Estimation of prostate size by trans-rectal ultrasound and its correlation with DRE and endoscopic grading

Aim: Digital rectal examination (DRE) grading and the grade of prostatomegaly on cystoscopy are routinely used in clinical practice, but its correlation to prostate volume is understudied. This study was done to assess the correlation of DRE and endoscopic grading with the prostate volume on trans-rectal ultrasound (TRUS). Materials and Methods: This study was carried out in 101 eligible patients with prostatomegaly. Each patient was evaluated for three parameters, prostate volume by TRUS examination, DRE and endoscopic grading on cystoscopy. Pearson correlation coefficient was calculated to find the correlation between variables, p<0.05 was taken to be statistically significant. Data were analyzed using the Epi Info (TM) 7.2.2.2. Results: Significant positive correlation (p<0.001) was found between TRUS Volume and DRE grading (Pearson Correlation=0.945) and TRUS volume and Endoscopic grading (Pearson Correlation=0.949). Both the grading were also significantly positively correlated (Pearson Correlation=0.989, p<0.001). Conclusion: Our attempt for correlating the digital rectal grading and endoscopic grading with prostate volume is satisfactorily validated in the clinical setting. These grades are sufficient to provide a rough estimation of the prostate volume and to classify patients with prostatomegaly.

Initial Experience of Transperineal Biopsy After Multiparametric Magnetic Resonance Imaging in Korea; Comparison With Transrectal Biopsy

PURPOSE: The aim of this study is to confirm the detection rate of transperineal biopsy after multiparametric magnetic resonance imaging (mpMRI) and compared it to that of transrectal biopsy. We also examined the role of mpMRI and the rate of complications for each method. MATERIALS AND METHODS: In a retrospective study, we analyzed 147 patients who underwent mpMRI before prostate biopsy because of elevated serum prostate-specific antigen and/or abnormal digital rectal examination findings at Korea University Hospital, Seoul, Korea from March 2017 to April 2018. Regions on the mpMRI that were suggestive of prostate cancer were categorized according to the Prostate Imaging–Reporting and Data System (PI-RADS v2). For transperineal biopsy, a 20-core saturation biopsy was performed by MRI-TRUS cognitive or fusion techniques and a 12-core biopsy was performed in transrectal biopsy. RESULTS: Sixty-three and 84 patients were enrolled in transperineal group and transrectal group, respectively. The overall detection rate of prostate cancer in transperineal group was 27% higher than that in transrectal group. Classification according to PI-RADS score revealed a significant increase in detection rate in all patients, as the PI-RADS score increased. Frequency of complications using the Clavien-Dindo classifications revealed no significant differences in the total complications rate, but two patients in transrectal group received intensive care unit care due to urosepsis. CONCLUSIONS: Our results confirmed that transperineal biopsy is superior to transrectal biopsy for the detection of prostate cancer. From the complication point of view, this study confirmed that there were fewer severe complications in transperineal biopsy.

The value of transrectal ultrasound and magnetic resonance imaging fusion targeted prostate biopsy in biopsy-naive men / 中华泌尿外科杂志

Objective To estimate the value of transrectal ultrasound/magnetic resonance imaging (TRUS/MR) fusion targeted prostate biopsy(targeted biopsy,TB) in the biopsy naive patients.Methods Between September 2015 and September 2016,91 patients with PI-RADS ≥ 3 suspicious regions on the multiparametric magnetic resonance imaging (mpMRI) were retrospectively evaluated.The age of patients was 46-83 years (median 68).Serum PSA level before biopsy was 1.2-85 ng/ml (median 11.2 ng/ ml),in which 36 cases with PSA ＜ 10 ng/ml,30 cases 10-20 ng/ml,and 25 cases ＞ 20 ng/ml.Two-core TB using real-time virtual sonography (RVS) platform for mpMRI-suspicious lesions was followed by 12-core systematic biopsy (SB).The detection rates for any cancer (PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB.Results The total detection rate for PCa was 57.1％,with a comparable positive rate between TB (44.0％) and SB (51.7％) groups which did not significantly differ (P =0.14).The proportion of CsPCa in TB group was higher than that in SB group (80.0％ vs.68.1％,P =0.21).In TB group,detection of PCa for grade 5 lesions was significantly higher than that for grade 3 lesions (77.1％ vs.10.3％,P ＜0.001).Detection of PCa was comparable between TB and SB groups in different regions of PSA ＜ 10 ng/ml,10 ～ 20ng/ml and ＞ 20ng/ml (27.8％ vs.36.1％,50％ vs.56.7％,60％ vs.68％,respectively).Conclusions This study revealed a similar rate of prostate cancer detection between 2-core targeted biopsy guided by TRUS/MR fusion and 12-core random biopsy in different PSA regions for no prior biopsy men.TB maybe tend to detect high proportion of CsPCa.PI-RADS is instructive to select appropriate patients for TB.

