TRUS-guided Biopsy Research Articles

Analysis of Voiding Impairment after Prostate Biopsy and the Effect of Doxazosin Treatment: Outcomes from a Regional Cancer Center

Introduction: The aim of this study was to investigate the association of transrectal ultrasound (TRUS)-guided prostate biopsy with voiding impairment and the efficacy of doxazosin treatment. Methods: A prospective observational study including 200 male patients undergoing TRUS-guided prostate biopsy was performed between May 2020 and December 2020. One hundred patients underwent biopsy with doxazosin (doxazosin group). The remaining 100 patients underwent biopsy without doxazosin (control group). All patients were questioned regarding post-biopsy voiding difficulty and acute urinary retention. The International Prostate Symptom Score (IPSS), maximal urinary flow rate (Q_max), and residual urine volume were recorded before biopsy and at 7 and 30 days after biopsy. Results: There were no significant differences in baseline parameters between the two groups. The rate of post-biopsy voiding difficulty in the doxazosin group was significantly lower than that in the control group. Compared with baseline values, doxazosin treatment significantly improved IPSS, quality of life scores, and Q_max after biopsy (p < 0.05). The baseline values of IPSS and prostate size may be risk factors for post-biopsy voiding difficulty. Conclusion: TRUS-guided prostate biopsy causes transient voiding impairments, which may be improved by doxazosin treatment.

Preliminary Evaluation of Hydraulic Needle Delivery System for Magnetic Resonance Imaging-Guided Prostate Biopsy Procedures

Abstract In clinical routine, the prostate biopsy procedure is performed with the guidance of transrectal ultrasound (TRUS) imaging to diagnose prostate cancer. However, the TRUS-guided prostate biopsy brings reliability concerns due to the lack of contrast difference between prostate tissue and lesions. In this study, a novel hydraulic needle delivery system that is designed for performing magnetic resonance imaging (MRI)-guided prostate biopsy procedure with transperineal approach is introduced. The feasibility of the overall system was evaluated through in vitro phantom experiments under an MRI guidance. The in vitro experiments performed using a certified prostate phantom (incorporating MRI visible lesions). MRI experiments showed that overall hydraulic biopsy needle delivery system has excellent MRI compatibility (signal to noise ratio (SNR) loss &amp;lt; 3%), provides acceptable targeting accuracy (average 2.05±0.46 mm) and procedure time (average 40 min).

Quantitative ultrasound shear wave elastography (USWE)-measured tissue stiffness correlates with PIRADS scoring of MRI and Gleason score on whole-mount histopathology of prostate cancer: implications for ultrasound image-guided targeting approach

ObjectiveTo correlate quantitative tissue stiffness measurements obtained by transrectal ultrasound shear wave elastography (USWE) with PI-RADS scoring of multiparametric magnetic imaging resonance (mpMRI) using Gleason scores of radical prostatectomy as a reference standard.Patients and methods196 men with localised prostate cancer were prospectively recruited into the study and had quantitative prostate tissue stiffness measurements in kilopascals (kPa) using transrectal USWE prior to radical prostatectomy. PI-RADS scores of mpMRI were also obtained in all the men. Imaging and histopathology of radical prostatectomy specimen were oriented to each other using patient specific customised 3D moulds to guide histopathology grossing of radical prostatectomy specimens. All included patients had confirmed PCa on TRUS-guided biopsies, had both USWE and mpMRI imaging data, and underwent radical prostatectomy. Chi-square test with 95% confidence interval was used to assess the difference between Gleason score (GS) of radical prostatectomy and PI-RADS classification, as well as GS of radical prostatectomy and stiffness (in Kpa) using USWE. The correlation coefficient (r) was calculated in order to investigate relation between PI-RADS classification and tissue stiffness in kPa.ResultsThere was a statistically significant correlation between USWE-measured tissue stiffness and GS (χ2 (2, N = 196) = 23.577, p < 0.001). Also, there was a statistically significant correlation between Gleason score and PI-RADS score (χ2 (2, N = 196) = 12.838, p = 0.002). High PIRADS on MRI and high stiffness on USWE (> 100 kPa) detected more than 80% and 90% high risk prostate cancer disease. However, a weak correlation coefficient of 0.231 was observed between PI-RADS score and level of tissue stiffness measured in kPa.ConclusionQuantitative USWE and mpMRI using PI-RADS classification provide a good degree of prediction for Gleason score of clinically significant prostate cancer (csPCa). Stiffer lesions on ultrasound showed a weak correlation with PI-RADS scoring system. USWE could be used to target suspected prostate cancer.

