Transrectal Guided Prostate Biopsy Research Articles

The evidence-based practice of bowel preparation by transrectal prostate biopsy

Objective To formulate and standardized the procedure of bowl preparation before transrectal ultrasound-guided prostate biopsy. Methods The standardized transrectal ultrasound-guided prostate biopsy flowchart were formulated based on the best evidences and recommendations. One hundred and forty patients selected with suspected of prostate cancer and scheduled for transrectal ultrasound-guided prostate biopsy was equally assigned to two groups, the control group was given routine hospital practice before biopsy, and the observation group followed the formulated flowchart. Monitoring two groups for complications, time cost for bowl preparation, medical billing and the average day of hospitalization. Results The incidence of complications and the number of hospitalization days between two groups were comparable, the observation group in bowl preparation time was (3.75±0.78) min, the control group in bowl preparation time was (11.88±1.93) min, the difference of two groups showed statistical significance (t=15.643, P<0.01). The observation group in medical bill was ¥(81.62±15.62), the control group in medical bill was ¥(427.78±76.87), the difference of two groups showed statistical significance (t=-36.964, P<0.01). Conclusions Application of evidence-based practice to formalize bowl preparation and antibiotic use in transrectal ultrasound-guided prostate biopsy patient can facilitate the clinical nurses to provide homogenized care to prostate biopsy patients as well as improve the efficiency of nursing work. Key words: Transrectal ultrasound guided prostate biopsy; Bowel preparation; Evidence-based practice

Analysis of positive detection, pain degree and safety of ultrasound guided transrectal prostate biopsy for early diagnosis of prostate cancer

Objective To evaluate the value of transrectal ultrasound guided prostate biopsy in the diagnosis of prostate cancer. Methods A total of 62 patients with suspected prostate cancer in our hospital from January 2013 to December 2016 were selected, and all patients were examined by transrectal ultrasound guided transrectal prostate biopsy. Positive detection of different puncture methods was analysed. Results Biopsy results were 25 cases of prostate cancer (40.32%). Of the 62 patients, 34 patients underwent 10 needle puncture, 28 patients underwent 12+ 1 needle puncture, the positive rate of the two kinds of puncture was 35.29% and 46.43%, respectively. The difference was not statistically significant (P>0.05). Positive detection rate of 10 needle puncture in patients with prostate volume ≥90 mL was 33.33%(5/15), which significantly lower than the 12+ 1 needle puncture 87.50%(7/8), the difference was statistically significant (P 0.05). There was no statistically significantly difference in hematuria, bloody stool, pain, urinary retention and infectionratio between 10 needle puncture and 12+ 1 needle puncture after the puncture (P>0.05). Conclusions According to the specific circumstances of patients, the puncture method is selected, when patients with prostate volume more than 90 mL, we should adopt 12+ 1 needle puncture for diagnosis of prostate cancer, and when the < 90 mL, 10 needle puncture is a suitable method. Key words: Prostatic Neoplasms; Biopsy, Needle; Ultrasonography, Doppler, Color

Assessment of Needle Tip Deflection During Transrectal Guided Prostate Biopsy: Implications for Targeted Biopsies.

To measure needle tip deflection during transrectal ultrasound (TRUS) prostate biopsy and evaluate predictors for needle tip deflection. Analysis of 568 prostate biopsies obtained from 51 consecutive patients who underwent a standard 12-core TRUS guided prostate biopsy. TRUS guided prostate biopsies were performed using BK flex500, with a side-fire biplane probe. Each biopsy core image was captured and clinical data were recorded prospectively. The angle between the expected trajectory of the needle and actual needle course was measured using the longitudinal view of the captured image. The distance between expected and actual needle tip was calculated. We measured median and interquartile needle tip deflection rate stratified by side and location (apex, midgland, base). Univariable and multivariable linear regressions analysis were performed. The overall median needle tip deflection was 1.77 mm (IQR 1.35-2.47). Location did not significantly alter needle deflection measurements. On multivariable linear regression analysis, higher prostate volume (B = 0.007 95%, CI 0.004, 0.011; p < 0.001) and the right sided biopsy (B = 0.191 95%, CI 0.047, 0.336; p = 0.010) emerged as predictors of higher needle tip deflection. To the best of our knowledge this is the first study to measure needle tip deflection during TRUS guided prostate biopsies. We demonstrated that larger prostate size and biopsy side may affect the accuracy of biopsies. These results may have clinical implication to those performing targeted biopsies.

