[Prostate health index for the diagnosis of prostate cancer in Asians in Macau with a PSA level of 4－10 µg/L].

OBJECTIVE: To evaluate the prostate health index (PHI) as a tool for the diagnosis of PCa with a PSA level of 4－10 µg/L and determine the best cut-off value of PHI. METHODS: Fifty-eight patients with a PSA level of 4－10 µg/L underwent transrectal ultrasound-guided prostatic biopsy in our hospital between April 2017 and June 2019. We constructed receiver operating characteristic (ROC) curves for the relationship of the biopsy results with the level of PSA, the ratio of ［－2ï¼½ proPSA to fPSA and PHI, and calculated the area under the ROC curves (AUC). RESULTS: Prostatic biopsy revealed 18 cases of PCa in the 58 patients (31.0%). Statistically significant differences were observed between the PCa and non-PCa groups in ［－2ï¼½ proPSA, %［－2ï¼½ proPSA and PHI, but not in tPSA, % fPSA and PSA-density. The AUCs of PSA, % fPSA, PSA-density, ［－2ï¼½ proPSA, %［－2ï¼½ proPSA and PHI were 0.556, 0.407, 0.533, 0.746, 0.751 and 0.774, respectively. The specificity of PHI was 27.50% (95% CI: 14.6%－43.9%), the highest among the above predictors at 90% sensitivity. By applying PHI to this cohort, 13 cases (22.4%) of unnecessary biopsy could be avoided. CONCLUSIONS: The application of PHI can increase the accuracy of PCa prediction and reduce unnecessary prostatic biopsy.、.

Prostate health index for the diagnosis of prostate cancer in Asians in Macau with a PSA level of 4－10 μg/L / 中华男科学杂志

Objective@#To evaluate the prostate health index (PHI) as a tool for the diagnosis of PCa with a PSA level of 4－10 μg/L and determine the best cut-off value of PHI.@*METHODS@#Fifty-eight patients with a PSA level of 4－10 μg/L underwent transrectal ultrasound-guided prostatic biopsy in our hospital between April 2017 and June 2019. We constructed receiver operating characteristic (ROC) curves for the relationship of the biopsy results with the level of PSA, the ratio of ［－2］ proPSA to fPSA and PHI, and calculated the area under the ROC curves (AUC).@*RESULTS@#Prostatic biopsy revealed 18 cases of PCa in the 58 patients (31.0%). Statistically significant differences were observed between the PCa and non-PCa groups in ［－2］ proPSA, %［－2］ proPSA and PHI, but not in tPSA, % fPSA and PSA-density. The AUCs of PSA, % fPSA, PSA-density, ［－2］ proPSA, %［－2］ proPSA and PHI were 0.556, 0.407, 0.533, 0.746, 0.751 and 0.774, respectively. The specificity of PHI was 27.50% (95% CI: 14.6%－43.9%), the highest among the above predictors at 90% sensitivity. By applying PHI to this cohort, 13 cases (22.4%) of unnecessary biopsy could be avoided.@*CONCLUSIONS@#The application of PHI can increase the accuracy of PCa prediction and reduce unnecessary prostatic biopsy.、.

Prediction of clinically significant prostate cancer after negative prostate biopsy: The current value of microscopic findings.

