Transrectal Ultrasound-guided Prostate Biopsy Research Articles

Implications and effects of COVID-19 on diagnosis and management of prostate cancer.

The Coronavirus disease 2019 (COVID-19) pandemic has led to uncertainty on the optimal management for prostate cancer (PCa). This narrative review aims to shed light on the optimal diagnosis and management of patients with or suspected to have PCa. Faecal-oral or aerosol transmission is possible during prostate procedures; caution must be in place when performing digital rectal examinations, transrectal ultrasound-guided prostate biopsies and prostate surgeries requiring general anaesthesia. Patients must also be triaged using preoperative polymerase chain reaction tests for COVID-19. COVID-19 has accelerated the adoption of multiparametric Magnetic Resonance Imaging (MRI), reducing the need for prostate biopsy unless when absolutely indicated, and the risk of COVID-19 spread can be reduced. Combined with prostate-specific antigen (PSA) density, amongst other factors, multiparametric MRI could reduce unnecessary biopsies in patients with little chance of clinically significant PCa. Treatment of PCa should be stratified by the risk level and preferences of the patient. COVID-19 has accelerated the development of telemedicine and clinicians should utilise safe and effective teleconsultations to protect themselves and their patients. COVID-19 transmission during prostate procedures is possible. Patients with a Prostate Imaging-Reporting and Data System (PI-RADS) of <3 and PSA density <0.15 ng/ml/ml are deemed low-risk and are safe to undergo surveillance without MRI-targeted biopsy. Intermediate- or high-risk patients should be offered definitive treatment within four months or 30days of diagnosis to avoid compromising treatment outcomes; three-month courses of neoadjuvant androgen deprivation therapy can be considered when a delay of surgery is anticipated.

A Nomogram Predicting Lymph Node Metastasis in Patients with Prostate Cancer Undergoing Ultrasound-Guided Transrectal Prostate Biopsy

A Nomogram Predicting Lymph Node Metastasis in Patients with Prostate Cancer Undergoing Ultrasound-Guided Transrectal Prostate Biopsy

Prostate-Specific Antigen Velocity Predicts Surgical Outcome of Thulium Laser Enucleation of the Prostate.

Background: We determined the effect of prostate-specific antigen velocity (PSAV) on the surgical outcome of thulium laser enucleation of the prostate (ThuLEP) in patients with benign prostatic hyperplasia (BPH).Methods: A retrospective review was performed of prospectively collected data of patients with BPH who underwent ThuLEP at any time from 2017 to 2019. Patients who had undergone BPH surgery or had prostate cancer previously were excluded, and patients with prostate-specific antigen (PSA) > 4 ng/ml were examined through transrectal ultrasound-guided prostate biopsy to rule out prostatic malignancy. Furthermore, patients were excluded if prostatic malignancy was diagnosed during postsurgery follow-up.Results: The PSA level, International Prostate Symptom Score (IPSS), and quality of life (QoL) of 27 male patients at 3 and 15 months postsurgery differed significantly from those at presurgery; the maximum flow rate (Qmax) and postvoid residual (PVR) significantly differed between 3 months postsurgery and presurgery; and 22 and 5 patients had good to excellent and fair to poor outcomes, respectively, at 15 months postsurgery. Patients were divided into two groups (fair and poor vs. good and excellent outcomes at 15 months postsurgery), which significantly differed with respect to PSAV at 3 months postsurgery (P = 0.04), IPSS presurgery (P < 0.02), surgical length (P = 0.01), and hospitalization duration (P = 0.04). In a receiver operating characteristic (ROC) analysis, the optimal cutoff value of PSAV of −0.52 ng/ml characterized effectiveness at 15 months after ThuLEP, and the area under the curve (AUC), sensitivity, and specificity were 0.82 (P < 0.02), 0.80, and 0.82, respectively. For PSAV < -0.52 and ≥-0.52 ng/ml, the percentages of reduction for IPSS, QoL, Qmax, and PVR were −78.6 and −71.4%, −33.3 and 0.0%, 94.4 and 40.0%, and −85.1 and −38.7%, respectively.Conclusions: Postsurgical PSAV was positively correlated with surgical success, and the PSAV cutoff was −0.52 ng/ml. PSAV can, thus, be used to guide the postsurgical follow-up treatment at 3 months after BPH surgery.

