ABSTRACT
Background: Prostate is an exocrine gland in male which is derived from Greek word prostates which means “one who stands before” or “protector” or a “guardian.” Its anatomical, chemical, and physiological functions digger among species. Differentiation of benign and malignant condition on sole clinical basis is difficult. Furthermore, there are various conditions in which serum prostate-specific antigen (PSA) is raised such as UTI and prostatitis. Our intent to conduct this study was to correlate clinical examination, Sr. PSA, and ultrasound to find prostatic volume to arrive at accurate diagnosis. Aims and Objectives: Our aim was to improve the accuracy of diagnosing prostatic disease and to effectively predict the nature of the disease; mainly benign or malignant (which is not accurate with a single investigation). Materials and Methods: The present study was conducted at C.U. Shah Medical College, Surendranagar, between December 2011 and September 2013. It was prospective observational study for which ethical clearance was obtained from the Institutional Ethics Committee. One hundred patients presenting to the outpatient department were enrolled in this study. Patients detailed presenting history with origin duration and progress, history, and personal history digital rectal examination (DRE) were recorded in pro forma. Serum PSA of all the patients was sent. After which, transurethral ultrasound (TRUS) was performed and a biopsy was taken and sent for histopathology. Comparison of all modalities was done and conclusion was made on basis of final diagnosis. Results: A total of 100 number of cases of enlarged prostate were studied who were admitted in the surgery department of our hospital. In our series, maximum patients with symptoms with enlarged prostate were in the age group of 40–60 years (54%). In our study, out of 100 patients, 52 (52%) were having obstructive symptoms, 28 (28%) were having irritative symptoms, and 20 (20%) patients were having both obstructive and irritative symptoms. On the basis of DRE, 76 (76%) cases were diagnosed as benign prostatic hyperplasia (BPH), 15 (15%) as Ca prostate, and 9 (9%) as prostatitis. On combination of DRE and PSA, 73% of cases had BPH, 21% Ca prostate, and 6% as prostatitis. With the help of DRE PSA and TRUS, 71% of patients were diagnosed as having BPH, 15% Ca prostate, and 14% as prostatitis. Final diagnosis was made on combination of all four modalities, that is, DRE PSA TRUS and TRUS-guided prostatic biopsy. About 66% of cases had BPH,13% had CA prostate, and 21% had prostatitis. Conclusion: The diagnosis of CA prostate was more accurate on the basis of all four modalities rather than considering only DRE and PSA which were sensitive but less specific.
ABSTRACT
Objective@#To assess the clinical value and safety of pelvic MRI combined with transurethral ultrasound (TRUS)-guided transperineal template mapping biopsy (TTMB) in the diagnosis of prostate cancer.@*METHODS@#A total of 164 men underwent MRI plus TRUS-guided TTMB for the diagnosis of prostate cancer from December 2015 to May 2018. The patients averaged 71.2 years of age and, based on the PSA level, were divided into four groups: PSA 100 μg/L (n = 27). All the patients received digital rectal examination, pelvic MRI and TRUS-guided X+12-core TTMB.@*RESULTS@#The procedures of TRUS-guided TTMB were successfully completed in all the patients, with an average number of 14.2 (14－16) cores and mean operation time of 18 (15－28) minutes. Post-biopsy complications included transient hematuria in 4 cases, perineal hematoma in 12 and fever in 1, but no acute urinary retention. Pathological results revealed 95 cases of prostate cancer, 2 cases of ductal epithelial carcinoma, 63 cases of prostatic hyperplasia with benign interstitial inflammation, and 4 cases of atypical prostatic hyperplasia. The positive biopsy rates in the PSA 100 μg/L groups were 25.00%, 42.86%, 73.58% and 100.00% respectively, with statistically significant difference between the PSA 100 μg/L groups (P < 0.01), but not between the PSA <10 μg/L and PSA 10－20 μg/L groups (P = 0.086).@*CONCLUSIONS@#Pelvic MRI combined with TRUS-guided X+12-core TTMB, with the advantages of high accuracy and low rate of complications, is an ideal approach to the diagnosis of prostate cancer.