OBJECTIVE: To assess the current ability of atypical small acinar proliferation (ASAP), multifocal high-grade prostatic intraepithelial neoplasia (mHGPIN), HGPIN with atypia (PINATYP) and other non-malignant lesions to predict clinically significant prostate cancer (csPCa) in repeat prostate biopsies. METHODS: This retrospective study analyzed 377 repeat prostate biopsies, carried out between 2.014 and 2.017, and excluding those with previous PCa or 5-alpha reductase inhibitors treatment. ASAP, mHGPIN, PINATYP, prostatic atrophy, prostatic hyperplastic atrophy, proliferative inflammatory atrophy (PIA), chronic prostatitis, acute prostatitis, or granulomatous prostatitis, were prospectively reported after 12-core transrectal ultrasound (TRUS) systematic negative previous biopsies. 3T-multiparametric magnetic resonance imaging (mpMRI) was performed previous repeat biopsies. At least 2-core TRUS targeted biopsies of Prostate Imaging-Reporting and Data Systemv2 lesions ≥3, and/or 12-core TRUS systematic biopsy were performed in repeat prostate biopsies. The main outcome measurements were csPCa detection, which was defined when the International Society of Uro-Pathology group grade >1 and avoided biopsies. After logistic regression analysis the most efficient model was selected, nomogram was designed with internal validation, and clinical utility was analyzed. RESULTS: Normal benign tissue alone was present in less than 2% of previous negative biopsies. mHGPIN (39.7%), ASAP (4.3%) and PINATYP (3.7%) failed to predict csPCa risk in repeat biopsies. The finding of PIA (38.2%) associated with a decreased the risk of csPCa with an Odd ratio of 0.54 (95% confidence interval: 0.31-0.95), P= 0.031. The area under the curve, to predict csPCa, of mpMRI was 0.736, increasing up to 0.860 (95% confidence internal:0.82-0.90) when PSA density, age, digital rectal examination, and differential PSA between biopsies and PIA finding were integrated in a predictive model. At 6% threshold, more than 20% of repeat prostate biopsies were saved without missing csPCa. CONCLUSION: Currently, mHGPIN in negative prostate biopsy seems not able to predict the risk of future csPCa. The low incidence of ASAP and PINATYP, in our series, did not allow us to draw conclusions. PIA finding associated with a reduced risk of csPCa, and it could be integrated in a useful based-mpMRI predictive nomogram.

Atrophic and Microcystic Limited Prostatic Adenocarcinomas.

Atrophic carcinoma and microcystic carcinoma have previously been classified as variants of conventional acinar adenocarcinoma. In this article, we studied 4 cases of atrophic carcinoma and 4 cases of limited microcystic carcinoma. We found an incidence of 0.8% in 250 needle prostatic biopsies and 1.3% of atrophic carcinoma in 150 radical prostatectomies. Microcystic carcinomas were found in 3 prostatectomies (1.2%) and in 1 needle biopsy (0.67%). The useful histological criteria for atrophic carcinoma included the irregular disposition of the glands, infiltrative pattern, "rigid" luminal borders, and intraluminal secretions. Cytological changes included scant cytoplasm, nucleomegaly, hyperchromatic nuclei, and visible nucleoli. The glands of the microcystic carcinoma differ from the benign glands because the malignant ones show a markedly greater dilatation and exhibit rigidity of glandular lumens. In some cases of microcystic carcinoma, the nuclei were flattened, small, and hyperchromatic; therefore, they can be difficult to recognize as malignant.

Assessment of the influence of transrectal and transperineal prostate biopsies on erectile function: A prospective observational single-center study.

OBJECTIVES: To assess the impact of transrectal versus transperineal prostate biopsy on erectile function. METHODS: This was a single-center, observational, prospective study of consecutive patients who underwent a prostate biopsy (transrectal or transperineal/fusion biopsy). Study participants completed the International Index of Erectile Function-5 questionnaire before the procedure, and 3 and 6 months after. Prostatic biopsies were carried out following the standard procedure for both techniques. RESULTS: The study included 135 male patients with a mean age of 63.5 years. At baseline, 28 patients (21%) presented normal erectile function, whereas 107 patients (82%) presented erectile dysfunction, which was severe in four (3%), moderate in 49 (36%) and mild in 54 (40%), with an overall mean International Index of Erectile Function-5 score of 17.70. After 3 months, the rates were 29%, 3%, 27% and 38%, respectively (mean International Index of Erectile Function-5 score 17.95). At 6 months, the rates were 30%, 6%, 28% and 34%, respectively (mean International Index of Erectile Function-5 score of 17.77). No significant differences between pre- and post-biopsy International Index of Erectile Function-5 scores at 3 and 6 months were observed, even when analyzing transrectal and transperineal separately. The number of biopsy cores and number of previous biopsies did not influence the International Index of Erectile Function-5 scores. CONCLUSIONS: Our findings suggest that prostate biopsy technique, number of biopsy cores and history of previous biopsy do not significantly impact erectile function in the medium term up to 6 months.

[Serum cellular inflammatory markers in the diagnosis of prostate cancer.] / Marcadores inflamatorios celulares séricos en el diagnóstico de cáncer de próstata.

