be analyzed for the testing of prostate tumor since it is raised in confirmed prostate carcinoma participants as compared to negative control units. The age groups of the prostate tumor participants had no significant variation in sarcosine concentration using ELISA method (p=0.57). Similarly, the age groups of the control individuals were not significantly different in sarcosine concentration (p=0.17). Future studies need to dwell in incorporating sarcosine metabolite in urine.

The Role of Free Prostate-Specific Antigen in the Diagnosis of Prostate Carcinoma: A Cross-Sectional Study in Rajshahi, Bangladesh

The prevalence of prostatic carcinoma is the outcome of several factors including improved awareness the general population of the significance of carcinoma of the prostate and progresses in diagnostic approaches. The PSA is a probable prostate cancer tumor marker, although it cannot distinguish prostate cancer from BPH solely. To assess the usefulness of free, total, and free/total PSA ratios in differentiating BPH and prostate cancer has been studied under this research work. The work was carried out at RMCH during April 2021 to March 2022, 350 purposively selected urology outpatients and inpatients at RMCH were studied cross-sectional study. Trans-rectal ultrasound (TRUS) and serum PSA levels were analyzed along with Digital rectal examination (DRE). A digital guided prostatic biopsy using a monopty biopsy gun confirmed the diagnosis. Data analysis was done in SPSS 26 software program. Prostatic cancer was more prevalent in men aged 70-80, whereas BPH was more common in men aged 60-70 (p = 0.00032). Histopathology revealed 95 prostate cancer patients, 82 with PSA >4 ng/ml and 85 patients had f/t PSA ratio>0.16. BPH was found in 255 individuals. 139 BPH patients had total PSA >4 ng/ml and 245 BPH patients had f/t PSA ratio ≤0.16. Total PSA had sensitivity and specificity of 86.32% and 45.49%, respectively, lower than f/t ratio. The (Positive predictive value) PPV and accuracy was significantly higher in f/t ratio than total PSA. Along with total PSA, free and free/total PSA ratio may help detect prostate cancer early and distinguish BPH from prostate cancer. J Bio-Sci. 30(1): 79-89, 2022 (June)

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.

WHO Classification of Tumours fifth edition: evolving issues in the classification, diagnosis, and prognostication of prostate cancer.

The fifth edition of the WHO Classification of Tumours of the Urinary and Male Genital Systems encompasses several updates to the classification and diagnosis of prostatic carcinoma as well as incorporating advancements in the assessment of its prognosis, including recent grading modifications. Some of the salient aspects include: (1) recognition that prostatic intraepithelial neoplasia (PIN)‐like carcinoma is not synonymous with a pattern of ductal carcinoma, but better classified as a subtype of acinar adenocarcinoma; (2) a specific section on treatment‐related neuroendocrine prostatic carcinoma in view of the tight correlation between androgen deprivation therapy and the development of prostatic carcinoma with neuroendocrine morphology, and the emerging data on lineage plasticity; (3) a terminology change of basal cell carcinoma to “adenoid cystic (basal cell) cell carcinoma” given the presence of an underlying MYB::NFIB gene fusion in many cases; (4) discussion of the current issues in the grading of acinar adenocarcinoma and the prognostic significance of cribriform growth patterns; and (5) more detailed coverage of intraductal carcinoma of prostate (IDC‐P) reflecting our increased knowledge of this entity, while recommending the descriptive term atypical intraductal proliferation (AIP) for lesions falling short of IDC‐P but containing more atypia than typically seen in high‐grade prostatic intraepithelial neoplasia (HGPIN). Lesions previously regarded as cribriform patterns of HGPIN are now included in the AIP category. This review discusses these developments, summarising the existing literature, as well as the emerging morphological and molecular data that underpins the classification and prognostication of prostatic carcinoma.

Ex Vivo Fluorescence Confocal Microscopy (FCM) of Prostate Biopsies Rethought: Opportunities of Intraoperative Examinations of MRI-Guided Targeted Biopsies in Routine Diagnostics.

Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa.