Comparison of amikacin with fosfomycin as an add-on to ciprofloxacin for antibiotic prophylaxis in transrectal prostate biopsy: A single-center retrospective study.

To assess the effect of ciprofloxacin (CP) and fosfomycin compared with CP and amikacin in patients with a fluoroquinolone (FQ)-resistant rectal flora who have undergone transrectal ultrasound-guided prostate biopsy (TRUSPB). In total, 516 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups according to prophylactic antibiotics. Patients in both groups were administered CP (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and 1 day after biopsy. The amikacin group (n=260) was administered a single injection of amikacin (1 g, IV) 1 hour before TRUSPB, whereas the fosfomycin group (n=256) was administered fosfomycin (3 g, orally) the night before the procedure. The primary endpoint was the rate of infectious complications in the two groups. Overall, 13 patients (2.5%) reported infectious complications: 12 patients (4.62%) in the amikacin group compared with 1 patient (0.39%) in the fosfomycin group (risk ratio, 0.09; 95% confidence interval [CI], 0.01-0.65), respectively, which was a statistically significant difference (p=0.017). This corresponds to a number needed to treat of 24 patients (95% CI, 15-65) to prevent one infectious complication. In the multivariate analysis to assess variables related to infectious complications, prophylactic antibiotics with added fosfomycin was associated with infectious complications (odds ratio, 0.060; 95% CI, 0.008-0.459). In the era of FQ resistance, CP and fosfomycin may reduce the rate of infectious complications compared with CP and amikacin prophylaxis.

Трансректальная полифокальная биопсия под контролем ультразвуковой навигации в диагностике рака предстательной железы

Background: prostate cancer (PCa) is a topic of special interest in the modern urologic oncology. PCa is associated with high rates of morbidity and mortality among the male population in Russia and worldwide. The current diagnostic algorithm for PCa detection includes a digital rectal examination to check the prostate, and a PSA test to measure levels of prostate specific antigen (PSA) in the blood, and a prostate biopsy followed by morphological verification. Aim: to analyze the results of transrectal ultrasound guided polyfocal biopsies of the prostate, performed from 2021 to 2022 in patients who underwent diagnosis and treatment at the Clinical Hospital "RZD-Meditsina" of the city of Krasnoyarsk. Patients and Methods: in all cases the evaluation of patients included the measurement of a total PSA (PSAtotal) concentration, standard examination, and the preparation for biopsy. The ultrasound guided prostate biopsy was performed in the hospital setting. After the procedure, all patients were followed up to control and prevent possible complications. Histological examination of the biomaterial included the verification of malignant neoplasms or benign lesions in the prostate tissue, Gleason score, and other morphological characteristics. Results: findings of 220 transrectal ultrasound guided prostate biopsies were analyzed. The median age of patients was 64 (44–89) years. Benign prostatic hyperplasia (BPH) was diagnosed in 112 (51%) patients, prostate cancer — in 108 (49%) patients. PSA level varied from 0.48 to 37.9 ng/ml in the BPH patients, and from 4.48 to 100.0 ng/ml in the PCa group. The median prostate volume was 74.61 (10.26–134.80) cm3 in the PCa group, and 153.45 (116.22–185.50) cm3 in the patients with BPH. Most of PCa patients had Gleason score ≤7 representing moderately differentiated tumors. Post-biopsy complications were observed in 141 (64.09%) patients and included hematuria, short-term rectal bleeding, chronic prostatitis exacerbation. All complications were cured successfully treated using conservative therapy. Conclusion: PCa can be diagnosed even in patients with low PSATotal levels or the normal prostate volume . Moderately differentiated tumors (Gleason score ≤7) predominated in the population of patients. These data are consistent with the effective early detection of PCa. Patients should be closely monitored in the early post-operative period after a diagnostic prostate biopsy to prevent potential complications. KEYWORDS: prostate cancer, biopsy, prostate, transrectal puncture biopsy, ultrasound navigation. FOR CITATION: Berezhnoy A.G., Dunaevskaya S.S., Auzina S.I. Ultrasound guided transrectal polyfocal biopsy in prostate cancer diagnosis. Russian Medical Inquiry. 2022;6(6):309–313 (in Russ.). DOI: 10.32364/2587-6821-2022-6-6-309-313.

