Transrectal Ultrasound-guided Prostate Needle Biopsy Research Articles

Effect of constipation on acute urinary retention following transrectal prostate biopsy.

To evaluate the possible effect of constipation on the acute urinary retention (AUR) after transrectal ultrasound-guided prostate biopsy (TRUS PB). A total of 1,167 patients with prostate-specific antigen (PSA) >4 ng/mL and/or abnormal digital rectal examination underwent a standard 12 core transrectal ultrasound-guided prostate needle biopsy in our hospital and the findings were examined prospectively. Chronic constipation (CC) was defined according to the Rome IV criteria. All cases were well evaluated with respect to clinical-histopathological factors; International Prostate Symptom Score (IPSS), prostate volume, post-void residue, age, body mass index, histopathological inflammation, and AUR. The mean age of patients was 64.63±8.31 years, the PSA level was 11.60±16.83 ng/mL, and the prostate volume was 54.66±25.44 mL. In 265 cases (22.7%), CC anamnesis was present and AUR developed in 28 (2.4%) of the cases. In the multivariate analysis for the risk of developing urinary retention, prostate volume, pre-operative IPSS, and presence of CC requiring manual maneuvers to facilitate defecation were found to be risk factors (p=0.023, 0.010, and 0.001, respectively). Our findings demonstrated that CC may be a critical factor in the prediction of AUR formation following TRUS PB.

Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy.

Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B). We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Overall, 86.4% (n = 312/361) and 62.6% (n = 226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% (n = 289/483) of the FQ-resistant and 66.0% (n = 202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% (n = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.

MP53-17 CULTURE-DIRECTED ANTIMICROBIAL PROPHYLAXIS IN TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSIES: CONTEMPORARY 7-YEAR EXPERIENCE

You have accessJournal of UrologyCME1 May 2022MP53-17 CULTURE-DIRECTED ANTIMICROBIAL PROPHYLAXIS IN TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSIES: CONTEMPORARY 7-YEAR EXPERIENCE Steven A Sidelsky, Pooja Talaty, Pranvera Sulejmani, Mira Suseno, Sandra Naegele, Kristian Novakovic, Brian T. Helfand, and Alexander P. Glaser Steven A SidelskySteven A Sidelsky More articles by this author , Pooja TalatyPooja Talaty More articles by this author , Pranvera SulejmaniPranvera Sulejmani More articles by this author , Mira SusenoMira Suseno More articles by this author , Sandra NaegeleSandra Naegele More articles by this author , Kristian NovakovicKristian Novakovic More articles by this author , Brian T. HelfandBrian T. Helfand More articles by this author , and Alexander P. GlaserAlexander P. Glaser More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002628.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infectious complications can occur in 1-5% of patients undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-PNB). Resistance to fluoroquinolones (FQ) has led to use of a pre-biopsy rectal swab to examine for FQ-resistant flora. As our practice and many others transition to transperineal (TP) biopsies, we sought to study the rate of infectious complications in a contemporary TRUS-PNB series with pre-biopsy rectal swabs. METHODS: Patients undergoing TRUS-PNB from 1/1/2014-12/31/2020 were identified using the Enterprise Data Warehouse. Clinical variables, rectal swab results, prophylactic antibiotic given, blood and urine cultures, admissions, and mortality within 90 days was extracted. Chart review was performed for all patients with a blood culture ordered within 90 days of TRUS-PNB. RESULTS: Of the 4,441 patients who underwent TRUS-PNB, 15-19% had FQ-resistant flora, and this rate did not significantly change per year (Figure 1; p=0.53). Thirty-nine (0.9%) patients had a blood culture ordered within 90 days. Chart review of these patients confirmed 20 (0.45%) were admitted with post-biopsy infection (Table 1). Others had blood cultures ordered for issues unrelated to prostate biopsy including post-prostatectomy complications (n=6), pneumonia (n=4), DVT/PE (n=2), ureteral stone (n=1), acute cholecystitis (n=1), and other unrelated issues (n=3). There were no identified deaths within 90 days. The rate of post-biopsy infection was higher for men with FQ-resistant flora (1.17%) compared to men without FQ-resistant flora (0.3%; p=0.0035). CONCLUSIONS: Rates of admission for infection after culture-directed antimicrobial prophylaxis are low (∼0.5%). Men with FQ-resistance are at higher risk for infection despite targeted prophylaxis. This data serves as a contemporary series for comparison as many practices transition to TP biopsy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e902 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven A Sidelsky More articles by this author Pooja Talaty More articles by this author Pranvera Sulejmani More articles by this author Mira Suseno More articles by this author Sandra Naegele More articles by this author Kristian Novakovic More articles by this author Brian T. Helfand More articles by this author Alexander P. Glaser More articles by this author Expand All Advertisement PDF DownloadLoading ...