The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy.

BackgroundThis study aimed to estimate whether multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion biopsy (FUS-TB) increases the detection rates of clinically significant prostate cancer (csPCa) compared with TRUS-guided systematic biopsy (TRUS-GB).MethodsThis retrospective study focused on patients who underwent mpMRI before prostate biopsy (PB) with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) scores ≥3 and prostate-specific antigen (PSA) level between 2.5 and 20 ng/mL. Before FUS-TB, the biopsy needle position was checked virtually using three-dimensional mapping. After confirming the position of the target within the prostate, biopsy needle was inserted and PB was performed. Suspicious lesions were generally targeted with 2 to 4 cores. Subsequently, 10–12 cores were biopsied for TRUS-GB. The primary endpoint was the PCa detection rate (PCDR) for patients with PCa who underwent combined FUS-TB and TRUS-GB.ResultsAccording to PI-RADS v2, 76.7% of the patients with PI-RADS v2 score ≥3 were diagnosed with PCa. The PCDRs in patients with PI-RADS v2 score of 4 or 5 were significantly higher than those in patients with PI-RADS v2 score of 3 (3 vs. 4, P<0.001; 3 vs. 5, P<0.001; 4 vs. 5, P=0.073). According to PCDR, the detection rates of PCa and csPCa in the FUS-TB were significantly higher than that in the TRUS-GB.ConclusionsFollowing detection of suspicious tumor lesions on mpMRI, FUS-TB use detects a higher number of PCa cases compared with TRUS-GB.

Transrectal ultrasound-guided prostate biopsy: periprostatic block versus caudal block for analgesia\u2014a randomized trial

BackgroundTransrectal ultrasound (TRUS)-guided prostate biopsy is a potentially painful procedure, due to the insertion of the TRUS probe in the anus and multiple passes of the biopsy needle through the rectum and prostate. Several methods of reducing pain and discomfort have been described. These include intra-rectal local anaesthetic gel (IRLA) instillation, periprostatic nerve block (PPNB), caudal block (CB) and oral analgesics. CB has potential complications of dural puncture and anaesthetic failure, while PPNB may be complicated by intravascular injection with systemic local anaesthetic toxicity. Only few studies have compared transrectal PPNB with CB with equivocal results. This study compared transrectal PPNB to CB in terms of efficacy of analgesia and incidence of complications.MethodsA prospective randomized clinical trial was carried out among 80 consenting patients with an indication for TRUS-guided prostate biopsy in the Urology division of [BLINDED FOR PEER REVIEW]. Eighty participants were each randomized to either of Group A (CB with 10 ml of 2% lidocaine) or Group B (PPNB with a total of 20 ml of 1% lidocaine). Pain was assessed using an 11-point numerical rating scale (NRS), and questions on satisfaction with the procedure and willingness for a repeat procedure were asked. The incidence of complications was also recorded.ResultsThere were no significant differences in the mean ages, body mass indices (BMIs), prostate-specific antigen (PSA) levels, digital rectal examination (DRE) findings and prostate sizes between the two groups. The mean NRS scores at administration of block, insertion of TRUS probe, prostate biopsy, 30 min and 1 day after biopsy were 2.9 ± 2.3, 2.1 ± 2.2, 3.1 ± 2.6, 1.4 ± 2.2 and 0.2 ± 0.4 respectively for CB and 3.1 ± 2.2, 2.3 ± 1.2, 2.8 ± 2.7, 1.4 ± 1.7 and 0.3 ± 0.5, respectively, for the PPNB group. There were no significant differences between the mean scores in both groups. There were also no statistically significant differences in the incidences of complications in both groups.ConclusionThe two methods of analgesia are similar in efficacy and are equally safe to employ in the performance of TRUS-guided prostate biopsy. Both methods can be learned to increase the repertoire of the urologist when faced with a TRUS-guided prostate biopsy.Trial registrationPACTR, PACTR202012779661309. Registered 11th December 2020—Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14564.

