Transrectal Ultrasound Prostate Biopsy Research Articles

Holmium Laser Enucleation of Prostate Within 6 Weeks of Transrectal Ultrasound Guided Prostate Biopsy is Safe and Effective

To evaluate the safety and efficacy of performing Holmium laser enucleation of the prostate (HoLEP) for the treatment of bladder outlet obstruction secondary to an enlarged prostate within 6-weeks of a transrectal ultrasound (TRUS) guided prostate biopsy. We performed a retrospective review of patients who underwent a HoLEP at our institution, excluding any patients with a confounding urologic history and compared patients who underwent a TRUS-guided 6- or 12-core prostate biopsy, and then underwent a HoLEP within 6 weeks (study group) with all other patients (control group). Our primary outcomes were enucleation efficiency (EE) and perioperative complication rate. Our secondary outcomes included postoperative drop in hemoglobin, duration of catheterization, length of hospital stay, voiding metrics at 1 and 6 months and rate of incidental prostate cancer diagnosed on histopathological examination of prostate specimens after HoLEP. To test for differences between the study and control groups, we performed independent sample t-test (2-tailed) and chi-square tests for quantitative and qualitative variables, respectively. P values of < 0.05 were considered statistically significant. 552 patients met inclusion criteria and 84 patients underwent prostate biopsy within a period of 45 days prior to HoLEP. Enucleation efficiency was higher in the study group (P=0.00). There was no significant difference between the 2 groups regarding perioperative complications, postoperative voiding outcomes, or rate of incidental prostate cancer detection. TRUS prostate biopsy performed within 6 weeks of HoLEP does not negatively impact operative difficulty or treatment outcome.

Development of Mobile Application for Dynamically Monitoring the Risk of Prostate Cancer and Clinicopathology.

ObjectiveTo develop an application dynamically monitoring the prostate cancer (PCa) risk for patients to assess their own progression of PCa risk at home.MethodsBetween January 2010 and December 2019, all of the 1697 patients underwent transrectal ultrasound prostate biopsy at the cancer center, which is one of the Chinese Prostate Cancer Consortium. Patients’ clinical parameters from January 2010 to May 2018 were used to establish models that consisted of several risk factors with P value <0.1 in univariate analysis and with P value <0.05 in multivariate analysis (n=1113), including model 1 (predicting PCa), model 2 (predicting PCa with high Gleason scores (7 or higher)) and model 3 (predicting PCa with the high clinical stage (T2b or higher)). Other patients from June 2018 to December 2019 were used to validate models (n=440). Patients with a lack of sufficient data were eventually excluded (n=144).ResultsA total of 1553 patients were involved in this study, and an application was used to perform the models. The predictive cut-off value and area under the curves (AUCs) of model 1, 2 and 3 were, respectively, calculated (cut-off: 0.53, 0.38 and 0.40, AUCs: 0.88, 0.89 and 0.89). Using a cut-off value of 10%, three models obtained a high sensitivity (>95%). Besides, more patients can be correctly reclassified via our models (42.9 to 55.5%). Decision curve analyses revealed a decent net benefit in any probability for models. These results were well verified in the validation cohort.ConclusionThis application showed decent performance in predicting the risk of PCa and clinicopathology, which was available and convenient for patients to self-assess the progress of PCa risks so that being better to participate in disease management.

Design and Experiment of Assistive Mechanism for Adjustment of Transrectal Ultrasound Probe.

Transrectal ultrasound prostate biopsy is the most commonly used method for the diagnosis of prostate cancer. During the operation, the doctor needs to manually adjust the ultrasound probe for repeated adjustments, which is difficult to ensure the efficiency, accuracy, and safety of the operation. This paper presents a passive posture adjusting mechanism of transrectal ultrasound probe. The overall mechanism has 7 degrees of freedom, consisting of a position adjustment module, a posture adjustment module, and an ultrasonic probe rotation and feed module. In order to achieve the centering function, the posture adjustment module is designed based on the double parallelogram. Centering performance is verified based on SimMechanics, and remote center point error of physical prototypes is evaluated. The maximum error of the azimuth remote center point motion and the maximum error of the remote center point motion of the ultrasonic probe are 4 mm and 3.4 mm, respectively, which are less than the anus that can withstand 6 mm. Meanwhile, the analysis of measurement error shows that the random error correlation is weak in different directions, the systematic error confidence intervals of azimuth and elevation angle are less than 2.5 mm, and the maximum relative fixed point error and the maximum relative standard error are 14.73% and 14.98%, respectively. The simulation and testing results have shown the effectiveness and reliability of the propose mechanism.

