ABSTRACT
Objective To detect the impact of ultrasound elastography in diagnosis of prostatic cancer,and to evaluate its capability in differentiating benign from malignant lesions.Methods From June 2013 to February 2015, we selected 50 patients with different prostatic lesions,and suspicious for malignancy were included.All patients had a conventional B-mode ultrasound examination and color Doppler imaging,and then real time ultrasound elastography was performed in the same session.Finally,the results were compared to the histopathological results of those lesions. Results The addition of Strain ratio parameter for evaluating the elastography images showed the highest sensitivity of 74.2%,specificity of 73.7% and accuracy of 74.0% at a best cut off point of 5.5 between benign and malignant lesions.Conclusion Prostate US combined with elastography can be a helpful tool for guiding malignant lesions.Also it can help in targeting the biopsy site.
ABSTRACT
La vigilancia activa (VA) constituye una alternativa de manejo válida para pacientes con cáncer de próstata que cumplen con ciertos criterios que incluyen las características anatomopatológicas de la biopsia preoperatoria transrectal. La subgraduación del puntaje de Gleason en la biopsia preoperatoria respecto de la biopsia definitiva se reporta en un 24-39 por ciento de los casos, lo que constituye un problema al momento de querer incluir a un paciente en un protocolo de vigilancia. El objetivo principal de este estudio consistió en determinar el porcentaje de subgraduación del score de Gleason en biopsias preoperatorias de pacientes que cumplían criterios para VA pero que fueron sometidos a prostatectomía radical y la relación con el número de punciones realizadas y el porcentaje de subgraduación. Se incluyó restrospectivamente a 167 pacientes sometidos a prostatectomía radical, que por sus características preoperatorias cumplían criterios para ingresar a un protocolo de VA. Se evaluó la concordancia entre las biopsias preoperatorias y definitivas y además la relación entre el número de punciones realizadas y el nivel de subgraduación. 52 pacientes (31,1 por ciento) tuvieron un puntaje de Gleason mayor a 6 (GS 7 n=49; GS 8 n=3) en la biopsia definitiva. El menor porcentaje de subgraduación (23.4 por ciento) se observó en el grupo de pacientes que se sometió a biopsias preoperatorias que incluyeron 15 o más punciones. La biopsia prostática preoperatoria presenta un significativo porcentaje de subgraduación respecto a la biopsia definitiva, que tiende a disminuir al aumentar el número de punciones realizadas. Estos factores deben ser considerados al momento de ofrecer al paciente su ingreso a un protocolo de VA.
Active surveillance (AS) is a validated alternative for the management of patients with prostate cancer that meet certain criteria including the histopathological characteristics of preoperative transrectal biopsy. The down-grading of preoperative Gleason score compared to postoperative biopsy is reported in 24-39 percent of cases, which represents a significative problem to include a patient in a AS protocol. The main objective of this study was to determine the percentage of down-grading Gleason score compared to postoperative biopsy is reported in 24-39 percent of cases, which represents a significative problem to include a patient in a AS protocol. The main objective of this study was to determine the percentage of down-grading of the preoperative Gleason score compared to the definitive score in biopsy specimens from patients that met criteria for AS but that were subjected to a radical prostatectomy, and the relation between the number of punctures and the percentage of downgrading. 167 patients subjected to radical prostatectomy were retrospectively included, all of them having preoperative characteristics that fulfilled the criteria for entry into an AS protocol. We evaluated the correlation between preoperative and postoperative biopsies. We also evaluated the relationship between the number of punctures and the percentage of down-grading in the preoperative biopsy. RESULTS: 52 patients (31.1 percent) were found to have a Gleason score higher than 6 (GS 7 n=49; GS 8 n=3) in the definitive biopsy. The lowest percentage of downgrading (23.4 percent) was observed in the group of patients with preoperative biopsies that included 15 or more punctures. The preoperative prostatic biopsy has a significant percentage of downgrading compared to the definitive biopsy, which tends to decrease with increasing the number of punctures. These factors must be considered when offering AS to a patient.
Subject(s)
Humans , Male , Adult , Middle Aged , Biopsy/methods , Watchful Waiting , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Neoplasm Staging , Retrospective Studies , Prostatectomy , RectumABSTRACT
The complications and the patients' attitude after transrectal systematic sextant biopsy of the prostate were evaluated by the questionnaire retrospectively. One hundred and sixty one of 211 men over 50 years old responded to the questionnaire. Transrectal sextant biopsy of the prostate under the finger guidance was performed by two doctors using Biopty Gun. The first 85 men (group A) received glycerin enema and oral administration of norfloxacin 30 minutes before the biopsy and norfloxacin was administered once again two to three hours after the biopsy. The other 126 men (group B) received the same procedures but the enema was performed using mixture of glycerin & betadine solution and the norfloxacin was administered 30 minutes before and for 3 days after the biopsy. Benign prostatic hyperplasia was diagnosed pathologically in 190 cases(90.1%) and prostate cancer in 8 cases(3.8%). No complication was less found in group A(23.4%) than in group B(40.5%)(P<0.05). Reported complications were perineal tenderness (group A: 42.9%,group B: 31.0%), hematuria (group A: 32.5%, group B: 34.5%), hemospermia (group A: 29.99%, group B: 19.0%), rectal bleeding (group A: 11.7%, group B: 11.9%), fever (group A: 15.69%, group B: 6.0%) and scrotal tenderness (group A: 2.6%, group B: 3.6%). In group A sepsis was developed in one case. Perineal tenderness lasted for 6.7 days in group A 5.1 days in group B. Hematuria was observed for 9.7 days in group A, 7.5 days in group B. Hemospermia was seen for 28.1 days in group A, 13.7 days in group B. Average duration of complications was shorter in group B (P<0.05). The better they understand the procedure of the biopsy, the less pain and the more satisfaction they experience. the rate of failure in obtaining tissue cores was 6.2%. If the doctor experiences more than about 120 cores of the tissue, the learning curve of success rate to obtain the proper specimens arrives to its plateau. In conclusion, the incidence of complications may be decreased by using appropriate pretreatment, especially adequate amount of antibiotics. Patient education is one of the most important steps to reduce the complications of this invasive technique.