Value of fine needle aspiration cytology under ultra-sound guided biopsy in the diagnosis of prostatic cancer

ABSTRACT

The detection of carcinoma of prostate [CaP] by trans rectal ultrasound [TRUS] depends on the feature produced by the new growth, which leads to changes in the glandular-stromal architecture, appears as Changes in the echogenicity of the prostatic lesion. The fine needle can be guided to the area of suspicion and cytology is done. This prospective study was conducted to demonstrate the usefulness of the fine needle aspiration cytology [FNAC] under transrectal ultrasound [TRUS] guidance in detection of carcinoma of the prostate [CaP]. Fifty male patients aged between [46 - 86] years, were chosen selectively, all with voiding symptoms and suspicion of CaP from an elevated prostate specific antigen [PSA] above the level of 4 ng/ml in all patients. Thirty patients had abnormal finding on digital rectal examination [DRE], thirty three patients had TRUS abnormal findings. This procedure was carried out in out - patient basis. The cytological results were compared with the tissue diagnoses obtained by surgical interventions. The cytological results revealed 24 case of malignancy and benign in the rest 26 case [23 case of BPH and 3cases of prostatitis]. Malignancy was correctly diagnosed by using cytology in 24 out of 28 case confirmed by histopathology as CaP. One case was considered initially as false positive, the cytological result consistent with adenocarcinoma but the histopathology failed to prove it. The statistical analysis revealed that the sensitivity, specificity and accuracy were 85%. 100% and 92% respectively. We conclude that FNAC under TRUS guide can be considered as an initial safe cost effective and reliable method for diagnosing of Prostate cancer