ABSTRACT
OBJECTIVE: To evaluate whether large-volume prostate cancers can be predicted by means of multiple needle biopsies. MATERIAL AND METHODS: In 115 men, 8-14 (mean 10) biopsies were taken, including eight from standardized positions (apex, mid-medial, mid-lateral and base). Biopsies were reviewed, the length of the cancer measured and the percentage cancer length calculated. All men underwent radical prostatectomy. The prostatectomy specimens were totally embedded and the tumor volume was measured planimetrically. The predictive values of the number and percentage of cores positive for cancer, cancer length and percentage cancer length were calculated for tumor volumes of >4, >6 and >8 ml. RESULTS: Using univariate logistic regression, cancer length and percentage cancer length predicted tumor volumes of >4 (p<0.001), >6 (p<0.001) and >8 ml (p<0.05). These measures were better predictors of tumor volume than the number and percentage of cores positive for cancer. A biopsy cancer length of > or =30 mm and a percentage cancer length of > or =25% predicted a tumor volume of >4 ml in 95% and 93% of cases, respectively. For tumor volumes of >6 or >8 ml, predictive values were lower. Tumor volumes of <2 and <4 ml were found in 13% and 35%, respectively of men with as many as six positive cores, indicating that the number of positive cores was less useful as a predictor of tumor volume than the cancer length. CONCLUSIONS: Cancer length and percentage cancer length are significant predictors of large tumor volumes. It is recommended that the linear extent of cancer in prostate biopsies should be reported by the pathologist.
Subject(s)
Prostatic Neoplasms/pathology , Adult , Aged , Biopsy, Needle/methods , Disease Progression , Endosonography , Humans , Male , Middle Aged , Neoplasm Staging , Prognosis , Prostatic Neoplasms/diagnostic imaging , Retrospective StudiesABSTRACT
PURPOSE: To investigate the changes in intraprostatic blood flow during ProstaLund Feedback Treatment (PLFT) using positron emission tomography (PET). PATIENTS AND METHODS: Three patients with bladder outlet obstruction caused by benign prostatic hyperplasia were treated with PLFT using the ProstaLund device, which has the ability to calculate the intraprostatic blood flow. Treatment was given for 1 hour. Five PET scans were done during each treatment to calculate the three-dimensional blood flow using [(15)O]H(2)O as the tracer. RESULTS: The prostatic blood flow increased steeply at the beginning of the treatment in all three patients, by as much as 100% at 20 and 35 minutes. For patients 1 and 2, there was a fast decline in intraprostatic flow at the last scan (55 minutes), clearly seen as a large zone with circulation arrest centrally in the prostate. The intraprostatic temperature was <50 degrees C during the first 30 minutes but increased to 52 degrees to 60 degrees C during the second part of the treatment. Patient 3 had high blood flow during the entire treatment. A reduction of the blood flow was seen at the end of the treatment but not to the same extent as in the other two patients. The intraprostatic temperature did not exceed 49 degrees C for this patient. CONCLUSION: The large variations seen in intraprostatic blood flow suggest that intraprostatic temperature monitoring is mandatory to optimize the treatment. The ProstaLund bioheat model calculates the change in intraprostatic blood flow accurately.
Subject(s)
Positron-Emission Tomography , Prostate/blood supply , Prostate/diagnostic imaging , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate , Aged , Body Temperature , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Monitoring, Physiologic , Oxygen Radioisotopes , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/diagnostic imaging , Regional Blood Flow , Urinary Bladder Neck Obstruction/etiology , Urinary Bladder Neck Obstruction/surgeryABSTRACT
PURPOSE: We investigated the incidence of prostate cancer after negative transrectal ultrasound (TRUS) guided multiple biopsies. Our secondary aim was to calculate the sensitivity of the extended protocol used. MATERIALS AND METHODS: A cohort of 547 men with elevated prostate specific antigen and/or abnormal digital rectal examination but with results negative for prostate cancer on a mean of 9 TRUS guided biopsies was followed through record linkage to the national cancer Registry. The observed number of prostate cancers was compared with the expected number during the same calendar period in an age matched male population to determine the standardized incidence ratio. The sensitivity of TRUS with multiple biopsies after 5 years of followup was calculated. Relative survival was estimated if there was an excess death rate due to undiagnosed prostate cancer. RESULTS: We found 11 men diagnosed with prostate cancer. The expected number in the age standardized male population was 15, resulting in a standardized incidence ratio of 0.8 (95% CI 0.4 to 1.2). Five-year sensitivity of the extended protocol of TRUS guided biopsies was 95.2% (95% CI 93.5 to 96.4) and relative survival was more than 100%, indicating a selection of men deemed candidates for curative treatment. CONCLUSIONS: Men with clinical suspicion of prostate cancer who are examined by an extended protocol of TRUS guided biopsies negative for cancer do not have an increased incidence of prostate cancer within 6 years compared with an age matched male population. Five-year sensitivity of this protocol was high.