Risk stratification in men with a negative prostate biopsy: an interim analysis of a prospective cohort study.

To investigate whether a risk score for prostate cancer (PCa) lifetime risk can be used to optimise triaging of patients with a negative prostate biopsy, but under sustained suspicion of PCa. In this prospective clinical study, we included, and risk scored patients who had a PCa-negative transrectal ultrasonography (TRUS)-guided prostate biopsy, but elevated prostate-specific antigen (PSA), a suspicious prostate digital rectal examination and/or a positive family history (FH) of PCa. The risk score estimated individual lifetime risk of PCa, based on a polygenic risk score (33 single nucleotide polymorphisms), age, and FH of PCa. Patients were followed, under urological supervision, for up to 4years with annual controls, always including PSA measurements. Multiparametric magnetic resonance imaging (mpMRI) and/or prostate biopsy was performed at selected annual controls depending on risk score and at the urologist's/patient's discretion, which means that the follow-up differed based on the risk score. We included 429 patients. After risk scoring, 376/429 (88%) patients were allocated to a normal-risk group (<30% PCa lifetime risk) and 53/429 (12%) to a high-risk group (≥30% PCa lifetime risk). The high-risk group had significantly different follow-up, with more biopsy and mpMRI sessions compared to the normal-risk group. PCa was detected in 89/429 (21%) patients, with 67/376 (18%) patients diagnosed in the normal-risk group and 22/53 (42%) in the high-risk group. There was no statistically significant difference in the cumulative incidence of PCa between the normal-risk group and the high-risk group after 4years of follow-up. Currently, 67/429 (16%) patients are still being followed in this ongoing study. In a 4-year perspective, our PCa lifetime risk score did not demonstrate significant prognostic value for triaging patients, with a negative TRUS-guided biopsy and sustained suspicion of PCa.

Transrectal ultrasound features and biopsy outcomes of transition PI-RADS 5.

Transition Prostate Imaging and Reporting and Data System (PI-RADS) 5 is easily detected owing to typical magnetic resonance imaging features. However, it is unclear as to how transition PI-RADS 5 appears on transrectal ultrasound (TRUS). To assess TRUS features of transition PI-RADS 5 and outcomes of TRUS-guided target biopsy. Between March 2014 and November 2018, 186 male patients underwent TRUS-guided biopsy of PI-RADS 5. Of them, 82 and 104were transition and peripheral PI-RADS 5, respectively. Transition and peripheral PI-RADS 5 were compared according to echogenicity (hyperechoic or hypoechoic) and hypoechoic rim (present or absent). Each tumor was targeted with TRUS based on TRUS features. Significant (Gleason score ≥7) and insignificant (Gleason score 6) cancer detection rates (CDRs) were compared between transition and peripheral PI-RADS 5. Standard reference was biopsy examination. Fisher's exact test was used for statistical analysis. Transition PI-RADS 5 was hyperechoic in 89.0% (73/82) and had a hypoechoic rim in 97.6% (80/82), whereas peripheral PI-RADS 5 was hypoechoic in 99.0% (103/104) and had a hypoechoic rim in 26.9% (28/104) (both, P<0.0001). The significant CDRs of transition and peripheral PI-RADS 5 were 56.1% (46/82) and 65.4% (68/104), respectively (P=0.2263). However, the insignificant CDRs of these categories were 22.0% (18/82) and 8.7% (9/104), respectively (P=0.0123). Transition PI-RADS 5 tends to have hyperechoic echogenicity and a hypoechoic rim. These findings help to target the transition PI-RADS 5 using TRUS. However, transition PI-RADS 5 is confirmed more frequently as insignificant cancer than peripheral PI-RADS 5.