Prevalence and risk factors for incidental prostate cancer in patients after transurethral resection of the prostate with negative results on prostate biopsy: A retrospective study.

PurposeThis study aimed to explore the prevalence and predictors of incidental prostate cancer (IPC) after transurethral resection of the prostate (TURP) with negative results on transperineal magnetic resonance imaging (MRI)/transrectal ultrasonography (TRUS) fusion prostate biopsy or TRUS-guided prostate biopsy.Materials and MethodsData of 253 patients who underwent TURP with a preliminary diagnosis of benign prostatic hyperplasia (BPH) were evaluated. The prevalence of IPC was calculated. Univariate and multivariate logistic regression analyses were conducted to explore independent predictive factors of IPC.ResultsA total of 253 patients were included. IPC was diagnosed in 12 patients (4.7%). The mean age of the patients and the mean prostate volume were 69.8±7.07 years and 89.3±49.29 mL, respectively. The prevalence of IPC was higher in the TRUS guided prostate biopsy group than in the transperineal MRI/TRUS fusion prostate biopsy group (11 of 203 [5.4%] vs. 1 of 50 [2.0%], p=0.47), but the difference was not statistically significant. Our results indicated that older age (≥70 y) (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.02–1.27; p=0.025) and smaller prostate volume (OR, 0.97; 95% CI, 0.938–0.998; p=0.039) were associated with an increased incidence of IPC after TURP.ConclusionsOur findings indicate that the prevalence of IPC may be higher among patients who undergo transrectal prostate biopsy before TURP than among those who undergo transperineal MRI/TRUS fusion prostate biopsy. Older age and smaller prostate volume were independent predictors of increasing the risk for IPC after TURP.

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

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

Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes.

BackgroundSedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure’s prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes.MethodsA retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates.ResultsThe cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction.ConclusionSedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.

Comparative Effectiveness of Single-Dose of Fosfomycin vs. Cefoxitin Plus Ciprofloxacin as A Prophylaxis to Prevent Transrectal Prostate Biopsy Complications

A total of 432 transrectal ultrasound guided prostate biopsies were performed: 241 patients received prophylaxis with cefoxitin 2 g i.v. 1 hour before the procedure combined with ciprofloxacin 750 mg p.o. 1 hour before and 8 hours after the procedure A total of 184 patients received prophylaxis with single dose of fosfomycin trometamol 3 g oral the night before the procedure Adverse events in the 30 days following the procedure were analyzed.

An R Package Unified Dose Finding for Continuous and Ordinal Outcomes in Phase I Dose-Finding Trials

A total of 432 transrectal ultrasound guided prostate biopsies were performed: 241 patients received prophylaxis with cefoxitin 2 g i.v. 1 hour before the procedure combined with ciprofloxacin 750 mg p.o. 1 hour before and 8 hours after the procedure A total of 184 patients received prophylaxis with single dose of fosfomycin trometamol 3 g oral the night before the procedure Adverse events in the 30 days following the procedure were analyzed.

Diagnostic yield and outcome of transrectal ultrasound-guided prostate biopsy in Sri Lanka.

