Normal Digital Rectal Examination Research Articles

A 2-year prospective evaluation of the Prostate Health Index in guiding biopsy decisions in a large cohort.

To prospectively evaluate how the Prostate Health Index (PHI) impacts on clinical decision in a real-life setting for men with a prostate-specific antigen (PSA) level between 4 and 10 ng/mL and normal digital rectal examination. Since 2016, the PHI has been available at no cost to eligible men in all Hong Kong public hospitals. All eligible patients who received PHI testing in all public Urology units (n = 16) in Hong Kong between May 2016 and August 2017 were prospectively included and followed up. All included men had a PHI test, with its result and implications explained; the subsequent follow-up plan was then decided via shared decision-making with urologists. Patients were followed up for 2 years, with outcomes including prostate biopsy rates and biopsy findings analysed in relation to the initial PHI measurements. A total of 2828 patients were followed up for 2 years. The majority (82%) had PHI results in the lower risk range (score <35). Knowing the PHI findings, 83% of the patients with elevated PSA decided not to undergo biopsy. In all, 11% and 45% opted for biopsy in the PHI score <35 and ≥35 groups, respectively. The initial detection rate of International Society of Urological Pathology (ISUP) Grade Group (GG) ≥2 cancer was higher in the PHI score ≥35 group (23%) than in the PHI score <35 group (7.9%). Amongst patients with no initial positive biopsy findings, the subsequent positive biopsy rate for ISUP GG ≥2 cancer was higher in the PHI score ≥35 group (34%) than the PHI score <35 group (13%) with a median follow-up of 2.4 years. In a real-life setting, with the PHI incorporated into the routine clinical pathway, 83% of the patients with elevated PSA level decided not to undergo prostate biopsy. The PHI pathway also improved the high-grade prostate cancer detection rate when compared to PSA-driven strategies. Higher baseline PHI predicted subsequent biopsy outcome at 2 years. The PHI can serve as a tool to individualise biopsy decisions and frequency of follow-up visits.

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

Effectiveness of Virchow’s Node Fine-Needle Biopsy for the Discovery of Occult Metastatic Prostate Cancer

In this case report, we describe the effectiveness of fine-needle aspiration of Virchow’s node for the diagnosis of metastatic prostate cancer in a 62-year-old male without any medical history, negative urinary tract symptoms, and a normal digital rectal examination. The patient presented with respiratory distress, diffuse lymphadenopathy, and high levels of prostate-specific antigen. Multiple studies were done with inconclusive results until positive findings of the NKX3.1 gene were found in the immunostain smear of the Virchow’s node, which led to the identification of metastatic prostate cancer.

Conservative management of fish bone-induced large bowel perforation: Case report.

IntroductionFish bone ingestion is one of the common medical complaint. Most foreign bodies passed safely through gastrointestinal tract (GIT) without any complications. The clinical presentation of foreign body ingestion is similar to other conditions such as diverticulitis. Most literatures focus on the surgical management of complications secondary to fish bone ingestion. In this case we report a case of an elder patient with complain of progressive abdominal pain.Presentation of case71-year-old female, admitted to surgical ward with the complain of progressive abdominal pain. Physical examination revealed right upper quadrant tenderness with normal digital rectal examination. An abdominal X-ray was obtained and was not remarkable. Computed tomography (CT) chest, abdomen, and pelvis with contrast revealed proximal transverse colon wall thickening with reginal soft tissue thickening, inflammation and a radiopaque foreign body. Patient was managed conservatively by bowel rest, and antibiotics.DiscussionFish bone swallowing account for two third of these foreign bodies. Most of the foreign bodies pass through the gastrointestinal tract (GIT)without any significant harm or complications. The clinical presentation of perforation secondary to fish bone is nonspecific which may delay the diagnosis. The management can be either medical or surgical depend on many factors.ConclusionAlthough, foreign body ingestion is one of the common complaints in the medical practice, its complications is extremely uncommon. However, improvement of medical imaging increased sensitivity and specify in detecting fish bone.

The Efficacy of Proclarix to Select Appropriate Candidates for Magnetic Resonance Imaging and Derived Prostate Biopsies in Men with Suspected Prostate Cancer.