Development and internal validation of a prediction model of prostate cancer on initial transperineal template-guided prostate biopsy

BackgroundDue to the invasiveness of prostate biopsy, a prediction model of the individual risk of a positive biopsy result could be helpful to guide clinical decision-making. Most existing models are based on transrectal ultrasonography (TRUS)-guided biopsy. On the other hand, transperineal template-guided prostate biopsy (TTPB) has been reported to be more accurate in evaluating prostate cancer. The objective of this study is to develop a prediction model of the detection of high-grade prostate cancer (HGPC) on initial TTPB.ResultA total of 1352 out of 3794 (35.6%) patients were diagnosed with prostate cancer, 848 of whom had tumour with Grade Group 2–5. Age, PSA, PV, DRE and f/t PSA are independent predictors of HGPC with p < 0.001. The model showed good discrimination ability (c-index 0.886) and calibration during internal validation and good clinical performance was observed through decision curve analysis. The external validation of CPCC-RC, an existing model, demonstrated that models based on TRUS-guided biopsy may underestimate the risk of HGPC in patients who underwent TTPB.ConclusionWe established a prediction model which showed good discrimination ability and calibration in predicting the detection of HGPC by initial TTPB. This model can be used to aid clinical decision making for Chinese patients and other Asian populations with similar genomic backgrounds, after external validations are conducted to further confirm its clinical applicability.

One-year experience of government-funded magnetic resonance imaging prior to prostate biopsy: A case for omitting biopsy in men with a negative magnetic resonance imaging

Objectives: This study aimed to characterise the accuracy of multiparametric magnetic resonance imaging (mpMRI) as an adjunct to prostate biopsy, and to assess the effect of the new Australian Medicare rebate on practice at a metropolitan public hospital. Patients and methods: We identified patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy at a single institution over a two-year period. Patients were placed into two groups, depending upon whether their consent was obtained before or after the introduction of the Australian Medicare rebate for mpMRI. We extracted data on mpMRI results and TRUS-guided biopsy histopathology. Descriptive statistics were used to demonstrate baseline patient characteristics as well as MRI and histopathology results. Results: A total of 252 patients were included for analysis, of whom 128 underwent biopsy following the introduction of the Medicare rebate for mpMRI. There was a significant association between Prostate Imaging Reporting and Data System v2 (PI-RADS) classification and the diagnosis of clinically significant prostate cancer ( p&lt;0.01). Only one man with PI-RADS ⩽2 was found to have clinically significant prostate cancer. Four men with a PI-RADS 3 lesion were found to have clinically significant cancer. A PI-RADS 4 or 5 lesion was significantly associated with the diagnosis of clinically significant cancer on multivariable analysis. Conclusion: mpMRI is an important adjunct to biopsy in the diagnosis of clinically significant prostate cancer. Our findings support the safety of omitting/delaying prostate biopsy in men with negative mpMRI. Level of evidence: Level 3 retrospective case-control study.

Safety and Efficacy of High-Powered Holmium Laser Enucleation of the Prostate within 1–3 Weeks Following Prostate Biopsy

Purpose: We aim to document the feasibility, perioperative safety, and the 12-month efficacy of holmium laser enucleation of the prostate (HoLEP) within 1–3 weeks following transrectal ultrasound (TRUS)-guided prostate biopsy. Methods: Data of the patients who underwent HoLEP following TRUS-guided prostate biopsy between March 2017 and July 2020 were analyzed retrospectively. Patients were divided into 2 groups: group 1 had undergone HoLEP in the early period after TRUS-guided prostate biopsy, while group 2 patients were biopsy-naive (“control group”). All patients were assessed preoperatively by a physical examination with the digital rectal examination; time from biopsy to HoLEP; measurement of Qmax, postvoiding residual volume, and prostate volume by transabdominal ultrasonography; serum prostate-specific antigen level, the International Prostate Symptom Score (IPSS); the International Index of Erectile Function-5 questionnaire; and urine analysis. The patients were reevaluated at 3- and 12-month follow-up. Perioperative and postoperative complications were documented according to the modified Clavien-Dindo System. Results: Group 1 comprised 66 patients with a mean age of 67.3 ± 6.7 (range, 53–86) years, and group 2 comprised 114 patients with a mean age of 69.4 ± 9.4 (range, 36–95) years. The operation, enucleation, and morcellation efficiencies were not statistically significant between the groups. Preoperative Qmax and IPSS values were significantly improved after HoLEP surgery in the 3rd and 12th months in all patients. Our complication rates were similar in both groups. Conclusion: High-powered HoLEP using 140 W energy within 1–3 weeks following TRUS-guided prostate biopsy is a feasible procedure with high enucleation efficiency, low perioperative morbidity, and excellent functional outcomes. A recent TRUS-guided prostate biopsy is not a contraindication to HoLEP.

A Nomogram Based on a Multiparametric Ultrasound Radiomics Model for Discrimination Between Malignant and Benign Prostate Lesions.

ObjectivesTo evaluate the potential of a clinical-based model, a multiparametric ultrasound-based radiomics model, and a clinical-radiomics combined model for predicting prostate cancer (PCa).MethodsA total of 112 patients with prostate lesions were included in this retrospective study. Among them, 58 patients had no prostate cancer detected by biopsy and 54 patients had prostate cancer. Clinical risk factors related to PCa (age, prostate volume, serum PSA, etc.) were collected in all patients. Prior to surgery, patients received transrectal ultrasound (TRUS), shear-wave elastography (SWE) and TRUS-guided prostate biopsy. We used the five-fold cross-validation method to verify the results of training and validation sets of different models. The images were manually delineated and registered. All modes of ultrasound radiomics were retrieved. Machine learning used the pathology of “12+X” biopsy as a reference to draw the benign and malignant regions of interest (ROI) through the application of LASSO regression. Three models were developed to predict the PCa: a clinical model, a multiparametric ultrasound-based radiomics model and a clinical-radiomics combined model. The diagnostic performance and clinical net benefit of each model were compared by receiver operating characteristic curve (ROC) analysis and decision curve.ResultsThe multiparametric ultrasound radiomics reached area under the curve (AUC) of 0.85 for predicting PCa, meanwhile, AUC of B-mode radiomics and SWE radiomics were 0.74 and 0.80, respectively. Additionally, the clinical-radiomics combined model (AUC: 0.90) achieved greater predictive efficacy than the radiomics model (AUC: 0.85) and clinical model (AUC: 0.84). The decision curve analysis also showed that the combined model had higher net benefits in a wide range of high risk threshold than either the radiomics model or the clinical model.ConclusionsClinical-radiomics combined model can improve the accuracy of PCa predictions both in terms of diagnostic performance and clinical net benefit, compared with evaluating only clinical risk factors or radiomics score associated with PCa.

Prostatic abscess with infected aneurysms and spondylodiscitis after transrectal ultrasound-guided prostate biopsy: a case report and literature review

BackgroundTransrectal ultrasonography (TRUS)-guided prostate biopsy is the conventional method of diagnosing prostate cancer. TRUS-guided prostate biopsy can occasionally be associated with severe complications. Here, we report the first case of a prostate abscess with aneurysms and spondylodiscitis as a complication of TRUS-guided prostate biopsy, and we review the relevant literature.Case presentationA 78-year-old man presented with back pain, sepsis, and prostate abscesses. Twenty days after TRUS-guided prostate biopsy, he was found to have a 20-mm diameter abdominal aortic aneurysm that expanded to 28.2 mm in the space of a week, despite antibiotic therapy. Therefore, he underwent transurethral resection of the prostate to control prostatic abscesses. Although his aneurysm decreased to 23 mm in size after surgery, he continued to experience back pain. He was diagnosed as having pyogenic spondylitis and this was managed using a lumbar corset. Sixty-four days after the prostate biopsy, the aneurysm had re-expanded to 30 mm; therefore, we performed endovascular aneurysm repair (EVAR) using a microcore stent graft 82 days after the biopsy. Four days after the EVAR, the patient developed acute cholecystitis, and he underwent endoscopic retrograde biliary drainage. One hundred and sixty days after the prostate biopsy, all the complications had improved, and he was discharged. A literature review identified a further six cases of spondylodiscitis that had occurred after transrectal ultrasound-guided prostate biopsy.ConclusionsWe have reported the first case of a complication of TRUS-guided prostate biopsy that involved prostatic abscesses, aneurysms, and spondylodiscitis. Although such complications are uncommon, clinicians should be aware of the potential for such severe complications of this procedure to develop.

Effect of lesion diameter and prostate volume on prostate cancer detection rate of magnetic resonance imaging: Transrectal-ultrasonography-guided fusion biopsies using cognitive targeting.

