Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (...Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (TRUS-SB) is the primary diagnostic method, prebiopsy multiparametric magnetic resonance imaging (mpMRI) is gaining popularity in identifying suspicious lesions. This study addresses the lack of comprehensive investigations into the efficacy of cognitive registration TRUS targeted biopsy (COG-TB) compared to conventional TRUS-SB, considering the resource limitations of the Malaysian healthcare system. Materials and Methods: A retrospective cohort study was conducted in two Malaysian healthcare facilities. 116 adult patients with a prostate-specific antigen (PSA) level of more than 4 ng/mL who underwent both COG-TB and TRUS-SB between October 2020 and March 2022 were included. Primary outcomes were cancer detection rate and histopathological outcomes, including Gleason score. Results: COG-TB showed a higher overall cancer detection rate (50%) compared to TRUS-SB (44%). Clinically significant cancer detection rates were similar between COG-TB and TRUS-SB (37.1%). Further analysis revealed that both COG-TB and TRUS-SB detected clinically significant cancer in 30.2% of patients, did not detect it in 56.0%, and had conflicting findings in 16 patients (p Conclusion: COG-TB and TRUS-SB have comparable detection rates for clinically significant prostate cancer, with COG-TB showing a higher tendency to detect insignificant prostate cancer. Further studies comparing these methods are warranted.展开更多
Objective To study the effects of 1% tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound （TRUS）-guided prostate biopsy. Methods A total of 100 patients receiving TRUS-guided ...Objective To study the effects of 1% tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound （TRUS）-guided prostate biopsy. Methods A total of 100 patients receiving TRUS-guided prostate biopsy were divided into two groups with 50 in each. In Group 1, patients received liquid paraffin, and in Group 2, patients were given 1% tetracaine hydrochloride jelly before biopsy. Pain score was measured by horizontal visual analogue scales （ VAS ）, and pain and discomfort were compared between the two groups. Results The average pain scores at the time of insertion of the ultrasound probe were 2. 9 ＋_1. 7 and 1. 4 ＋_1. 8 （ P =0. 000） and the average pain scores at the time of performing biopsy were 5. 2 ＋-1. 5 and 3. 1 ＋ 1. 7 （P =0. 000） in Group 1 and Group 2, respectively. There were no significant differences between the two groups in terms of age, serum prostate specific antigen, digital rectal examination, TRUS, and biopsy core number （ P 〉 O. 05 ）. There were no significant differences of complications after biopsy, such as hematuria, acute urinary retention, urinary tract infection, rectum bleeding, and fever （ P 〉0. 05）. Conclusion TRUS-guided prostate biopsy is safe. Use of 1% tetracaine hydrochloride jelly in the rectum and anus before TRUS-guided prostate biopsy is an effective method for relieving TRUS-guided prostate biopsy-induced pain during the procedure.展开更多
This systematic review was performed to compare the efficacy and complications of transperineal （TP） vs. transrectal （TR） prostate biopsy. A systematic research of PUBM ED, EMBASE and the Cochrane Library was perf...This systematic review was performed to compare the efficacy and complications of transperineal （TP） vs. transrectal （TR） prostate biopsy. A systematic research of PUBM ED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer （PCa） detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen （PSA） levels and digital rectal examination （DRE） findings. The Cochrane Collaboration＇s RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials （RCTs） and four casecontrol studies （CCS）, met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups （risk difference （RD）, -0.02; 95% confidence interval （CI）, -0.08-0.03; P=0.34）. Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group （RD, -0.01; 95% CI, -0.05-0.04; P=0.81）. There was no significant difference in PCa detection rate between the saturation TR and TP approaches （31.4% vs. 25.7%, respectively;P=0.3）. There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists.展开更多