PurposeTo analyze how Proclarix is valuable to appropriately select candidates for multiparametric magnetic resonance imaging (mpMRI) and derived biopsies, among men with suspected prostate cancer (PCa). Proclarix is a new marker computing the clinically significant PCa (csPCa) risk, based on serum thosmbospondin-1, cathepsin D, prostate-specific antigen (PSA) and percent free PSA, in addition to age, that has been developed in men with serum PSA 2 to 10 ng/mL, prostate volume ≥35 mL, and normal digital rectal examination (DRE).Materials and MethodsProclarix score (0%–100%) is analyzed in a prospective frozen serum collection of 517 correlative men scheduled for guided and/or systematic biopsies after mpMRI. Outcome variables were csPCa detection (grade group ≥2), insignificant PCa (iPCa) overdetection and avoided mpMRIs.ResultsThe area under the curve of Proclarix was 0.701 (95% CI 0.637–0.765) among 281 men with serum PSA 2 to 10 ng/mL, prostate volume ≥35 mL, and -normal DRE, and 0.754 (95% CI 0.701–0.807) in the others, p=0.038. Net benefit of Proclarix existed in all men. After selecting 10% threshold, Proclarix was integrated in an algorithm which also used the serum PSA level and DRE. A reduction of 25.4% of mpMRIs request was observed and 17.7% of prostate biopsies. Overdetection of iPCa was reduced in 18.2% and 2.6% of csPCa were misdiagnosed.ConclusionsProclarix is valuable in all men with suspected PCa. An algorithm integrating Proclarix score, serum PSA, and DRE can avoid mpMRI requests, unnecessary prostate biopsies and iPCa overdetection, with minimal loss of csPCa detection.

PD65-07 LIFESTYLE MODIFICATIONS AND THEIR EFFECT ON SERUM PROSTATE SPECIFIC ANTIGEN LEVELS

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII (PD65)1 Sep 2021PD65-07 LIFESTYLE MODIFICATIONS AND THEIR EFFECT ON SERUM PROSTATE SPECIFIC ANTIGEN LEVELS Alexandre R. Zlotta, Jimmy Misurka, Katherine Lajkosz, Andrea Mari, Serena Marzario, Cynthia Kuk, Sophie O’Halloran, Alex Zisman, Annette Erlich, Michael Nesbitt, Dhiral Kot, Rob Hamilton, Girish Kulkarni, Nathan Perlis, Anto Finelli, Sigrid Carlsson, and Neil Fleshner Alexandre R. ZlottaAlexandre R. Zlotta More articles by this author , Jimmy MisurkaJimmy Misurka More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , Andrea MariAndrea Mari More articles by this author , Serena MarzarioSerena Marzario More articles by this author , Cynthia KukCynthia Kuk More articles by this author , Sophie O’HalloranSophie O’Halloran More articles by this author , Alex ZismanAlex Zisman More articles by this author , Annette ErlichAnnette Erlich More articles by this author , Michael NesbittMichael Nesbitt More articles by this author , Dhiral KotDhiral Kot More articles by this author , Rob HamiltonRob Hamilton More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , Nathan PerlisNathan Perlis More articles by this author , Anto FinelliAnto Finelli More articles by this author , Sigrid CarlssonSigrid Carlsson More articles by this author , and Neil FleshnerNeil Fleshner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002109.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guidelines recommend to repeat serum Prostate Specific Antigen (PSA) measurement to confirm an elevated value before proceeding with further testing. The effect of diet and lifestyle on repeat PSA levels to minimize false positives has rarely been examined. We aimed here to explore the effects of dietary and lifestyle changes on serum PSA values in men with intermediate PSA levels and normal digital rectal examination (DRE). METHODS: We used a case-control design including 204 men with PSA levels between 2-10ng/ml. 82 men who followed lifestyle changes (intervention group) were matched with 122 men (control group), who did not undergo any lifestyle modifications (avoiding spicy foods, alcohol, caffeine consumption and biking) before repeat PSA. PSA changes between baseline and repeat measurement were compared between the intervention group and controls using the Mann-Whitney U test. Multivariable logistic regression models were used to assess differences in PSA changes below different pre-determined thresholds. Linear mixed models implemented for changes in PSA as a continuous covariate helped visualize the predicted change in PSA from baseline. RESULTS: Age (61.0 vs 60.3 years), prostate volume (52.3 vs 49.0 cc) and PSA levels at baseline (5.83 vs 5.75 ng/ml) in the control and intervention arm, respectively, were not different. Compared to controls, at a median 2.81 months interval (IQR: 1.69-4.61), men in the intervention arm had a significantly lower total PSA on repeat PSA testing (4.14 vs 5.32ng/ml, p<0.001). Lifestyle changes resulted in PSA levels dropping below 4ng/ml in 40% of men with initial PSA 4-10 ng/ml in the intervention group vs 22% in controls (p=0.02). In the 2-4ng/ml range, 45% of men in the intervention group vs 14% in controls had their repeat PSA <2ng/ml (p=0.02). Intervention was an independent predictor of repeat PSA dropping <3ng/ml for men with baseline PSA of 3-10ng/ml (OR 5.39, 95% CI 1.96, 14.8, p=0.001). Limitations include the retrospective design of the study, absence of use of metrics to measure adherence to recommendations and lack of cycling information. CONCLUSIONS: In men with intermediate PSA levels and negative DRE, dietary and lifestyle modifications decrease serum PSA values more, and in a larger proportion than simply repeating the test. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1154-e1154 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre R. Zlotta More articles by this author Jimmy Misurka More articles by this author Katherine Lajkosz More articles by this author Andrea Mari More articles by this author Serena Marzario More articles by this author Cynthia Kuk More articles by this author Sophie O’Halloran More articles by this author Alex Zisman More articles by this author Annette Erlich More articles by this author Michael Nesbitt More articles by this author Dhiral Kot More articles by this author Rob Hamilton More articles by this author Girish Kulkarni More articles by this author Nathan Perlis More articles by this author Anto Finelli More articles by this author Sigrid Carlsson More articles by this author Neil Fleshner More articles by this author Expand All Advertisement Loading ...