'One Stop Prostate Clinic': prospective analysis of 1000 men attending a public same-day prostate cancer assessment and/or diagnostic clinic.

This study reported the outcomes of the first 1000 men to attend the One Stop Prostate Clinic, a consultant-led same-day prostate cancer assessment and diagnostic clinic at a tertiary public hospital. Prospective audit of demographic and clinical data between August 2011 and November 2017 was conducted for same-day urological assessment and/or trans-rectal ultrasound (TRUS)-guided prostate biopsies with peri-prostatic infiltration local anaesthetic (PILA) and antibiotic prophylaxis. A total of 466 (47%) rural and 534 (53%) metropolitan men attended. Rural mean (range) age was 63 years (38-86) and 65 years (37-89) for metro men (P = 0.006). Rural median (range) prostate specific antigen (PSA) level was 6.7 g/mL (0.2-450) and 7.3 ng/mL (0.5-860) for metro men (P = 0.011). Twenty-five men (2.5%) refused/could not tolerate TRUS-guided biopsy using PILA. One hundred and fifty-one (15%) men had multi-parametric magnetic resonance imaging prior to TRUS biopsy and 876 (88%) men had prostate biopsies, with a new cancer diagnostic rate of 51% (443 men). Clinically significant prostate cancer was detected in 339 (34%) men. The overall infective complication rate requiring hospital admission rose from 1.4% to 2.9% after the prophylactic antibiotic regimen changed from six doses of 500 mg ciprofloxacin to a single dose of 500 mg (P = 0.398). This is the largest single institution prospective TRUS prostate biopsy series in Australasia. Biopsies using PILA were well tolerated with low complication rates and diagnosed a high rate of clinically significant prostate cancer. The 'One Stop' pathway generates efficiencies with combined assessment and diagnostic process, lessens demand on outpatient clinic appointments and reduces travel time and costs for rural men.

Factors Affecting Surgical Margin Positivity after Radical Prostatectomy in the Turkish Population: A Multicenter Study of the Urooncology Association

Background: The prediction of positive surgical margins (SM) after radical prostatectomy (RP) is important for planning the surgical modality and adjuvant therapy in patients with prostate cancer (PCa). Objectives: To investigate factors affecting SM positivity in patients diagnosed with PCa who underwent RP using the PCa database of the Urooncology Association (Turkey). Methods: Patients who underwent RP due to clinically T1c–T3 PCa and who had detailed SM data for the RP specimen were included in the study. Pathological data of 12 core transrectal ultrasound prostate biopsies and RP were evaluated. Patients were divided into 2 groups (SM positive and SM negative) according to SM status after RP. Data were compared between the groups. Factors affecting SM positivity, the number of positive SM sites, and the location of positive SM were separately evaluated with regression models. Results: A total of 2,643 patients from 6 different centers (median age: 63 years) with a prostate-specific antigen (PSA) level of 7.3 ng/mL were investigated in the study. BMI, PSA, biopsy Gleason score (GS), and perineural invasion (PNI) were found to be independent predictive factors for SM positivity and the number of positive SM locations, respectively (p < 0.05). According to the positive SM location, PSA was found to be associated with positive SM in apex, anterior prostate, and bladder neck locations. Also, according to posterolateral SM status, PNI and nerve-sparing RP (nsRP) rates were 21.3 and 44% for patients with negative posterolateral SM, and rates were 35.4 and 50.6% for patients with positive posterolateral SM, respectively (p < 0.05). In patients who underwent nsRP, positive SM was present in 22.2% of patients who did not have PNI on prostate biopsy, whereas positive SM was present in 40.6% of patients with PNI (p < 0.001). Similarly, 10.9% of patients without PNI had positive posterolateral SM, whereas 17.3% of patients with PNI had positive posterolateral SM (p = 0.031). Conclusions: BMI, PSA, biopsy GS, and biopsy PNI positivity were found to be predictive factors affecting SM positivity. The most important factors affecting posterolateral positive SM were biopsy PNI and nsRP, indicating that the nsRP approach may cause positive SM in the posterolateral margin of the prostate (neurovascular bundle location) in patients with positive PNI on biopsy.

