Ultrasound-guided Prostate Needle Biopsy Research Articles

The importance of prostate volume in prostate needle biopsy.

Although ultrasound-guided prostate needle biopsy is the gold standard method in the diagnosis of prostate cancer, biopsy schemes and the number of repeated biopsies are still controversial today. It is known that the rate of prostate cancer decreases with increasing prostate volume. In this study, we evaluated the effects of prostate volume on cancer detection in our patient series. In our clinic, data for 992 patients who had gray zone PSA levels (2.5-10 ng/mL) and whose 10 core biopsies were taken between 2004 and 2010 were evaluated. Among them, 500 patients from whom 6 to 8 biopsies were taken, whose information was lacking and who had suspicious cancer findings after digital rectal examination were excluded from the study. Patient ages, free/total PSA levels (f/TPSA), PSA densities (PSAD), Gleason scores, and prostate volumes were compared between patients with (Group 1) or without biopsy-proven prostate cancer (Group 2). Student's t-test was used for statistical analysis. According to biopsy findings, prostate cancer was detected in 74 patients while no cancer was detected in 418 patients. The mean age of Groups 1, and 2 were 65±8.6, and 64±8.1 years, respectively The mean prostate volume in Groups 1, and 2 were 45±23 cc, and 58±26 cc, respectively. In line with the literature, the average prostate volume of the prostate cancer group was significantly lower. This supports the notion that cancer detection is more probable in small prostates than in high-volume prostates.

Successful radiation therapy for primary mucosa-associated lymphoid tissue lymphoma of the prostate

We report a case of primary mucosa-associated lymphoid tissue (MALT) lymphoma of the prostate. A 57-year-old man complained of dysuria, nocturia, and sensation of residual urine for 3 years. The laboratory data showed that the serum prostate-specific antigen (PSA) level was 5.2 ng/mL. A physical examination revealed mild prostate enlargement and no lymphadenopathy. Magnetic resonance imaging (MRI) suggested benign prostatic hyperplasia. A transrectal ultrasound-guided prostate needle biopsy was performed and the prostatic tissues of the biopsy showed the features of MALT lymphoma. And then complete clinical investigation, including bone marrow biopsy and positron emission tomography (PET), did not show any other involved site. The patient was diagnosed as having extranodal marginal zone B cell MALT-type lymphoma of the prostate, low grade and stage I. He received external beam radiation therapy to the prostate with a total dose of 44 Gy in 22 fractions. A follow-up biopsy of the prostate was performed 12 months after the radiation therapy. The immunohistochemical analysis showed no evidence of disease. He became free of disease within the following 24 months.

Abstract 2870: Prostatic inflammation and proliferative inflammatory atrophy: Are there any associations with prostatic cancer.

Abstract Background: Prostate cancer (PCa) is the second most common worldwide neoplasm in men [1]. Proliferative inflammatory atrophy (PIA) is proposed as a “risk factor lesion” as it has an important inflammatory component and the associated oxidative stress has been suggested to have a role in prostatic carcinogenesis [2,3] Objectives: To determine correlations between pathological findings of inflammation and proliferative inflammatory atrophy (PIA), in prostate biopsy specimens and to compare their prevalence in biopsies with and without prostate adenocarcinoma. Methods: A prospective study was conducted between December 2010 and June 2012 in the Hospital Universitario del Caribe, Cartagena, Colombia. Patients referred for transrectal ultrasound-guided prostate needle biopsy for suspected PCa were invited to participle and signed an informed consent. Initial prostate biopsies were examined for the presence of PCa, chronic inflammation and atrophy. The inflammation was scored for grade, localization and extension using the classification system of the CPCRN and IPCN consensus [4]. Atrophy was classified according to “Working Group Classification of Focal Prostate Atrophy Lesions” [5], and grade of atrophy was graduated using categories described by Postma [6]. For statistical analysis we compared parameters between groups with and without PCa. This study was approved for the Ethical Review Board of the participating institutions. Results: 97 patients were included, between the ages of 47 and 87 years (mean age: 68.32, SD: 8.9). Adenocarcinoma was identified in 50 of the 97 (51.5%) biopsies examined. There was a significant age difference between the PCa and benign groups (p=0.0031) and PSA levels were significantly higher in patients with cancer. Inflammation was detected in 95.87% of biopsies. Inflammation grade was significantly different between PCa and benign samples (p=0.038) but extension and localization of inflammation was not different between the groups. PIA was observed in 61 cases (62.8%) of which 23 had PCa. Atrophy grade and type were not different between groups and simple atrophy was the most frequently observed type. Morphological transition PIA-HGPIN was significantly more frequent in PCa group (p=0.0002) Conclusions: Our data provide evidence for a role of PIA as a PCa precursor lesion as we observed a strong association between morphological transition PIA-HGPIN and PCa. As inflammation was observed in the vast majority of patient samples, our analysis did not detect an association with PCa. Likewise, a clear association between atrophy and PCa was not observed. Citation Format: Ines Benedetti, Oscar Correa, Jan Geliebter, Raj Tiwari, Niradiz Reyes. Prostatic inflammation and proliferative inflammatory atrophy: Are there any associations with prostatic cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2870. doi:10.1158/1538-7445.AM2013-2870

Editorial Comment

No AccessJournal of UrologyOncology: Prostate/Testis/Penis/Urethra1 Jan 2013Editorial Comment Janet Colli Janet ColliJanet Colli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.11.055AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 189(1S), pp. S17–S18 References 1 : Safety and morbidity of first and repeat transrectal ultrasound guided prostate needle biopsies: results of a prospective European prostate cancer detection study. J Urol2001; 166: 856. Link, Google Scholar Department of Urology, University of Alabama, Birmingham, Alabama© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 1SJanuary 2013Page: S17-S18 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Janet Colli More articles by this author Expand All Advertisement PDF downloadLoading ...

Reduction in Hospital Admission Rates Due to Post-Prostate Biopsy Infections After Augmenting Standard Antibiotic Prophylaxis

We evaluated the incidence of infectious complications requiring hospitalization after transrectal ultrasound guided prostate biopsy, comparing an augmented regimen of antibiotic prophylaxis to the standard regimen, and established cost-effectiveness at our center. Our standard antibiotic prophylaxis regimen consisted of 3 days of ciprofloxacin or Bactrim™ DS in the perioperative period. An increase in hospital admissions related to infection after transrectal ultrasound guided biopsy from January 2010 through December 2010 led us to initiate an augmented regimen of 3 days of ciprofloxacin or Bactrim DS in addition to 1 dose of intramuscular gentamicin before biopsy from January 2011 to December 2011. Urine and blood cultures along with bacterial susceptibilities were obtained at admission and compared between the 2 groups. Cost analysis was done to determine the cost-effectiveness of standard and augmented regimens. The rate of hospitalization due to post-biopsy infections was 3.8% (11 patients among 290 biopsies) in 2010, which decreased to 0.6% (2 patients among 310 biopsies) in 2011 (p <0.001). Of the admitted patients who received standard prophylaxis, 73% had fluoroquinolone resistant Escherichia coli urinary infection and/or bacteremia and only 9% had strains resistant to gentamicin. Multivariate analysis showed that the standard regimen was significantly associated with hospital admission due to post-biopsy infection (HR 2.078 ± 0.84, p = 0.013). The augmented regimen resulted in a cost savings of $15,700 per 100 patients compared to the standard regimen. The addition of gentamicin to current prophylactic regimens significantly reduced the rate of hospitalization for post-biopsy infectious complications and was shown to be cost-effective.

A Prospective Randomized Trial of Povidone-Iodine Prophylactic Cleansing of the Rectum Before Transrectal Ultrasound Guided Prostate Biopsy

Transrectal ultrasound guided prostate biopsy can lead to urinary tract infections in 3% to 11% and sepsis in 0.1% to 5% of patients. We investigated the efficacy of rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy to reduce infectious complications. Between 2009 and 2011, 865 men were prospectively randomized to rectal cleansing (421) or no cleansing (444) before transrectal ultrasound guided prostate biopsy. Patients received ciprofloxacin prophylaxis and rectal swab cultures were obtained before transrectal ultrasound guided prostate biopsy. Patients completed a telephone interview 7 days after undergoing the biopsy. The primary end point was the rate of infectious complications, a composite end point of 1 or more of 1) fever greater than 38.0C, 2) urinary tract infection or 3) sepsis (standardized definition). Chi-square significance testing was performed for differences between groups and a multivariate analysis was performed to assess risk factors for infectious complications. Infectious complications were observed in 31 (3.5%) patients, including 11 (2.6%) treated and 20 (4.5%) control patients (p = 0.15). Sepsis was observed in 4 (1.0%) treated and 7 (1.6%) control patients (p = 0.55). On multivariate analysis resistance to ciprofloxacin in the rectal swab culture (p = 0.002) and a history of taking ciprofloxacin in the 3 months preceding transrectal ultrasound guided prostate biopsy (p = 0.009) predicted infectious complications. Rectal cleansing with povidone-iodine before transrectal ultrasound guided prostate biopsy was safe, but the 42% relative risk reduction of infectious complications was not statistically significant. Patients who have received ciprofloxacin within 3 months of transrectal ultrasound guided prostate biopsy should be considered for alternate prophylaxis or possibly a delay of biopsy beyond 3 months.

The Impact of Prostate Biopsy on Urinary Symptoms, Erectile Function, and Anxiety

Transrectal ultrasound-guided prostate needle biopsy (PB) is considered the gold standard for the diagnosis of prostate cancer. Recently, lower urinary tract symptoms and erectile dysfunction have been reported following PB. We reviewed the literature on PB and these symptoms and summarized known findings between these conditions and other variables, such as periprostatic nerve block, saturation biopsy, serial biopsies, and psychological factors associated with PB and cancer. A PubMed search was performed using keywords "prostate biopsy," "complications," "erectile dysfunction," "lower urinary tract symptoms," "anxiety," and "quality of life." Eleven key papers are discussed and personal experience is drawn upon. Based upon available evidence, PB appears to be associated with short-term exacerbation of urinary symptoms in some men, as well as associated with anxiety and temporary erectile dysfunction, without a distinct relationship to periprostatic nerve block or the number of cores biopsied. Additional studies are warranted to determine the definitive etiology of these symptoms and to determine if interventions could reduce patient morbidity. In the interim, patients should be educated and counseled about these risks before undergoing PB.

The impact of obesity on the predictive accuracy of PSA in men undergoing prostate biopsy

Obese men have been reported to have lower serum PSA values relative to normal-weight men in population-based studies, screening cohorts, and in men with prostate cancer (CaP) treated with surgery. There are concerns that PSA may be less accurate in detecting prostate cancer in men with increased body mass index (BMI). We determine whether the diagnostic potential of PSA is negatively influenced by obesity by comparing its operating characteristics across BMI categories among men undergoing prostate biopsy. Demographic, clinical, and histopathological data on 917 men who underwent trans-rectal ultrasound-guided prostate needle biopsy from 2002 to 2010 at a University hospital in Italy were used in the study. Men were categorized for BMI as follows: <25 kg/m(2) (normal weight), 25-29.9 kg/m(2) (overweight), and ≥ 30 kg/m(2) (obese). Receiver operator characteristics (ROC) curves were used to assess PSA accuracy for predicting prostate cancer overall and then stratified according to digital rectal examination (DRE) findings using the area under the ROC curve (AUC). The obesity rate of the study cohort was 21 %. There was no statistically significant difference in the overall AUCs of PSA for predicting CaP among normal-weight (AUC = 0.56), overweight (AUC = 0.60), and obese men (AUC = 0.60; p = 0.68) in either DRE-positive or negative men. In a cohort of Italian men undergoing prostate biopsy, the performance accuracy of PSA as a predictor of CaP is not significantly altered by BMI. Obesity does not negatively impact the overall ability of PSA to discriminate between CaP and benign conditions.

Increasing Risk of Infectious Complications After Transrectal Ultrasound–Guided Prostate Biopsies: Time to Reassess Antimicrobial Prophylaxis?

BackgroundAn increasing risk of infectious complications following transrectal ultrasound–guided prostate needle biopsy (PNB) has been observed recently in some centers. ObjectiveTo delineate the risk factors associated with post-PNB bacteremia and/or urinary tract infection (UTI) and determine why this risk has risen over time. Design, setting, and participantsA case–control study in a Canadian tertiary-care center. Cases were all patients who developed bacteremia and/or UTIs after PNB between 2002 and 2011; controls were randomly selected among patients who underwent a PNB without such complications. Outcome measurements and statistical analysisCrude and adjusted odds ratios and their 95% confidence intervals were calculated using logistic regression. Results and limitationsA total of 5798 PNBs were performed during the study period, following which there were 48 cases of urinary sepsis (42% with bacteremia). The incidence increased from 0.52 infections per 100 biopsies in 2002–2009 to 2.15 infections per 100 biopsies in 2010–2011 (p<0.001). Escherichia coli was the predominant pathogen (75% of cases). Among 42 patients whose post-PNB infection was caused by aerobic or facultative Gram-negative rods, 22 patients (52%) were infected by pathogens resistant to ciprofloxacin. Independent risk factors for post-PNB infection were diabetes, hospitalization during the preceding month, chronic obstructive pulmonary disease, and performance of the biopsy in 2010–2011. In 2010–2011, the minimal inhibitory concentrations for ciprofloxacin increased compared with 2002–2009 (p<0.03). The major limitation of the study was its retrospective hospital-based nature, which hampered data collection on outpatient antibiotic prescriptions. ConclusionsIn the past 2 yr, ciprofloxacin resistance contributed to the increasing incidence of post-PNB infections in our center. Novel antibacterial prophylaxis approaches need to be evaluated.

Findings in 12-Core Transrectal Ultrasound-Guided Prostate Needle Biopsy That Predict More Advanced Cancer at Prostatectomy

We analyzed 5 features on 12-core transrectal ultrasound-guided prostate needle biopsy (TRUS) to predict the extent of cancer at radical prostatectomy (RP). In 388 TRUS-RP pairs, number of positive cores (NPC), percentage of each core involved (%PC), perineural invasion (PNI), Gleason score (GS), distribution of positive cores (DPC), and preoperative prostate-specific antigen (PSA) were correlated with extraprostatic extension (EPE), seminal vesicle invasion (SVI), positive surgical margin (R1), positive lymph nodes (N1), and tumor volume. All features predicted EPE and SVI. NPC, GS, %PC, and PNI strongly predicted R1 status. RP tumor volume was directly proportional to the NPC and %PC. PSA alone and with selected biopsy findings correlated with tumor volume, stage, SVI, and N1 (P < .0001). Contiguous DPC was a significant risk for EPE and SVI (P < .0001) compared with isolated positive cores. Findings at 12-core TRUS along with preoperative PSA reliably predict advanced local disease and have practical value as guides to effective planning for surgical resections.

Targeted Antimicrobial Prophylaxis Using Rectal Swab Cultures in Men Undergoing Transrectal Ultrasound Guided Prostate Biopsy is Associated With Reduced Incidence of Postoperative Infectious Complications and Cost of Care

We evaluated targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy based on rectal swab culture results. From July 2010 to March 2011 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy. Targeted prophylaxis used rectal swab cultures plated on selective media containing ciprofloxacin to identify fluoroquinolone resistant bacteria. Patients with fluoroquinolone susceptible organisms received ciprofloxacin while those with fluoroquinolone resistant organisms received directed antimicrobial prophylaxis. We identified men with infectious complications within 30 days after transrectal ultrasound guided prostate biopsy using the electronic medical record. A total of 457 men underwent transrectal ultrasound guided prostate biopsy, and of these men 112 (24.5%) had rectal swab obtained while 345 (75.5%) did not. Among those who received targeted prophylaxis 22 (19.6%) men had fluoroquinolone resistant organisms. There were no infectious complications in the 112 men who received targeted antimicrobial prophylaxis, while there were 9 cases (including 1 of sepsis) among the 345 on empirical therapy (p=0.12). Fluoroquinolone resistant organisms caused 7 of these infections. The total cost of managing infectious complications in patients in the empirical group was $13,219. The calculated cost of targeted vs empirical prophylaxis per 100 men undergoing transrectal ultrasound guided prostate biopsy was $1,346 vs $5,598, respectively. Cost-effectiveness analysis revealed that targeted prophylaxis yielded a cost savings of $4,499 per post-transrectal ultrasound guided prostate biopsy infectious complication averted. Per estimation, 38 men would need to undergo rectal swab before transrectal ultrasound guided prostate biopsy to prevent 1 infectious complication. Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infectious complications after transrectal ultrasound guided prostate biopsy caused by fluoroquinolone resistant organisms as well as a decrease in the overall cost of care.

Complications following prostate needle biopsy requiring hospital admission or emergency department visits – experience from 1000 consecutive cases

• To review a contemporary cohort of patients undergoing a transrectal ultrasound-guided prostate needle biopsy (TRUS PNBx) at a single centre to determine the incidence of major complications necessitating hospital admission or emergency department (ED) visits. • The charts of 1000 consecutive patients undergoing TRUS PNBx were reviewed. • All patients received peri-procedural antibiotic prophylaxis with either ciprofloxacin or co-trimoxazole. • Hospital admission and ED visits within 30 days of the procedure were identified for indication, management and outcome. • Patient comorbidities and biopsy characteristics were reviewed for association with complications. • Of the 1000 patients, 25 (2.5%) had post-biopsy complications requiring hospital admission or an ED visit. • Indications included twelve patients (1.2%) with urosepsis, eight (0.8%) with acute urinary retention requiring urethral catheterization, four (0.4%) with gross haematuria requiring bladder irrigation for <24 h, and one (0.1%) with a transient ischaemia attack 1 day after biopsy. • Patients with urosepsis had an average hospitalization of 5 days, and 75% carried quinolone-resistant Escherichia coli organisms. • All patients with urinary retention had catheters removed within 10 days. No patients with haematuria required a blood transfusion. • No demographic or biopsy variables were particularly associated with development of a post-procedure complication. • In this large contemporary series of TRUS PNBx, we observed a 2.5% rate of major complications requiring hospital admission or an ED visit. • No clinical or biopsy variables were directly associated with development of complications. • These data may be valuable when counselling patients before biopsy.

Vertebral osteomyelitis following transrectal ultrasound-guided biopsy of the prostate.

Transrectal ultrasound-guided needle biopsy of the prostate (TRUS) is a well-tolerated and standardized procedure for the diagnosis of prostate cancer. Complications associated with TRUS requiring emergency room visits or hospital admissions are relatively low and include complications, such as a 1% risk of urinary retention and less than 1% chance of bacterial sepsis. Vertebral osteomyelitis is a rare complication of TRUS; there are 3 reported cases. Vertebral osteomyelitis has an insidious onset and usually resolves following medical intervention. We present an extremely rare case of vertebral osteomyelitis following TRUS, its clinical outcome and management.

Effect of Prostatitis on Lower Urinary Tract Symptoms: Retrospective Analysis of Prostate Biopsy Tissue

PurposeMost patients, even some urologists, assume that prostate volume is the most important prognostic factor for lower urinary tract symptoms (LUTS). In some cases, however, prostatic inflammation is a more important factor in LUTS than is prostate volume. For this reason, comparison of the impact on LUTS of inflammation and prostate volume is an attractive issue.Materials and MethodsFrom January 2000 to May 2009, 1,065 men aged between 47 and 91 years (who underwent transrectal ultrasound-guided prostate needle biopsy and transurethral prostatectomy) were retrospectively investigated. Components such as age, serum prostate-specific antigen (PSA) level, prostate volume, and the presence of prostatitis were investigated through independent-sample t-tests, chi-square tests, and univariate and multivariate analyses.ResultsChi-square tests between prostatitis, prostate volume, serum PSA, and severe LUTS showed that prostate volume (R=0.173; p=0.041) and prostatitis (R=0.148; p<0.001) were related to LUTS. In particular, for a prostate volume under 50 ml, prostatitis was a stronger risk factor than was prostate volume. Among the multivariate predictors, prostatitis (odds ratio [OR]: 1.945; p<0.001) and prostate volume (OR, 1.029; p<0.001) were found to be aggravating factors of LUTS.ConclusionsFor patients with prostate volume less than 50 ml, prostatitis was found to be a more vulnerable factor for LUTS. For those with prostate volume over 50 ml, on the other hand, the volume itself was a more significant risk factor than was prostatitis. In conclusion, the presence of prostatitis is one of the risk factors for LUTS with increased prostate volume.

UP-02.143 Major Complications and Associated Risk Factors of Transrectal Ultrasound Guided Prostate Needle Biopsy: A Retrospective Study of 611 Cases

UP-02.143 Major Complications and Associated Risk Factors of Transrectal Ultrasound Guided Prostate Needle Biopsy: A Retrospective Study of 611 Cases

1476 COST EXPENDITURES FOR ACTIVE SURVEILLANCE VERSUS ACTIVE TREATMENTS FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111476 COST EXPENDITURES FOR ACTIVE SURVEILLANCE VERSUS ACTIVE TREATMENTS FOR LOCALIZED PROSTATE CANCER Rebecca S. Lavelle, Stephen B. Williams, and Kevin R. Loughlin Rebecca S. LavelleRebecca S. Lavelle Boston, MA More articles by this author , Stephen B. WilliamsStephen B. Williams Boston, MA More articles by this author , and Kevin R. LoughlinKevin R. Loughlin Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1411AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Active surveillance (AS) versus definitive treatments for localized prostate cancer is underutilized. We sought to estimate Medicare cost expenditures for several published AS protocols versus treatment in order to discern whether there is a cost benefit associated with AS. METHODS We reviewed the Klotz, Patel, and Carter et al AS protocols and the National Comprehensive Cancer Network (NCCN) guidelines. Medicare reimbursement fees were derived from the 2010 Current Procedural Terminology (CPT) codes assigned to each of the follow up criteria defined in the AS protocols and NCCN guidelines. The follow up criteria were outlined for each protocol including the following: PSA, DRE, ultrasound guided prostate needle biopsy. The total cost expenditure was calculated at 1, 5, 10 and 15 years after diagnosis. The cost was calculated for a patient who remains on active surveillance without signs of disease progression. We used previously published literature regarding cost expenditures for radical prostatectomy, external beam radiation and brachytherapy treatments. The published literature included estimated cost expenditures from the CaPSURE database (1995–2004), SEER Medicare database (1991–1999), and Health Care Financial Administration public use files (1993–1996). RESULTS The Medicare cost expenditure for AS protocols were estimated to range from $105 to $1,781 at one year and $3042 to $24,362 at fifteen years after diagnosis. For the 6 month period after diagnosis/treatment, the cost expenditure for radical prostatectomy ranged from $12,184–$19,019. The cost expenditure for external beam radiation ranged from $10,996-$24,204, whereas brachytherapy ranged from $7,588–$15,301. CONCLUSIONS Active surveillance is an underutilized management option for patients with low-risk, localized prostate cancer. The cost expenditure for AS protocols varies drastically based on frequency of screening ultrasound needle guided biopsy. Our estimated cost expenditure of the least costly AS protocol (NCCN guidelines) at 15 years does not exceed the initial 6 month cost of treament. The estimated cost expenditure of the most costly AS protocol (Carter et al) does not exceed the initial 6 month cost of treament until 5 years of AS. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e592 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca S. Lavelle Boston, MA More articles by this author Stephen B. Williams Boston, MA More articles by this author Kevin R. Loughlin Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevalence and Significance of Fluoroquinolone Resistant Escherichia coli in Patients Undergoing Transrectal Ultrasound Guided Prostate Needle Biopsy