Diagnosis of advanced prostate cancer at the community level in Rwanda.

Prostate cancer is the second most common cancer in men and sixth leading cause of mortality. If not recognized early, patients with advanced prostate cancer can experience debilitating complications which can otherwise be prevented by early androgen deprivation therapy. This research intends to define clear diagnostic tools that will guide practitioners in the rural community setting toward early management of advanced prostate cancer. We conducted a cross-sectional observational study at three referral hospitals in Kigali, Rwanda on patients who presented with clinical suspicion of advanced prostate cancer over a period of 6months. All patients underwent prostate biopsy as well as metastatic work up (CT or MRI), for those who were eligible. Statistical analysis was done using STATA 14.2. 114 patients were included in the study. The median age was 70years (interquartile range: 65-79years). In total 14 (12.3%) patients were found to have benign disease, while 100 (87.7%) patients were found to have cancer. Among those who had cancer, 85 (85%) had advanced prostate cancer. 110/114 (96.5%) were symptomatic at presentation. Common presenting symptoms were lower urinary tract symptoms (80.7%), back pain (54.4%), and urinary retention (36.8%). Abnormal digital rectal examination (DRE) was a strong risk factor for both cancer and advanced disease. Prostate cancer was found in 92.2% of those with abnormal DRE compared to 41.7% in those with normal DRE (p = 0.001). Also, cancer was found in 96.1% of those with multinodular prostate on DRE (p = 0.02) and had high odds (OR 14.6; CI 3.41-62.25) of having advanced prostate cancer (p < 0.001). The mean (± SD) PSA was 643.3 ± 1829.8ng/ml and the median (range) was 100ng/ml (9.05-10,000ng/ml) for the whole study population. All patients with prostatic-specific antigen (PSA) of 100ng/ml or above had advanced prostate cancer. The results show that there is a significant correlation between clinical findings and advanced prostate cancer. All patients with abnormal DRE and PSA above 100ng/ml had advanced prostate cancer. Diagnosis of advanced prostate cancer is possible at the community level if PSA testing is utilized and practitioners are well trained.