MP20-17 NEGATIVE AND EQUIVOCAL PREBIOPSY MULTIPARAMETRIC PROSTATE MAGNETIC RESONANCE IMAGING

INTRODUCTION AND OBJECTIVE: Pre-biopsy multiparametric MRI (mp-MRI) are widely performed to indicate the presence or absence of prostate cancer these days. Patients and clinicians often consider deferring a biopsy if the MRI is normal. Our objective was to study the possibility to avoid a prostate biopsy with normal and equivocal mp-MRI and to look for factors which may indicate a clinically significant cancer (csCa). METHODS: Histology outcome of 265 transrectal ultrasound prostate biopsy (TRUS-PB) specimens was evaluated and compared with the pre-biopsy mp-MRI Prostate Imaging Reporting and Data System (PI-RADS) scores 1, 2, 3 and reported normal MRIs. The data were collected retrospectively for 12 months from August 2017. Total number of cancer (Gleason Score (GS) ≥ 3+3), percentage of csCa (defined as GS ≥3+4), maximum cancer core length (MCCL) and the number of positive cores against total cores were studied. Digital rectal examination (DRE) findings and prostate specific antigen density (PSAD) were also evaluated to see the relationship to csCa. RESULTS: Only five of the studied MRIs reported as PI-RADS 1 and none of them showed cancer on biopsy. In total, 21/109 (19.3%) of PI-RADS 2, 8/67 (11.9%) of reported normal MRI and 20/84 (23.8%) of PI-RADS 3 lesions showed cancer. On further study, 9.2%, 9% and 11.9% of them were found to be csCa respectively. In other words, 8.8% (16/181) of csCa were observed with negative MRIs (PI-RADS 1, 2 and normal MRI) at a negative predictive value of 92.2%. Seventy-five (27.3%) patients didn’t have prostate biopsies following their MRI and 73.3% (51/75) of them had benign prostate on DRE. Among those who underwent biopsies, 24.1% of cases resulted in a cancer diagnosis when the prostate felt suspicious, whereas only 14.4% of cancer found when prostate felt benign (p=0.044). Mean PSAD among the benign, GS 3+3 and csCa was 0.14, 0.16 and 0.27 ng/ml/ml respectively (p<0.001). A positive correlation was observed with percentage cancer, MCCL and the number of positive cores in the biopsy specimen against PSAD (p<0.001). The average percentage of cancer in the biopsy specimen for csCa and GS 3+3 was 20.1% and 3.2% respectively. MCCL and percentage of positive cores from the total number of cores were higher in csCa when compared to GS 3+3 (6.5 mm Vs 2.5 mm and 37.9% Vs 12% respectively). These findings suggest a higher volume of cancer with high PSAD and in higher GS. CONCLUSIONS: Since our study has demonstrated 9.8% of csCa with normal and equivocal prebiopsy mp-MRI findings, patients must be warned about this possibility if a biopsy is avoided based on such MRI findings alone. Source of Funding: None.