Transrectal ultrasound-guided prostate needle biopsy remains a safe method in confirming a prostate cancer diagnosis: a multicentre Australian analysis of infection rates.

Worldwide, transrectal ultrasound-guided prostate needle remains the most common method of diagnosing prostate cancer. Due to high infective complications reported, some have suggested it is now time to abandon this technique in preference of a trans-perineal approach. The aim of this study was to report on the infection rates following transrectal ultrasound-guided prostate needle biopsy in multiple Australian centres. Data were collected from seven Australian centres across four states and territories that undertake transrectal ultrasound-guided prostate needle biopsies for the diagnosis of prostate cancer, including major metropolitan and regional centres. In four centres, the data were collected prospectively. Rates of readmissions due to infection, urosepsis resulting in intensive care admission and mortality were recorded. 12,240 prostate biopsies were performed in seven Australian centres between July 1998 and December 2020. There were 105 readmissions for infective complications with rates between centres ranging from 0.19 to 2.60% and an overall rate of 0.86%. Admission to intensive care with sepsis ranged from 0 to 0.23% and overall 0.03%. There was no mortality in the 12,240 cases. Infective complications following transrectal ultrasound-guided prostate needle biopsies are very low, occurring in less than 1% of 12,240 biopsies. Though this study included a combination of both prospective and retrospective data and did not offer a comparison with a trans-perineal approach, TRUS prostate biopsy is a safe means of obtaining a prostate cancer diagnosis. Further prospective studies directly comparing the techniques are required prior to abandoning TRUS based upon infectious complications.

The Effectiveness of Caudal Block with Low Doses of Dexmedetomidine and Pethidine in Transrectal Prostate Biopsy: Preliminary Results

Purpose To evaluate the effectiveness of caudal block (CB) using dexmedetomidine and pethidine instead of local anesthesia (LA) for prostate needle biopsy and the effect of CB on urinary retention. Material and Methods A transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) was performed on 68 patients with a mean age of 65 ± 2.18 years. CB with a combination of dexmedetomidine and pethidine without LA was administered to the patients. The pain levels of the patients were determined using numeric rating scale (NRS) scores to evaluate the effectiveness of CB. Preoperative and postoperative postvoid residual urine volumes (PRUV) were also calculated. Results The CB success rate was 93.15%. The NRS scores were 0.79 ± 0.19 and 0.89 ± 0.22 during probe entry and manipulation and biopsy, respectively, without any significant differences between them (p = 0.382). The mean PRUVs before and after biopsy did not differ significantly (41 ± 15.6 vs. 71.93 ± 22.3, p = 0.379). The degree of sedation, as assessed using the Ramsay scale, was 2 or 3 in all patients. Conclusion The combination of dexmedetomidine and pethidine for CB in TRUS-Bx provided quality analgesia for the patient and prevented the development of postoperative urinary retention.

