ABSTRACT
Background: Prostate carcinoma screening tests usually include digital rectal examination (DRE) and prostate-specific antigen (PSA) levels. If these tests detect some abnormality, further evaluation is recommended using transrectal ultrasound (TRUS), TRUS guided biopsy, or magnetic resonance imaging (MRI). MRI is a preferred tool among three as its noninvasive and has high sensitivity and specificity. In MRI, most of the medical centers perform multi-parametric MRI. The present study is an endeavor to evaluate the feasibility of using biparametric study for detection of prostate cancer; thereby reducing the scan time and avoiding the use of contrast. Objective: The objective of the study was to compare the diagnostic efficacy of using biparametric MRI (T2-weighted imaging [T2WI] and Diffusion-weighted images [DWI]) for detection of carcinoma prostate as compared to multiparametric MR study which in addition also includes dynamic contrast-enhanced (DCE) and spectroscopic MRI sequences. Materials and Methods: This prospective cross-sectional study included 60 patients suspected to have prostate cancer on the basis of PSA levels and DRE. All the patients underwent pre-treatment MRI on 1.5 T scanner followed by TRUS guided biopsy. MRI protocol included T1-weighted images, T2W, DWI, DCE MRI, and MR spectroscopy. The diagnostic performance of T2WI + DWI and multi-parametric MRI for diagnosis of prostate cancer was determined and compared with each other using histopathology as the gold standard. Results: The sensitivity for detection of carcinoma prostate for biparametric MRI (T2WI + DWI) is 63.3%, specificity 78.95%, positive predictive value (PPV) 86.6%, and negative predictive value of (NPV) 50.00%. The sensitivity of multiparametric MRI was 78.05%, specificity 68.42 % with PPV 84.2%, and NPV of 59.09%. Conclusion: For the detection of prostate cancer biparametric (DWI/T2WI) and multi-parametric MRI both showed comparable results. Multi-parametric MRI involves the administration of intravenous contrast and requires longer acquisition time; T2/DWI is faster and non-contrast sequences and is workhorse sequence in the detection of prostate cancer.
ABSTRACT
Objectives: We prospectively evaluated our perioperative and five-year oncological results of 200 cases of open radical cystectomy with urinary diversion, for formulating contemporary benchmarks, for future comparison of minimally invasive techniques. This is one of the largest prospective series reported from India of open radical cystectomy. Materials and Methods: Between 2004 and 2009, patients undergoing open radical cystectomy with urinary diversion, at our institution, were prospectively enrolled in the study. Data were recorded and analyzed statistically. Results: Two hundred patients were enrolled in the study. The mean age was 65.1 years. The patients undergoing ileal conduit and orthotopic neobladder were 159 (79.5%) and 41 (20.5%), respectively. The mean operating time was 275 minutes. The mean operating time for ileal conduit and orthotopic neobladder were 262 minutes and 288 minutes, respectively. The mean estimated blood loss was 690 ml. Blood transfusion was required in 37 (18.5%) patients. The mean hospital stay was 6.1 days. Major and minor complications were recorded in 16 (8%) and 31 (15.5%) patients, respectively. Perioperative mortality was recorded in only two (1.5%) patients. The pathologically organ-confined and non-organ-confined cases were 135 (67.5%) and 65 (32.5%), respectively. Thirty-three (16.5%) patients had pathologically confirmed lymph nodes. Median follow-up was 60.1 months. Local recurrence and distant metastases were recorded in 16 (8%) and nine (4.5%) patients, respectively. A five-year disease-free survival, cancer-specific survival, and overall survival were 75.5, 71.5, and 63.5%, respectively. Conclusions: Open radical cystectomy has an acceptable perioperative morbidity and mortality, along with a favorable five-year oncological efficacy. Minimally invasive techniques need a long-term prospective comparison with this approach, before being accepted as a standard treatment for urinary bladder malignancy.