Digital Rectal Examination Findings Research Articles

Abnormalities detected on digital rectal examinations in dogs are common and influence diagnostic and treatment plans.

To determine the frequency of abnormal findings on digital rectal examination (DRE) performed during physical examinations at a tertiary referral veterinary hospital, to establish what abnormal findings are most common and whether they impact diagnostic and treatment plans, and to assess whether patient signalment or admitting service influences the frequency of abnormalities. Client-owned dogs (n = 440). Veterinarians performed DREs on dogs as part of a physical examination. Patient signalment and DRE findings were recorded in a standardized survey. Findings were deemed normal or abnormal and described. Whether the findings changed the diagnostic or treatment plan was also recorded. Abnormalities were detected on DRE in 160 of 440 (36%) dogs. Changes to the diagnostic plan occurred in 41 of 160 (26%) cases when an abnormality was found. Changes to the treatment plan occurred in 20 of 160 (12.5%) cases when an abnormality was found. Age (P = .2), sex (P = .9), and breed (P = 1) did not significantly influence the frequency of abnormal findings. Abnormal findings were significantly more common in dogs presenting to the emergency service than elective services (P = .005). Among dogs presenting to a tertiary veterinary hospital, abnormalities found on DRE are common and change the diagnostic plan in 1 out of 4 dogs and treatment plan in 1 out of 8 dogs. This study supports the continued practice of DREs in dogs, especially in emergency settings, regardless of signalment.

Prostate Biopsy May Not Be Indicated Early after Bacillus Calmette Guérin Treatment.

Bacillus Calmette-Guérin (BCG) treatment for non-muscle-invasive bladder cancer frequently causes an intraprostatic BCG granuloma. We investigated the optimal timing for a prostate biopsy after BCG treatment by retrospectively analyzing the cases of 22 patients with non-muscle-invasive bladder cancer who underwent a prostate biopsy after BCG treatment at our institute (2013-2017). Biopsies were indicated for a rising prostate-specific antigen (PSA) level, positive digital rectal examination findings, or the appearance of de novo low apparent diffusion coefficient lesions on MRI. The control group was comprised of 28 age- and PSA-matched patients. The relationships among the cancer detection rate and the patients' PSA levels and MRI findings were analyzed. Prostate cancer was detected by biopsy in only 13.9% (3/22) of the patients in the BCG group but in 78.5% (22/28) of the control patients (p=0.0001). The three patients in the BCG group in whom prostate cancer was detected had all undergone the biopsy > 1 year after their BCG treatment. The remaining biopsies were performed within 1 year after BCG treatment and resulted in no diagnoses of prostate cancer. We suggest that performing a prostate biopsy early after BCG treatment is not informative or useful.

Evaluation of expression of immunohistochemical markers high molecular weight cytokeratin (HMWCK) and alpha-methylacyl coa racemose (AMACR) in prostatic needle biopsies and transurethral resection of prostate (TURP) specimen – A one year observational study

In view of increasing incidence of Prostate cancer with age, its early detection and management is of utmost importance. Digital rectal examination, clinical picture and USG findings are non-specific. In prostatic lesions having a suspicious morphology, IHC staining (HMWCK and AMACR) is done to distinguish benign from malignant lesions. Absence of myoepithelial layer (HMWCK negative) along with cytoplasmic granular staining in glands (AMACR positive) is consistent with malignant diagnosis.To evaluate the utility of IHC markers HMWCK and AMACR in resolving morphologically suspicious foci on Prostatic needle core biopsies and TURP specimens.Observational StudyA total of 30 cases of prostatic lesions were studied. The specimens were fixed in 10% formalin and routinely processed. Haematoxylin-Eosin (H&E) and IHC staining (HMWCK and AMACR) was done in all 30 cases.Data collected was analyzed using appropriate statistical test.A total of 30 cases including 19 cases prostatic needle core biopsies and 11 cases of TURP specimens were included in our study. Histopathological diagnosis included 1 case each of Adenosis, Atypical adenomatous hyperplasia and Transitional cell metaplasia; 9 cases of BPH with suspicious foci, 4 cases of LGPIN, 3 cases of HGPIN and 11 cases Prostatic adenocarcinoma. In 5 cases including 3 cases of BPH with suspicious foci and 1 case each of adenosis and AAH, the diagnosis was changed to Prostatic Adenocarcinoma after IHC analysis. We conclude that IHC staining should be done in cases where routine H&E sections have an ambiguous morphology. HMWCK along with AMACR is a good marker combination to differentiate Benign from Malignant lesions.