The study was aimed to determine the diagnostic yield and outcome of transrectal ultrasound-guided prostate biopsy (TRUSPB) in a cohort of Sri Lankan men. A prospective study was conducted among 333 (median age: 70 years, range:48-88) men from a single urology unit. All patients underwent TRUSPB for persistently elevated serum prostate specific antigen (PSA)≥4.00 ng/mL or suspicious rectal examination. The prostate cancer (PCa) detection rate was 57.7%. The PCa detection rate for PSA levels of 4.00 to <10, 10.00 to <20, 20.00 to <40, 40.00 to <100 and ≥100.00 ng/mL were 15/43(34.9%), 23/88(26.1%), 41/72(56.9%), 51/63(81.0%) and 60/62(96.8%) respectively. Ten patients required further biopsies for rising PSA despite a first benign biopsy and three had PCa. Mild complications were identified in 6.9%(n=23). The high PCa detection rate probably reflects the difference in our policy to perform biopsies only when serum PSA level is persistently elevated. TRUSPB appears to have a satisfactory yield with acceptable level of complications in the Sri Lankan resource limited setting.

Effect of alpha-blocker use on morbidity and lower urinary tract symptoms in patients undergoing transrectal ultrasound-guided prostate biopsy.

To evaluate voiding dysfunction and morbidity after transrectal ultrasound (TRUS)-guided prostate biopsy and to investigate whether pre-intervention alpha-blocker treatment had any effect on morbidity and voiding dysfunction. The study included 197 consecutive patients who underwent TRUS-guided prostate biopsy between January 2014 and January 2018. The patients were divided into two groups, those receiving alpha-blocker (silodosin) and those not receiving alpha-blocker treatment before the procedure (controls). All patients were evaluated before and one week after the procedure with the International Prostate Symptom Score (IPSS), measurements of maximum flow rate (Qmax), post-void residual urine volume (PVR) and prostate volume, and procedure-related complications were also recorded. All analyzed parameters were compared by within-group and between-group evaluations. There was no significant difference between the two groups in terms of IPSS, Qmax and prostate volume values before biopsy. In the follow-up evaluation performed on the seventh day after biopsy, IPSS, PVR and prostate volume were found to be increased, whereas Qmax was decreased in the control group (p < 0.05). In the silodosin group, an increase in prostate volume was observed, but there were no significant changes in IPSS, Qmax and PVR values. Acute urinary retention (AUR) after the biopsy procedure developed in two patients (2%) in the silodosin group, and in nine patients (9.1%) in the control group (p = 0.02). No significant difference was found between the two groups in terms of biopsy-related complications, except for AUR. We believe that alpha-blocker treatment initiated before biopsy may be advantageous in preventing voiding dysfunction that may develop after the procedure.

Pneumonia and sepsis due to carbapenem-resistant Klebsiella Pneumoniae after transrectal prostate biopsy

Transrectal ultrasound-guided prostate biopsy (TRUSPB) with local anesthesia and prophylactic antibiotics is the most commonly used diagnostic method for prostate cancer today. Even though TRUSPB has a low complication rate, infective complications may arise on occasion. Despite the fact that prophylaxis is controversial to prevent infective complications after TRUSPB, quinolones (ciprofloxacin, ofloxacin, levofloxacin) and trimethoprim-sulfamethoxazole are the most frequently preferred antibiotics in prophylaxis. However, as with many antibiotics today, there is an increase in resistance to trimethoprim-sulfamethoxazole and quinolones. This report describes a case of sepsis due to carbapenem-resistant Klebsiella pneumoniae and pneumonia following transrectal prostate biopsy.

Prophylactic role of ciprofloxacin and ceftriaxone in prostate biopsy-related infection: randomized comparative study of bacterial spectrum and antibiotic sensitivities

