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
Background: Prostate carcinoma is the second leading cause of cancer‑related deaths in males worldwide. The burden is expected to grow 1.7 million new cases and 499,000 new deaths by 2030. In developing countries such as India, prostate carcinoma will show an increase by 140% in the next few years. Although the diagnosis of prostate carcinoma can usually be made on histological features, now a days many immunohistochemical (IHC) markers are used to distinguish it from benign mimickers as well as in predicting prognosis and treatment. Out of these markers, Ets‑related gene (ERG product) is a proto‑oncogene which participates in chromosomal translocations and is frequently over expressed in prostate carcinoma which harbors ERG‑transmembrane protease, serine 2 fusion. Materials and Methods: Fifty cases of carcinoma prostate diagnosed in needle biopsies and prostatic chips, in the Department of Pathology of a tertiary care teaching hospital in Punjab, India, were included in the present study. The slides were observed under the light microscope, and Gleason scoring was done using the 2005 International Society of Urological Pathology modified Gleason system. IHC study for ERG expression was done on all the cases, for which anti‑ERG monoclonal rabbit clone antibody EP111 (Dako, Denmark) was used. Lymphocytes and endothelial cells were taken as in built positive controls for staining. The intensity of ERG positivity was scored as no staining (0), weak staining (+1), moderate staining (+2) and intense staining (+3). The H score was then calculated by multiplying the intensity of the stain with the percentage (0–100) of the cells showing that staining intensity. The H‑score has a range of 0–300. The relationship between IHC expression and clinico‑pathological parameters was compared and analyzed using Chi-square test. P < 0.05 was considered statistically significant. Results: Majority of patients included in the study were in the age group of 61–80 (84% of the total). When ERG expression was studied with age‑specific rates, it was not found to be statistically significant. The most common pattern noted in the present study was 4 + 3, constituting 36% of total, followed by 3 + 4 constituting 32%. Calculating the score, the majority of patients had a Gleason score of 5–8, constituting 76% of total. Out of the total fifty cases of prostate carcinoma, ERG was positive in 29 cases (58%) and negative in 21 cases (42%). Fourteen out of 21 (48%) of the ERG positive cases had an intensity score of 3. When the ERG intensity was correlated with the Gleason score group, it was seen that patients having Gleason score 7–8 showed ERG positivity in 19 out of 38 cases (50%), with 11/19 (57%) cases showing an ERG intensity score of 3. The Gleason score group 9–10 showed ERG positivity in 83% (10/12) cases, 20% (2/10) cases showing intensity score of 3. This correlation was found to be statistically significant. Conclusion: ERG immunostaining was performed in a small Indian cohort of prostate cancer patients, diagnosed in trucut biopsy specimens and prostatic chips. ERG expression was found in 58% patients. An increase in the ERG expression was observed with an increase in Gleason score. The intensity of ERG expression, however, decreased with an increasing Gleason score.
ABSTRACT
The objective of the study was to evaluate and compare the role of total and free/total ratio of serum prostate specific antigen level in diagnosing carcinoma prostate. A cross sectional study was conducted at the Department of Biochemistry, Dhaka Medical College (DMC) with collaboration of the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka from July 2008 to June 2009. This study was carried out on 60 patients above 50 years of age who attended the Department of Urology, Dhaka Medical College Hospital, complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically benign prostatic hyperplasia (BPH) or cancer prostate. It was aimed to assess the role of total and free/total ratio of serum PSA in diagnosis of BPH and carcinoma prostate with reference to histological diagnosis. All the cases were evaluated by history, physical examination including digital rectal examination, serum prostate specific antigen level, transabdominal/ trans-rectal ultra- sonogram. From all patients, blood sample were collected before digital rectal examination or any per urethral manipulation. Final diagnosis was obtained by histo-pathological examination, specimen being obtained by perrectal biopsy with biopsy-gun. Histopathological examination detected prostate cancer in 20 out of 60 patient and 17 of these Cap 20 have a total PSA 4 ng/ml and only 3 have total PSA 4 ng/ml. 18 of these 20 have free to total ratio 0.16 and 02 have f/t ratio 0.16. Among 60 patients, 40 patients were detected BPH on histopathological diagnosis. 20 of these BPH patient have tPSA 4 ng/ml and 20 of BPH have tPSA 4 ng/ml. 38 of 40 BPH patient have f/t ratio>0.16 and 2 of 40 patient are f/t ratio 0.16. Receiver operating characteristic analysis indicated a threshold f/t ratio 0.16 was optimum discriminatory level. The sensitivity of total serum PSA (at cut off value of>4 ng/ml) in correctly differentiating prostatic carcinoma of those who have the condition is 85%, while the specificity of the test in correctly detecting those who do not have the disease is 50%. The PPV is 45.9%, NPV is 87% and accuracy is 61.7%. The sensitivity of free/total serum PSA (at cut off value of 0.16 ng/ml) in correctly differentiating prostatic carcinoma from BPH is 90%, while the specificity of the test in correctly detecting those who do not have prostatic carcinoma is 95%. The PPV of the test is 90% and the NPV of the test is 95%. The overall accuracy of the test is 93.3%. This study showed significant difference of total and free/total ratio of serum prostate specific antigen (PSA) in differentiating benign prostatic hyperplasia (BPH) from carcinoma prostate. Receiver operating characteristic curves showed advantage for the f/t PSA ratio when compared with total PSA in detecting prostate cancer. From the study it may be concluded that total and f/t ratio of prostate specific antigen (PSA) is a useful marker in diagnosis of carcinoma prostate. Free/total ratio is more accurate than total PSA.
ABSTRACT
This is a case of a 69-year old male who presented with gradual loss of vision and protrusion of the right eye because of metastatic prostate carcinoma. Radiologic studies (CT scan and bone scan), PSA and prostate biopsy confirmed the diagnosis. Symptoms were abated after bilateral orchiectomy. Although considered to be unusual, orbital metastasis with its consequent eye involvement can be the presenting symptom of an elderly male with prostate cancer. (Author)