PROPOSe: A Real-life Prospective Study of Proclarix, a Novel Blood-based Test to Support Challenging Biopsy Decision-making in Prostate Cancer

BackgroundProstate-specific antigen (PSA)-based detection of prostate cancer (PCa) often leads to negative biopsy results or detection of clinically insignificant PCa, more frequently in the PSA range of 2–10 ng/ml, in men with increased prostate volume and normal digital rectal examination (DRE). ObjectiveThis study evaluated the accuracy of Proclarix, a novel blood-based diagnostic test, to help in biopsy decision-making in this challenging patient population. Design, setting, and participantsTen clinical sites prospectively enrolled 457 men presenting for prostate biopsy with PSA between 2 and 10 ng/ml, normal DRE, and prostate volume ≥35 cm3. Transrectal ultrasound–guided and multiparametric magnetic resonance imaging (mpMRI)-guided biopsy techniques were allowed. Outcome measurements and statistical analysisSerum samples were tested blindly at the end of the study. Diagnostic performance of Proclarix risk score was established in correlation to systematic biopsy outcome and its performance compared with %free PSA (%fPSA) and the European Randomised Study of Screening for Prostate Cancer (ERSPC) risk calculator (RC) as well as Proclarix density compared with PSA density in men undergoing mpMRI. Results and limitationsThe sensitivity of Proclarix risk score for clinically significant PCa (csPCa) defined as grade group (GG) ≥2 was 91% (n = 362), with higher specificity than both %fPSA (22% vs 14%; difference = 8% [95% confidence interval {CI}, 2.6–14%], p = 0.005) and RC (22% vs 15%; difference = 7% [95% CI, 0.7–12%], p = 0.028). In the subset of men undergoing mpMRI-fusion biopsy (n = 121), the specificity of Proclarix risk score was significantly higher than PSA density (26% vs 8%; difference = 18% [95% CI, 7–28%], p < 0.001), and at equal sensitivity of 97%, Proclarix density had an even higher specificity of 33% [95% CI, 23–43%]. ConclusionsIn a routine use setting, Proclarix accurately discriminated csPCa from no or insignificant PCa in the most challenging patients. Proclarix represents a valuable rule-out test in the diagnostic algorithm for PCa, alone or in combination with mpMRI. Patient summaryProclarix is a novel blood-based test with the potential to accurately rule out clinically significant prostate cancer, and therefore to reduce the number of unneeded biopsies.

Detection rate of prostate cancer following 12-core extended biopsy in a Semi-urban Nigerian Tertiary Hospital.

Background:Transrectal prostate biopsy using the extended protocol has become the standard mode of obtaining tissue for histological diagnosis with cancer detection rate varying with race and geographical regions. This study is aimed at evaluating the cancer detection rate following a 12-core extended transrectal biopsy of the prostate in a semi-urban Nigerian tertiary hospital.Materials and Methods:This was a hospital-based prospective study. Patients who had one or combination of elevated prostate-specific antigen (PSA) levels, abnormal digital rectal examination (DRE), and suspicious ultrasound findings were recruited into this study. Each had 12-core extended biopsy done. Their clinical and histological information were recorded in a pro forma. Data analysis was performed using the statistical programming for social sciences (SPSS) version 21. For all statistical tests, P < 0.05 was regarded as significant.Results:Of the 120 patients, 78 (65%) had prostate cancer. The cancer detection rate in participants aged 50–59, 60–69, 70–79, 80–89, 90–100 were 75%, 46.7%, 72.3%, 85.7%, and 100%, respectively. Overall, the cancer detection rate at PSA levels 4.0–10.0 was 25%, 10.1–20.0 was 54.7%, 20.1–50.0 was 67.4%, 50.1–100.0 was 100%, and >100.0 was 100%. The cancer detection rate for men with suspicious DRE and prostatic ultrasound findings were comparatively higher than those with normal DRE and prostatic ultrasound findings at similar PSA levels.Conclusion:This study showed a higher cancer detection rate with a 12-core biopsy protocol when compared to similar studies from the Western world, the Middle East, and urban centers in Nigeria due to poor awareness and late presentation in our environment.