Hematuria after Transrectal Prostate Biopsy: A Warning of Future Infection

Purpose: To identify the incidence and predictive factors of infectious complications in a prophylactic-controlled cohort of men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) at a single institution. Materials and Methods: A retrospective review was performed on 539 patients who underwent TRUS-Bx between 2010-2015. All patients received prophylactic Sulfamethoxazole/Trimethoprim and Levofloxacin prior to the biopsy. Charlson Comorbidity Index (CCI) was calculated for each patient. The characteristics of patients with and without infectious complications were compared using Fisher exact tests and student’s t-test. Results: 539 biopsies were performed. Mean age was 64 years, PSA was 17, prostate volume was 41 mL, and CCI score was 3. A total of 7 (1.3%) infectious complications were reported 48-72 hours after biopsy, with 2 (0.4%) developing sepsis. Analysis indicated no significant differences in mean age (p=0.544), PSA (p=0.881), prostate volume (p=0.532), or CCI score (p=0.499) among patients who developed infection. Individual components of the CCI revealed no statistically significant differences. Additional complications following biopsy included: hematuria (8.3%), rectal bleeding (1.3%), urinary urgency (0.9%), and new onset erectile dysfunction (0.6%). Hematuria was associated with the development of infectious complications (OR=8.75, CI 1.895–40.400, p=0.0055). Conclusions: Our cohort of patients undergoing TRUS-Bx had a lower infectious rate compared to that reported by the AUA (1.1% vs 5-7%). Although this study has limited power, CCI was poorly predictive of infectious complications following TRUS-Bx. Persistent hematuria following biopsy was associated with infectious complications. The clinical importance of hematuria following TRUS-Bx, if any, needs to be further clarified.

Characterization of Escherichia coli isolates potentially covered by ExPEC4V and ExPEC10V, that were collected from post-transrectal ultrasound-guided prostate needle biopsy invasive urinary tract and bloodstream infections

There is an increasing incidence of infectious complications caused by extraintestinal pathogenic Escherichia coli (ExPEC) after transrectal ultrasound-guided prostate needle biopsy (TRUS-PNB), and a need for prophylaxis methods effective against associated antibiotic–resistant organisms. We aimed to identify the O-serotypes of ExPEC isolates collected in a sample of 60 patients with invasive ExPEC disease (IED) after TRUS-PNB, by serotype–specific agglutination and polymerase chain reaction (PCR) assays. The prevalence of O–serotypes included in a tetravalent ExPEC vaccine was 38.3% by agglutination and 46.7% by PCR, while the prevalence of O-serotypes included in a decavalent vaccine was 58.3% and 73.3%, respectively. Therefore, compared to the tetravalent vaccine, the decavalent vaccine would theoretically provide coverage for serotypes carried by a higher proportion of circulating ExPEC in patients undergoing TRUS-PNB, including a high proportion of antibiotic-resistant organisms.

Hematuria after Transrectal Prostate Biopsy: A Warning of Future Infection

Purpose: To identify the incidence and predictive factors of infectious complications in a prophylactic-controlled cohort of men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) at a single institution. Materials and Methods: A retrospective review was performed on 539 patients who underwent TRUS-Bx between 2010-2015. All patients received prophylactic Sulfamethoxazole/Trimethoprim and Levofloxacin prior to the biopsy. Charlson Comorbidity Index (CCI) was calculated for each patient. The characteristics of patients with and without infectious complications were compared using Fisher exact tests and student’s t-test. Results: 539 biopsies were performed. Mean age was 64 years, PSA was 17, prostate volume was 41 mL, and CCI score was 3. A total of 7 (1.3%) infectious complications were reported 48-72 hours after biopsy, with 2 (0.4%) developing sepsis. Analysis indicated no significant differences in mean age (p=0.544), PSA (p=0.881), prostate volume (p=0.532), or CCI score (p=0.499) among patients who developed infection. Individual components of the CCI revealed no statistically significant differences. Additional complications following biopsy included: hematuria (8.3%), rectal bleeding (1.3%), urinary urgency (0.9%), and new onset erectile dysfunction (0.6%). Hematuria was associated with the development of infectious complications (OR=8.75, CI 1.895–40.400, p=0.0055). Conclusions: Our cohort of patients undergoing TRUS-Bx had a lower infectious rate compared to that reported by the AUA (1.1% vs 5-7%). Although this study has limited power, CCI was poorly predictive of infectious complications following TRUS-Bx. Persistent hematuria following biopsy was associated with infectious complications. The clinical importance of hematuria following TRUS-Bx, if any, needs to be further clarified.

Smoking reduces PSA accuracy for detection of prostate cancer: results from an Italian cross-sectional study.