BackgroundThe mainstay for the diagnosis of prostate cancer is transrectal ultrasound-guided prostate biopsy. However, prostate biopsy is associated with a significant risk of complications including urinary tract infection. This study aims to compare the bacterial profile and antibiotic susceptibility pattern in urinary tract infection after prostate biopsy between patients on 2 different antimicrobial prophylactic regimens.MethodsThis was a comparative cross-sectional study done at the urology unit of our institution, over 13 months. Fifty-six patients who met the inclusion criteria made up the study population and were randomly assigned to two groups. Those in group 1 (28) received intravenous ciprofloxacin (Juhel) 400 mg at induction of anesthesia, while those in group 2 (28) received intravenous ceftriaxone (Rocephin) 1 g at induction of anesthesia. All patients received bisacodyl (dulcolax) rectal suppositories 20 mg nocte starting 2 nights before the procedure as well as intravenous metronidazole (Juhel) at induction of anesthesia. Urine samples were taken for urine culture and sensitivity three days after biopsy. Isolated organisms and their antibiotics sensitivities were documented. Statistical analysis was done using SPSS version 21.0 with the level of significance set at P < 0.05.ResultsIn group 1 the prevalence of urinary tract infection was 61%. Escherichia coli was isolated in 11(64.71%) cases, Klebsiella species in 3(17.65%), staphylococcus aureus in 1(5.88%), Proteus species in 1(5.88%), and non-hemolytic streptococcus species in 1(5.88%). In this group, all isolated bacterial organisms were resistant to ciprofloxacin. In group 2 the prevalence of urinary tract infection was 43%. Klebsiella spp was isolated in 6(50%) cases, Pseudomonas aeruginosa in 3(25%), E. coli in 2(16.67%), Staphylococcus in 1(8.33%). In group 2 all isolated bacterial organisms were resistant to ceftriaxone.ConclusionCiprofloxacin and ceftriaxone are both associated with a high rate of urinary tract infection when used as prophylaxis for prostate biopsy. The bacterial etiology of prostate biopsy-related urinary tract infection is dependent on the prophylactic antibiotics used. Based on the high rate of urinary tract infection associated with the use of either ciprofloxacin or ceftriaxone, we recommend a combination of both drugs as prophylaxis for prostate biopsy.

Tissue expression of MMP-9, TIMP-1, RECK, and miR338-3p in prostate gland: can it predict cancer?

Prostate cancer is the most frequent malignancy affecting men worldwide. Due to the low sensitivity and specificity of the prostate-specific antigen test and the digital rectal exam as screening modalities, several alternatives are being studied. This study aimed to evaluate the application of MMP-9 and its regulators (TIMP-1, RECK, and miR-338-3p) as diagnostic and prognostic indicators of prostate cancer. A total of 134 randomly selected patients under investigation for prostate cancer submitted to a transrectal ultrasound-guided prostate biopsy were enrolled in the study; of these, 61 were positive for the disease (cases), and 73 were negative (control group). The tissue samples were further analyzed by gene and miR-338-3p expression analysis using qRT-PCR (one randomly selected fragment of each patient). Approximately 58% of the patients with prostate cancer presented MMP9 upregulation, while 73%, 65%, and 69% downregulated IMP-1, RECK, and miR-338-3p, respectively. MiR-338-3p was expressed at lower levels in patients with PSA concentrations exceeding 20 ng/mL (p=0.045) and abnormal DRE (p=0.006), while the RECK was more expressed in patients with abnormal DRE (p=0.01). We found that most patients with prostate cancer overexpressed MMP-9; on the other hand, most of them underexpressed TIMP-1, RECK, and miR-338-3p. MiR-338-3p presented as a possible predictor of poor prognosis. Further studies are warranted to evaluate these biomarkers as prognosis factors better.

An analysis of three different prostate cancer risk calculators applied prior to prostate biopsy: A Turkish cohort validation study.

The study aimed to investigate the best-performing of three risk calculators (RCs) for the Turkish population in predicting cancer-free status and high-risk prostate cancer (PCa) in patients undergoing transrectal ultrasound-guided prostate biopsy. The electronic medical records of 527 patients who underwent prostate biopsy for the first time due to PSA of 0.3-50ng/dl and/or cancer suspicion at digital rectal examination (DRE) between January 2017 and December 2020 were retrieved retrospectively. The predictive power of the RCs in the biopsy and the surgical cohort was calculated by two urologists using European Randomised Study of Screening for Prostate Cancer (ERSPC) RC, the North American Prostate Cancer Prevention Trial-RC (PCPT-RC), and the Prostate Biopsy Collaborative Group (PBCG)-RC. All three RCs were successful in predicting PCa and high-risk disease at ROC analysis (p<0.0001). Of these three nomograms, PBCG-RC outperformed PCPT-RC 2.0 and ERSPC-RH in predicting benign pathology outcomes at biopsy. A better performance of PBCG-RC was also observed in terms of prediction of high-risk disease at biopsy. Using any of the available RCs prior to biopsy is of greater assistance to prostate-specific antigen and DRE than examination alone. The study results show that PBCG-RC performed before biopsy has a higher predictive power than the other two RCs.