Effect of Antibiotic on Men with Raised Prostatic-Specific Antigen (4-10 ng/ml)

Background: The managing of raised Prostate-Specific Antigen (PSA) in a range of 4 to 10 ng/ml is still controversial among urologists. In addition to prostatic cancer, benign prostatic hyperplasia, and prostatitis is established to increase PSA. PSA reduction after antibiotic therapy might detect those patients in whom biopsy can be avoided or postponed. Objectives: To evaluate the effectiveness of a 6 weeks levofloxacin course on the serum total PSA level and PSA density (PSAD) in patients with PSA 4 -10 ng/ml and ordinary digital rectal examination and ultrasonography results. Materials and Methods: The study conducted at Al-Ramadi Teaching Hospital from February 2016 to December 2019. A total of 177 men with benign prostatic hyperplasia or lower urinary tract symptoms were with a normal digital rectal examination, chronic prostatitis (Expressed prostatic secretion was done before treatment), total PSA 4-10 ng/ml, and ultrasonography findings that did not reveal a hypoechoic lesion in the prostate will be included in this study. Serum PSA and PSAD were measured before, and after treatment with a 6 weeks course of levofloxacin. Results: The age of our 177 men was ranged from 40-80 years with a mean age of 56.52 years ± 7.253. The mean prostatic size was 49.5 ± 28.5 g (range, 23-150 g). In 89 (50.2%) patients of the 177 men, total PSA has normalized to less than 4 ng/ml after antibiotics treatment. In 56 patients of 89 men had a high level of PSAD. PSAD was normalized (less than 0.15 ng/ml/cm3) after treatment in 49 patients of the 56 patients. A significant reduction in total PSA and PSAD after treatment (p <0.05).

Significance of Core Length in Current Transrectal Ultrasound-guided Prostate Biopsy in Patients with Normal Digital Rectal Examination

Significance of Core Length in Current Transrectal Ultrasound-guided Prostate Biopsy in Patients with Normal Digital Rectal Examination

P-02-44 Implications of Multiparametric Prostate MRI in Patients With Hematospermia

Hematospermia is a benign condition that is rarely associated with significant disease and the need to exclude malignanancy is controversial. In this context we aimed to evaluate multiparametric prostate MRI (MP-MRI) findings in patients with hematospermia. In this prospectively managed retrospective study, twenty-three patients with hematospermia received 3T MP-MRI between October 2017 and September 2019. We also studied prostate-spesific antigen (PSA), mycobacterium tuberculosis DNA-polymerase chain reaction (TB-PCR) in the urine and urine analysis/culture. Median age was 49 (Range 30-73). No patient had gross hematuria episodes or a family history of prostate cancer or was using anticoagulants. Past medical history revealed chronic prostatitis (2) and epididimitis (2) in a total of 4 patients. All patients had normal digital rectal examination. Median PSA was 0.88 ng/ml (Range 0.6-5.4). TB-PCR and urine analysis/culture test were negative for all patients. Four (17%) patients had utricular cyst on MP-MRI imaging. MP-MRI revealed PI-RADS 1, PI-RADS 2, PI-RADS 3 and PI-RADS 4 lesions in 3 (13%), 13 (57%), 3 (13%) and 4 (17%) patients, respectively. All PI-RADS 2 and PI-RADS 3 lesions were commented as either focal chronic prostatitis or fibrosis by uroradiologist. Three patients with PI-RADS 3 lesions and low PSA values (< 1 ng/ml) were recommended PSA follow-up only. Patients with PI-RADS 4 (Mean PSA: 3.65 ng/ml (range: 1.58-5.39)) underwent cognitive MRI-guided biopsy. One patient (PSA 2.7 ng/ml) was diagnosed with a Gleason 3+4 prostate cancer.

Microsurgical subinguinal cremaster muscle release for chronic orchialgia secondary to hyperactive cremaster muscle reflex in adults.

A careful history and evaluation of men with chronic orchialgia elucidates the aetiology in some men to be a hyperactive cremaster muscle reflex with testicular retraction as the cause. The objective is to evaluate outcomes in men who underwent microsurgical subinguinal cremaster muscle release (MSCMR) with a retrospective chart review between September 2011 and April 2019. Nineteen men with hyperactive cremaster muscle reflex in 25 spermatic cord units underwent MSCMR, six bilateral and thirteen unilateral. Candidacy for MSCMR included answering yes to the question: “at times of testicular pain, does the testicle retract up in the groin to the extent that you have to milk it back down to the scrotum?”, normal digital rectal examinations, negative urinalyses, negative scrotal Doppler ultrasounds, vigorous retraction of testis with Valsalva on examination and pain without an anatomic or pathologically identifiable aetiology except testicular retraction. Of the men who underwent MSCMR, 100% (25/25) of spermatic cord units had resolution of testicular retraction and 92% (23/25) of spermatic cord units had complete resolution of orchialgia. There was one complication, a small scrotal hematoma which resolved. MSCMR is an effective option for men with orchialgia secondary to testicular retraction due to a hyperactive cremaster muscle reflex.