CUT-OFF VALUES OF PROSTATE SPECIFIC ANTIGEN DENSITY– AN EFFECTIVE SCREENING MARKER BEFORE PROSTATE BIOPSY

OBJECTIVE: To determine cut-off values for prostate specific antigen density (PSAD) in diagnosing prostate carcinoma in symptomatic patients. METHODS: This cross sectional, observational study conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan from June 2020 to May 2021. Symptomatic patients (309) having prostatic enlargement on ultrasound were selected through consecutive sampling. All the patients underwent prostate biopsy for histopathological diagnosis. Prostate specific antigen density was calculated and compared between different age groups and different diseases. ROC curve was constructed and area under the curve was calculated to find out cut-off values value for PSAD. Sensitivity, specificity and accuracy were calculated at the cut-off values. RESULTS: Among 309 patients of median age was 68 years (IQR 43 – 75). There was a significant difference of PSAD in different age groups (p<0.001) and diseases like prostate carcinoma, benign prostatic hyperplasia and other prostatic disorders. PSAD had AUC of 0.878 at cut-off value of 0.135 ng/ml where sensitivity was 100%. A higher cut-off 0.20 ng/ml was suggested in younger age group as compared to the old age group where cut-off was found 0.135. CONCLUSION: Using PSAD as part of evaluation profile for prostate lesion, number of unnecessary biopsies can be significantly decreased. PSAD cut-off to aid in decision of invasive prostate biopsy is suggested to be 0.135 ng/ml with close biochemical follow up afterwards.

Role of MRI in staging of prostatic cancer based on PIRADS classification version 2

Background; Prostate cancer is the second most common cancer in men worldwide. Two thirds of prostate cancer cases are diagnosed in the more developed regions of the world. Aim and objectives: The aim of this study was to evaluate the role of MRI imaging in staging of prostate cancer based on Prostate Imaging Reporting and Data System (PI-RADS) version 2. Subjects and methods: Thirty male patients were included in our study. They were referred to the department of Radiology, Minia Oncology Center with clinical and pathological diagnosis of prostatic carcinoma during the period extended from January 2019 to January 2021. Results: There was a statistically significant difference between PIRADs 4 and PIRADs 5 lesions as regard patients’ PSA, with higher values among PIRADs 5 cases. There was a statistically highly significant difference between PIRADs 4 and PIRADs 5 lesions as regard patients’ Gleason score, with higher values among PIRADs 5 cases. Conclusion: MRI examination of the prostate gland has a high specificity and sensitivity in primary diagnosis or staging over clinical assessment alone (PSA level and DRE), and other modalities like ultrasound.

Comparison of Different Machine Learning Models in Prediction of Postirradiation Recurrence in Prostate Carcinoma Patients.

After primary treatment of localized prostate carcinoma (PC), up to a third of patients have disease recurrence. Different predictive models have already been used either for initial stratification of PC patients or to predict disease recurrence. Recently, artificial intelligence has been introduced in the diagnosis and management of PC with a potential to revolutionize this field. The aim of this study was to analyze machine learning (ML) classifiers in order to predict disease progression in the moment of prostate-specific antigen (PSA) elevation during follow-up. The study cohort consisted of 109 PC patients treated with external beam radiotherapy alone or in combination with androgen deprivation therapy. We developed and evaluated the performance of two ML algorithms based on artificial neural networks (ANN) and naïve Bayes (NB). Of all patients, 72.5% was randomly selected for a training set while the remaining patients were used for testing of the models. The presence/absence of disease progression was defined as the output variable. The input variables for models were conducted from the univariate analysis preformed among two groups of patients in the training set. They included two pretreatment variables (UICC stage and Gleason's score risk group) and five posttreatment variables (nadir PSA, time to nadir PSA, PSA doubling time, PSA velocity, and PSA in the moment of disease reevaluation). The area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy was calculated to test the models' performance. The results showed that specificity was similar for both models, while NB achieved better sensitivity then ANN (100.0% versus 94.4%). The ANN showed an accuracy of 93.3%, and the matching for NB model was 96.7%. In this study, ML classifiers have shown potential for application in routine clinical practice during follow-up when disease progression was suspected.

Superscan Appearance of 68Ga PSMA PET/CT in a Patient with Refractory Prostate Cancer.

A 64-year-old male patient with metastatic prostate carcinoma diagnosis received lutetium-177 prostate-specific membrane antigen (PSMA) treatment; however, his disease progressed. Herein, presented the final images of the patient that demonstrated a superscan appearance in the Gallium-68 PSMA positron emission tomography/computed tomography, which is a rare phenomenon.