Prostate Health Index Density Outperforms Prostate Health Index in Clinically Significant Prostate Cancer Detection

BackgroundProstate-specific antigen (PSA) is considered neither sensitive nor specific for prostate cancer (PCa). We aimed to compare total PSA (tPSA), percentage of free PSA (%fPSA), the PSA density (PSAD), Prostate Health Index (PHI), and the PHI density (PHID) to see which one could best predict clinically significant prostate cancer (csPCa): a potentially lethal disease.MethodsA total of 412 men with PSA of 2–20 ng/mL were prospectively included. Serum biomarkers for PCa was collected before transrectal ultrasound guided prostate biopsy. PHI was calculated by the formula: (p2PSA/fPSA) x √tPSA. PHID was calculated as PHI divided by prostate volume measured by transrectal ultrasound.ResultsOf the 412 men, 134 (32.5%) and 94(22.8%) were diagnosed with PCa and csPCa, respectively. We used the area under the receiver operating characteristic curve (AUC) and decision curve analyses (DCA) to compare the performance of PSA related parameters, PHI and PHID in diagnosing csPCa. AUC for tPSA, %fPSA, %p2PSA, PSAD, PHI and PHID were 0.56、0.63、0.76、0.74、0.77 and 0.82 respectively for csPCa detection. In the univariate analysis, the prostate volume, tPSA, %fPSA, %p2PSA, PHI, PSAD, and PHID were all significantly associated with csPCa, and PHID was the most important predictor (OR 1.41, 95% CI 1.15–1.72). Besides, The AUC of PHID was significantly larger than PHI in csPCa diagnosis (p=0.004). At 90% sensitivity, PHID had the highest specificity (54.1%) for csPCa and could reduce the most unnecessary biopsies (43.7%) and miss the fewest csPCa (8.5%) when PHID ≥ 0.67. In addition to AUC, DCA re-confirmed the clinical benefit of PHID over all PSA-related parameters and PHI in csPCa diagnosis. The PHID cut-off value was positively correlated with the csPCa ratio in the PHID risk table, which is useful for evaluating csPCa risk in a clinical setting.ConclusionThe PHID is an excellent predictor of csPCa. The PHID risk table may be used in standard clinical practice to pre-select men at the highest risk of harboring csPCa.

Transrectal povidone-iodine efficiency in reducing infections occurring after transrectal ultrasound guided biopsy of the prostate.

The present study aimed to compare infectious complications in men undergoing transrectal ultrasound-guided prostate biopsy (TRUS-Bx) with and without povidone-iodine transrectal injection using a gavage syringe.The records of 112 patients, who underwent TRUS-Bx between January 2016 and December 2019, were retrospectively reviewed. The biopsy indication was considered high prostate-specific antigen (PSA) level and/or suspicious digital rectal prostate examination findings. Patients’ ages, underlying diseases, PSA levels, prostate volumes, pathologic results, and infectious complications after the biopsy were investigated. All the patients received 1500 mg of ciprofloxacin (750 mg twice a day) for 5 days, starting from the day before the procedure. Forty-seven (41.96%) patients received ciprofloxacin prophylaxis with povidone-iodine transrectal injection, while 65 (58.03%) only received ciprofloxacin prophylaxis. All the patients, who were readmitted to the hospital after the procedure, especially with a temperature of higher than 37.8°C, were detected. For the purposes of the study, the priority was placed on the emergence of the rate of febrile infectious complications. Differences in febrile infectious complications in patients, who received ciprofloxacin prophylaxis with transrectal povidone-iodine, and those, who received ciprofloxacin prophylaxis alone before TRUS-Bx, were studied.Febrile infectious complications developed in 10 cases (15.38%) in patients, who received ciprofloxacin antibiotics prophylaxis alone. In the povidone-iodine rectal disinfection group, there was only 1 case of febrile infectious complication (2%). There was no significant difference by clinicopathologic features, age, PSA level, and cancer detection rate between both groups (P > .05). Multivariate logistic regression analysis did not identify any patient subgroups at a significantly higher risk of infection after prostate biopsy. There was no significant side effect associated with povidone iodine.In addition to the use of prophylactic antibiotics, transrectal povidone-iodine was useful in reducing the febrile infection complications following TRUS-Bx.