P007 - Utility of Prostate Health Index and Prostate Health Index Density in predicting detection of clinically significant prostate cancer in a cohort of patients with PSA in the grey zone and normal digital rectal examination

P007 - Utility of Prostate Health Index and Prostate Health Index Density in predicting detection of clinically significant prostate cancer in a cohort of patients with PSA in the grey zone and normal digital rectal examination

Detección de cáncer de próstata incidental con resección transuretral de próstata en pacientes con síntomas de tracto urinario inferior y antígeno prostático específico elevado del Hospital General de México

Objetivo: Evaluar la tasa de detección temprana de cáncer de próstata en zona de transición mediante realización de resección transuretral de próstata en pacientes con sospecha de cáncer sin o con biopsia transrrectal de próstata negativa.&#x0D; Materiales y métodos: Estudio retrospectivo y transversal que compara la eficacia de la resección transuretral de próstata en detección temprana de cáncer de próstata en zona de transición. Se incluyeron pacientes masculinos mayores de 40 años, que acudieron a consulta externa de Urología del Hospital General de México por presencia de síntomas del tracto urinario bajo, antígeno prostático elevado, tacto rectal normal y biopsia transrrectal de próstata negativa.&#x0D; Resultados: En el grupo de pacientes con riesgo alto para cáncer de próstata con btrp, 121 (96.03%) resultaron con diagnóstico negativo para cáncer posterior a rtup; adicionalmente 5 (3.97%) resultaron con diagnóstico positivo para cáncer de próstata posterior a rtup a pesar de tener antecedente de biopsia transrrectal negativa; en cuanto al Gleason en 2 (40%) fue 6, y 7, 9 y 10 representaron 1 (20%) respectivamente. En el grupo de pacientes con riesgo bajo para cáncer de próstata no candidatos para btrp, pero con síndrome obstructivo bajo, resultaron 111 (88.09%) con diagnóstico negativo para cáncer de próstata posterior a rtup, adicionalmente 15 (11.91%) resultaron con diagnóstico de cáncer, 7 (46.7%) con Gleason 7, Gleason 6 en 3 (20%) y Gleason 9 con 3 (20%), Gleason 8 y 10 se presentaron en 1 (6.7%).&#x0D; Conclusiones: Los pacientes detectados con cáncer de próstata por rtup representan un grupo diverso en los cuales dicha técnica puede resultar diagnóstica y terapéutica; corroborando que la rtup como herramienta diagnóstica es útil, mejora la detección de cáncer de próstata en casos aislados y específicos como se muestra en dicho estudio. Es importante destacar que la rtup aislada con fines puramente diagnostico, no se recomienda.&#x0D;

External validation of prostate health index-based nomogram for predicting prostate cancer at extended biopsy

Introduction/Objective. Prostate Health Index (PHI)-based nomograms were created by Lughezzani et al. (2012) and Zhu et al. (2015) for predicting prostate cancer (PCa) at extended biopsy. The aim of the study was to externally validate two nomograms in the Serbian population. Methods. This retrospective study comprised 71 patients irrespective of digital rectal examination (DRE) findings, with prostate-specific antigen level &lt; 10 ng/ml, who had undergone prostate biopsies, and PHI testing. Data were collected in accordance with previous nomograms predictors. Independent predictors were identified by using logistic regression. The predictive accuracy was measured by the area under the receiver operating characteristic curve (AUC). The calibration belt was used to assess model calibration. The clinical utility was measured by using decision curve analysis (DCA). Results. There were numerous differences in underlying risk factors between validation dataset and previously available data. Analysis demonstrated that the DRE and PHI were independent predictors. AUCs for both nomograms, in patients with normal DRE had shown to have a good discriminatory ability (77.2?86.2%). In the entire population AUC of nomogram had exceptional discrimination (92.9%). Zhu et al. nomogram is associated with lower false positive predictions. The calibration belt for Zhu et al. nomogram was acceptable. Our DCA suggested that both nomograms are likely to be clinically useful. Conclusion. We performed external validation of two PHI-based nomograms predicting the presence of PCa in both the initial and the repeat biopsy setting. The PHI-based nomograms displayed adequate accuracy and justifies its use in Serbian patients.