Left supraclavicular (Virchow\u2019s) node metastasis detected before primary infradiaphragmatic tumor: a case series

BackgroundMetastasis of infradiaphragmatic tumors to the left supraclavicular lymph node is reported to be rare. When metastasis is detected in the left supraclavicular node in patients with head and neck carcinoma, locating the primary cancer remains a difficult and time-consuming challenge despite the dramatic development of screening technologies and treatment methods.Case presentationWe report three cases of malignant infradiaphragmatic tumor diagnosed following an initial finding of left supraclavicular node metastasis after surgery for tongue squamous cell carcinoma (follow-up period, range 18–62 months). In these cases, adenocarcinoma was diagnosed based on left supraclavicular node biopsies, and a second primary tumor was found, in a 78-year-old Japanese woman with a diagnosis of cholangiocarcinoma, a 64-year-old Japanese man with a diagnosis of bladder carcinoma, and a 61-year-old Japanese man with a diagnosis of prostate carcinoma. In the cholangiocarcinoma case, carbohydrate antigen 19-9 and alpha-fetoprotein levels helped to diagnose cholangiocarcinoma. Palliative care only was given, with survival for 11 months after diagnosis of lymph node metastasis. In the bladder carcinoma case, pathological analysis of fine-needle aspiration biopsy specimen of the metastatic cervical lymph node showed atypical cells with slight squamous differentiation. Hematoxylin–eosin staining of the bladder lesion did not identify a clear glandular or squamous component, and we could not make a definitive diagnosis of whether the lesion was poorly differentiated squamous cell carcinoma, adenocarcinoma, or high-grade urothelial carcinoma. GATA3 staining aided in the diagnosis of urothelial bladder cancer with left supraclavicular node metastasis. He survived for 2 months after diagnosis of left supraclavicular lymph node metastasis. In the prostate carcinoma case, 18F‐fluorodeoxyglucose uptake was weak. Prostate-specific antigen levels and magnetic resonance imaging findings aided the diagnostic process. This patient underwent bilateral orchiectomy and adjuvant hormonal therapy and survived for 47 months after diagnosis of left supraclavicular node metastasis.ConclusionsPathological diagnosis on the basis of immunohistochemistry and specific diagnosis methods such as radiological and serological assessments are important for providing rapid diagnosis and appropriate treatment.

Clinicopathological Significance of Exosomal Proteins CD9 and CD63 and DNA Mismatch Repair Proteins in Prostate Adenocarcinoma and Benign Hyperplasia.

Introduction. Recently, it has been shown that exosomal biomarkers and DNA mismatch repair proteins (MMR) could play an important role in cancer risk stratification and prognosis assessment. The gold standard for prostate carcinoma (PCa) diagnosis is biopsy and histopathological examination. Thus, the complex evaluation of exosomal and MMR proteins could be beneficial for prostate cancer risk stratification and diagnostics. The aim of the current study was to evaluate and compare the expression of exosomal proteins CD9 and CD63 and MMR proteins in the tissue of patients with prostate benign hyperplasia (BPH) and PCa. Methods. The study was retrospective. Altogether, 92 patients with PCa and 20 patients with BPH (control group) were enrolled in the study. Exosomal and MMR protein expression was analyzed by immunohistochemistry (IHC). The follow-up for each PCa patient in our study lasted till disease progression and/or a maximum of 5 years. Results. Low-grade PCa was observed in 56 patients and high-grade PCa in 36 patients. CD63 expression was significantly higher in patients with high-grade PCa compared to those with low-grade PCa. CD9 expression was significantly downregulated in PCa patients compared to the control group. MMR protein expression deficiency was observed in 10 PCa patients. MMR proteins were maintained in all cases of BPH. The study found a negative correlation between MMR protein loss and PCa ISUP grade groups. Progression-free survival (PFS) in patients with MMR deficiency was significantly shorter than in patients with maintained MMR expression. Conclusions. CD9 protein expression was downregulated in PCa, compared to BPH, while CD63 protein expression was upregulated in high-grade PCa but downregulated in low-grade PCa. CD63 protein upregulation, CD9 downregulation, and loss of MMR protein characterized the shorter PFS of high-grade PCa patients. CD9, CD63, and MMR could be the routine immunohistochemical biomarkers for the diagnosis and risk stratification of PCa.