Prostate cancer (PCa) is one of the most frequent neoplasms in the masculine sex, which has multiple etiological factors, inflammation is one of them. OBJECTIVE: To determine the role of different inflammatory markers in the diagnosis of PCa in first prostatic biopsies. METHODS: This is a prospective study evaluating neutrophil/ lymphocyte (NLR), neutrophil/monocyte (NMR) and platelet/lymphocyte (PLR) ratios of 78 patients with suspected PCa due to PSA alteration and/or abnormal digital rectal examination, and its correlation with twelve-cylinder biopsy result. RESULTS: The NLR, NMR and PLR were all higher in the group diagnosed with PCa compared to the group with benign prostatic hyperplasia (p > 0.05). CONCLUSIONS: Inflammatory markers can be predictive factors in the diagnosis of PCa, although more studies are needed for their routine use.

El cáncer de próstata (CaP) es una de las neoplasias más frecuentes en el sexo masculino, la cual tiene descrito múltiples factores etiológicos, entre ellos la inflamación. OBJETIVO: Describir el papel de diferentes marcadores inflamatorios en el diagnóstico de CaP en biopsias prostáticas por primera vez.MÉTODOS: Es un estudio prospectivo donde se evaluaron las relaciones neutrófilo/linfocito (RNL), neutrófilo/ monocito (RNM) y plaqueta/linfocito (RPL) séricas de 78 pacientes con sospecha de CaP por alteración de PSA y/o tacto rectal, y su correlación con el resultado de biopsia de 12 cilindros. RESULTADOS: Las RNL, RNM y RPL fueron todas más elevadas en el grupo con diagnóstico de CaP en comparación al grupo con hiperplasia prostática benigna (p > 0,05). CONCLUSIONES: Los marcadores inflamatorios pueden ser factores predictivos en el diagnóstico de CaP, que necesitan más estudios para su utilización rutinaria.

[Shear wave elastography for guiding prostate puncture and differential diagnosis of prostatic lesions].

OBJECTIVE: To assess the value of transrectal shear wave elastography (SWE) in improving the detection of PCa and differentiating benign from malignant prostatic lesion. METHODS: We performed transrectal ultrasonography (TRUS) and SWE for 83 PCa-suspected patients and measured the maximum (Emax) and mean elastic modulus (Emean) of the lesions. In addition to conventional "6+X" puncture, we conducted SWE-guided prostate puncture and evaluated SWE in improving the detection rate of PCa based on the pathological results. Then, we obtained the threshold value of the Emax using the ROC curve and analyzed its correlation with the clinicopathological data. RESULTS: SWE-guided puncture was completed in all the 83 patients, of whom 31 were pathologically diagnosed with PCa and the other 52 with BPH. Compared with the BPH patients, the men with PCa showed significantly higher values of Emax (ï¼»47.13 ± 9.95ï¼½ vs ï¼»63.70 ± 14.29ï¼½ kPa, P < 0.05) and Emean (ï¼»33.25 ± 4.61ï¼½ vs ï¼»43.04 ± 8.57ï¼½ kPa, P < 0.05). The area under the ROC curve of Emax was 0.913, with a sensitivity of 90.1% and a specificity of 80.2%, with 54.15 kPa as the diagnostic threshold. The positive rates of PCa detected by SWE-guided puncture and single-needle puncture were 32.53% and 72.38%, respectively, significantly higher than 28.92% and 17.27% by TRUS-guided puncture and single-needle puncture (P < 0.05). Compared with TRUS, SWE exhibited a remarkably higher sensitivity (54.84% vs 80.65%, P < 0.05), specificity (67.31% vs 86.54%, P < 0.05), accuracy (62.65% vs 84.34%, P < 0.05), positive predictive value (50.00% vs 78.13%, P < 0.05) and negative predictive value (71.43% vs 88.26%, P < 0.05) in the differential diagnosis of benign and malignant prostatic lesions. Emax was positively correlated with the Gleason scores of the PCa patients. CONCLUSIONS: SWE can help determine the biopsy target, improve the detection of PCa and differentiate PCa from BPH.

Vasohibin-1 as a novel microenvironmental biomarker for patient risk reclassification in low-risk prostate cancer.