Objectives—to determine correlation between GSs(Gleason scores)on needle biopsy and RP(radical prostatectomy),evaluating diagnostic tests on biopsy and RP within the last years,between 1984 and 2018.Method—analysis ...Objectives—to determine correlation between GSs(Gleason scores)on needle biopsy and RP(radical prostatectomy),evaluating diagnostic tests on biopsy and RP within the last years,between 1984 and 2018.Method—analysis of 100 patients,diagnosed with PCa(prostate cancer)needle biopsy using 18-gauge needle,who underwent RP with lymphadenectomy and for which preoperative and postoperative GSs were available.GS group analysis used three categorization schemes for differentiation:mild,moderate and poor for the whole group and we determined SE(sensitivity),SP(specificity),PVPR(positive predictive value),negative predictive value and accuracy.Results—we found that 42%of the patients had no changes between GS on biopsy and prostatectomy,while 20%were overgraded and 38%undergraded by needle biopsy.Graduation of+1 point in GS(32%)or-1 point(17%)was the most common.Most patients were classified as moderately differentiated by biopsies(78 and 35%in scheme 1 and 2 or 3,respectively),while 43%of patients received an intermediate differentiation classification.Biopsy accuracy varied from 44 to 76%for the analysis of all three schemes.Conclusion—there are differences in correlation between GS on biopsy and on surgical specimen,and Gleason’s graduation also depends on the experience of the pathologist.We have shown that sextant biopsies using 18-gauge and a same group of pathologists showed acceptable concordance values(42%)between the GS on biopsy and prostatectomy.展开更多
Prostate biopsy is a very common procedure performed worldwide which still represents the only way for prostate cancer diagnosis and reference point for subsequent treatments. Even if transrectal prostate biopsy is co...Prostate biopsy is a very common procedure performed worldwide which still represents the only way for prostate cancer diagnosis and reference point for subsequent treatments. Even if transrectal prostate biopsy is considered a safe procedure, it may be accompanied by infective complications, ranging from asymptomatic bacteriuria to symptomatic urinary tract infections and sepsis. During the recent decade we observed an increasing number of infectious complications and subsequent hospitalizations after and transrectal prostate biopsy. The most probable reason for the increasing rate of infectious complications after prostate biopsy is the increasing antimicrobial resistance, especially to the current first-line recommended fluoroquinolone antibiotics. We believe the time has come to re-think our current practice of diagnosing prostate cancer. We need to focus on the selection of patients at higher risk of infective complications, on microbiological sampling of the faecal flora prior to biopsy to identify resistance to specific agents, on the number of biopsy cores, on the biopsy route(perineal or transrectal approach) and, finally, consider alternative antibiotics with improved susceptibility to be used for prophylaxis.展开更多
Prostate cancer is the most common neoplasm diagnosed in men. Whilst treatment modalities have progressed, diagnostic investigations in terms of biopsy methods have been assessed but there is no consensus of when the ...Prostate cancer is the most common neoplasm diagnosed in men. Whilst treatment modalities have progressed, diagnostic investigations in terms of biopsy methods have been assessed but there is no consensus of when the different diagnostic methods in terms of transrectal ultrasound(TRUS) or transperineal template(TPT) should be utilised. TPT biopsy has a higher diagnostic yield than TRUS in those with a primary biopsy, in those with previous negative biopsies with TRUS as well as those undergoing saturation biopsies. Despite the increased likelihood of diagnosing cancer with TPT than TRUS this maybe secondary to the increasednumber of biopsies being utilised. However there is no consensus regarding the ideal number of biopsies that should be utilised with TPT. Furthermore it is felt that the increased number of biopsies utilised with TPT is associated the higher complication rates with TPT. The role of TPT biopsy is recognised in those with previous negative biopsies with transrectal ultrasound but further work is required regarding the ideal number of biopsies. Furthermore, it is felt that TPT biopsy may have a role in primary biopsy.展开更多