PD53-12 THE PROSTATE HEALTH INDEX IMPROVES PREDICTIVE VALUE IN PATIENTS WITH PI-RADS 3 LESIONS

INTRODUCTION AND OBJECTIVE: Major technical improvements in multiparametric MRI (mpMRI) of prostate with the standard approach to interpretation using the PI-RADS v2 offers reliable visualization of potentially clinically significant prostate cancer (csPca) and thus has shown advantages as a means by which to better select patients for biopsy and facilitate direct targeting of lesions during biopsy.However, currently available data show that the actual prevalence of csPCa after targeted biopsy in PI-RADS 3 lesions vary from 16% to 21%. We hypothesize that biomarkers such as PHI may better stratify a higher risk subgroup that harbor csPCa in patients with PI-RADS 3 lesions. METHODS: Patients with at least one PI-RADS = 3 lesion on mpMRI were enrolled for cognitive MRI-TRUS fusion-targeted prostate biopsy. All these patients had either PSA greater than 4 ng/ml and/or suspicious digital rectal examination (DRE) and/or previous negative systematic transrectal ultrasound (TRUS) prostate biopsy. All patients had received PHI test before the prostate biopsy. AUC under the ROC curves were estimated for the various PSA derivatives, along with the specificity at a pre-specified sensitivity of 90%. RESULTS: As PI-RADS 3 lesions have relatively low rates of csPCa and may present a new “grey zone” cognitive MRI-TRUS fusion-targeted prostate biopsy. Adding PHI to mpMRI improved predictive performance for overall PCa (AUC 0.818, CI 0.702-0.934) and csPCa detection (AUC 0.881, CI 0.787-0.975). The PHI alone was a significant predictor for any cancer (OR 5.95, 95% CI 1.35–42.36, p = 0.026) and significant cancers (OR 12.41, 95% CI 3.06–28.4, p < 0.001) after adjusting for age, prostate volume, previous negative biopsy and abnormal DRE in logistic regression. We found the optimal cutoff to be ≥ 39.7 which would allow 39.3 % of patients to avoid biopsy. At this level, no csPCa was missed and both sensitivity and NPV were 100%. CONCLUSIONS: In patients with PI-RADS 3 index lesions, which is a gray zone for PI-RADS v2, PHI exhibits outstanding performance in predicting csPCa. Using a PHI cutoff of ≥ 39.7, up to 39 % of prostate biopsy could be avoided in patients with PI-RADS 3 lesions and no csPCa will be missed.Source of Funding: nil

The Management of Patients Diagnosed with Incidental Prostate Cancer: Narrative Review.

5–14% of patients underwent surgery for benign prostate hyperplasia harboring prostate cancer (PCa) focus. The best management of incidental prostate cancer (iPCa) has been debated. The decision “treatment or no treatment” should be determined by predictors which accurately foretell PCa progression after transurethral resection of the prostate (TURP). The purpose of this study is to review the available data that can be useful in daily clinical judgment. Transrectal ultrasound prostate biopsy (TRUSBx) did not provide further Gleason score (GS) data in most patients diagnosed with iPCa. TRUSBX may be useful before active surveillance, but not in all following radical prostatectomy. The decision “treatment or no treatment” should be dependent on the expected chance of having residual cancer and clinical progression. Prostate-specific antigen (PSA) levels before and after TURP are good predictors of residual cancer after TURP. Pathological report of T0 is most likely seen in patients with low PSA density after TURP and indistinguishable lesion on multiparametric magnetic resonance imaging. The decision “treatment vs no treatment” is judged by life expectancy, tumor characteristic in the pathology report of TURP sample and PSA level following TURP. Active surveillance should be contemplated in patients with iPCa who have both prostate-specific antigen density ≤0.08 after TURP and indistinguishable cancer lesion on multiparametric magnetic resonance imaging. Patients who do not meet the criteria for active surveillance are candidates for radical prostatectomy or radiotherapy (RT). Radical prostatectomy could be peacefully done after TURP with somewhat greater morbidity. RT in patients who had a history of TURP could be safely done and is associated with acceptable quality of life.

The impact of diurnal variation of PSA on timing of measurement in prostate biopsy.

Prostate-specific antigen (PSA) synthesis is related to testosterone, which has a diurnal rhythm. PSA might have a diurnal variation and the timing of measurement could change the clinical practice for prostate biopsy. Male patients complaining of lower urinary tract symptoms (group 1) and diagnosed with prostate cancer (group 2) were recruited into the study. Morning fasting blood samples were withdrawn between 9.00 and 11.00 am for the determination of biochemical parameters, PSA (PSA1), total testosterone (T1), and estradiol (E1) levels. In the afternoon, between 15.00 and 15.30 pm, blood samples were again obtained from the same participants at the same day and the serum concentration of PSA (PSA2), total testosterone (T2), and estradiol (E2) were measured. A total of 160 and 30 patients were enrolled in groups 1 and 2, respectively. One hundred forty (87.5%) and 26 (86.6%) patients had a decrease in the PSA levels when measured in the afternoon. The Wilcoxon signed-rank test determined a statistically significant difference between the PSA levels measured in the morning and in the afternoon in each group. An analysis of covariance test revealed no statistically significant difference in PSA concentration between the groups after adjustment for baseline concentration (F(1.187) = 0.203, P = .653). There was a weak positive correlation between PSA1/PSA2 and T1/T2, rs (160) = 0.163, P = .034. An extra unit increase in PSA1 concentration leads to a 0.805 (95% confidence interval [CI], 0.781-0.830) and 0.828 (95% CI, 0.807-0.849) ng/mL increase in PSA2 concentration in groups 1 and 2, respectively, that is, patients with and without prostate cancer had a similar decrease in the PSA levels. When measured in the afternoon, 66.6% and 50% patients with a morning PSA level over 3 or 4 ng/mL had a PSA drop below these levels, respectively. PSA has a diurnal variation and the timing of measurement may alter the decision of the clinician for transrectal ultrasound prostate biopsy.