We estimated the prevalence of fluoroquinolone resistant Escherichia coli in patients undergoing repeat transrectal ultrasound guided prostate needle biopsy and identified high risk groups. From January 2009 to March 2010 rectal swabs of 136 men from 3 institutions undergoing transrectal ultrasound guided prostate needle biopsy were obtained. There were 33 men with no previous biopsy who served as the controls. Participants completed questionnaires and rectal swab culture was obtained just before performing the prostate biopsy. Selective media was used to specifically isolate fluoroquinolone resistant E. coli and sensitivities were obtained. The patients were contacted via telephone 7 days after the procedure for a followup questionnaire. A total of 30 patients had cultures positive for fluoroquinolone resistant bacteria for an overall rate of 22% (95% CI 15, 29). Patients with diabetes and Asian ethnicity had higher risks of resistant rectal flora colonization (OR 2.3 and 2.8, respectively). However, differences did not reach statistical significance (p = 0.09 and p = 0.08, respectively). Patients with no prior biopsy had a positive rate of 15% (5 of 33) compared to 24% (25 of 103) in those with 1 or more prior biopsies (OR 1.8, p = 0.27). Five patients (3.6%) had post-biopsy fever while only 1 of those patients had a positive rectal swab. Using selective media to isolate fluoroquinolone resistant E. coli from the rectum before transrectal ultrasound guided prostate biopsy, we isolated organisms in 22% of patients with a wide resistance pattern. This protocol may be used to provide information regarding targeted antibiotic prophylaxis before transrectal prostate biopsies.

Prevalence and Significance of Fluoroquinolone Resistant Escherichia coli in Patients Undergoing Transrectal Ultrasound Guided Prostate Needle Biopsy

Prevalence and Significance of Fluoroquinolone Resistant Escherichia coli in Patients Undergoing Transrectal Ultrasound Guided Prostate Needle Biopsy

Consequences of Switching 5α-Reductase Inhibitors on Prostate Specific Antigen Velocity

The 5alpha-reductase inhibitors improve urinary symptoms related to benign prostatic hyperplasia, deter benign prostatic hyperplasia progression and provide prostate cancer chemoprevention. Currently there are a number of 5alpha-reductase inhibitor formularies, including Proscar, generic finasteride and dutasteride. While all formularies decrease serum prostate specific antigen (a proxy for prostate volume), they may not accomplish this to the same degree, which may have dramatic effects on prostate specific antigen kinetics in men changing 5alpha-reductase inhibitor formularies. We examined prostate specific antigen velocity after changes in 5alpha-reductase inhibitor formularies. We identified patients treated with 2 or more 5alpha-reductase inhibitor formularies who had sufficient prostate specific antigen values to calculate prostate specific antigen velocity during each 5alpha-reductase inhibitor treatment. Patient data were grouped depending on the formularies received. Statistical analysis was done to compare prostate specific antigen velocity at various time points while on different 5alpha-reductase inhibitors. Eight men changed from dutasteride to generic finasteride (group 1), 21 changed from dutasteride to Proscar (group 2), 49 changed from Proscar to dutasteride (group 3) and 77 changed from Proscar to generic finasteride (group 4). We noted a significant increase in prostate specific antigen velocity in groups 1 and 2 (p <0.05), and 4 (p <0.005). The increase was greater than 0.35 ng/ml per year, the common cutoff for prostate biopsy recommendations, in more than a third of patients. Results confirm that changing 5alpha-reductase inhibitors drugs can be associated with a clinically significant change in prostate specific antigen velocity. These prostate specific antigen velocity changes could place patients at risk for unnecessary prostate biopsy. Additional prospective studies are warranted.