The aim of our study is to evaluate the diagnostic accuracy of prostate-specific antigen (PSA) according to the smoking status in a cohort of European men undergoing prostate biopsy. From 2008 onwards, we consecutively enrolled, at a single institution in Italy, men undergoing 12 core transrectal ultrasound-guided prostate needle biopsy. Demographic, clinical and histopathological data were collected. We excluded men who had PSA >30 ng/mL. Patients were classified in three groups: non-smokers, smokers and former smokers. Receiver-operator characteristics (ROC) curve analysis were used to compare predictive properties of PSA across smoking categories for the final histopathological diagnosis of prostate cancer. 872 patients were enrolled. with a median age and PSA of 67 years (IQR: 61/74) and 6.2 ng/mL (IQR: 4.4/9.7) respectively.402/872 patients (46%) were non-smokers; 151 of 872 were smokers (17%) and 319 of 872 were former smokers (36%); 374 of 872 (43%) had cancer on biopsy. PSA accuracy for smokers (AUC= 0.47, P=0.490) was lower when compared to non-smokers (AUC=0.59, P=0.003) and former smokers (AUC=0.59, P=0.005). In a cohort of Italian men undergoing prostate biopsy, the performance accuracy of PSA, as a predictor of prostate cancer, is lower in smokers. Although the molecular link behind our findings is still unknown, our study firstly showed that the PSA accuracy for PCa diagnosis is significantly influential by smoking.

Evaluation of concordance between histopathological prognostic findings from prostate needle biopsy samples and serum prostate-specific antigen levels

Prostate cancer is the most common cancer in men. Although the prostate-specific antigen (PSA) is still used as a diagnostic and screening test, there are some controversies about its performance for the differentiation of high-risk cancer from low-risk cancer at an early stage. The Gleason grading system for the pathological grading of prostatic adenocarcinoma is based on the architectural patterns of prostatic glands and it is one of the major predictors of prostate cancer prognosis and clinical management. This study aimed to investigate the concordance between histopathological prognostic findings from prostate needle biopsy samples and serum PSA levels. This retrospective study included data from 150 patients with histopathologically diagnosed as prostatic adenocarcinoma. All patients underwent multi-core transrectal ultrasound-guided prostate needle biopsy because of elevated PSA. Pathological data were classified as high-grade (≥7, 4+3) and low-grade (≤7, 3+4) based on the Gleason score values. Laboratory data were classified as high-risk (>10 ng/mL) and low-risk (≤10 ng/mL) based on the PSA levels. Ninety three (62%) patients had PSA >10 ng/mL. Seventy patients (46.7%) had Gleason score ≥7 (4+3). Age, tumor volume, PSA levels, and the number of tumor-positive cores were significantly higher in the tumors with Gleason score ≥7 (4+3). Tumor volume, Gleason score, and the number of tumor-positive cores were significantly higher in the tumors with PSA >10 ng/mL. Lymphovascular invasion (LVI) and perineural invasion (PNI) positivity were more often in the high-grade and high-risk tumors. Age, tumor volume, PSA, and the number of tumor-positive cores showed a significant positive correlation with the Gleason score and tumor volume. The cut-off values of PSA (Gleason score ≤7 vs ≥7) was 15.45 ng/mL with AUC=0.882 (95% confidence interval, CI: 0.82 to 0.94), sensitivity was 87% (95% CI: 0.76 to 0.94), specificity was 81% (95% CI: 0.69 to 0.88), and likelihood ratio was 4.4.

Predictors of fluoroquinolone-resistant bacteria in the rectal vault of men undergoing prostate biopsy.

Fluoroquinolone (FQ)-resistant rectal vault flora is associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy(TRUS-PNB). To determine the patient factors that predict FQ-resistant rectal cultures in men who are undergoing transrectal ultrasound-guided prostate needle biopsy. An IRB approved retrospective review of 6183 consecutive men who had undergone a rectal swab culture in preparation for TRUS-PNB between January 2013 and December 2014 was performed. Multivariable logistic regression was used to determine the clinical and demographic factors associated with FQ-resistant Enterobacteriaceae in the rectal vault. Of the 6179 rectal swabs analyzed, 4842 (78%) were FQ-sensitive, and 1337 (22%) were FQ-resistant. On univariable analysis, increasing age, prior TRUS-PNB, higher number of biopsy cores obtained, diabetes mellitus, antimicrobial use within the past 6 months and non-Caucasian race were predictors of FQ-resistance (all p < 0.05). Men with FQ-resistantcultures were more likely to have benign pathology on TRUS-PNB (p = 0.004). On multivariable analysis, increasing patient age (OR = 1.01/year [1.00-1.02]), use of antimicrobials in the last 6 months (OR = 2.85[2.18-3.72]), African American (OR = 1.99 [1.66-2.37]), Asian (OR = 3.39 [2.63-4.37]), and Hispanic (OR = 2.10 [1.72-2.55]) races were independently associated with FQ-resistant rectal cultures. The overall infectious rate was 1.1% (56/5214) and the sepsis rate was 0.46% (24/5214). The infection rate in the FQ-resistant group was 3.9% (43/1107) compared to FQ-sensitive group 0.3% (13/4107), p < 0.001. In this cohort, increasing age, recent antimicrobial-use, and non-Caucasian race were independent predictors of FQ-resistance in the rectal vault. As FQ-resistance is associated with infectious complications from transrectal ultrasound-guided prostate needle biopsy, understanding risk factors may assist infection control efforts.