A new ASAP Scoring System and Risk Table to predict second prostate biopsy outcomes

IntroductionThis study aimed to discuss the necessity of a second prostate biopsy in patients with atypical small acinar proliferation (ASAP) and to develop a scoring system and risk table to be used as new criteria for a second biopsy.Material and methodsThe study reviewed the data of 2,845 patients; who underwent transrectal ultrasonography-guided prostate biopsy in the period between January 2008 and May 2019. A total of 128 patients with ASAP were included in the study. The tPSA, fPSA, f/tPSA, and PSA-Density levels before the first and second biopsies and changes in the measured levels between the values obtained before the first and the second biopsies were recorded. “ASAP Scoring System and risk table” (ASS-RT) was evaluated before the second biopsy.ResultsThe mean age of 128 patients with ASAP was 62.9±7.8 years. The ASS-RT scores of prostate cancer patients were significantly higher compared to patients without prostate cancer (p: 0.001). In the ROC curve analysis of ASS-RT, the area under the curve was 0.804 and the standard error was 0.04. The area under the ROC curve was significantly higher than 0.5 (p:0.001). The cut-off point of ASS-RT scores in diagnosing cancer was ≥ 7 with 60.8% sensitivity and 80.5% specificityConclusionsThe cut-off value of 7 determined for the ASS-RT score in this study suggests that patients with ASS-RT scores of ≥7 should undergo a second prostate biopsy. We think that there may be no need for a second biopsy if the ASS-RT score is &lt;7, especially for low-risk patients.

499 A Retrospective Audit on Detection Rate of Clinically Significant Cancer Among MP-MRI Targeted Biopsy – A Single Centre Experience

Abstract Men with high serum prostate specific antigen (PSA) typically undergo standard transrectal ultrasound-guided prostate biopsy (TRUS-biopsy) during which 10 to 12 cores are obtained. TRUS-biopsy can cause side-effects including bleeding, pain, and infection. Multi-parametric MRI (MP-MRI) used as a triage test might allow men to avoid unnecessary TRUS-biopsy and improve diagnostic accuracy. According to the renowned PROMIS study, for clinically significant cancer, MP-MRI was more sensitive and less specific than TRUS-biopsy. In this study, we performed a single centre, retrospective audit on the detection rate of clinically significant cancer among MP-MRI targeted biopsy and compare it with the standard TRUS biopsy. Clinically significant cancer is defined as Gleason score ³ 4 +3 or a maximum cancer core length 6mm or longer. Besides, we also compare the rate of clinically significant cancer in MP-MRI targeted biopsy against the PROMIS study. Through this audit, we found that in 2019, there is a 54% (60 out of 112 patients) of clinically significant cancer in MP-MRI biopsy and 41% (26 out of 64 patients) of clinically significant cancer among standard TRUS biopsy. Comparing it with the PROMIS study in which clinically significant cancer was detected in 38% in the MP-MRI targeted biopsy group and 26% in the standard-biopsy group, the adjusted difference in our study (13%) is similar to PROMIS study which is 12%. In conclusion, our study reaffirms that MP-MRI targeted biopsy reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer.