Value of transrectal ultrasonography for tumor node metastasis restaging in patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy

Objective:To explore the value of transrectal ultrasonography(TRUS)for tumor node metastasis(TNM)restaging for patients with locally advanced rectal cancer after neoadjuvant chemoradiotherapy(neo-CRT).Methods:One hundred and forty-nine patients with locally advanced rectal cancer(cT3-4 or cN+)who underwent TRUS after neo-CRT were retrospectively reviewed.TRUS restaging was compared with the results of post-operative pathological TNM findings.Results:After neo-CRT,the accuracy of TRUS for diagnosing T-staging was 30.9%,with 60.4%(90/149)of cases overestimated.The sensitivity of TRUS for T-staging(T0 vs T1 vs T2 vs T3 vs T4)were 16.3%,0%,12.5%,42.6%and 75.0%,respectively.The accuracy of TRUS for diagnosing N-staging after neo-CRT was 81.2%,with the sensitivities of N0 and N+were 93.3%and 31.0%,respectively.After neo-CRT,27.5%(41/149)of patients achieved pathologically complete response(pCR).The sensitivity,specificity,positive predictive value and negative predictive values of TRUS for pCR were 17.1%,99.1%,87.5%and 75.9%,respectively.Conclusions:TRUS can be applied for restaging T4 and N0,and has potential for screening out patients with pCR in those with locally advanced rectal cancer after neo-CRT,although some stages are overestimated for T-staging and its sensitivity for predicting pCR is low.

A study of the hypoechoic hypertrophic lesions and hypoechoic cancer lesions in hypertrophic prostate inner glands with transrectal color doppler ultrasonography

Objective: To observe the sonographic and hemodynamic features of hypoechoic hypertrophic lesions and hypoechoic cancer lesions in the hypertrophic prostate inner glands, in order to raise the accuracy of early diagnosis rate for prostate cancer. Methods: 31 cases of hypoechoic hypertrophic lesions and 18 cases of hypoechoic cancer lesions in the hypertrophic prostate inner glands were observed by transrectal ultrasonography and comparatively analyze the shape, edge and the systolic peak velocity (Vs) , resistance index (RI) and pulsatility index (PI) of the lesions. Results: In contrast with hypertrophic group, the cancer group presented irregular shape and unclear edge, and obviously higher Vs, RI and PI. Conclusion: The sonographic appearance and Vs. RI. PI have important value in distinguishing hypoechoic hypertrophic lesions and hypoechoic cancer lesions in the hypertrophic prostate inner glands.

Characters of normal prostate and prostate cancer lesions by transrectal contrast enhanced ultrasonography

Objective:The aim of the study was to observe the characters and differences of the inner and outer parts of prostate gland, the prostatic cancer lesions in inner and outer parts of prostate glands by transrectal contrast enhanced ultrasonography (TRCEUS) in order to provide valuable information for diagnosing of prostatic cancers. Methods: The ultrasound contrast agent was SonoVue (from Bracco Company, Italian). Instrument adopted Esaote Company Technos DU8 (transrectal ultrasonography). We observed the starting and ending times of transrectal contrast enhancement in the normal prostate inner gland group (16 cases), normal prostate outer gland group (16 cases), and the prostatic cancer lesions in inner gland group (8 cases) as well as in outer gland group (11 cases), respectively. Results: There was no significant difference in the starting time of the normal prostate glands between the inner gland and outer gland groups (P>0.05), likewise no significant difference between the cancer lesions in the inner gland and outer gland groups (P>0.05), but starting times of the cancer lesions in both groups were earlier than those of the normal prostate inner and outer glands groups (P<0.01). The ending time of enhancement was no significant difference among all groups (P>0.05). Conclusion: The earlier starting time of contrast enhancement in prostatic cancer lesions by TRCEUS has important value of distinguishing the cancer lesions from normal prostate glands. It is helpful to diagnose the prostatic cancer lesions.

Prostate Cancer: Risk Factors and Outcome Indicators

Background: Prostate cancer, which is the second most frequent cancer diagnosis made in men, more commonly occurs in the elderly. This disease is often diagnosed late in resource-limited settings, which results in people having advanced forms of the disease and a poor prognosis. This study aimed to identify factors indicative of prostate cancer aggressivity and a poor prognosis in patients with prostate cancer at a single center in Douala, Cameroon. Methods: We performed a retrospective study from 2015 to 2020 at the Centre medico-chirugical d’urologie in Douala, Cameroon, in which we included 203 patients aged 41 years to 85 years who had prostate cancer diagnosed via histopathology after either prostate biopsyor laparoscopic prostatectomy. Epi-info 7 was used for data analysis and logistic regression analyses were performed to identify factors associated with prostate cancer aggressivity and patients’ outcomes (survival or mortality). Results: The mean age of our study participants was 64.76 ± 7.48 years. Ten patients had a contributive family history of prostate cancer. The patients presented with lower urinary tract symptoms in 61.58% of cases. All patients had serum prostate-specific antigen (PSA) levels of >4 ng/ml, 100 patients were anemic, and 36 patients had aggressive forms of the disease. Eighty-eight patients had remarkable digital rectal examination (DRE) findings. The median prostate volume, as determined via transrectal ultrasonography (TRUS), was 59 [43 - 80] ml. Fifty-nine patients had abnormal prostate echostructures, and 33 patients died during follow-up. The presence of paraplegia and the practice of professions requiring unskilled labor were significantly associated with aggressive prostate cancer. The presence of lymphoedema, abnormal DRE findings, anemia, enlarged prostate glands (prostate volume >50 ml), and abnormal prostatic echostructures were significantly associated with both prostate cancer aggressivity and patients’ outcomes. Conclusion: The late diagnosis of prostate cancer is a major public health problem in Cameroon because of the complications and poor prognosis of the disease at an advanced stage. Certain clinical, biological, and imaging factors are associated with prostate cancer aggressivity and a poor prognosis, whose identification could help guide clinicians in making therapeutic choices for their patients.