Risk factors associated with transrectal ultrasound guided prostate needle biopsy in patients with prostate cancer.

BACKGROUND: Transrectal ultrasound (TRUS) guided prostate needle biopsy is a commonly used diagnostic procedure. We determined associated risk factors for patients who suffered major complications and required hospitalization after TRUS-guided prostate biopsy. METHODS: A total of 1,529 patients, 27 to 92 years old (mean 67.6 years) were included in this study conducted between January 2003 and July 2006. Each patient underwent sextant prostate biopsy under transrectal ultrasound guidance. Six-core transrectal biopsies were performed by urologists, consultant urologists and residents in training. RESULTS: The mean prostate-specific antigen (PSA) level and prostate volume were 113.2 ng/ml and 46.2 grams, respectively. One hundred forty-seven patients had complications. Some patients may have had more than one complication, but no major sequelae were seen immediately after biopsy. Sixty-two (4.1%) of these patients had gross hematuria, while 26 (1.7%) had acute urinary retention, 21 (1.4%) had urinary tract infection, 17 (1.1%) had hematospermia,14 (0.9%) had anal bleeding and 7 (0.5%) had anal pain. Urinary tract infection and rectal preparation were found significantly associated with complications. CONCLUSIONS: The results of our study demonstrate that minor complications occur without sequelae. Thus, TRUS-guided prostate needle biopsy is a safe and effective diagnostic tool. Urinary tract infection and rectal preparation might affect the complication rate.

Web-based clinical pathway for reducing practice variations in radical prostatectomy.

BACKGROUND: A clinical pathway support system on the Internet (CPSSI) has been designed for creating and implementing a web-based clinical pathway for radical prostatectomy. This investigation assessed the effects of the web-based clinical pathway for radical prostatectomy on practice variations. METHODS: From June 2002 to Jun 2003, 22 consecutive patients with localized prostate cancer who underwent radical prostatectomy were treated according to the web-based clinical pathway. The treatment results were compared with an identically sized sample of patients treated during the year before implementing the web-based clinical pathway. Variations before and following the implementation of the web-based clinical pathway for radical prostatectomy were also assessed. The CPSSI automatically measured pathway variations and length of hospital stay. RESULTS: After implementing the web-based clinical pathway, the average hospital stay was reduced significantly (p=0.0001). The mean number of variations also differed markedly (p=0.0002). CONCLUSION: This study concludes that the CPSSI-based clinical pathway support system may provide a good tool for creating and implementing a web-based clinical pathway. After implementing the web-based clinical pathway for radical prostatectomy, practice variations and length of stay were reduced considerably. Moreover, automatically assessing the effects of web-based clinical pathway implementation can enhance the quality of patient care.

Synchronous primary carcinomas of the bladder and prostate.

AIM: To determine the incidence of adenocarcinoma of the prostate for patients undergoing radical cystoprostatectomy for bladder cancer in Taiwan. METHODS: A total of 248 patients in Taiwan who were histologically confirmed for transitional cell carcinoma of the bladder underwent cystoprostatectomy. Histopathologic evaluation of the prostate specimens sectioned at 5 mm intervals was performed. RESULTS: Of the 248 patients, 10 (4.03%) were found to have prostate cancer. Of the 10 cases of unsuspected prostate cancer, eight proved to be at stage T1 or T2, and two at T3 and T4, respectively. This rate of incidentally found prostate cancer amongst our bladder cancer patients appeared to be lower than that found in bladder cancer patients in similar studies in USA. CONCLUSION: Although the incidence of incidental prostate cancer in patients in Taiwan with bladder cancer is not high compared with that in Western countries, we suggest that digital rectal examination and prostate-specific antigen (PSA) are important screening tools for men with bladder cancer, especially for those aged 60 years and older in Taiwan.

Comparative study of laparoscopic and open adrenalectomy.

BACKGROUND: Laparoscopic adrenalectomy (LA) had become the preferred operation for management of adrenal neoplasm. We conducted this cohort study to evaluate the outcome of laparoscopic and open adrenalectomy (OA). METHODS: A total of 67 patients with complete medical records were included in this study. Thirty patients underwent OA and the other 37 patients received LA. The intraoperative and perioperative data analyses focused on surgery time, blood loss, pain scale rating, resumption of oral feeding, hospital stay, complications and convalescence. RESULTS: LA was completed in all 37 patients without conversion to OA or mortality. The surgery times (203.4 vs. 192.9, p = 0.776) were similar for both OA and LA groups. There was less blood loss in the LA group (355.0 vs. 104.0, p = 0.021). The postoperative pain scale rating was lower in the LA group (5.6 vs. 4.5 p = 0.035) as was analgesia demand (57.4 vs. 3.7, p < 0.001). Oral feeding resumed earlier in the LA group (91.7 vs. 16.4, p < 0.001) and these patients had a shorter postoperative hospital stay (8.4 vs. 3.9, p < 0.001). The complication rate in both groups was similar. In the LA group, patients with primary aldosteronism had shorter surgery times and less blood loss than patients with other tumor types (p < 0.05). CONCLUSIONS: LA results in good surgical outcome without increased risks. We suggest that LA should be the preferred choice for management of adrenal neoplasms. We also suggest that surgeons inexperienced in LA consider beginning with a case of primary hyperaldosteronism.

Correlation between the Gleason scores of needle biopsies and radical prostatectomy specimens.

BACKGROUND: The Gleason score has been shown to offer important information with regard to prognosis and therapy for patients with adenocarcinoma of the prostate gland. In this study, Gleason scores, as determined by 18-gauge core needle biopsies, were compared with both Gleason scores and the pathological staging of corresponding radical prostatectomy specimens. METHODS: Records of 78 consecutive patients undergoing a radical retropubic prostatectomy between 1998 and 2002 were reviewed. In total, 78 patients were enrolled, all of whom had been diagnosed with adenocarcinoma by transrectal needle biopsies using an 18-gauge automated spring-loaded biopsy gun. RESULTS: Grading errors were greatest with well-differentiated tumors. The accuracy was 6 (23%) for Gleason scores of 2-4 on needle biopsy. Of the 36 evaluable patients with Gleason scores of 5-7 on needle biopsy, 28 (78%) were graded correctly. All of the Gleason scores of 8-10 on needle biopsy were graded correctly. Eighteen (33%) of 54 patients with a biopsy Gleason score of < 7 had their cancer upgraded to above 7. Tumors in 6 patients (60%) with both a Gleason score < 7 on the needle biopsy and a Gleason score of 7 for the prostatectomy specimen were confined to the prostate. CONCLUSION: The potential for grading errors is greatest with well-differentiated tumors and in patients with a Gleason score of < 7 on the needle biopsy. Predictions using Gleason scores are sufficiently accurate to warrant its use with all needle biopsies, recognizing that the potential for grading errors is greatest with well-differentiated tumors.