Risk factors of complications after transrectal ultrasound guided prostate biopsy

Objective To explore the risk factors of complications after transrectal ultrasound guided prostate biopsy (TRUSPB). Methods 1 350 patients subject to TRUSPB between January 2011 and June 2016 were reviewed. The associations between biopsy complications and suspected factors were analyzed. Results There were 123 patients with complications in the 1350 patients after TRUSPB with the incidence of complications being 9.11%. Prostate volume >45 ml [odds ratio (OR)=7.916, 95% confidence interval (CI): 4.771-13.134], diabetes (OR=3.593, 95%CI: 1.680-7.682), urinary tract infection (OR=4.676, 95%CI: 1.875-11.661), prophylactic un-use of antibiotics (OR=0.015, 95%CI: 0.007-0.035) were related to the incidence of postoperative complications (χ2 values were 33.754, 12.279, 9.246, 17.911; P values were 0.000, 0.000, 0.001, 0.001). Age, biopsy core number, hypertension, prostatic cancer, prostate specific antigen (PSA) >20 ng/ml were not related to the incidence of postoperative complications (χ2 values were 0.348, 0.001, 2.587, 0.060, 0.116, 1.262; P values were 0.555, 0.980, 0.108, 0.806, 0.837). Conclusion Prostate volume >45 ml, diabetes and urinary tract infection were related risk factors of complications after TRUSPB, and prophylactic un-use of antibiotics was protective factor. Risk factors should be analyzed before TRUSPB, and some measures should be adopted to reduce complications. Key words: Prostate biopsy; Ultrasound; Prostatic diseases; Complications; Risk factors

Evaluation of MR targeted biopsy for the diagnosis of prostate cancer

Objective To evaluate the efficacy of MR targeted and transrectal ultrasond guided prostate biopsy for the diagnosis of prostate cancer. Methods From July 2014 to March 2015, 35 patients underwent MR guided prostate biopsy and 141 patients underwent TRUS guided biopsy were retrospectively evaluated. The MRI results and pathology were analyzed. Results There were no statistical differences between the two groups in term of age, prostate volume and serum PSA level (P>0.05). The overall positive rate for prostate cancer was 48.3%, with a higher positive rate in MR targeted group (57.1%) compared with TRUS group (46.1%). More patients with high grade prostate cancer were diagnosed by MR targeted biopsy compared with TRUS guided biopsy and statistical significant differences was present in patients with PSA<10 ng/ml. Conclusions The MR targeted biopsy showed a high positive rate for high grade prostate cancer, which is of great value for the prevention of over-diagnosis and overtreatment of prostate cancer. Key words: Prostate cancer; Diagnosis; Biopsy

A Comparative Analysis of Sextant and Extended 5 – Region 13 Core Transrectal Ultrasound Guided Prostate Biopsy

Objective: To compare the diagnostic value of Exten-ded 5 – Region (13 core) Trans-rectal Ultrasound gui-ded Prostate Biopsy with Standard Sextant Biopsy. Materials and Methods: 60 patients underwent tra-nsrectal ultrasound guided biopsy of prostate. In addi-tion to sextant biopsies, cores were taken from far late-ral and mid regions of the gland. Pathological findings of the additional regions were compared to those of the sextant regions. Results: We performed 5 – region trans-rectal ultra-sound guided prostate biopsy of 60 patients The reason for biopsy was abnormal digital rectal examination in 10 patients (16.7%), elevated PSA in 26 (43.3%) and combined abnormalities in 24 (40%). Out of these 60 cases, 37 (61.6%) came out to have prostate cancer. Of the cancer patients 5 (13.5% had an abnormal digital rectal examination, 14 (37.8%) had elevated PSA and 18 (48.6%) had both abnormalities. Among these 37 positive for carcinoma prostate cases, 22 patients were positive for prostate cancer in additional (zone 1, 3, 5) as well as sextant regions(zone 2, 4), 12 patients had cancer only in additional region 1, 3 and 5 and 3 pati-ents were positive for prostate cancer in sextant regi-ons alone. Conclusion: Five region technique of prostate biopsy is an efficient mean of significantly increasing the dia-gnostic yield of prostate biopsy in finding carcinoma of the prostate. We have found this technique to be safe, efficacious and superior to sextant biopsies in diagnosing prostate cancer in patients with a PSA level of less than 10 ng / ml. Key Words: Sextant and extended systematic 5 – region trans-rectal ultrasound guided prostate biopsy, Carcinoma of prostate.

The value of B7-H3 expression in expressed prostatic secretions in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone

Objective To investigate the value of B7-H3 in expressed prostatic secretions (EPS) in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone (4-10 ng/ml). Methods One hundred and sixteen patients from the ages of 19 to 80 years (mean, 40 years) were stu-died. In the group there were 91 chronic prostatitis (CP) patients (mean age 31 years, 19-49 years), including 11 chronic bacterial prostatitis (type II) patients, 26 inflammatory nonbacterial prostatitis (IIIA) patients and 54 noninflammatory nonbacterial prostatitis (IIIB) patients. Transrectal ultrsound guided prostate biopsy was performed on 25 patients (mean age 71 years, 62-80 years) with t-PSA in gray zone (7.21±2.60 ng/ml). Five had positive results, Gleason score was 6 in two cases, 7 in two cases and 8 in one case. Twenty patients had negative results, of whom 11 patients had inflammatory cell infiltration. EPS was collected by transrectal massage, and Enzyme-linked immunosorbent assays (ELISA) were performed for B7-H3 detection. In addition, 11 normal male controls with a mean age of 30 years (24-46 years) were recruited into the study. Volunteers were excluded if they had a history of genitourinary symptoms or surgery.Results The EPS B7-H3 levels of controls, II, IIIA, IIIB groups were 49.81±11.54, 19.33±13.90, 17.67±15.76, 25.14±13.44 ng/ml, respectively. The levels of EPS B7-H3 in positive biopsy, noninflammatory negative biopsy and inflammatory negative biopsy groups were 26.30±16.32, 30.23±18.42, 10.11±5.42 ng/ml, respectively. The highest levels were found in the control group (P 0.05). The EPS B7-H3 levels in the inflammatory negative biopsy group were statistically lower than in positive biopsy and noninflammatory biopsy groups (P 0.05). Receiver operating curve (AUC=0.883, P=0.001) utilizing EPS B7-H3 levels≤16.24 ng/ml identified patients with inflammatory elevation of PSA with a sensitivity of 78.6% and a specificity of 81.8% from patients with t-PSA in gray zone. Conclusion The EPS B7-H3 detection provides a new way for differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone resulting in a reduction of unnecessary prostate biopsy. Key words: Prostatic neoplasms; Carcinoma; Prostate-specific antigen; Expressed prostatic secretions; B7-H3

851 EARLY DEVELOPMENT OF A MULTIPLEX GIANT MAGNETORESISTIVE NANOSENSOR TO DETECT URINARY MARKERS TO DISCRIMINATE BETWEEN HIGH AND LOW GRADE PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Transperineal mapping template prostate biopsy (TMTPB) has emerged as a diagnostic option for men with a history of negative transrectal guided prostate biopsies. Reported advantages include more precise sampling of the entire prostate gland including the anterior and apical regions. We sought to determine the detection rate and distribution of prostate cancer (PCa) in a group of men with previous negative TRUS biopsy. METHODS: Forty one patients with a history of 1 or more previous negative biopsies underwent TMTPB for primary indication of elevated PSA, elevated PSA velocity, and/or abnormal DRE. Using a transperineal approach, the prostate was systematically biopsied in 26 unique regions guided by a brachytherapy template. Prostate size determined total number of cores. Clinical and biopsy parameters were evaluated as predictors for presence and location of PCa. RESULTS: The overall PCa detection rate was 53.7% (22 of 41). Significant PCa (Gleason score 7) was noted in 14 of 41 (34.1%) patients including 4/41 (9.8%) with high grade PCa (Gleason score 8). There was an average of 4.32 cores positive (S.D. 3.54). 79.8% of positive cores were in the anterior zones vs. only 22.2% were in the posterior zones (p 0.0001). However, the 13 positive cores for Gleason 8 or 9 cancers were evenly distributed: anterior in 7 cores, posterior in 5 cores and periurethral in 1 core. Men had a mean of 2.78 (S.D. 1.46) prior biopsies prior to TMTPB and the number of prior biopsies was not associated with detection. On multivariate analysis for predictors of presence of cancer, only prostate volume was significant (p 0.03). Complications were limited in 8 patients (19.5%): urinary retention (3), hematuria (4) and atrial fibrillation with rapid ventricular rate (1) requiring admission. CONCLUSIONS: TMTPB has a high rate of cancer detection, especially in the anterior zones, even in the setting of multiple previous negative biopsies. A majority of the detected cancers were clinically significant based on Gleason score. Therefore, TMTPB should be considered in any high risk patient with previous negative biopsies.