To Determine the Diagnostic Accuracy of Diffusion-Weighted Imaging in the Diagnosis of Prostate Carcinoma Taking Histopathology As the Gold Standard.

IntroductionCarcinoma of the prostate is the most common malignancy among males. Serum prostate-specific antigen (PSA) levels and digital rectal examination (DRE) are the initial investigations for the detection of prostate cancer. In recent years, some investigators have used color Doppler ultrasound and diffusion-weighted imaging (DWI) for the diagnosis of prostate cancer and avoided invasive and painful investigation, i.e., biopsy. The purpose of the study is to determine the validity of DWI in detecting prostatic cancer taking histopathology as the gold standard.Material and methodsThis cross-sectional study was conducted prospectively in the radiology department of a tertiary care hospital from January 1, 2019, to December 31, 2020. This study was approved by the Departmental Research Committee. A total of 272 male patients were included in our study who have elevated PSA levels (>4.0 ng/ml) with symptoms of hematuria and urinary retention. All included subjects were sent to the radiology department for DWI imaging. The DWI imaging was analyzed for prostate cancer and the results were correlated with histopathological diagnosis.ResultsThe average age of patients was 50.28±9.93 years. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of DWI in the diagnoses of prostate cancer were 86.7%, 87.8%, 75.8%, 93.8%, and 87.5%, respectively.ConclusionDWI is an informative and non-invasive imaging modality with high diagnostic accuracy for the diagnosis of prostate carcinoma.

A STUDY ON CORRELATION OF SERUM PROSTATE SPECIFIC ANTIGEN WITH CLINICAL AND PATHOLOGICAL VARIABLES IN PATIENTS OF PROSTATOMEGALY

Background: In clinical practice, biopsies are generally performed only when the results ofprostate specific antigen (PSA) test or digital rectal examination (DRE) are abnormal. This leads to misdiagnosis of most small prostatic cancers present in many older men. Patients with lower urinary tract infection (LUTS) who have serum PSA levels higher than 4ng/ml are primarily advised to undergo prostate biopsy to rule out cancer. However, PSA is organ specific not disease specific, so the presence of other prostate diseases such as benign prostatic hyperplasia (BPH) and prostatitis may influence its effectiveness for cancer detection. Hence, the PSA based prostate cancer detection is fraught with high false positive rate.
 Aim:To evaluate the utility of PSA assay as a method of investigation in diagnosis of prostatic lesion.
 Objectives: The use of Serum PSA levels for the early detection of prostate cancer and evaluate its role with other modalities for diagnosis of prostate cancer and to diagnose different diseases of prostate, i.e. prostatitis, BPH in prostatomegaly, and its correlation with Serum PSA levels.
 Materials and Methods: This prospective descriptive study was conducted in Index Medical College, Hospital & Research Centre, Indore, M.P,India in the period of August 2019 to July 2021. The patients were selected from the outdoor Department of General Surgery.
 Results: A total of 80 male patients presenting with LUTS were included. Their mean age was 68.66 years. The majority i.e. 41 of the study group were in the age group of 61-70 years. 42 of patients had Serum PSA < 4ng/ml. Biopsy proven adenocarcinoma cases 34% of the cases are in the age group of 61-70 years. Out of the biopsy proven adenocarcinoma cases, DRE was suspicious of malignancy in 89%.
 Conclusion: Serum PSA levels have a significant correlation with the age group, with the increase in age there is rise in Serum PSA levels. Transabdominal ultrasound, DRE and Serum PSA has high sensitivity in diagnosis of prostatomegaly but it was found that none of the screening tool has got much efficacy in differentiating carcinoma prostate from benign hypertrophy, but the combination of DRE and Serum total PSA or DRE, Serum total PSA and ultrasound abdomen showed higher efficacy in diagnosis of carcinoma prostate. Increase in Serum PSA is directly related to carcinoma, but there is no absolute cut-off for Serum PSAfor diagnosis of carcinoma.
 Key-Words: Prostate specific antigen, Prostatomegaly, Benign Prostatic Hypertrophy, Digital Rectal Examination, International Prostate Severity Score, Carcinoma Prostate.

Consensus on specimen handling and pathological diagnosis of prostatic carcinoma (2021 version)

Consensus on specimen handling and pathological diagnosis of prostatic carcinoma (2021 version)