This study aimed to evaluate the effect of prostate volume and lesion size on the clinically significant prostate cancer (csPCa) detection rates of transrectal ultrasonography (TRUS)-guided prostate biopsies, performed by a cognitive targeting method for sampling peripheral zone lesions. We retrospectively enrolled 219 consecutive patients, who underwent multiparametric magnetic resonance imaging with a 3-T scanner and had peripheral zone lesions suspected for prostate cancer. All of these patients underwent combined cognitive targeted biopsy of suspicious lesions and TRUS-guided systematic biopsy. The detection rates of csPCa according to different lesion diameters (<5 mm, 5-9.9 mm, and ≥10 mm) and prostate volumes (<30 mL, 30-49.9 mL, 50-79.9 mL, and ≥80 mL) were calculated per lesion basis. In addition, subgroup analysis of csPCa detection rates was performed according to Prostate Imaging Reporting and Data System scores of lesions. The csPCa detection rates according to lesion diameters <5 mm, 5-9.9 mm, and ≥10 mm were 4%, 9.8%, and 33.1%, respectively, and were significantly lower for lesions <10 mm (p<0.001). The csPCa detection rates were 61.5%, 24.1%, 16.2%, and 6.9%, respectively, for prostate volumes <30 mL, 30-49.9 mL, 50-79.9 mL, and ≥80 mL, and were significantly higher for prostate volumes <30 mL (p<0.001). Clinicians should be very careful when they prefer cognitive targeted prostatic biopsy in patients with periferal zone lesions less than 10 mm and with prostate volumes greater than 30 mL, because of significantly low csPCa detection rates.

Transrectal ultrasonography and biopsy of the prostate

When compared to other solid organ malignancies, the diagnosis of prostate cancer is not reliant on imaging findings alone. Men found to have abnormal digital rectal examination findings, raised serum prostate-specific antigen levels, or both are subjected to prostate biopsy to arrive at a diagnosis. Since its introduction in the 1970s, Transrectal ultrasonography (TRUS) plays a vital role in the diagnostic pathway to guide prostatic biopsy. However, many men are subjected to unnecessary biopsies, leading to a diagnosis of clinically-indolent cancer or occasionally missing a focus of clinically significant disease. Currently, TRUS-guided prostate biopsy performed under local anesthesia is in widespread use for the diagnosis of prostate cancer. The peripheral zone of the prostate showing a hypoechoic lesion is the most common finding consistent with prostate cancer. In this review, we aim to highlight the ultrasonographic anatomy of prostate, the technique, and associated complications along with a brief note on the recent advances in imaging technology for the diagnosis of prostate cancer.

The Profile of Ciprofloxacin-Resistant Bacteria in the Rectum of Patients Undergoing Transrectal Ultrasound-Guided Prostate Biopsy, Its Relation to Post-Biopsy Infection and Alternative Prophylactic Antibiotics

Background: Fluoroquinolone has been routinely given as a prophylactic antibiotic to patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. Currently, there is no data on the profile of fluoroquinolone-resistant bacteria, its association with post-biopsy sepsis, and alternative prophylactic antibiotics.Methods: A cross-sectional study was conducted in patients undergoing TRUS-guided prostate biopsy at Urology Clinic, Cipto Mangunkusumo National Central General Hospital between August and December 2015. Specimens were taken from rectal swabs prior to biopsy. Gramnegative bacilli and Gram-positive cocci were characterized on the Vitek®2 using GN and GP cards (BioMérieux, USA). Antimicrobial susceptibility testing was done by Kirby Bauer disc diffusion method. Post-biopsy infection was monitored within one week after biopsy by telephone call and diagnosed by clinical examination.Results: A total of 52 patients aged 52-80 years were enrolled. Sixty-six isolates grew from 52 swabs; 14 swabs among them grew 2 isolates. The commonest pathogen was Escherichia coli (78.8%), followed by Klebsiella pneumoniae (13.6%), Enterococcus faecium (3.0%), Acinetobacter haemolyticus, Morganella morganii subsp. morganii, and Enterococcus faecalis (1.5%), respectively. Ciprofloxacin-resistant bacteria were found in 33 (50.0%) isolates which were predominated by E. coli. Meanwhile, 90.4% and 96.2% of isolates were sensitive to amoxicillinclavulanate and ampicillin-sulbactam, respectively. Post-biopsy infection was established in 7 patients requiring no hospitalization.Conclusions: The proportion of ciprofloxacin-resistant bacteria in the rectum among patients undergoing prostate biopsy was 50.0%. Escherichia coli is the commonest resistant pathogen to fluoroquinolone. The recommended alternatives for prophylactic antibiotics are amoxicillinclavulanate and ampicillin-sulbactam. Routine pre-biopsy rectal swab cultures should also be encouraged.