Life-Threatening Hypovolemic Shock after Transrectal Ultrasonography Guided Prostate Biopsy: Treatment with Selective Arterial Embolization

254 접수일자: 2011년 11월 8일, 수정일자: 2011년 12월 12일, 게재일자: 2011년 12월 15일 Correspondence to: Hong Seok Shin Department of Urology, Catholic University of Daegu School of Medicine, 3056-6, Daemyung-4 dong, Nam-gu, Daegu 705-718, Korea Tel: 053-650-4673, Fax: 053-623-4660 E-mail: uroshin@cu.ac.kr Life-Threatening Hypovolemic Shock after Transrectal Ultrasonography Guided Prostate Biopsy: Treatment with Selective Arterial Embolization

POS-03.85: Serum PSA levels and prostate cancer in Iranian men

There is no evidence-based cut-off level for serum PSA in Iran, and we use the western cut-off level of 4 ng/mL. However, there are reports in the Middle East that the level is much higher. This study determines a normal serum PSA level for Iranian patients by correlating different levels of serum PSA to the histologically diagnosed prostate cancer in transrectal guided prostate biopsy (TRUSGB) specimens.

Role of advanced 2 and 3-dimensional ultrasound for detecting prostate cancer.

We explored the clinical usefulness of spectrum analysis and neural networks for classifying prostate tissue and identifying prostate cancer in patients undergoing transrectal ultrasound for diagnostic or therapeutic reasons. Data on a cohort of 215 patients who underwent transrectal ultrasound guided prostate biopsies at Memorial-Sloan Kettering Cancer Center, New York, New York were included in this study. Radio frequency data necessary for 2 and 3-dimensional (D) computer reconstruction of the prostate were digitally recorded at transrectal ultrasound and prostate biopsy. The data were spectrally processed and 2-D tissue typing images were generated based on a pre-trained neural network classification. We used manually masked 2-D tissue images as building blocks for generating 3-D tissue images and the images were tissue type color coded using custom software. Radio frequency data on the study cohort were analyzed for cancer probability using the data set pre-trained by neural network methods and compared with conventional B-mode imaging. ROC curves were generated for the 2 methods using biopsy results as the gold standard. The mean area under the ROC curve plus or minus SEM for detecting prostate cancer for the conventional B-mode and neural network methods was 0.66 +/- 0.03 and 0.80 +/- 0.05, respectively. Sensitivity and specificity for detecting prostate cancer by the neural network method were significantly increased compared with conventional B-mode imaging. In addition, the 2 and 3-D prostate images provided excellent visual identification of areas with a higher likelihood of cancer. Spectrum analysis could significantly improve the detection and evaluation of prostate cancer. Routine real-time application of spectrum analysis may significantly decrease the number of false-negative biopsies and improve the detection of prostate cancer at transrectal ultrasound guided prostate biopsy. It may also provide improved identification of prostate cancer foci during therapeutic intervention, such as brachytherapy, external beam radiotherapy or cryotherapy. In addition, 2 and 3-D images with prostate cancer foci specifically identified can help surgical planning and may in the distant future be an additional reliable noninvasive method of selecting patients for prostate biopsy.

