value of transrectal ultrasound guided needle biopsy in the diagnosis of non-malignant prostatec conditions

ABSTRACT

The majority of patients [60-65%] undergoing prostatic needle biopsies because of an elevated serum PSA levels and/or abnormal digital rectal examination will not have adenocarcinoma of their prostates upon pathological examination. Benign prostatic hyperplasia [BPH] and prostatitis are common causes of serum PSA elevation. We selected to evaluate the distribution of malignant and non-malignant conditions in patients undergoing prostatic needle biopsies. For this purpose 408 consecutive patients underwent 12 core transrectal ultrasound [TRUS] guided prostatic needle biopsies were evaluated. None of them had clinical prostatitis. Prostatic volume was estimated during the procedure. Pathologic examination focused on the presence of normal prostate, BPH, Prostatitis and cancer in every core. According to serum PSA levels, patients were classified into four different groups ranging between 0.1 to more than 20 ng/ml. Prostatic volume ranged between 10-178 ml. Prostate cancer was detected in 139 patients [34%] with average volume 36 ml, 89 patients [22%] showed pathologic evidence of chronic prostatitis with average volume 59 ml. BPH changes were elicited in 153 patients [37.5%] with average volume 42 ml while 27 patients [6.5%] were having normal prostates with average volume 51 ml. The incidence of prostate cancer, prostatitis, BPH and normal prostate was 25% 17%, 50% and 8% for group I [[PSA 0.1-4 ng/ml], [n = 94]] this incidence was 30%, 25%, 40 and 5% for group II [PSA 4.1-10 ng/,l], [n = 188]], it was 38%, 19%, 37% and 6% for group III [[PSA 10.1-20 ng/ml]], [n = 100] and it was 50%, 21%, 17% and 12% for group IV patients [[PSA > 20 ng/ml] [n = 22]1 respectively. From the above mentioned results we can conclude that the majority of patients suspected to harbour cancer in their prostates shows no malignancy upon pathologic examination of their biopsies, with BPH being the most common [37.5%] and prostatitis was a significant finding in 22% of patients. Prostate volume was not a crucial factor in predicting the pathologic entity. After excluding prostatitis, the higher the serum PSA level the higher the incidence of prostate cancer