Prostate biopsy findings in Indian men: A hospital-based study.

Aims: To review prostatic biopsy findings in Indian patients with elevated serum prostate-specific antigen (PSA) attending the Urology department at a tertiary care hospital. Settings and Design: A retrospective study of 119 patients, who underwent TRUS-guided prostatic biopsy, was conducted. Materials and Methods: A total of 119 patients undergoing TRUS-guided prostatic biopsy were evaluated. Age, presentation, PSA, digital rectal examination, number of cores, and final histology were analyzed. Minimum 10 cores biopsies were performed in 109/119 (92%) and 12 cores in 92/119 (77%). Patients were stratified into three groups based on their PSA: 4-10 ng/ml (group I), 10-20 ng/ml (group II), and >20 ng/ml (group III). Statistical Analysis: Unpaired t-test, Chi-square test, and logistic regression were calculated using an Excel (Ver 2007) and online calculators (P < 0.05 significant). Results: Mean age was 67.6 years. Inflammatory pathology (30/119) was common at all PSA levels. In men with negative DRE and PSA > 10 ng/ml, inflammatory pathology was more likely (Chi 4.2798, P = 0.039). Cancer was found in 29/119 biopsies (group I 2/28, group II 3/45, and group III 24/46). Patients with PSA > 20 ng/ml were more likely to show cancer. Precursor lesions were noted in 10/119 (8.4%). On univariate analysis age, PSA, and DRE all showed significant association with histologic cancer but on multiple logistic regression analysis, only PSA (OR 1.03, P = 0.0021) and DRE (OR 8.07, P = 0.0007) were predictive of cancer. Conclusions: Cancer is less common and inflammatory lesions more common at all levels of PSA in our patients. The effect of antibiotics on PSA and biopsy in our patients needs to be explored.

Prostate cancer detection at rebiopsy after an initial benign diagnosis: results using sextant extended prostate biopsy

INTRODUCTION: Sextant prostate biopsy remains the standard technique for the detection of prostate cancer. It is well known that after a diagnosis of small acinar proliferation (ASAP) or high grade prostate intraepithelial neoplasia (HGPIN), the possibility of finding cancer is approximately 40 percent and 30 percent, respectively. OBJECTIVE: We aim to analyze follow-up biopsies on patients who initially received a benign diagnosis after exclusion of HGPIN and ASAP. METHODS: From July 2000 to December 2003, 1177 patients were submitted to sextant extended prostate biopsy in our hospital. The mean patient age was 65.5 years old, and the median number of fragments collected at biopsy was 13. HGPIN and ASAP were excluded from our study. We only considered patients who had a diagnosis of benign at the first biopsy and were subjected to rebiopsies up until May 2005 because of a maintained suspicion of cancer. RESULTS: Cancer was initially detected in 524 patients (44.5 percent), and the diagnosis was benign in 415 (35.3 percent). Rebiopsy was indicated for 76 of the latter patients (18.3 percent) because of a persistent suspicion of cancer. Eight cases of adenocarcinoma (10.5 percent) were detected, six (75 percent) at the first rebiopsy. Six patients were submitted to radical prostatectomy, and all tumors were considered clinically significant. CONCLUSION: Our data indicate that in extended prostate biopsy, the first biopsy detects more cancer, and the first, second, and third rebiopsies after an initial benign diagnosis succeed in finding cancer in 7.9 percent (6/55), 5.9 percent (1/15) and 20 percent (1/4) of patients, respectively.

Inflammatory atrophy on prostate needle biopsies: is there topographic relationship to cancer?

INTRODUCTION: Chronic inflammation of longstanding duration has been linked to the development of carcinoma in several organ systems. It is controversial whether there is any relationship of inflammatory atrophy to prostate cancer. It has been suggested that the proliferative epithelium in inflammatory atrophy may progress to high-grade prostatic intraepithelial neoplasia and/or adenocarcinoma. The objective of our study is to compare on needle prostate biopsies of patients showing cancer the topographical relation of inflammatory atrophy and atrophy with no inflammation to adenocarcinoma. MATERIALS AND METHODS: The frequency and extent of the lesions were studied on 172 needle biopsies of patients with prostate cancer. In cores showing both lesions, the foci of atrophy were counted. Clinicopathological features were compared according to presence or absence of inflammation. RESULTS: Considering only cores showing adenocarcinoma, atrophy was seen in 116/172 (67.44 percent) biopsies; 70/116 (60.34 percent) biopsies showed atrophy and no inflammation and 46/116 (39.66 percent) biopsies showed inflammatory atrophy. From a total of 481 cores in 72 biopsies with inflammatory atrophy 184/481 (38.25 percent) cores showed no atrophy; 166/481 (34.51 percent) cores showed atrophy and no inflammation; 111/481 (23.08 percent) cores showed both lesions; and 20/481 (4.16 percent) showed only inflammatory atrophy. There was no statistically significant difference for the clinicopathological features studied. CONCLUSION: The result of our study seems not to favor the model of prostatic carcinogenesis in which there is a topographical relation of inflammatory atrophy to adenocarcinoma.

Associaçäo da neoplasia intraepitelial prostática com achados histopatológicos em ressesçöes cirúrgicas / The prostatic intraepithelial neoplasia associated with histopathological findings in surgical ressections

O câncer de próstata é um dos tumores mais freqüentes no sexo masculino, cuja patogênese é conhecida. Atualmente existem diversas alteraçöes displásicas no órgäo que estariam relacionadas com a origem do tumor, sendo portanto, consideradas lesöes pré-malígnas. Dentre estas, a principal é a Neoplasia Intraeptelial Prostática (PIN). O objetivo deste estudo foi verificar a presença do PIN associada aos achados histológicos benignos e malignos em amostras cirúrgicas de pacientes submetidos à cirurgia protática. Foram estudadas 73 pacientes que foram operados através de ressecçäo transuretral (RTU), biópsia transretal ou prostatectomia (radical ou adenomectomia) no ano de 1997, no Hospital Ofir Loiola. A procura do PIN foi realizada através da revisäo das lâminas dos espécimes cirúrgicos por um único patologista. Os resultados foram analisados estatisticamente baseando-se na presença do PIN relacionado à idade dos pacientes, ao tipo de cirurgia, e ao diagnóstico histológico das amostras. Observou-se que o percentual de positividade do PIN foi mais significativo nas amostras de biópsia, coexistindo com o câncer na maioria dos casos. Conclui-se entäo que o PIN está mais relacionado ao câncer de próstawta, do que as alteraçöes benignas do órgäo, reforçando a hipótese de que seja uma lesäo pré-maligna