The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data Sy...The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data System(PI-RADS)system for avoiding unnecessary mpMRI-guided targeted biopsy(TB).From January 2018 to October 2019,fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients.The study included 188 suspicious lesions on mpMRI in 156 patients,all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy(SB).Univariate analyses were performed to investigate the relationship between TRUS features and PCa.Then,logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa.The detection rates of PCa based on TB alone,SB alone,and combined SB and TB were 55.9%(105 of 188),52.6%(82 of 156),and 62.8%(98 of 156),respectively.The significant predictors of PCa on TRUS were hypoechogenicity(odds ratio[OR]:9.595,P=0.002),taller-than-wide shape(OR:3.539,P=0.022),asymmetric vascular structures(OR:3.728,P=0.031),close proximity to capsule(OR:3.473,P=0.040),and irregular margins(OR:3.843,P=0.041).We propose subgrouping PI-RADS score 3 into categories 3a,3b,3c,and 3d based on different numbers of TRUS predictors,as the creation of PI-RADS 3a(no suspicious ultrasound features)could avoid 16.7%of mpMRI-guided TBs.Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.展开更多
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 peo...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.展开更多
We aimed to determine short-term patient-reported outcomes in men having general anesthetic transperineal （TP） prostate biopsies. A prospective cohort study was performed in men having a diagnostic TP biopsy. This w...We aimed to determine short-term patient-reported outcomes in men having general anesthetic transperineal （TP） prostate biopsies. A prospective cohort study was performed in men having a diagnostic TP biopsy. This was done using a validated and adapted questionnaire immediately post-biopsy and at follow-up of between 7 and 14 days across three tertiary referral hospitals with a response rate of 51.6%. Immediately after biopsy 43/201 （21.4%） of men felt light-headed, syncopal, or suffered syncope. Fifty-three percent of men felt discomfort after biopsy （with 95% scoring 〈5 in a 0-10 scale）. Twelve out of 196 men （6.1%） felt pain immediately after the procedure. Despite a high incidence of symptoms （e.g., up to 75% had some hematuria, 47% suffered some pain）, it was not a moderate or serious problem for most, apart from hemoejaculate which 31 men suffered. Eleven men needed catheterization （5.5%）. There were no inpatient admissions due to complications （hematuria, sepsis）. On repeat questioning at a later time point, only 25/199 （12.6%） of men said repeat biopsy would be a significant problem despite a significant and marked reduction in erectile function after the procedure. From this study, we conclude that TP biopsy is well tolerated with similar side effect profiles and attitudes of men to repeat biopsy to men having TRUS biopsies. These data allow informed counseling of men prior to TP biopsy and a benchmark for tolerability with local anesthetic TP biopsies being developed for clinical use.展开更多
This study aimed to assess the role of prostate-specific antigen density(PSAD)and negative multiparametric magnetic resonance imaging(mpMRI)in predicting prostate cancer for biopsy-naive men based on a large cohort of...This study aimed to assess the role of prostate-specific antigen density(PSAD)and negative multiparametric magnetic resonance imaging(mpMRI)in predicting prostate cancer for biopsy-naive men based on a large cohort of the Chinese population.From a prostate biopsy database between March 2017 and July 2021,we retrospectively identified 240 biopsy-naive patients with negative prebiopsy mpMRI(Prostate Imaging Reporting and Data System version 2[PI-RADS v2]score<3).Logistic regression analysis was performed to select the potential predictors for clinically significant prostate cancer(csPCa).Receiver operating characteristic(ROC)curve analysis and area under the ROC curve(AUC)were performed to assess the diagnostic accuracy.The negative predictive values of mpMRI in excluding any cancer and csPCa were 83.8%(201/240)and 90.8%(218/240),respectively.R0C curve analysis indicated that PSAD was the most promising predictor,with an AUC value of 0.786(95%confidence interval[CI]:0.699-0.874),and multiparametric logistic regression analysis confirmed that higher PSAD remained a significant marker for predicting csPCa(odds ratio[0R]:10.99,95%CI:2.75-44.02,P<0.001).Combining negative mpMRI and PSAD below 0.20 ng ml^(-2)obviously increased the predictive value in excluding PCa(91.0%,101/111)or csPCa(100.0%,111/111).If a PSAD below 0.20 ng ml^(-2)was set as the criterion to omit biopsy,nearly 46.3%of patients(463 per 1000)with negative mpMRI could safely avoid unnecessary biopsy,with approximately 4.2%of patients(42 per 1000)at risk of missed diagnosis of PCa and no patients with csPCa missed.A PI-RADS v2 score<3 and a PSAD<0.20 ng ml^(-2)could be potential criteria for the Chinese population to omit prompt biopsy safely.展开更多
Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate v...Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate volume,individually and in combination,for the detection of prostate cancer(Pca)in biopsy-naïve patients.Methods:We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging.A standard 12-core biopsy procedure was performed.Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not Pca.Results:The median age,PSA level,and PSAD were 70 years,8.6 ng/mL,and 0.18 ng/mL/mL,respectively.A total of 374(59.4%)of 630 patients were biopsy-positive for Pca,and 241(64.4%)of 374 were diagnosed with clinically significant Pca(csPCa).The PI-RADS v2 score and PSAD were independent predictors of Pca and csPCa.The PI-RADS v2 score of 5 regardless of the PSAD value,or PI-RADS v2 score of 4 plus a PSAD of<0.3 ng/mL/mL,was associated with the highest csPCa detection rate(36.1%-82.1%).Instead,the PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL yielded the lowest risk of csPCa.Conclusion:The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies.Patients with a PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL could potentially avoid a prostate biopsy.展开更多
文摘Introduction: Prostate cancer (PCa) is the third most prevalent cancer among Malaysian males, often diagnosed at advanced stages, leading to suboptimal outcomes. While transrectal ultrasound-guided systematic biopsy (TRUS-SB) is the primary diagnostic method, prebiopsy multiparametric magnetic resonance imaging (mpMRI) is gaining popularity in identifying suspicious lesions. This study addresses the lack of comprehensive investigations into the efficacy of cognitive registration TRUS targeted biopsy (COG-TB) compared to conventional TRUS-SB, considering the resource limitations of the Malaysian healthcare system. Materials and Methods: A retrospective cohort study was conducted in two Malaysian healthcare facilities. 116 adult patients with a prostate-specific antigen (PSA) level of more than 4 ng/mL who underwent both COG-TB and TRUS-SB between October 2020 and March 2022 were included. Primary outcomes were cancer detection rate and histopathological outcomes, including Gleason score. Results: COG-TB showed a higher overall cancer detection rate (50%) compared to TRUS-SB (44%). Clinically significant cancer detection rates were similar between COG-TB and TRUS-SB (37.1%). Further analysis revealed that both COG-TB and TRUS-SB detected clinically significant cancer in 30.2% of patients, did not detect it in 56.0%, and had conflicting findings in 16 patients (p Conclusion: COG-TB and TRUS-SB have comparable detection rates for clinically significant prostate cancer, with COG-TB showing a higher tendency to detect insignificant prostate cancer. Further studies comparing these methods are warranted.
文摘Objective To study the effects of 1% tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound （TRUS）-guided prostate biopsy. Methods A total of 100 patients receiving TRUS-guided prostate biopsy were divided into two groups with 50 in each. In Group 1, patients received liquid paraffin, and in Group 2, patients were given 1% tetracaine hydrochloride jelly before biopsy. Pain score was measured by horizontal visual analogue scales （ VAS ）, and pain and discomfort were compared between the two groups. Results The average pain scores at the time of insertion of the ultrasound probe were 2. 9 ＋_1. 7 and 1. 4 ＋_1. 8 （ P =0. 000） and the average pain scores at the time of performing biopsy were 5. 2 ＋-1. 5 and 3. 1 ＋ 1. 7 （P =0. 000） in Group 1 and Group 2, respectively. There were no significant differences between the two groups in terms of age, serum prostate specific antigen, digital rectal examination, TRUS, and biopsy core number （ P 〉 O. 05 ）. There were no significant differences of complications after biopsy, such as hematuria, acute urinary retention, urinary tract infection, rectum bleeding, and fever （ P 〉0. 05）. Conclusion TRUS-guided prostate biopsy is safe. Use of 1% tetracaine hydrochloride jelly in the rectum and anus before TRUS-guided prostate biopsy is an effective method for relieving TRUS-guided prostate biopsy-induced pain during the procedure.