Use of the prostate health index in the detection of prostate cancer at all PSA levels (use of prostate health index in prostate cancer).

To determine the efficiency of prostate health index (PHI) calculated simultaneously during an ultrasound-guided fine-needle prostate biopsy in prostate cancer diagnosis. The present study included 258 subsequent patients who underwent a TRUS-guided biopsy in our clinic between August 2015 and March 2016 due to elevated blood levels of PSA and suspicion of prostate cancer. The total PSA, free PSA and pro-PSA were analysed in all patients before the procedure. The average age of 258 patients was 63.5 (36-91) years, and the mean PSA level and mean PHI values were 40.1 (0.12-2170) and 118 (0.41-1308), respectively. According to the PSA data, the patients were divided into two groups: the low PSA (<4ng/mL) group containing ten patients with adenocancer (31.2%) and 22 patients with BPH (68.8%) and the high PSA (>4ng/mL) group consisting of 86 patients with adenocancer (42.2%) and 118 (57.8%) with BPH. The sensitivity and specificity of PSA in detecting prostate adenocancer were calculated as 89.6% and 15.7%, respectively. Similarly, when a PHI level below 55 was accepted as low, and a PHI level at or above 55 was accepted as high, PHI's sensitivity and specificity were determined as 71.9% and 67.9%, respectively. The overall findings indicate that the specificity of PHI is higher than PSA in terms of prostate cancer detection.

What is the risk of prostate cancer mortality following negative systematic TRUS-guided biopsies? A systematic review

ObjectiveTo investigate the risk of prostate cancer-specific mortality (PCSM) following initial negative systematic transrectal ultrasound-guided (TRUS) prostate biopsies.DesignSystematic review.Data sourcesPubMed and Embase were searched using a string combination with keywords/Medical...

Can mean ADC value and ADC ratio of benign prostate tissue to prostate cancer assist in the prediction of clinically significant prostate cancer within the PI-RADSv2 scoring system?

BackgroundThe aim of this study is to investigate whether quantitative DW metrics can provide additive value to the reliable categorization of lesions within existing PI-RADSv2 guidelines. Fifty-eight patients with clinically suspicious prostate cancer who underwent PR examination, PSA serum levels, sextant TRUS-guided biopsies, and bi-parametric MR imaging were included in the study.ResultsSixty-six lesions were detected by histopathological analysis of surgical specimens. The mean ADC values were significantly lower in tumor than non-tumor tissue. The mean ADC value inversely correlated with Gleason score of tumors with a significant p value < 0.001.Conversely, a positive relationship was found between the ADC ratio (ADC of benign prostatic tissue to prostate cancer) and the pathologic Gleason score with a significant elevation of the ADC ratio along with an increase of the pathologic Gleason score (p < 0.001). ROC curves constructed for the tumor ADC and ADC ratio helped to distinguish pathologically aggressive (Gleason score ≥ 7) from non-aggressive (Gleason score ≤ 6) tumors and to correlate it with PIRADSv2 scoring to predict the presence of clinically significant PCA (PIRADSv2 DW ≥ 4). The ability of the tumor ADC and ADC ratio to predict highly aggressive tumors (GS> 7) was high (AUC for ADC and ADC ratio, 0.946 and 0.897; p = 0.014 and 0.039, respectively). The ADC cut-off value for GS ≥ 7 was < 0.7725 and for GS ≤ 6 was > 0.8620 with sensitivity and specificity 97 and 94%. The cutoff ADC ratio for predicting (GS > 7) was 1.42 and for GS ≤ 6 was > 1.320 with sensitivity and specificity 97 and 92%. By applying this ADC ratio cut-off value the sensitivity and specificity of reader 1 for correct categorization of PIRADSv2 DW > 4 increased from 90 and 68% to 95 and 90% and that of reader 2 increased from 94 and 88% to 97 and 92%, respectively.ConclusionEstimation of DW metrics (ADC and ADC ratio between benign prostatic tissue and prostate cancer) allow the non-invasive assessment of biological aggressiveness of prostate cancer and allow reliable application of the PIRADSv2 scoring to determine clinically significant cancer (DW score > 4) which may contribute in planning initial treatment strategies.