The Effect of Transrectal Ultrasound-guided Prostate Needle Biopsy on Lower Urinary Tract Symptoms

The Effect of Transrectal Ultrasound-guided Prostate Needle Biopsy on Lower Urinary Tract Symptoms

External validation of Chun, PCPT, ERSPC, Kawakami, and Karakiewicz nomograms in the prediction of prostate cancer: A single center cohort-study

ObjectivesThe aim of our study was to analyze the performance of 5 different risk calculators for prostate cancer diagnosis: Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC), European Randomized Study of Screening for Prostate Cancer Risk Calculator (ERSP-RC), Karakiewicz nomogram, Chun nomogram, and Kawakami Nomogram. MethodsFrom 2008 onwards, we consecutively enrolled, at a single institution in Italy, men undergoing 12-core transrectal ultrasound-guided prostate needle biopsy. Demographic, clinical, and pathological data were collected. The risk of prostate cancer (PCa) was calculated according to the PCPT-RC, ERSPC-RC, Karakiewicz, Kawakami, and Chun nomograms. Calibration and discrimination were assessed using calibration plots and receiver operator characteristic analysis. Additionally, decision curve analyses (DCA) were used to assess the net benefit associated with the adoption of each model. ResultsOverall, 1,100 patients were evaluated, 39% presented PCa and out of them 26% presented high-grade PCa (defined as Gleason ≥ 4 + 3). All the models showed good discrimination capacities for PCa on receiver operator characteristic analysis (area under the curve: 0.59–0.72) On calibration curves the ERSCP, the PCPT and the Chun nomogram underestimated the risk of PC while the Kawakami overestimated it. At DCA, the net benefit associated with the use of the models in the prediction of cancer was observed when the threshold probability was between 40% and 60%. ConclusionIn a cohort of Italian men undergoing prostate biopsy, the performance accuracy of these calculators for the prediction prostate cancer is suboptimal. According to our experience the use of these calculator in clinical practice should be encouraged. Although integration with new serum/urine markers or magnetic resonance imaging results is warranted.