基金This review was supported by Nationnal Natural Science Foundation of China （NSFC 81172439）.
文摘This systematic review was performed to compare the efficacy and complications of transperineal （TP） vs. transrectal （TR） prostate biopsy. A systematic research of PUBM ED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer （PCa） detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen （PSA） levels and digital rectal examination （DRE） findings. The Cochrane Collaboration＇s RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials （RCTs） and four casecontrol studies （CCS）, met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups （risk difference （RD）, -0.02; 95% confidence interval （CI）, -0.08-0.03; P=0.34）. Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group （RD, -0.01; 95% CI, -0.05-0.04; P=0.81）. There was no significant difference in PCa detection rate between the saturation TR and TP approaches （31.4% vs. 25.7%, respectively;P=0.3）. There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists.
文摘Objectives—to determine correlation between GSs(Gleason scores)on needle biopsy and RP(radical prostatectomy),evaluating diagnostic tests on biopsy and RP within the last years,between 1984 and 2018.Method—analysis of 100 patients,diagnosed with PCa(prostate cancer)needle biopsy using 18-gauge needle,who underwent RP with lymphadenectomy and for which preoperative and postoperative GSs were available.GS group analysis used three categorization schemes for differentiation:mild,moderate and poor for the whole group and we determined SE(sensitivity),SP(specificity),PVPR(positive predictive value),negative predictive value and accuracy.Results—we found that 42%of the patients had no changes between GS on biopsy and prostatectomy,while 20%were overgraded and 38%undergraded by needle biopsy.Graduation of+1 point in GS(32%)or-1 point(17%)was the most common.Most patients were classified as moderately differentiated by biopsies(78 and 35%in scheme 1 and 2 or 3,respectively),while 43%of patients received an intermediate differentiation classification.Biopsy accuracy varied from 44 to 76%for the analysis of all three schemes.Conclusion—there are differences in correlation between GS on biopsy and on surgical specimen,and Gleason’s graduation also depends on the experience of the pathologist.We have shown that sextant biopsies using 18-gauge and a same group of pathologists showed acceptable concordance values(42%)between the GS on biopsy and prostatectomy.
文摘Prostate biopsy is a very common procedure performed worldwide which still represents the only way for prostate cancer diagnosis and reference point for subsequent treatments. Even if transrectal prostate biopsy is considered a safe procedure, it may be accompanied by infective complications, ranging from asymptomatic bacteriuria to symptomatic urinary tract infections and sepsis. During the recent decade we observed an increasing number of infectious complications and subsequent hospitalizations after and transrectal prostate biopsy. The most probable reason for the increasing rate of infectious complications after prostate biopsy is the increasing antimicrobial resistance, especially to the current first-line recommended fluoroquinolone antibiotics. We believe the time has come to re-think our current practice of diagnosing prostate cancer. We need to focus on the selection of patients at higher risk of infective complications, on microbiological sampling of the faecal flora prior to biopsy to identify resistance to specific agents, on the number of biopsy cores, on the biopsy route(perineal or transrectal approach) and, finally, consider alternative antibiotics with improved susceptibility to be used for prophylaxis.