Carbapenem sparing in the management of post-transrectal prostate biopsy bacteraemia.

Sepsis following transrectal ultrasound (TRUS)-guided prostate biopsy is a major complication. With the emergence of multidrug-resistant organisms, empirical use of carbapenem antibiotics has been increasing. This study, conducted in the Illawarra Shoalhaven Local Health District (ISLHD), Australia, quantifies how much we can spare carbapenem use. A retrospective audit of patients who underwent TRUS prostate biopsy and were admitted post-operatively with proven bacteraemia between January 2007 and April 2016. Of 2719 TRUS procedures, 50 (1.84%) cases had bacteraemia. The most common isolate was Escherichia coli in 44 of 50 (88%) of which six of 50 (12%) were extended-spectrum beta-lactamase (ESBL)-producing. Sixteen different empirical antimicrobial regimens were used, to which 42 of 50 (84%) of isolates were susceptible. Eight (16%) isolates were resistant to the chosen empiric combination, with five switched over to appropriate treatment once antimicrobial sensitivity results became available. Empirical carbapenem was utilized in 12 of 50 (24%) patients with only two of the ESBL isolates covered. A further 10 of 50 patients received carbapenems during their admission. Carbapenems could have been avoided in 18 of 22 (82%). A total of 86% of organisms (n = 43) were susceptible to the combination of amoxicillin-clavulanate and gentamicin. Although the rates of bacteraemia with ESBL-producing organisms post-TRUS biopsy are increasing, use of carbapenem-free combination antimicrobials as empirical therapy appears to be safe and effective in our setting. Clinicians can utilize local resistance patterns to inform targeted and appropriate therapy for septic patients.

IJU this issue

This issue deals with a wide range of clinical topics of urology, and contains two Review Articles, nine Original Articles and three Urological Notes. Pelvic fractures from high-energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury (PFUI). PFUI should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. In this issue, the key factors in the management of PFUI are reviewed and current topics are summarized by Horiguchi (Tokorozawa, Japan). Although PFUIs are relatively rare, this review is considered very useful when we treat PFUI. In recent years, the induction of novel agents, including molecular-targeted agents and immune checkpoint inhibitors, have dramatically changed therapeutic options and their outcomes for metastatic renal cell carcinoma. Several prognostic models based on the data of patients with metastatic renal cell carcinoma treated with targeted agents or cytokine therapy have been useful in real clinical practice. In this review article, Teishima et al. (Hiroshima, Japan) discusses the conventional prognostic models and clinical factors, and recent advances of the identification of some of the most promising molecules as novel biomarkers for metastatic renal cell carcinoma. Type 2 diabetes mellitus (DM) is a chronic metabolic disease. It is known that DM has morbid effects on multiple organs, such as the peripheral nerves, retina, kidney and so on. Diabetic cystopathy is one of the common diabetic complications. Majima et al. (Nagoya, Japan) analyzed sequential changes of diabetic cystopathy based on urodynamic data in patients with DM. They demonstrate that diabetes patients have diverse progressive bladder dysfunction according to the diabetes stage. They also indicate that optimal screening program is necessary to detect and manage diabetic cystopathy at an early stage. The above results are important when we check patients with DM. Skeletal-related events (SREs) induced by bone metastasis (BM) can result in reduced quality of life and an increase in healthcare burdens. Therefore, preventing SREs is important for the management of patients with BM. Owari et al. (Kashihara, Japan) evaluated the clinical benefit of bone-modifying agents and identified the risk factors of SREs in patients with genitourinary cancer with newly diagnosed BM. They demonstrate that early treatment with bone-modifying agents should be considered, especially for patients with bone pain and elevated alkaline phosphatase levels, to prevent SREs in patients with genitourinary cancer with BM. The above results are helpful in considering when we start bone-modifying agents to patients with genitourinary cancer with BM. Transrectal ultrasound (TRUS) prostate biopsy is widely used to diagnose prostate cancer. The frequency of infective complications was reported to be 0.83% in Japan, and the major pathogen was Escherichia coli. Hiyama et al. (Sapporo, Japan) evaluated a regimen of targeted prophylaxis using rectal swab culture in patients undergoing TRUS-guided prostate biopsy, and investigate the characteristics of isolated fluoroquinolone-resistant Escherichia coli. They demonstrate that targeted antimicrobial prophylaxis in patients undergoing TRUS-guided prostate biopsy can be associated with reducing severe infectious complications caused by fluoroquinolone-resistant Escherichia coli. None declared.