MP11-09 METABOLIC SYNDROME INCREASES THE RISK OF UPGRADING EPSTEIN 2015 GLEASON SCORE IN PATIENTS WITH PROSTATE CANCER ON BIOPSY: A RADICAL PROSTATECTOMY MULTICENTER COHORT STUDY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2018MP11-09 METABOLIC SYNDROME INCREASES THE RISK OF UPGRADING EPSTEIN 2015 GLEASON SCORE IN PATIENTS WITH PROSTATE CANCER ON BIOPSY: A RADICAL PROSTATECTOMY MULTICENTER COHORT STUDY Cosimo De Nunzio, Giuseppe Simone, Costantino Leonardo, Riccardo Mastroianni, Collura Devis, Giovanni Muto, Michele Gallucci, Riccardo Lombardo, Carlo De Dominicis, and Andrea Tubaro Cosimo De NunzioCosimo De Nunzio More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Collura DevisCollura Devis More articles by this author , Giovanni MutoGiovanni Muto More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Carlo De DominicisCarlo De Dominicis More articles by this author , and Andrea TubaroAndrea Tubaro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.375AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aim of our study was to investigate the association of metabolic syndrome (Mets) with the risk of upgrading and down grading in patients with PCA on biopsy using the new Epstein Gleason score classification in a series of men undergoing radical prostatectomy(RP). METHODS Between 2012 and 2016, 400 patients with clinically localized PCa were treated with retropubic radical prostatectomy (RRP) at three tertiary referral centres. Body mass index (BMI) and waist circumference were measured before RRP. Blood samples were collected for PSA, fasting glucose, triglycerides and HDLs. Blood pressure was recorded. All the patients underwent a 12 core trans-rectal ultrasound-guided prostate needle biopsy in the same referral center where the radical prostatectomy was performed. Biopsy specimens as well as radical prostatectomy specimens were graded according to 2015 Epstein Gleason grading system and then compared. Clinically significant upgrading was defined as: Epstein score raising from = 2 to =3 or from 3 to 5. As well clinically significant downgrading was defined as: Epstein score decreasing from =3 to = 2 or from 5 to = 3. The accuracy of the biopsy for patients with and without MetS was determined using the kappa coefficient of agreement: <0.4 poor agreement, 0.4-0.75 good agreement and > 0.75 excellent agreement. MetS was defined according to Adult Treatment Panel III (ATPIII). RESULTS Median age and preoperative PSA levels were 65 years (IQR: 60-70) and 7.4 ng/ml (IQR: 5.5-10.9), respectively. Median BMI was 26.0 kg/m2 (IQR: 24.3-28.0). On pathological evaluation 163/400 (40,8%) had locally advanced disease (=pT3a), 115/400 (28,7%) had high grade disease and 15/400 (3,8%) had nodal involvement. Overall 148/400 (37%) patients presented the MetS. Patients with MetS presented higher upgrading rates (33/148:22.3% vs 25/252:9.9%; p = 0.001) on RRP specimens when compared to patients without MetS while downgrading rates were similar (13/148 : 8.7% vs 18/252: 7.1 %; p=0.566). The kappa-statistics measures of agreement between needle biopsy and radical prostatectomy specimens was worst for patients with MetS when compared to patients without MetS (k= 0.439±0.071 vs k= 0.553±0.071). Patients with MetS also presented a significantly higher rates of pT3 disease (84/148:56.8% vs 79/252:31,3%, p=0.001) and Epstain Gleason score > 2 (61/148:41% vs 54/252, p=0.001), data confirmed on multivariate analysis (OR: 2.818; CI: 1.774-4.476, p=0.001 and OR: 3.577; CI: 2.230-5.737, p=0.001respectively) CONCLUSIONS In this multicenter radical prostatectomy cohort, MetS represents a significant risk factor for advanced disease and high grade disease. Nonetheless patients with MetS carry a higher risk of upgrading on RRP specimens. Further studies with a pathological review and reclassification of the specimens are needed to confirm our data. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e130-e131 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Cosimo De Nunzio More articles by this author Giuseppe Simone More articles by this author Costantino Leonardo More articles by this author Riccardo Mastroianni More articles by this author Collura Devis More articles by this author Giovanni Muto More articles by this author Michele Gallucci More articles by this author Riccardo Lombardo More articles by this author Carlo De Dominicis More articles by this author Andrea Tubaro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevalence of fluoroquinolone-resistant rectal flora in patients undergoing transrectal ultrasound-guided prostate needle biopsy: A prospective multicenter study.

To estimate the prevalence of fluoroquinolone-resistant rectal flora in patients undergoing transrectal ultrasound-guided prostate needle biopsy and to identify the high-risk groups. From January 2015 to March 2016, rectal swabs of 557 men who underwent transrectal ultrasound-guided prostate needle biopsy were obtained from five institutions. Clinical variables, including demographics, rectal swab culture results and infectious complications, were evaluated. Univariable and multivariable analyses were used to identify the risk factors for fluoroquinolone resistance of rectal flora and infectious complications. The incidence of fluoroquinolone-resistant and extended-spectrum beta-lactamase production was 48.1 and 11.8%, respectively. The most common fluoroquinolone-resistant bacteria was Escherichia coli (81% of total fluoroquinolone-resistant bacteria, 39% of total rectal flora), and 16 (2.9%) patients had infectious complications. Univariable and multivariable analysis of clinical parameters affecting fluoroquinolone resistance showed no factor associated with fluoroquinolone resistance of rectal flora. The clinical parameter related to infectious complications after prostate biopsy was a history of operation within 6 months (relative risk 6.60; 95% confidence interval 1.99-21.8, P = 0.002). These findings suggest that a risk-based approach by history taking cannot predict antibiotic resistance of rectal flora, and physicians should consider targeted antibiotic prophylaxis or extended antibiotic prophylaxis for Korean patients undergoing transrectal ultrasound-guided prostate biopsy because of high antibiotic resistance of rectal flora.

A study of the pain score following TRUS guided prostate biopsy with and without periprostatic lignocaine infiltration

Introduction: Prostate cancer is one of the most common cancers in Western countries and is now increasing worldwide. Transrectal ultrasound guided prostate needle biopsy (TRUS) is the standard procedure to diagnose or exclude prostate cancer. TRUS-guided biopsy is associated with several complications and discomfort. We evaluated painless yet less invasive prostate biopsy. Material and Methods: A randomised xwas conducted in 30 consecutive men divided into two groups. Group I consisted of fifteen patients who did not receive any analgesia, and another fifteen constituted study group, Group II, who received periprostatic infiltration of 1 % lignocaine. Patient with suspected DRE findings or elevated PSA or both were advised to undergo TRUS guided prostate biopsy. Pain intensity during the procedure was evaluated using Visual Analogue Scale. A visual analog scale was used to assess the pain score. Statistical analysis of pain scores was performed using the Student t test. Chi-square/ Fisher Exact test was used to find the significance of study parameters on categorical scale between two. Results: In Group 2, there was a marked reduction in the pain experienced during the procedure. The Chi-squared test for trend showed a significant association between the periprostatic infiltration of 1 % lignocaine and reduction in pain on probe insertion and on taking the biopsy (P = 0.0001). Conclusion: The use of periprostatic infiltration of lignocaine before taking the needle biopsy significantly reduces the pain experienced by the patient during TRUS-guided prostate biopsy.

Does obesity modify prostate cancer detection in a European cohort?

IntroductionTo investigate prostate-specific antigen (PSA) accuracy and digital rectal examination (DRE) accuracy in detecting prostate cancer according to body mass index (BMI) in Spanish men with an indication of the first prostate biopsy.Material and methodsWe reviewed the clinical and histopathological data of 1,319 patients who underwent transrectal ultrasound-guided prostate needle biopsy. The patients were categorised according to the BMI as follows: <25 kg/m2 (normal weight); 25–29.9 kg/m2 (overweight); and ≥30 kg/m2 (obese). Receiver operator characteristic curves were used to assess PSA accuracy and DRE accuracy by calculating the area under the curve.ResultsThe obesity rate of the cohort was 14%. PSA accuracy for predicting prostate cancer in each BMI category was 0.52, 0.58 and 0.62, respectively (p = 0.01). After stratification by DRE findings, there was no difference in the performance accuracy of PSA in predicting the presence of cancer across BMI groups in abnormal DRE (p = 0.90). Serum PSA, DRE and BMI were strong predictors of prostate cancer diagnosis (odds ratio 1.07, 2.02 and 1.4, respectively; p <0.001). When the DRE was abnormal, a BMI ≥30 increased the risk of prostate cancer twice. With the addition of BMI to the model, the area under the curve of the combined PSA and DRE for diagnosing prostate cancer improved from 0.60 to 0.63.ConclusionsThe predictive value of PSA in predicting prostate cancer is not poorer in the obese population and the predictive value of an abnormal DRE in cancer detection is significantly modified by the patient’s BMI.

Abstract 1849: CXXC5 is overexpressed in human prostate epithelial cancer cell lines in culture and human prostate cancer tissue