文摘Prostate cancer is the most common neoplasm diagnosed in men. Whilst treatment modalities have progressed, diagnostic investigations in terms of biopsy methods have been assessed but there is no consensus of when the different diagnostic methods in terms of transrectal ultrasound(TRUS) or transperineal template(TPT) should be utilised. TPT biopsy has a higher diagnostic yield than TRUS in those with a primary biopsy, in those with previous negative biopsies with TRUS as well as those undergoing saturation biopsies. Despite the increased likelihood of diagnosing cancer with TPT than TRUS this maybe secondary to the increasednumber of biopsies being utilised. However there is no consensus regarding the ideal number of biopsies that should be utilised with TPT. Furthermore it is felt that the increased number of biopsies utilised with TPT is associated the higher complication rates with TPT. The role of TPT biopsy is recognised in those with previous negative biopsies with transrectal ultrasound but further work is required regarding the ideal number of biopsies. Furthermore, it is felt that TPT biopsy may have a role in primary biopsy.
基金This work was supported in part by the National Natural Science Foundation of China(No.81671695,81725008,81801700 and 81927801)Fundamental Research Funds for the Central Universities(No.22120190213)+1 种基金Shanghai Municipal Health Commission(No.2019LJ21 and SHSLCZDZK03502)the Science and Technology Commission of Shanghai Municipality(No.19DZ2251100 and 19441903200).
文摘The purpose of this study was to explore transrectal ultrasound(TRUS)findings of prostate cancer(PCa)guided by multiparametric magnetic resonance imaging(mpMRI)and to improve the Prostate Imaging Reporting and Data System(PI-RADS)system for avoiding unnecessary mpMRI-guided targeted biopsy(TB).From January 2018 to October 2019,fusion mpMRI and TRUS-guided biopsies were performed in 162 consecutive patients.The study included 188 suspicious lesions on mpMRI in 156 patients,all of whom underwent mpMRI-TRUS fusion imaging-guided TB and 12-core transperineal systematic biopsy(SB).Univariate analyses were performed to investigate the relationship between TRUS features and PCa.Then,logistic regression analysis with generalized estimating equations was performed to determine the independent predictors of PCa and obtain the fitted probability of PCa.The detection rates of PCa based on TB alone,SB alone,and combined SB and TB were 55.9%(105 of 188),52.6%(82 of 156),and 62.8%(98 of 156),respectively.The significant predictors of PCa on TRUS were hypoechogenicity(odds ratio[OR]:9.595,P=0.002),taller-than-wide shape(OR:3.539,P=0.022),asymmetric vascular structures(OR:3.728,P=0.031),close proximity to capsule(OR:3.473,P=0.040),and irregular margins(OR:3.843,P=0.041).We propose subgrouping PI-RADS score 3 into categories 3a,3b,3c,and 3d based on different numbers of TRUS predictors,as the creation of PI-RADS 3a(no suspicious ultrasound features)could avoid 16.7%of mpMRI-guided TBs.Risk stratification of PCa with mpMRI-TRUS fusion imaging-directed ultrasound features could avoid unnecessary mpMRI-TBs.
文摘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.
文摘We aimed to determine short-term patient-reported outcomes in men having general anesthetic transperineal （TP） prostate biopsies. A prospective cohort study was performed in men having a diagnostic TP biopsy. This was done using a validated and adapted questionnaire immediately post-biopsy and at follow-up of between 7 and 14 days across three tertiary referral hospitals with a response rate of 51.6%. Immediately after biopsy 43/201 （21.4%） of men felt light-headed, syncopal, or suffered syncope. Fifty-three percent of men felt discomfort after biopsy （with 95% scoring 〈5 in a 0-10 scale）. Twelve out of 196 men （6.1%） felt pain immediately after the procedure. Despite a high incidence of symptoms （e.g., up to 75% had some hematuria, 47% suffered some pain）, it was not a moderate or serious problem for most, apart from hemoejaculate which 31 men suffered. Eleven men needed catheterization （5.5%）. There were no inpatient admissions due to complications （hematuria, sepsis）. On repeat questioning at a later time point, only 25/199 （12.6%） of men said repeat biopsy would be a significant problem despite a significant and marked reduction in erectile function after the procedure. From this study, we conclude that TP biopsy is well tolerated with similar side effect profiles and attitudes of men to repeat biopsy to men having TRUS biopsies. These data allow informed counseling of men prior to TP biopsy and a benchmark for tolerability with local anesthetic TP biopsies being developed for clinical use.