Association of Obesity with Prostate Cancer at Time of Biopsy: A MultiCentre 10-Year Retrospective Study

Background and Aim: The incidence of Prostate cancer (PCa) is on the rise in Cameroon, making it the most commonly diagnosed cancer amongst men. Factors, such as obesity, smoking, and the consumption of high fat diet have been reported to play a role in the aetiology and progression of cancers in general. However, the exact relationship between obesity and prostate cancer in Africans is still poorly described. The present study aimed to evaluate the association between obesity as measured by the body mass index (BMI) and high-grade prostate cancer in Cameroonians. Methods: This was a retrospective analyses of the clinical records of 300 consecutive men who underwent transrectal ultrasound-guided core needle prostate biopsy between January 2010 and January 2020. Patients were grouped as obese (BMI ≥30kg/m²) and non-obese (BMI <30kg/m²) and binary logistic regression modelling was used to compare the association between obesity and patient characteristics, such as age, digital rectal examination (DRE) findings, prostate specific antigen (PSA) level, prostate volume, PSA density, and Gleason score (GS). Results: The mean age at diagnosis of PCa was 65.46 ± 8.54 years (Range: 34-89 years), the mean BMI was 28.93 ± 4.57 kg/m² (Range: 18.35-42.37 kg/m²), and the median total PSA level was 44.2 ng/ml. In total, 142 men (47.3%) were obese and biopsies detected high-grade prostate cancer in 160 men (63.3%). Obese men were significantly younger and had a higher risk (OR= 2.74, p <0.001) of having high-grade PCa compared to nonobese men. Furthermore, 94 obese men (58.75%) had high-grade PCa. Obese men had higher age-adjusted PSA densities (P<0.001), while there was no statistical difference in DRE findings (OR= 1.06, p= 0.225). Conclusion: This study demonstrated that obesity is associated with a higher risk of high-grade prostate cancer. This risk is more pronounced among younger patients and DRE findings are not influenced by BMI.

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%.

Stability of Prognostic Estimation Using the CAPRA Score Incorporating Imaging-based vs Physical Exam-based Staging.

Although official T-staging criteria for prostate cancer are based on digital rectal examination findings, providers increasingly rely on transrectal US and MRI to define pragmatic clinical stage to guide management. We assessed the impact of incorporating imaging findings into T-staging on performance of a well-validated prognostic instrument. Patients who underwent radical prostatectomy for prostate cancer diagnosed between 2000 and 2019 with stage ≤cT3a on both digital rectal examination and imaging (transrectal US/MRI) were included. The University of California, San Francisco CAPRA (Cancer of the Prostate Risk Assessment) score was computed 2 ways: (1) incorporating digital rectal examination-based T stage and (2) incorporating imaging-based T stage. We assessed for risk changes across the 2 methods and associations of CAPRA (by both methods) with biochemical recurrence, using unadjusted and adjusted Cox proportional hazards models. Model discrimination and net benefit were assessed with time-dependent area under the curve and decision curve analysis, respectively. Of 2,222 men included, 377 (17%) increased in CAPRA score with imaging-based staging (P < .01). Digital rectal examination-based (HR 1.54; 95% CI 1.48-1.61) and imaging-based (HR 1.52; 95% CI 1.46-1.58) CAPRA scores were comparably accurate for predicting recurrence with similar discrimination and decision curve analyses. On multivariable Cox regression, positive digital rectal examination at diagnosis (HR 1.29; 95% CI 1.09-1.53) and imaging-based clinical T3/4 disease (HR 1.72; 95% CI 1.43-2.07) were independently associated with biochemical recurrence. The CAPRA score remains accurate whether determined using imaging-based staging or digital rectal examination-based staging, with relatively minor discrepancies and similar associations with biochemical recurrence. Staging information from either modality can be used in the CAPRA score calculation and still reliably predict risk of biochemical recurrence.

Clinical and prostate multiparametric magnetic resonance imaging findings as predictors of general and clinically significant prostate cancer risk: A retrospective single-center study.

To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2 (PI-RADS v2), prostate-specific antigen (PSA) level, PSA density (PSAD), digital rectal examination findings, and prostate volume, individually and in combination, for the detection of prostate cancer (PCa) in biopsy-naive patients. We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging. A standard 12-core biopsy procedure was performed. Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not PCa. The median age, PSA level, and PSAD were 70 years, 8.6 ng/mL, and 0.18 ng/mL/mL, respectively. A total of 374 (59.4%) of 630 patients were biopsy-positive for PCa, and 241 (64.4%) of 374 were diagnosed with clinically significant PCa (csPCa). The PI-RADS v2 score and PSAD were independent predictors of PCa and csPCa. The PI-RADS v2 score of 5 regardless of the PSAD value, or PI-RADS v2 score of 4 plus a PSAD of <0.3 ng/mL/mL, was associated with the highest csPCa detection rate (36.1%-82.1%). Instead, the PI-RADS v2 score of <3 and PSAD of <0.3 ng/mL/mL yielded the lowest risk of csPCa. The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies. Patients with a PI-RADS v2 score of <3 and PSAD of <0.3 ng/mL/mL could potentially avoid a prostate biopsy.

