Ultrasound-guided Prostate Needle Biopsy Research Articles

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

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

411. Characterization of Antibiotic Prophylaxis Prior to Trans Rectal Ultrasound Guided Prostate Needle Biopsy (TRUS PNB): A 5-Year Nationwide Study among Patients in the United States Veterans Health Administration

Abstract Background Prophylactic antibiotics are used prior to TRUS PNB to reduce risk for infectious complications such as UTI, prostatitis, epididymitis, orchitis, bacteremia and sepsis. Fluoroquinolones have been commonly used for prophylaxis, however, the incidence of post TRUS PNB infections caused by fluoroquinolone resistant Escherichia coli has increased. The purpose of this study was to characterize the prophylaxis agents used nationwide in the Veterans Health Administration (VHA) prior to TRUS PNB. Methods We conducted a review of records of all patients undergoing TRUS PNB in the VHA database from January 1st, 2013 to December 31st, 2018. We collected data about outpatient oral prophylaxis antibiotics, inpatient injectable antibiotics and microbiology results from rectal swabs and urine cultures performed within 90 days prior to the procedure. Results Of 153,055 patients undergoing prostate biopsy between January 1st, 2013 and December 31st, 2018, 27.6% (n=42,319) had urine cultures and 3.9% (n=5,294) had rectal swab cultures done within the 90-day window prior to the procedure. Among these who had urine and rectal swabs culture, 3.0% (n=1,292) and 20.1% (n=1,062) were positive for E. coli, respectively; 40.2% of E. coli isolates recovered from urine and 89.6% recovered from rectal swabs were resistant to fluoroquinolones. Table 1 shows the frequencies and percentages of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure. Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Frequency and percentage of oral prophylactic agents administered within the 90 days prior to the procedure and injectable antibiotics administered on the day of the procedure Conclusion Despite the high rate of recovery of fluoroquinolone-resistant E. coli in pre-procedure urine and rectal swabs, oral fluoroquinolones remained the most frequently used prophylactic agents prior to TRUS PNB. This inadequate prophylactic coverage may increase the risk of infectious complications following prostate biopsy. Disclosures Elie Saade, MD, MPH, FIDSA, Janssen: Advisor/Consultant.

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

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

Non-infectious complications following transrectal prostate needle biopsy - Outcomes from over 8000 procedures.

BackgroundProstate needle biopsy (PNB) remains the referent standard for diagnosing prostate cancer. Contemporary data highlight an increase in PNB-related infections particularly when performed transrectally. Non-infectious complications, however, may similarly contribute to biopsy-related morbidity. We review the incidence and predictors of non-infectious complications following transrectal PNB in a large statewide quality registry.MethodsTransrectal ultrasound-guided prostate needle biopsies performed between 2015 and 2018 were retrospectively reviewed. The incidence and distribution of non-infectious complications were annotated. Clinical, demographic, and biopsy variables of interest were evaluated by logistic regression for potential association with specific types of non-infectious complications.ResultsOf 8,102 biopsies, 277 (3.4%) biopsies had reported post-procedure complications including 199 (2.5%) non-infectious and 78 (0.9%) infectious. Among the non-infectious complications, the most common events included urinary or rectal bleeding (74; 0.9%), urinary retention (70, 0.9%), vasovagal syncope (13, 0.2%), and severe post-operative pain (10, 0.1%). Approximately 56% of these non-infectious complications required an Emergency Department visit (111/199) and 27% (54/199) hospital admission for monitoring. Increasing transrectal ultrasound prostate volume was associated with post-procedure urinary retention (Odds ratio (OR) 1.07, 1.02–1.11, p = 0.002). No specific variables noted association with post-biopsy bleeding.ConclusionNon-infectious complications occurred 2.5 times more often than infectious complications following transrectal ultrasound prostate needle biopsies. Larger prostate size was associated with a greater risk of post-procedure urinary retention. These data originating from experience from over 100 urologists across different health systems provide an important framework in counseling patients regarding expectations following transrectal prostate biopsy.

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

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

EDITORIAL COMMENT

Transrectal ultrasound guided prostate needle biopsy is the standard prostate cancer diagnostic modality. Over the past decades, there has been an evolution of biopsy needle technology, number of cores taken, and improvements in pre-biopsy imaging to help with lesion identification. The goal is to identify clinically significant prostate cancers while decreasing those that are clinically insignificant, minimize both infectious, and non–infectious complications, and provide a tolerable procedure in terms of pain control, bleeding, and urinary function post-biopsy.

P0997 - Transrectal ultrasound guided prostate needle biopsy is still a standard of care for prostate cancer diagnosis – A multicentre Australian analysis of infection rates

P0997 - Transrectal ultrasound guided prostate needle biopsy is still a standard of care for prostate cancer diagnosis – A multicentre Australian analysis of infection rates

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

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

Hematuria after Transrectal Prostate Biopsy: A Warning of Future Infection

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

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

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

Hematuria after Transrectal Prostate Biopsy: A Warning of Future Infection

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

Prostat Biyopsisi Sonrası Streptococcus agalactiae’ya Bağlı Gelişen Paravertebral Apse ve Spondilodiskit

Streptococcus agalactiae, is the species designation for streptococci belonging to Lancefied group B and are facultative, gram-positive diplococci. In the previous years, it was known as urinary tract infection agent in pregnant women, it was rarely detected in other infections in adults. Nowadays, S. agalactiae is increasingly recognized as a cause of invasive infections such as bacteraemia without any focus, skin and soft tissue infections, upper respiratory tract infections, osteoarticular infections, peritonitis, cardiac infections, meningitis and other focal infections among non-pregnant adults, especially in the elderly and immunocompromised patients. Although rare in the literature, osteoarticular infections caused by S. agalactiae have been reported in adults. In this case report, we aimed to present a patient with iatrogenic spondylodiscitis due to S. agalactiae after ultrasound-guided transrectal prostate needle biopsy.

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

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

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

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

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

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

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

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

Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice.

To report outcomes 5years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol. A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring. Median age and PSA of men included in this study were 64years and 12ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring. What started as a resident quality safety project 5years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

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

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

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

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

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

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