Abstract Background: CXXC5 encodes a retinoid-inducible nuclear factor that plays an essential role in human hematopoiesis (1, 2). We have previously identified the differential expression of this gene in rat cancer cell lines with different cancer phenotypes (3). However, knowledge on the expression of this gene in human prostate cell lines or tissue is lacking, both at the transcript and protein level. Methods: Prospective study conducted between January-2012 through June-2015 at the University of Cartagena, Colombia. Expression of CXXC5 was evaluated by quantitative PCR, both in prostate cancer cell lines and tissue biopsies from patients undergoing transrectal ultrasound-guided prostate needle biopsy for suspected prostate cancer (PCa). A total of 65 prostate tissue samples, consisting of 24 benign prostatic tissue biopsies and 41 prostate cancer tissue biopsies were included in the study. Transcript levels in individual biopsies from each group were normalized to transcript levels of beta-actin of the corresponding sample and compared. The protein expression level of CXXC5 was analyzed by immunohistochemistry in benign and malignant prostate tissue. A final score was determined by multiplying the highest intensity of staining by the mean percentage of positive cells stained to yield a value between 0 and 300 for each case. For statistical analysis we compared parameters between group of cases with PCa and without PCa. This study was approved by the Ethical Review Board of the academic institution. Results: CXXC5 transcript expression levels were significantly lower in immortalized non-tumoral prostate cell line PWR-1E compared to PCa cell lines: LNCaP (Fold change: 10.5, p = 0.001), and PC3 (Fold change: 2.8, p = 0.014). In prostate tissue we observed a significant higher expression in low grade prostate cancer compared to benign prostate tissue (p = 0.034). IHC evaluation showed that CXXC5 staining was higher in tissue samples from patients with prostate cancer compared to patients with benign disease (p = &amp;lt;0.001). In the prostate cancer group, immunostaining was also stronger in malignant acini than in adjacent, benign acini, within the same patient sample. Conclusions: CXXC5 exhibits differential expression in prostate cell lines with different cancer phenotypes and between cancer and benign prostate tissue. Additional studies are required to determine the biological and clinical significance of CXXC5 in prostate cancer.

A Prospective Randomized Trial Comparing a Combined Regimen of Amikacin and Levofloxacin to Levofloxacin Alone as Prophylaxis in Transrectal Prostate Needle Biopsy.

We investigated whether addition of amikacin to levofloxacin-based antimicrobial prophylaxis reduces febrile urinary tract infections after transrectal ultrasound-guided prostate needle biopsy (TRUSB). A total of 447 patients undergoing TRUSB were prospectively randomized into two groups. The 230 patients in Group A were given one oral dose of levofloxacin 400 mg prior to TRUSB; the 217 patients in Group B each received the same dose of levofloxacin and one 200 mg intravenous dose of amikacin. Patients' characteristics were assessed prior to TRUSB and their symptoms were checked after the TRUSB. Both regimens were well tolerated with no side effects. No statistically significant difference in patients' characteristics, or in incidence of inflammation- or infection-related symptoms was seen between the two groups; nor any significant difference among those who developed fever and those who did not. Two Group A patients and one Group B patient developed febrile urinary tract infections. Accountable pathogens determined by urine and blood cultures were fluoroquinolone-resistant E.coli and extended-spectrum β-lactamase-producing E.coli. All pathogens isolated were levofloxacin-resistant, amikacin-susceptible species. Although the present study was under-powered by unexpectedly low overall incidence of febrile urinary tract infections, addition of one intravenous administration of amikacin to one oral administration of levofloxacin showed no advantage compared with levofloxacin alone as antimicrobial prophylaxis in TRUSB. Strikingly, all pathogens isolated from febrile patients were sensitive to amikacin in vitro. Therefore, further understanding of amikacin's drug kinetics in the prostate is necessary to develop a more efficient drug delivery system for amikacin.

The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety.

Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure. Additionally, prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity. Thus, in this study, we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. Sixty-four patients presenting for TRUS-guided prostate needle biopsy were randomly assigned to receive either 10-min presurgery hypnosis session (n = 32, mean age 63.5 ± 6.1, p = 0.289) or a presurgery control session (n = 32, mean age 61.8 ± 6.8, p = 0.289). The hypnosis session involved suggestions for increased relaxation and decreased anxiety. Presurgery pain and anxiety were measured using visual analog scales (VAS), Beck Anxiety Inventory (BAI), and Hamilton Anxiety Scale (HAS), respectively. In our statistics, p < 0.05 was considered statistically significant. Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS [mean 1 (0-8); p = 0.011], BAI (6.0 vs 2.0; p < 0.001), and HAS (11.0 vs 6.0; p < 0.001). The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical anxiety, and therefore pain, in patients awaiting diagnostic prostate cancer surgery.