Transperitoneal laparoscopic treatment for recurrence of a giant multilocular prostatic cystadenoma: A case report and review of the literature.

Giant multilocular prostatic cystadenomas (GMPC) are very rare benign tumors that originate from the prostate with extensive spread into the pelvis. The lesion may present as large abdominal mass causing obstructive voiding dysfunction and usually not invading adjacent structures. All of the previously reported patients with GMPC underwent open surgery. Although the natural history of prostatic cystadenoma remains unknown, complete surgical excision may not always be necessary. We report the case of a 74-year-old male who presented a retrovesical recurrence of prostatic cystoadenoma after 16 years, treated with a laparoscopic approach. To our knowledge this is the first case of laparoscopic management of GMPC. In this article we review the current literature about this rare tumor and discuss the diagnostic and management dilemmas posed by this rare pathologic condition. We believe that physicians should at least be aware of the existence of this disease in the differential diagnosis of pelvic cavity tumours and, considering the benignity of GMPC, they should propose--as first--a minimally invasive approach.

The role of the elastography in the diagnosis of prostate cancer: a retrospective study on 460 patients.

OBJECTIVE: Prostate cancer is one of the most common cancer among men in industrialized total Prostatic Specific Antigen (PSA) and PSA ratio, Trans Rectal Ultrasound Scan (TRUS) and prostate biopsy, which is the gold standard for tumoral diagnosis. The poor sensibility of TRUS, when DRE and/or PSA are abnormal, requires prostate biopsy for diagnostic confirmation. The aim of this study was to evaluate the sensibility and the specificity of real time elastography (SE) with and without the association of TRUS for cancer diagnosis. MATERIAL AND METHODS: We retrospectively evaluated 460 patients who underwent TRUS-guided prostate biopsy. The mean age of patients was 66.4 years, the mean PSA was 7.96 ng/ml and the mean PSA ratio was 17.19%. We compared histopathological findings of prostate biopsies with the results of TRUS and elastography. RESULTS: 32.17% of all patients were positive for prostate cancer.TRUS showed a sensitivity of 76.35% with a low specificity (43.59%), a Positive Predictive Value (PPV) of 39.1% and a Negative Predictive Value (NPV) of 79.53%. SE showed a lower sensitivity (61.49%), but better specificity (75%), PPV (53.85%) and NPV (80.41%). The association of TRUS + SE showed an increase in the sensitivity (79.79%) and in the NPV (86.71%). We separately evaluated the results of the two urologists with a greater experience in the use of these diagnostic methods who got an excellent sensitivity (91.42%) and an high NPV (92.68%). CONCLUSIONS: SE is certainly an useful diagnostic method for the detection of prostate cancer, especially in association with TRUS. A great experience of the sonographist and an adequate training are indispensable to make, in the future, elastography a "structural marker".