基金supported by the National Natural Science Foundation of China(grant No.81974099,82170785,81974098,82170784)programs from Science and Technology Department of Sichuan Province(grant No.21GJHZ0246)+2 种基金Young Investigator Award of Sichuan University 2017(grant No.2017SCU04A17)Technology Innovation Research and Development Project of Chengdu Science and Technology Bureau(No.2019-YF05-00296-SN)Sichuan University-Panzhihua science and technology cooperation special fund(No.2020CDPZH-4).
文摘This study aimed to assess the role of prostate-specific antigen density(PSAD)and negative multiparametric magnetic resonance imaging(mpMRI)in predicting prostate cancer for biopsy-naive men based on a large cohort of the Chinese population.From a prostate biopsy database between March 2017 and July 2021,we retrospectively identified 240 biopsy-naive patients with negative prebiopsy mpMRI(Prostate Imaging Reporting and Data System version 2[PI-RADS v2]score<3).Logistic regression analysis was performed to select the potential predictors for clinically significant prostate cancer(csPCa).Receiver operating characteristic(ROC)curve analysis and area under the ROC curve(AUC)were performed to assess the diagnostic accuracy.The negative predictive values of mpMRI in excluding any cancer and csPCa were 83.8%(201/240)and 90.8%(218/240),respectively.R0C curve analysis indicated that PSAD was the most promising predictor,with an AUC value of 0.786(95%confidence interval[CI]:0.699-0.874),and multiparametric logistic regression analysis confirmed that higher PSAD remained a significant marker for predicting csPCa(odds ratio[0R]:10.99,95%CI:2.75-44.02,P<0.001).Combining negative mpMRI and PSAD below 0.20 ng ml^(-2)obviously increased the predictive value in excluding PCa(91.0%,101/111)or csPCa(100.0%,111/111).If a PSAD below 0.20 ng ml^(-2)was set as the criterion to omit biopsy,nearly 46.3%of patients(463 per 1000)with negative mpMRI could safely avoid unnecessary biopsy,with approximately 4.2%of patients(42 per 1000)at risk of missed diagnosis of PCa and no patients with csPCa missed.A PI-RADS v2 score<3 and a PSAD<0.20 ng ml^(-2)could be potential criteria for the Chinese population to omit prompt biopsy safely.
文摘Background:To evaluate the predictive values of Prostate Imaging Reporting and Data System version 2(PI-RADS v2),prostate-specific antigen(PSA)level,PSA density(PSAD),digital rectal examination findings,and prostate volume,individually and in combination,for the detection of prostate cancer(Pca)in biopsy-naïve patients.Methods:We retrospectively analyzed 630 patients who underwent transrectal systematic prostate biopsy following prostate multiparametric magnetic resonance imaging.A standard 12-core biopsy procedure was performed.Univariate and multivariate analyses were performed to determine the significant predictors of clinically significant cancer but not Pca.Results:The median age,PSA level,and PSAD were 70 years,8.6 ng/mL,and 0.18 ng/mL/mL,respectively.A total of 374(59.4%)of 630 patients were biopsy-positive for Pca,and 241(64.4%)of 374 were diagnosed with clinically significant Pca(csPCa).The PI-RADS v2 score and PSAD were independent predictors of Pca and csPCa.The PI-RADS v2 score of 5 regardless of the PSAD value,or PI-RADS v2 score of 4 plus a PSAD of<0.3 ng/mL/mL,was associated with the highest csPCa detection rate(36.1%-82.1%).Instead,the PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL yielded the lowest risk of csPCa.Conclusion:The combination of the PI-RADS v2 score and PSAD could prove to be a helpful and reliable diagnostic tool before performing prostate biopsies.Patients with a PI-RADS v2 score of<3 and PSAD of<0.3 ng/mL/mL could potentially avoid a prostate biopsy.