When should the evaluation of erectile function be done before radical prostatectomy?

The aim of this study is to assess the erectile function of patients before and after transrectal ultrasound prostate biopsy comparatively in order to determine the appropriate time to evaluate erectile function before radical prostatectomy. A total of 44 patients underwent transrectal ultrasound biopsy. We used the International Index of Erectile Function-5 questionnaire to assess all the patients. In total, 44 volunteered patients were included in this study. All patients were evaluated with the International Index of Erectile Function-5 questionnaire before the biopsy and at 4 weeks after the transrectal ultrasound biopsy. A total of 50% of patients were potent before the biopsy was done. A month after the biopsies, erectile dysfunction was reported by 29 of 44 patients (66%) as mild in 10 (22.7%), as mild-moderate in 14 (31.8%), as moderate in 4 (9.1%), and severe in 1 (2.3%). The differences were statistically significant in the first month of the biopsy (p < 0.05). The effect of prostate biopsy upon the erectile function is non-negligible. However, this situation is temporary and transient. Therefore, it is recommended that the International Index of Erectile Function-5 questionnaire is to be administered prior to prostate biopsy rather than before surgical treatment.

Combining Prostate-Specific Antigen Parameters With Prostate Imaging Reporting and Data System Score Version 2.0 to Improve Its Diagnostic Accuracy.

BackgroundAny non-invasive test that can predict the absence of prostate cancer (PCa) or absence of clinically significant PCa (CSPCa) is necessary, as it can reduce the number of unnecessary biopsies in patients with gray zone prostate-specific antigen (PSA, 4 - 10 ng/mL). This study evaluated the diagnostic performance of free PSA% and PSA density (PSAD), and Prostate Imaging Reporting and Data System (PIRADS) score (version 2.0) alone and combined in predicting CSPCa in patients with PSA between 4 and 10 ng/mL.MethodsThis prospective study included a total of 104 consecutive patients with lower urinary tract symptoms (LUTS) and serum PSA between 4 and 10 ng/mL, with or without abnormal digital rectal examination (DRE) findings or any hypoechoic lesion on ultrasound sonography of prostate and without prior transrectal ultrasound (TRUS) biopsy of prostate. PIRADS score was calculated using multi-parametric magnetic resonance imaging (mp-MRI) before TRUS biopsy of prostate. Relationships among PIRADS score, PSAD, free PSA% and presence of CSPCa in TRUS biopsy were statistically analyzed.ResultsIn patients with CSPCa, significantly higher median age (P = 0.001), PSA level (P < 0.001), PSAD (P < 0.001) and significantly lower prostate volume (P < 0.001) and free PSA% were observed as compared to patients with non-CSPCa. Significantly higher proportion of patients with CSPCa showed PIRADS positive test compared to those with non-CSPCa (86.4% vs. 53.3%, P < 0.001). Cut-off values for PSAD and free PSA% were 0.12 ng/mL2 and 25%, respectively. Age, PSAD and free PSA% were significant predictors of PCa, while age and PSAD were significant predictors of CSPCa. Criteria 2, 3 and 4 demonstrated higher specificity and positive predictive value (PPV) in predicting CSPCa as compared to criterion 1. The overall accuracies of criterion 1, 2, 3 and 4 were 64.42%, 85.58%, 80.77% and 79.81%, respectively. The area under the curve (AUC) values of criterion 2, 3 and 4 were higher (0.827, 0.732 and 0.792) than criterion 1 (0.665).ConclusionUsing PIRADS score for predicting CSPCa as a screening test, criteria 2, 3 and 4 have much higher diagnostic performance and present accuracy of mp-MRI to predict CSPCa can be increased with addition of PSAD and free PSA%.