Local anesthesia in transrectal ultrasound-guided prostate biopsy: EMLA cream as a new alternative technique

The aims of the present study were to evaluate the efficacy of eutectic mixture of local anesthetics (EMLA) cream in transrectal-guided prostate biopsy and to compare its effect with that of other injectable anesthetic procedures. Eighty male patients with prostate-specific antigen (PSA) levels > 4 ng/ml or who had prostate nodules on digital rectal examination were randomly divided into four groups. In Group 1 (controls), prostate biopsy was performed after application of a placebo cream. In Group 2, local surface anesthesia with EMLA cream was performed 15 min before biopsy. Periprosthetic nerve blockade was performed with 1% prilocaine and 1% lidocaine in Groups 3 and 4, respectively. Pain was evaluated using a visual analog scale (VAS) after each core biopsy. In addition, blood pressure, heart rate and oxygen saturations were recorded after each biopsy and then at 5-min intervals for 15 min. Average VAS scores in Groups 1-4 were 5.5, 2.9, 2.4 and 2.2, respectively. There was a statistically significant difference in VAS scores between the treatment groups and the placebo group (p = 0.000). There were no statistically significant differences in VAS scores between the three treatment groups (p2-3 = 0.126, p2-4 = 0.303, p3-4 = 0.537). We detected no statistically significant differences between the groups based on the hemodynamic data (pMAP = 0.899). Moreover, these measurements did not show statistically significant changes with time in any of the groups (p > 0. 05). Intrarectal application of EMLA cream provides equal anesthesia to periprostatic nerve blockade with prilocaine and lidocaine.

A simple method to improve the efficiency of transrectal ultrasound guided prostate biopsy.

It is estimated that 190,000 cases of prostate cancer will be diagnosed in 20021 and transrectal ultrasound biopsy is the current diagnostic gold standard.2 The cancer detection rate for transrectal ultrasound biopsy has been estimated at 25% to 35%,3– 6 implying that more than 500,000 biopsies are performed annually. Unless a patient specifically requests, it is usually performed under minimal, if any, anesthesia due to the short (7 to 10 minutes) duration of the procedure.7 However, many patients complain that the ultrasound probe is painful, and all of them want the procedure to be over as quickly as possible. Although the procedure takes only a few minutes, the majority of the time is spent removing the specimen and reloading the biopsy gun. We present a simple method that reduces the time needed to obtain 10 biopsies to 120 seconds. METHOD At our institution the most time consuming portion of the biopsy is removal of the specimen from the biopsy needle. The usual removal method requires the physician performing the biopsy to hand the biopsy gun (Radioplast AB Biotpy, Bromma Sweden) to the assistant who opens it, removes the biopsy needle and places the specimen into a designated container of formalin. The specimen often adheres to the biopsy needle, requiring the assistant to immerse the needle in the formalin, and in many cases use another device (the plastic sleeve included in the packaging of the biopsy needle is commonly used) to scrape the specimen off the biopsy needle. When this is complete, the biopsy needle must be rinsed in saline to remove the formalin, reloaded and handed back to the physician. In our experience this process takes at least 30 seconds and frequently results in broken specimens which may be more difficult for the pathologist to mount, section and interpret. All the while the patient lays with the probe uncomfortably in the rectum. RESULTS In our method when the physician hands the biopsy gun to the assistant, he recocks it and points the tip into the mouth of the specimen container but not in contact with the formalin. He fires the biopsy gun and the specimen is expelled into the container intact, without contaminating the needle and with no further manipulation needed. Should the needle touch the formalin, it can be rinsed in saline without removing it from the biopsy gun. By using this simple method and pre-labeled specimen containers we have reduced the time needed for the biopsy portion of the transrectal ultrasound (10 biopsies) to 120 seconds. CONCLUSIONS While patients still experience some discomfort, they are often surprised and uniformly grateful that the procedure is over so quickly. This simple modification makes a common procedure dramatically faster, has no deleterious effect on the accuracy of the test, reduces the chance for needle stick exposure and may actually improve specimen quality. REFERENCES