Focusing on MRI-suspected lesions in targeted transrectal prostate biopsy guided by MRI-TRUS fusion imaging for the diagnosis of prostate cancer / 中华男科学杂志

<p><b>Objective</b>To improve the accuracy of prostate cancer (PCa) detection by focusing biopsy on the suspected lesion manifested by MRI with the total number of biopsy cores relatively unchanged.</p><p><b>METHODS</b>A prospective randomized analysis was performed on 262 cases of suspected PCa detected by multi-parametric MRI (mp-MRI), each with a single suspected lesion with 10 μg/L≤ PSA <20 μg/L. All the patients underwent targeted transrectal prostate biopsy guided by fusion imaging of MRI with transrectal ultrasonography (TRUS), using the 6X+6 strategy (6 cores in the suspected region and another 6 in the systematic prostate) for 134 cases and the traditional 12+2X method (12 cores in the systematic prostate and 2 in the suspected region) for the other 128. Comparisons were made between the two methods in the PCa detection rate in the cases of suspected lesion, total PCa detection rate, incidence of post-biopsy complications, and Gleason scores. Analyses were performed on the prostate imaging reporting and data system (PI-RADS) score, location, transverse section, and diameter of the suspected lesion.</p><p><b>RESULTS</b>Both the total PCa detection rate and that in the cases of suspected lesion were significantly higher in the 6X+6 (44.8% and 37.3%) than in the 12+2X group (37.5% and 27.3%) (P<0.05). MRI showed that the suspected lesions were mostly (45%) located in the middle part of the prostate, the mean area of the transverse section was (0.48±0.11) cm2, and the mean diameter of the tumor was (8.51±2.21) mm. The results of biopsy showed that low-grade tumors (Gleason 3+3=6) accounted for 68% in the 6X+6 group and 71% in the 12+2X group. No statistically significant differences were found between the two groups in the incidence rate of post-biopsy complications.</p><p><b>CONCLUSIONS</b>Compared with the traditional 12+2X method, for the suspected lesion manifested by mp-MRI, focusing biopsy on the suspected region with the 6X+6 strategy can achieve a higher PCa detection rate without increasing the incidence of complications.</p>

Correlation between Gleason scores of prostatic biopsies and radical prostatectomy specimens.

Objective: The incidence of prostatic adenocarcinoma in Thailand has been increasing since 1989. Increased public awareness may have contributed to early detection of the disease. Findings of abnormal digital examination, elevated serum prostate-specific antigen (PSA) level and abnormal transrectal ultrasonography (TRUS) lead to more multiple core biopsies. The Gleason grading system is the most common histologic grading of prostate carcinoma as approved by the World Health Organization. The Gleason score, one of the prognostic predictors, thus plays an important part in the therapeutic decision. The correlation between Gleason scores in biopsies and subsequent prostatectomy specimens is the main purpose of this study. Associations of Gleason scores with organ confinement, perineural invasion and serum PSA levels before prostatectomy were also studied. Methods: The specimens from 100 patients, who underwent TRUS core biopsy and subsequent prostatectomy between January 2001 and June 2004, were included. Results: Gleason grade concordance was found in 35 cases. In TRUS core biopsy, 35, 9, and 1 cases were 1, 2, and 3 scores undergraded, respectively. Thirteen and 7 cases were 1 and 2 scores overgraded, respectively. Eighty three percent show a difference of not more than 1 score. Conclusion: We concluded that the Gleason scoring in prostatic biopsy remains a good predictor of the final Gleason grading of the radical prostatectomy specimen. However, the urologists and radiotherapists should keep in mind that undergrading and overgrading in TRUS core biopsies are both possible.

Proper Measurement of the Prostate Volume by Transrectal Ultrasound: Experimental Study about the Prostate with Focal Intravesical Protrusion of the Enlarged Central Gland

PURPOSE: To evaluate the proper volume measurement of prostate with focal intravesical protrusion of enlarged central gland by comparison between methods using craniocaudal length from top of protruded central gland and from prostate base near bladder neck to prostate apex. MATERIALS AND METHODS: We made 20 prostate models with focal intravesical protrusion (volume range: 20~50 mL, height of protrusion: about 1 cm) using devil's tongue jelly. Two radiologists measured volume of models 3 times by two kinds of methods using craniocaudal length from top of protruded central gland (method 1) and from prostate base near bladder neck (method 2) by transrectal ultrasound. The accuracy of volume measurement of models was evaluated statistically by comparing their average volume to true volume. Intra- and interobserver agreement was also evaluated. RESULTS: Average true volume of models was 31.05 mL. Each average volume using method 1 by two observers was 37.07 mL and 38.56 mL. Each average volume using method 2 was 30.69 mL and 31.55 mL. Volume measurement using method 2 was approximated to true volume of prostate statistically (p = .654, .823). There was no significant inter- and intra-observer variation in both methods. CONCLUSION: To measure the accurate volume of porstate with focal intravesical protrusion of enlarged central gland, its craniocaudal length should be measured from prostate base near bladder neck.