Benign Prostatic Hyperplasia in 69 Years Old Man with Highest Serum PSA Level >3500 ng/mL

Objective: To describe a case of 69 years old man who had Benign Prostatic Hyperplasia (BPH) with highest serum Prostate Specific Antigen (PSA) (>3500 ng/mL). Materials and Methods: This is a case report of elevated PSA in 69 years old man with BPH. Results: We were reported a 69 years-old man who was admitted for low urinary tract symptoms. In medical history, we were found PCa (Prostate Cancer) case in his family. Digital Rectal Examination (DRE) found soft, enlarged, smooth prostate. Serum PSA level was highest (>3500 ng/mL). Computed tomography chest-abdominal-pelvic revealed: integrity of prostate capsule and bladder decompensation; neither iliac-inguinal lymph nodes nor bones damage were not found. Transrectal ultrasound prostate biopsy realized. Anatomopathological screening prostate biopsy was negative. Anatomopathological screening of prostatectomy piece confirmed BPH. Serum PSA test done two weeks later. The result was 0.48 ng/mL. Conclusion: Serum PSA test can misleading. Elevated serum PSA can be associated with BPH.

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

Developing a new one-stop urology diagnostics service.

A newly built NHS 'one-stop' urology diagnostics unit has been created to provide a genuinely patient-centred experience for all new patients presenting with urological symptoms. Patients across the region now receive not only their initial specialist consultation, but also all diagnostic investigations and a treatment plan during a single visit to the unit. The purpose-built service has reduced the patient diagnostic pathway from several visits over many weeks to a matter of hours. The unit has facilities for urodynamic studies, ultrasound, flexible cystoscopy and trans-rectal ultrasound prostate biopsy in addition to full physiological measurement capabilities. Designing a new purpose-built unit in the current healthcare climate brought its own challenges as the project progressed. Having the right nursing team in place was essential, and this article describes the insights afforded in developing the project.

3D Fusion MRI and (18)F-Choline-Positron Emission Tomography-Targeted Prostate Biopsies: A New Concept

Abstract Background: Contemporary transrectal ultrasound (TRUS) prostate biopsy can be guided by high-resolution ultrasound (US), magnetic resonance imaging (MRI), or MRI–US fusion. Objectives: To ...

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

The impact of metformin use on the risk of prostate cancer after prostate biopsy in patients with high grade intraepithelial neoplasia.

ABSTRACTPurposeWe report our experience on metformin use in diabetic patients and its impact on prostate cancer (PCa) after a high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosis.Materials and MethodsWe retrospectively analyzed 551 patients with a diagnosis of HGPIN without PCa in a first prostate biopsy. The cohort of the study consisted of 456 nondiabetic subjects, and 95 diabetic patients. Among the patients with diabetes 44 were treated with metformin, and 51 with other antidiabetic drugs. A transrectal ultrasound prostate biopsy scheme with 22 cores was carried out 4-6 months after the first diagnosis of HGPIN.ResultsAmong 195 (35.4%) patients with cancer, there were statistically significant differences in terms of PCa detection (p<0.001), Gleason score distribution (p<0.001), and number of positive biopsy cores (p<0.002) between metformin users and non-users. Metformin use was associated with a decreased risk of PCa compared with neveruse (p<0.001). Moreover, increasing duration of metformin assumption (≥2 years) was associated with decreasing incidence of PCa and higher Gleason score ≥7 compared with assumption <2 years.ConclusionsThis preliminary experience suggests that metformin use may have some beneficial effects in patients with diabetes and HGPIN; metformin should not be overlooked in these patients because it is neither new nor expensive.

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.