The use of prostate specific antigen density to predict clinically significant prostate cancer

The purpose of this study was to assess the predictive value of prostate specific antigen density (PSAD) for detection of clinically significant prostate cancer in men undergoing systematic transrectal ultrasound (TRUS)-guided prostate biopsy. We retrospectively analyzed data of men who underwent TRUS-guided prostate biopsy because of elevated PSA (≤ 20 ng/ml) or abnormal digital rectal examination. Receiver operating characteristic curve analysis to compare PSA and PSAD performance and chi-square automatic interaction detector methodologies were used to identify predictors of clinically significant cancer (Gleason score ≥ 7 or international society of urological pathology grade group ≥ 2). Nine-hundred and ninety-two consecutive men with a median age of 66 years (IQR 61–71) were included in the study. Median PSAD was 0.10 ng/ml2 (IQR 0.10–0.22). Prostate adenocarcinoma was diagnosed in 338 men (34%). Clinically significant prostate adenocarcinoma was diagnosed in 167 patients (50% of all cancers and 17% of the whole cohort). The AUC to predict clinically significant prostate cancer was 0.64 for PSA and 0.78 for PSAD (P < 0.001). The highest Youden's index for PSAD was at 0.20 ng/ml2 with 70% sensitivity and 79% specificity for the diagnosis of clinically significant cancer. Men with PSAD < 0.09 ng/ml2 had only 4% chance of having clinically significant disease. The detection rate of clinically significant prostate cancer in patients with PSAD between 0.09 and 0.19 ng/ml2 was significantly higher when prostate volume was less than 33 ml. In conclusion, PSAD was a better predictor than PSA alone of clinically significant prostate cancer in patients undergoing TRUS-guided biopsy. Patients with PSAD below 0.09 ng/ml2 were unlikely to harbor clinically significant prostate cancer. Combining PSAD in the gray zone (0.09–0.19) with prostate volume below 33 ml adds diagnostic value of clinically significant prostate cancer.

Metastatic Prostate Adenocarcinoma in Rectal Polyp: A Rare Clinical Presentation

Abstract Introduction/Objective Prostate cancer is known to metastasize to bone, lymph node, lungs, liver, and brain, with the GI tract being an uncommon site of metastasis. More commonly, prostate adenocarcinoma involves GI tract by direct colonic extension. Interestingly, few cases have been reported with metastasis presenting as a GI polyp. Methods We herein report a case of 69-year-old African American male who was diagnosed with metastasis of prostate adenocarcinoma presenting as rectal polyp. The patient originally presented with lower urinary tract symptoms. Further examination revealed PSA level of 220. The patient underwent TRUS-guided prostate biopsy which showed prostate adenocarcinoma with Gleason score of 9 (grade group 5). Follow-up CT and radioisotope scans showed direct extension of prostate lesion into bladder, seminal vesicle and rectum. Metastases were noted to right lesser trochanter, L5 vertebra and retroperitoneal lymph nodes. Colonoscopy was performed 1 month after prostate biopsy due to abnormal CT finding of rectal wall thickening. Endoscopy found a single 0.5 mm sessile polyp which was resected by cold snare polypectomy. Results Microscopically, a nodule of tubular glands arranged back to back containing pleomorphic cells with large nuclei, prominent nucleoli, and vacuolated cytoplasm was seen underlying normal colonic mucosa. The malignant cells expressed prostate specific antigen (PSA) and phosphate specific acid phosphatase (PSAP). It was negative for CK7 and CDX2, rendering a diagnosis of metastatic prostate adenocarcinoma. Patient is currently receiving androgen deprivation treatment and enzalutamide with future plans for external beam radiation. The germline alteration testing was positive for BRCA2 which is associated with increased risk of prostate cancer. Conclusion Albeit rare, it’s important for pathologists to be aware of this entity presenting uncommonly as a rectal polyp, particularly given the history of prostate adenocarcinoma which could be mistaken for colonic adenocarcinoma. In rare cases, tumor seeding following TRUS-guided prostate biopsy has also been implicated.