BACKGROUND: We previously reported high expression of vasohibin-1 (VASH1), which is specifically expressed in activated vascular endothelial cells, was a prognostic indicator of disease progression in prostate cancer. The aim of this study was to assess whether VASH1 expression at the area of normal prostatic tissue as well as that of intratumoral tissue could reflect the grade of malignancy of prostate cancer. RESULTS: Pathological upgrade of Gleason Score ≥7 by radical prostatectomy was observed in 48 patients (upgraded group). The median VASH1 densities of the intratumoral and normal areas were 9.7 ± 9.5 and 13.3 ± 11.8, respectively, and the median MVDs were 58.6 ± 20.3 and 64.1 ± 23.5, respectively. We detected a strong positive correlation with each other for both VASH1 density (ρ = 0.589, p < 0.001) and MVD (ρ = 0.342, p < 0.001). VASH1 density was significantly higher in the upgreaded group than in the non-upgraded group regardless of prostatic location (intratumoral area: p < 0.001, normal area: p < 0.001). CONCLUSIONS: Even if the tumor volume was low in biopsy samples, VASH1 density reflected the grade of malignancy throughout the prostate. These results suggested that VASH1 expression could be a novel microenvironmental biomarker for patient risk reclassification in low-risk prostate cancer. MATERIALS AND METHODS: Among the 1177 patients who underwent radical prostatectomy, 104 patients diagnosed with Gleason Score ≤6 and positive cores ≤3 were included. We immunohistochemically examined the microvessels positive for anti-CD34 as microvessel density (MVD), and those with activated endothelial cells as VASH1 density using prostatic biopsy samples, and evaluated the association between their expressions and clinicopathological findings.

Transition zone and anterior stromal prostate cancers: Evaluation of discriminant location criteria using multiparametric fusion-guided biopsy.

PURPOSE: The purpose of this study was to evaluate precise location criteria on magnetic resonance imaging (MRI) to improve detection of transition zone (TZ) and anterior stroma (AS) prostate cancers using targeted MRI/transrectal ultrasound fusion biopsies as a reference standard. MATERIAL AND METHODS: Ninety-six men (mean age: 65 years±7.7 [SD] [range: 46-83 years]) with an elevated prostate-specific antigen (PSA) (PSA≥4ng/mL) who underwent standard and targeted biopsies on a TZ/AS suspicious lesion were included. The database was reviewed to assess topographical and morphological features of each suspicious lesion on MR images (T2-weighted anatomical images on 1.5T MRI or 3T) including PI-RADS score assessed by a senior radiologist. Histopathological examination of MRI-transrectal ultrasound fusion biopsy specimens was used as the reference standard. RESULTS: Ninety patients had a positive targeted biopsy with a median [IQR] lesion size of 16mm [13-20mm]. Homogeneous hypointensity on T2-weighted mages, lenticular shape, lack of capsule and indistinct margins were present in 77/90 (85%) patients. All TZ/AS prostate cancers were located in the anterior half of the prostate: 3% at the base, 69% in the mid gland and 28% at the apex. Lesions were mainly located close to or within the AS (74%) and more rarely laterally compressed close to the peripheral anterior horn. CONCLUSION: Our results suggest that specific topographic criteria of TZ and AS prostate cancers could add independent information to the usual diagnostic criteria in prostate MRI. Transrectal ultrasound fusion-targeted biopsies based on these specific criteria improve volume estimation of prostate cancers with substantial impact for prognosis and treatment planning.

Minimal (Limited) Pseudohyperplastic Prostatic Adenocarcinoma in Needle Prostatic Biopsy.

BACKGROUND: Study of minimum adenocarcinoma has been done almost exclusively on conventional acinar adenocarcinoma. Pseudohyperplastic adenocarcinoma can be confused with benign lesions because of its well-differentiated appearance and has not been studied when the biopsy shows few malignant glands (limited carcinoma). METHODS: We reviewed 94 pseudohyperplastic adenocarcinomas diagnosed in prostatic biopsies for a period of 12 years and selected those measuring less than 1 mm or involving less than 5% of the biopsied tissue. We also reviewed 200 consecutive consultations. RESULTS: Four (4.2%) of the 94 cases were limited pseudohyperplastic adenocarcinomas, and 3 were from consultations. Three of them were mistaken for hyperplastic nodules, prostatic adenosis, or prostatic intraepithelial neoplasm. The number of glands varied between 6 and 50 (average 23). Three nodular histological patterns were identified-nodular, adenosis-like, and pseudohyperplastic carcinoma resembling prostatic intraepithelial neoplasia. The diagnosis of adenocarcinoma was not related to the number of neoplastic glands. Histological criteria that were useful included: crowded medium to large glands, papillary infoldings, branching glands, straight luminal borders, hyperchromatic nuclei, nucleomegaly, and apparent nucleoli. Areas of transition to conventional acinar adenocarcinoma were useful in recognizing four of these neoplasms, but were barely apparent in 2 of them. Hyperchromatic nuclei were found in all cases, whereas apparent nucleoli and nucleomegaly were only present in 4. CONCLUSIONS: The architectural and cytological criteria for limited acinar adenocarcinoma are only partially useful in interpreting minimum pseudohyperplastic adenocarcinomas. Knowledge of the criteria for malignancy in both neoplasms is important in order to avoid underdiagnosis of malignancy.