La vaporización fotoselectiva del adenoma prostático con el ktp-láser (kalium-titanyl-phosphat) de 80 watt y la RTU-P de baja presión hidráulica / The photoselective vaporization of prostate adenoma with the 80 watt ktp-laser (kalium-titanyl-phosphat) and the low hydraulic pressure tur-p

El objetivo de este trabajo prospectivo es determinar la eficacia del método KTP-láser de 80 watt para la vaporización y ablación de la HPB sintomática. También se analizan los resultados al combinar el KTP-láser con la RTU-P y su repercusión sobre la hemoglobina. Material y Método: 300 pacientes con HPB sintomática fueron tratados entre agosto del 2004 y noviembre del 2006 con el KTPláser o combinado con RTU-P. La resección adicional fue efectuada en pacientes con adenomas grandes o por lóbulo medio acentuado. El efecto ablativo fue controlado al final de la operación por medio de TRUS. Resultados: 300 pacientes fueron tratados en 2 grupos. El grupo 1 (n: 50) con sólo tratamiento láser y pequeños adenomas, la hemoglobina se redujo un 3,2 por ciento y nadie requirió una transfusión. El grupo 2 (n: 250) con tratamiento combinado de KTP-láser y RTU-P en adenomas grandes, la hemoglobina se redujo en promedio 15,2 por ciento después de la intervención; 2 pacientes (0,8 por ciento) necesitaron una transfusión. Conclusión: El estudio pone de manifiesto, las ventajas de combinar ambos procedimientos quirúrgicos para obtener un mejor resultado en la ablación del adenoma sobre todo en próstatas de gran tamaño.

The objective of this prospective study is to determine the effectiveness of the 80 watt KTP laser method for the vaporization and ablation of the symptomatic BPH. Also the results when combining the KTP-laser with the TUR-P and their repercussion on the haemoglobin are analysed. Material and Method: 300 patients with symptomatic BPH were treated between august 2004and november 2006 with the KTP-Laser or combined with TUR-P. The additional Resection was carried out in those patients with great adenomas or to have accentuated middle lobule. The ablative effect was controlledat the end of the operation with TRUS (transrectal ultrasound). Results: 300 patients were treated in 2 groups. The group 1 (n: 50) just by laser treatment and small adenomas, the haemoglobin was reduced a 3.2 percent and nobody required a transfusion. Group 2 (n: 250) with combined treatment of KTP-laser and TURP in great adenomas, the haemoglobin was reduced in average 15,2 percent after the intervention; 2 patients (0,8 percent) needed a transfusion. Conclusion: Our study puts of open, the advantages to combine both surgical procedures to mainly obtain a better result in the ablation of the prostate adenoma in prostates of great size.

Predictability of PSA, DRE and TRUS for Detection of Prostatic Cancer in Considering the Non-surgical Treatment of BPH Patients / 대한비뇨기과학회지

Recently, some forms of non-surgical treatment modalities for BPH such as microwave or laser induced hyperthermia have been available and its demand by patient is increasing. The advantage of these treatment is its out-patient basis of treatment(no admission & no anesthesia). However, it leaves no surgical specimens for the pathological examination and detection of stage A prostate cancer may be impossible. Therefore, early detection of prostatic cancer prior to the non-surgical treatment of BPH is considered important if there are any suspicious signs of prostate cancer from the results of prostate specific antigen (PSA), digital rectal examination (DRE), or transrectal ultrasound(TRUS). The aims of our study is to compare the predictability of the DRE, PSA, and TRUS in the detection of prostate cancer before planning to take non- surgical treatment of BPH. One hundred thirty three patients between 50 to 85 years old (mean age 67.9) with symptoms of prostatism were examined serum PSA, DRE and TRUS prior to the treatment of BPH and predictability for the detection of prostatic cancer by each test were analyzed. Of the 133 cases, 3 were diagnosed as inflammations, 1 as tuberculosis, 1 as infarct, 110 as nodular hyperplasia, 18 as prostate cancers. Positive predictability of each test were as followed: 59.3% of the patients with abnormal DRE, 57.7% of the patients with abnormal TRUS and, 34% of the patients with abnormal PSA level( > 10 ng/ml). For the 44 patients with abnormal PSA level( > l0 ng/ml) and, coexisting abnormalities on either TRUS or DRE, positive predictability was 72%. However, in the 26 patients with abnormal PSA( >10ng/ml) with normal findings at DRE and TRUS, only 2 patients have prostate cancer. Of the 17 patients showing abnormal findings at DRE and TRUS irrespective of PSA level, 15 patients(positive predictability of 90%) have prostate cancer. Of the 12 patients having abnormal DRE and TRUS with elevated PSA level(more than 10.0 ng/ml), all patients had cancer. Conclusively, cancer predictability of single application of these screening test was low. Positive predictability of the elevated PSA level above 10 ng/ml was low if there were no abnormalities at DRE and TRUS. However, if there were abnormalities at DRE and TRUS, predictability of cancer became high. It is suggested that, if there were no abnormalities found at DRE and TRUS, prostate needle biopsy seem to be necessary despite the normal level of PSA( < 4 ng/ml). For the gray zone of the PSA level( 4-10 ng/ml) with no suspicious findings at DRE and TRUS, careful observation with follow up PSA measurement could be suggested.