Impact of prebiopsy MRI on prostate cancer staging: Results from the Norwegian Prostate Cancer Registry.

The aim of this study is to evaluate the 2015 introduction of prebiopsy magnetic resonance imaging of the prostate (MRI-P) as the standard of care for diagnosing prostate cancer (PCa) by the Norwegian public health care authorities. There were three specific objectives of this study: first, to evaluate the consequences of using different TNM manuals for clinical T-staging (cT-staging) in a national setting; second, to determine if the data reveals that MRI-P based cT-staging is superior to digital rectal examination (DRE)-based cT-staging compared with pathological T-stage (pT-stage) post radical prostatectomy; and third, to assess whether treatment allocations have changed over time. All patients registered in the Norwegian Prostate Cancer Registry between 2004 and 2021 were retrieved and 5538 were eligible for inclusion. Concordance between clinical T-stage (cT-stage) and pT-stage was assessed by percentage agreement, Cohen's kappa and Gwet's agreement. MR visualisation of lesions influences reporting of tumour extension beyond DRE findings. Agreement between cT-stage and pT-stage declined from 2004 to 2009, which coincided with an increase in the percentage being pT3. From 2010, agreement increased, which aligned with changes in cT-staging and the introduction of MRI-P. From 2017, regarding the reporting of cT-DRE and cT-Total (overall cT-stage), agreement diminished for cT-DRE but remained relatively stable (>60%) for cT-Total. Regarding treatment allocation, the study suggests that staging with MRI-P has shifted treatment towards radiotherapy in locally advanced high-risk disease. Introduction of MRI-P has affected cT-stage reporting. Agreement between cT-stage and pT-stage appears to have improved. This study suggests that use of MRI-P influences treatment decisions in certain patient subgroups.

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.

Correlation of multiparametric MRI with histopathological grade of peripheral zone prostate carcinoma.

Prostatic cancer is the second most common malignant tumor in men. Preoperative grading of prostate cancer is important for its management. Our objective is to compare individual and combined detection rates of T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI), and magnetic resonance spectroscopy (MRS) for prostate cancer with histopathological diagnosis as its golden standard. Forty-four patients with positive digital rectal examination (DRE) findings and elevated prostate specific antigen (PSA), underwent multiparametric MRI (Mp-MRI). T2WI, DWI, DCE-MRI and MRS were done in all the patients. Cognitive magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy was done in all the patients. Sensitivity and specificity of T2WI, DWI, DCE-MRI, and Prostate Imaging - Reporting and Data System PIRADS version 2 was obtained. Apparent diffusion coefficient (ADC) value and choline/citrate ratio were obtained for each lesion and correlated with histopathological grade. The mean age of the patients was 68.7 ± 10.1 years, and the mean serum PSA level was 58.1 ± 22.4 ng/dL. Of the 38 lesions in peripheral zone, 33 (87%) had histopathologically proven prostate cancer. T2WI had a sensitivity and specificity of 75.8% and 80% and DWI had a sensitivity and specificity of 90.9% and 80%, respectively, for detection of malignant prostatic lesion. The mean ADC values for prostate cancer, prostatitis, and normal prostatic parenchyma were 0.702 ± 0.094 × 10-3 mm2/sec, 0.959 ± 0.171 × 10-3 mm2/sec, and 1.31 ± 0.223 × 10-3 mm2/sec, respectively. Type 3 curve has lower sensitivity (45.5%) but high specificity (80%) for diagnosing prostate cancer. DWI can be useful to differentiate benign from malignant prostatic lesions, and low-grade from high-grade prostate carcinoma. ADC value has a positive correlation with histopathological grade of prostate cancer.

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.

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.

Focal High-Intensity Focused Ultrasound vs. Active Surveillance for ISUP Grade 1 Prostate Cancer: Medium-Term Results of a Matched-Pair Comparison.