1560 ISOLATED SINGLE CORE HIGH GRADE PROSTATIC ADENOCARCINOMA IS ASSOCIATED WITH INCREASED RISK FOR EXTRAPROSTATIC EXTENSION, SEMINAL VESICLE INVASION AND POSITIVE MARGIN STATUS ON RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized VI1 Apr 20101560 ISOLATED SINGLE CORE HIGH GRADE PROSTATIC ADENOCARCINOMA IS ASSOCIATED WITH INCREASED RISK FOR EXTRAPROSTATIC EXTENSION, SEMINAL VESICLE INVASION AND POSITIVE MARGIN STATUS ON RADICAL PROSTATECTOMY Daniel Fajardo, Alan Partin, Mario Eisenberger, Theodore DeWeese, and George Netto Daniel FajardoDaniel Fajardo More articles by this author , Alan PartinAlan Partin More articles by this author , Mario EisenbergerMario Eisenberger More articles by this author , Theodore DeWeeseTheodore DeWeese More articles by this author , and George NettoGeorge Netto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High grade PCa can rarely be diagnosed as a single focus involving a single biopsy core. It is of clinical interest to determine whether such limited high grade prostatic adenocarcinoma biopsy involvement carry the same aggressive implications in regard to risk of extraprostatic extension (EPE), seminal vesicle invasion (SVI) and likelihood of positive margin status (MG+) on radical prostatectomy(RRP). METHODS 92 PCa patients diagnosed with a standard ultrasound guided prostate needle biopsy procedure revealing only a single positive core and undergoing subsequent prostatectomy were retrieved from our surgical pathology archives (1999-2008). Cases were of four Gleason score (GS) groups: 3+3=6(group1), 3+4=7 (group2), 4+3=7 (group3) and ≥8 (group4). Bx data on pt age, pre-biopsy PSA(prePSA), GS, percentage of core involvement (Pos%), and total number of cores performed per case were collected. In addition, prostatectomy data on GS, extent of RRP involvement by PCa (RRPext), EPE, margin status, SVI, lymphovascular invasion (LVI), and lymph node metastasis (LN) were gathered on all cases. RESULTS No statistically significant difference was observed among the four biopsy groups in: Total number of cores obtained, prePSA or Pos% (p:NS). A significantly higher rate of EPE was observed in group 4 compared to groups 1-3 (50.0%, 4.3%, 8% and 30% respectively; p<0.0006). Likewise, a significantly higher incidence of positive MG status (p<0.03), SVI (p<0.003), and LVI(p<0.008) was also observed in group 4 compared to the remaining groups. Furthermore, when cases in group 4 were stratified, according to their %Pos involvement of their single positive core using 50% as a cutoff, the incidence of EPE was higher in those with PCa involving ≥50% of one core compared to cases with cancer involving <50% (p<0.0001). The latter cases in turn had a higher incidence of EPE than the groups of cases with GS≤7. CONCLUSIONS Isolated single biopsy core GS ≥8 prostatic adenocarcinoma is associated with a higher incidence of adverse RRP findings (EPE, SVI, LVI, and positive margins) when compared to cases with a single biopsy core containing PCa with ≤7. Cases with GS≥8 involving less than 50% of a single core are still more likely to have EPE on RRP compared to those with a single GS≤7 core cases. Baltimore, MD© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e602-e603 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Fajardo More articles by this author Alan Partin More articles by this author Mario Eisenberger More articles by this author Theodore DeWeese More articles by this author George Netto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...