Role of sterile pyuria in association to elevated PSA values in the diagnosis of non-palpable prostate cancer?

Although cancer is believed to develop and progress with the involvement of inflammation, it is still unclear what the correlation between inflammation and prostate cancer is. This study based on results of transrectal ultrasound-guided prostate biopsies aimed to determine whether C-reactive protein (CRP) and sterile pyuria were clinically useful in the evaluation of patients with suspect of prostate cancer. This study is a cross-sectional prospective study of patients without clinical prostatitis symptoms. Characteristics of the 200 consecutive patients recruited were 3-20 ng/mL value of serum prostate-specific antigen (PSA), normal digital rectal examination finding, and sterile urine culture result. All patients underwent 12-core prostatic biopsy. 163 of the 200 patients had benign prostatic hyperplasia confirmed through histology, while the residual 37 patients had prostate cancer. Patients with pre-treatment urinary leukocyte count ≤ 3/high power field were categorized as non-pyuria, whilst those with pre-treatment urinary leukocyte count > 3/high power field were categorized as pyuria. The serum CRP level was also used to differentiate patients before the biopsy. Subgroups were compared regarding a number of clinical variables. Histology revealed that 70% of pyuria patients and 38.5% of non-pyuria patients presented inflammation (p = 0.001). The pyuria group exhibited significantly higher total PSA compared to the non-pyuria group (p = 0.044). The two groups did not differ significantly regarding cancer detection rate (p = 0.752). CRP groups were similar regarding cancer detection and histologically-detected inflammation rates. In patients with no evidence of clinical prostatitis, sterile pyuria should be considered as a cause of increased PSA. Although sterile pyuria cannot predict non-palpable prostate cancer, it should be taken into account in urological evaluation in order to demonstrate minute prostatic inflammation due to its simplicity, convenience and non-invasiveness.

504 Golden-Finger: Digital Rectal Exam Predicts Dyssynergic Defecation but Not Type of Dyssynergy Pattern on ARM

INTRODUCTION: Functional defecation disorders are a common cause of chronic constipation and the diagnosis include an abnormality in two or more of the following tests: balloon expulsion test (BET), anorectal manometry (ARM) or uncoordinated defecation on electromyography. Additionally, there have been four types of anorectal manometry dyssynergy patterns identified. Rao et al have shown that digital rectal examination (DRE) performed by a single expert gastroenterologist can accurately detect patients with dyssynergia. We conducted a study evaluating whether DRE performed by gastroenterology specialists could predict the presence and type of dyssynergia in patients with chronic constipation. METHODS: Patients with chronic constipation as defined by Rome IV criteria were evaluated by GI specialty providers at a single tertiary care hospital. After performing a DRE, each provider documented a prediction regarding the type of dyssynergy pattern that would be identified on ARM as well as whether the patient would pass the balloon during BET. An abnormal BET was defined as failure to pass the balloon in less than 60 seconds. Patients subsequently underwent ARM and BET and results of predicted and measured values on ARM and BET were compared. RESULTS: 21 patients were referred to undergo ARM and BET. 19 patients met the inclusion criteria. 16 displayed a dyssynergy pattern on ARM. Of the 16 patients, 11 were also identified to have features of dyssynergia on DRE with a detection rate of 69% (Table 1). One patient was noted to have features of dyssynergia on DRE but had normal ARM. Two patients had normal DRE with normal ARM. 11 of the 16 patients with dyssynergia on ARM had abnormal BET. Of the 11 patients with abnormal BET, 7 were predicted to have abnormal BET based on DRE (64% detection rate). DRE predicted the correct type of dyssynergia (type 1-4) in 31% of patients (Table 2). CONCLUSION: Studies have shown that DRE can predict dyssynergia when performed by a single expert gastroenterologist with a detection rate of 73%. Our analysis suggests that DRE can be used to predict dyssynergia on ARM and outcomes of BET even when multiple providers perform the exam. However, DRE is not a good predictor of the type of dyssynergia. Further studies are needed to evaluate the differences in detection rates between types of dyssynergia classified by ARM, and to assess whether there is a difference in detection rates between trainees and attendings.