Only 1 randomized controlled trial has compared focal therapy and active surveillance (AS) for the low-risk prostate cancer (PCa). We investigated whether focal HIFU (fHIFU) yields oncologic advantages over AS for low-risk PCa. We included 2 non-randomized prospective series of 132 (fHIFU) and 421 (AS) consecutive patients diagnosed with ISUP 1 PCa between 2008 and 2018. A matched pair analysis was performed to decrease potential bias. Study main outcomes were freedom from radical treatment (RT) or androgen-deprivation therapy (ADT), treatment-free survival (TFS), time to metastasis, and overall survival (OS). Median fHIFU follow-up was 50 months (interquartile range, 29-84 months). Among matched variables, no major differences were recorded except for AS having more suspicious digital rectal examination findings (P = .0074) and recent enrollment year (P = .0005). Five-year intervention-free survival from RT or ADT was higher for the fHIFU cohort (67.4% vs. 53.8%; P = .0158). Time to treatment was approximately 10 months shorter for AS than for fHIFU (time to RT, P = .0363; time to RT or ADT, P = .0156; time to any treatment, P = .0319). No differences were found in any-TFS (fHIFU, 61.4% vs. AS, 53.8%; P = .2635), OS (fHIFU, 97% vs. AS, 97%; P = .9237), or metastasis (n=0 in fHIFU and n = 2 in AS; P = .4981). Major complications (≥ Clavien 3) were rare (n = 4), although 36.4% of men experienced complications. No relevant changes were noted in continence (P = .3949). At a 4-year median follow-up, fHIFU for mainly low-risk PCa (ISUP grade 1) is safe, may decrease the need for radical treatment or ADT and may allow longer time to treatment compared to AS. Nonetheless, no advantages are seen in PCa progression and/or death (OS).

Sistematik ve kognitif hedefe yönelik biyopsi: klinik olarak anlamlı prostat kanseri ile ilgili parametrelerinin değerlendirilmesi ve tespit oranlarının karşılaştırılması

Objective: This study aims to compare the clinically significant prostate cancer (csPCa) detection rates of cognitive targeted biopsy (CTB) and systematic biopsy (SB) and to reveal the factors affecting csPCa detection rates. Material and Methods: Patients diagnosed with localized prostate cancer between 2016-2019 were evaluated retrospectively. Patients who underwent SB and concomitant CTB were recorded. The number of cores taken from the index lesion in CTB, age, prostate-specific antigen (PSA) level, Gleason score, International Society of Urological Pathology (ISUP) grade, Prostate Imaging and Data Reporting System (PIRADS) score, the diameter of index lesion, and digital rectal examination (DRE) findings was recorded. We also studied whether there was a concordance between the localization of the lesion on MRI (magnetic resonance imaging) and the localization of the nodule detected on DRE. Results: Eighty patients were included in the study. csPCa was detected in 55 (68.7%) patients with SB, whereas CTB alone detected csPCa in 35 (43.7%) patients (p&lt;0,01). SB missed 2 patients with csPCa, but 35% of the men with csPCa would be missed by CTB. Detection rates of csPCa in SB and CTB were significantly higher in patients with a concordance between DRE and mpMRI (p= 0.012 and p&lt;0.01, respectively). In patients who had csPCa in CTB, significant differences were detected in the mean age, prostate volume, PSA, lesion diameter, number of cores, and PIRADS score (p=0.005, p=0.02, p=0.005, p=0.003, p=0.017, and p=0.002, respectively) Conclusion: SB maintains its importance in the diagnosis of csPCa. CTB can be preferred in patients with larger lesions. Keywords: Prostate cancer, prostate biopsy, magnetic resonance imaging, targeted biopsy

Comparative Study on Cancer Yielding Rate Between sextant vs Ten Cores TRUS Biopsy

Background: The standard sextant biopsy protocol misses about 15% of cancer when compared with results obtained from a more extensive biopsy procedure. The number of systematic biopsies has increased over the years, with 10–12 cores currently accepted as the minimum standard. Objectives: To compare the detection rate of carcinoma prostate through standard sextant biopsy and extended 10-core biopsy in Bangladeshi male subjects. Methods: This prospective experimental study was conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka from January 2007 to May 2008 including a total of 69 male patients aged over 56 years having normal digital rectal examination (DRE) findings with serum PSA level of 4 ng/mL or greater or having abnormal findings on DRE irrespective of serum PSA level. The subjects underwent transrectal ultrasound (TRUS) and biopsies were taken systematically. Biopsy results were interpreted according to different sextant biopsy protocols and also following extended 10-core biopsy protocol. Data collection sheet containing the selected points were filled up. Data were analysed using SPSS version 12. The test statistic used to analyse the data were descriptive statistics and McNemar’s test. The level of significance was set at 0.05 and p &lt;0.005 was considered significant. Result: Out of the total 69 subjects, 29 (42%) were diagnosed to have prostate cancer following biopsy. In the standard mid lobar sextant protocol the cancer detection was lowest (79.3%) while it was highest (89.7%) when lateral zone biopsy was performed. The extended 10-core biopsy regimen had higher cancer detection rate than any of the standard sextant protocols and it was 96.6%. The difference in the cancer detection rates between the two schemes was statistically significant (p &lt;0.001). Conclusion: The sextant biopsy is inadequate in detecting carcinoma prostate and extended 10-core biopsy protocol including the apex, midlobar mid gland, lateral mid gland and lateral base with more extensive sampling of the lateral aspects of the prostate is superior. Bangladesh J. Urol. 2021; 24(2): 214-219

Digital Rectal Examination in Stockholm3 Biomarker-based Prostate Cancer Screening

BackgroundPathological digital rectal examination (DRE) is suggestive of prostate cancer but has low sensitivity and specificity. DRE is incorporated in many clinical risk calculators, but there is less evidence on how DRE performs in the setting of blood biomarkers and polygenic risk prediction models other than prostate-specific antigen (PSA) associated with prostate cancer. The Stockholm3 test combines a blood test and clinical variables including DRE. ObjectiveTo assess the predictive performance of DRE for finding clinically significant prostate cancer in systematic biopsy and evaluate its added value to the multivariable diagnostic test Stockholm3. Design, setting, and participantsThis population-based study in the screening by invitation setting included 5543 men aged 50–69 yr with PSA ≥3 ng/ml who were referred for systematic prostate biopsy between 2012 and 2015. The STHLM3 study is registered with ISRCTN.com as ISRCTN84445406. Outcome measurements and statistical analysisPredictive performance was assessed via estimates of sensitivity and specificity and in logistic regression. Clinically significant cancer was defined as International Society of Urological Pathology grade group ≥2 (GG ≥2) cancer on systematic biopsy. Results and limitationsWe found that 11% of men with PSA ≥3 ng/ml had a suspicious DRE. A suspicious DRE was associated with a 3.16-fold higher risk (95% confidence interval [CI] 2.83–3.52) of GG ≥2 cancer and greater length of cancer on biopsy. The risk of nonsignificant cancer was similar regardless of the DRE finding. The risk of GG ≥2 cancer was 46.2% (95% CI 42.2–50.3%) for men with a suspicious DRE versus 14.6% (95% CI 13.7–15.7%) for men with a negative DRE. The elevated risk of GG ≥2 cancer persisted after adjusting for the other Stockholm3 test parameters (odds ratio 2.88, 95% CI 2.32–3.57). For detection of GG ≥2 cancer among men with PSA ≥3 ng/ml, DRE had sensitivity of 27.8% (95% CI 25.1–30.7%) and specificity of 92.8% (95% CI 92.1–93.6%). ConclusionsIn this screening-by-invitation setting we found that for men with PSA ≥3 ng/ml, a suspicious DRE indicates more than threefold higher risk of harboring significant prostate cancer. DRE as a variable adds significant precision to the Stockholm3 prediction model. Men with a suspicious DRE should be referred for further diagnostic workup, including biopsy. Patient summaryWe investigated the ability of digital rectal examination to predict if a patient has clinically significant prostate cancer. We found that digital rectal examination provides valuable information and can help doctors in making an informed decision on whether to recommend prostate biopsy.

Prostate Cancer Diagnostic Methods in Korle Bu Teaching Hospital, Accra, Ghana

Objective: The diagnosis of prostate cancer is based on a combination of digital rectal examination (DRE), serum prostate specific antigen (SePSA) estimation and trans-rectal ultrasound guided biopsy (TRUS-B) of the prostate, the latter being the gold standard for prostate cancer diagnosis. This study compared the diagnostic rate of prostate cancer in patients attending the urology clinic at Korle-bu Teaching Hospital, Accra, Ghana, using these methods.Patients and Methods: One hundred and fifty male patients 45 years and older with abnormal DRE and raised or rising SePSA had TRUS biopsy done. The biopsies were processed routinely and all cancer positive slides were graded using the Gleason scoringsystem. DRE findings were comparatively analysed statistically against SePSA and histological findings.Results: Of the 150 subjects, 71(47.3%) were diagnosed as benign and 79(52.7%) had cancer on TRUS-B. Cancer diagnosis rate using a combination of DRE and SePSA was slightly higher (66.4%) than using DRE (64.5%) or SePSA (53.7%) in isolation.Conclusion: DRE was found to have a high positive predictive value, probably due to the late presentation of majority of the patients in this study. SePSA alone is not very reliable, and results must be interpreted with caution due to significant false positive rates. Combining DRE and SePSA improves cancer diagnosis rates.