Prostatic Ductal Adenocarcinoma Masquerading as a Rectal Mass: A Case Report

Abstract Objective The approach to a patient presenting with a rectal mass who has a history of bright red blood per rectum (BRBPR) renders a wide range of differential diagnoses. The clinical reasoning to suspect prostatic ductal adenocarcinoma (PDA) in a patient with BRBPR without a classical clinical presentation is highly unlikely. The incidence of PDA is rare with only 0.4% to 0.8% in pure ductal origin. Methods A 71-year-old African American male presented with 3-month history of watery, bloody diarrhea and a recent history of BRBPR with unintentional weight loss. Patient underwent colonoscopy, which showed a large polyp 10 cm from the anal verge, measuring 7 cm. The unclear history of this patient contributed to an initial impression of a colorectal cancer leading to a biopsy of the colonic mass. Results An erroneous diagnosis of tubulovillous adenoma was rendered initially. Further workup showed a large mass originating from the prostate area that was seen penetrating the colorectal region on an abdominal CT scan. The patient’s serum prostate-specific antigen (PSA) level was alarmingly high (4,800 ng/mL) and a subsequent prostate biopsy showed PDA. The colonic biopsy was reviewed again by a genitourinary pathologist and a correct diagnosis was rendered. Conclusion The role of pathology in diagnosing PDA is crucial as patients with PDA can have normal digital rectal examination (DRE) as well as a normal serum PSA level (less than 4.0 ng/mL). Majority of PDAs originate from periurethral prostatic ducts. The unique presentation of primary prostate pathology offers appreciation into the approach and workups to diagnose PDA. Diagnosing PDA can be challenging due to its more aggressive nature of PDA compared to prostatic acinar adenocarcinoma. The clinical reasoning and pathological findings from this rare case can aid clinicians and pathologists to establish the diagnosis of PDA in a timely and efficient manner.

Prostate Volume Index Is Able to Differentiate between Prostatic Chronic Inflammation and Prostate Cancer in Patients with Normal Digital Rectal Examination and Prostate-Specific Antigen Values

Introduction: To assess the association of prostate volume index (PVI), defined as the ratio of the central transition zone volume to the peripheral zone volume, and prostatic chronic inflammation (PCI) as predictors of prostate cancer (PCA) risk in patients presenting with normal digital rectal exam and prostate-specific antigen (PSA) ≤10 ng/mL at baseline random biopsies. Methods: We evaluated patients with a negative digital rectal examination (DRE) and a PSA ≤10 ng/mL who underwent initial baseline prostate biopsy from 2010 to 2017. Parameters evaluated included age, PSA, total prostate volume (TPV), PSA density (PSAD), PVI and PCI. All patients underwent 14 core trans-perineal standard biopsies. The association of factors with the risk of PCA was evaluated by logistic regression analysis, utilizing 2 multivariate models: model I included age, TPV, PVI and PCI; model II included age, PSAD, PVI and PC. Results: Overall, 564 Caucasian patients were included. PCA and PCI were detected in 242 (42.9%) and 129 (22.9%) cases respectively. In patients with PCA, the median PVI was 0.83 (interquartile range [IQR] 0.62–1.04). In patients with PCI, the median PVI was 1.12 (IQR 0.81–1.47). In model I, age (OR 1.080) TPV (OR 0.961), PVI (OR 0.517) and PCI (OR 0.249) were associated with PCA risk. In model II, the age (OR 1.074), PSAD (OR 3.080), PVI (OR 0.361) and PCI (OR 0.221) were associated with PCA risk. Conclusions: Higher PVI and PCI predicted decreased PCA risk in patients presenting with normal DRE, and a PSA ≤10ng/mL at baseline random biopsy. In this subset of patients, PVI is able to differentiate patients with PCI or PCA.