Diagnostic value of urine-based PCA3 score in prostate cancer patients undergoing initial prostatic biopsy / 军事医学

Objective To evaluate the diagnostic value of urine-based prostate cancer antigen 3 ( PCA3 ) score in detecting prostate cancer during initial prostatic biopsy .Methods Urine was collected after digital rectal examination ( DRE) ( three strokes per lobe ) from 248 men before prostate biopsy .The specimens were collected between January 2010 and December 2012.The expression of PCA3 mRNA and prostate specifc antigen (PSA) mRNA was determined by quanti-tative real time polymerase chain reaction ( qRT-PCR ) .PCA3 scores were calculated by PCA 3 mRNA/PSA mRNA × 1000 .The ability of the PCA3 score to predict the biopsy outcome was assessed with AUC-ROC analysis and compared with the serum PSA levels.Results The rate of positive prostate biopsy was 32.3%(80 patients with positive prostatic biopsy versus 168 patients with negative prostate biopsy ) .PCA3 scores were significantly higher in patients with positive biopsy than in those with negative biopsy results (P<0.001).The ROC curve analysis demonstrated that the area under the ROC curve (AUC) of serum total PSA (tPSA), PCA3 score and the duplex model combining tPSA and PCA 3 score was 0.620, 0.693 and 0.724, respectively.Further analysis of the diagnostic performance of PCA3 score revealed that at a cut-off of 90.2456, the sensitivity was 67.5%and the specificity was 61.9%for discriminating positive biopsy from negative biopsy. The duplex model combining tPSA and PCA 3 score represented a better approach than tPSA alone in PCa diagnosis by pros-tatic biopsy (P=0.011), but there was no statistically significant difference between tPSA and PCA 3 score (P=0.160). In addition , a comprehensive diagnostic model based on multiple risk factors of prostate cancer combined with PCA 3 score could further improve the predictive accuracy of prostate cancer .Conclusion PCA3 could be a good predictor of prostate cancer in initial prostate biopsy in Chinese population .The comprehensive diagnostic model can improve the diagnostic potency .Further large-scale multicenter studies in China are needed to confirm our findings .

Feasibility study of a randomized controlled trial comparing docetaxel chemotherapy and androgen deprivation therapy with sequential prostatic biopsies from patients with advanced non-castration-resistant prostate cancer.

BACKGROUND AND OBJECTIVE: Sequential tissue biopsies taken during clinical trials of novel systemic anticancer therapies for advanced prostate cancer (PCa) may aid pharmacodynamic evaluation and biomarker discovery. We conducted a single institution phase-II open-labeled randomized study to assess the safety, tolerability, and early efficacy of docetaxel chemotherapy plus androgen deprivation therapy (ADT) vs. ADT alone for patients with advanced non-castration-resistant PCa with sequential prostatic biopsies. PATIENTS AND METHODS: We randomized 30 patients with newly diagnosed high-grade locally advanced or metastatic (cT3-4/N0-1/M0-1) PCa to receive ADT with (n = 15) or without (n = 15) docetaxel. Transrectal ultrasound-guided prostatic biopsies were taken at randomization and ~22 weeks after treatment initiation. Primary end point: biochemical response rate. Secondary end points: time to progression and tumor profiling. RESULTS: Both treatments appear to be well tolerated, and there was no difference in mean nadir prostate-specific antigen and time to prostate-specific antigen relapse between treatment arms (P>0.05). No adverse effects of pre- and post-treatment prostatic biopsies were observed. The study was neither designed nor sufficiently powered to demonstrate statistically significant differences in oncological outcomes or safety profiles between the 2 treatment arms. CONCLUSIONS: Despite the lack of statistical power, our study suggests that docetaxel and ADT in combination may be well tolerated with apparently similar short-term efficacy compared with ADT alone for high-grade locally advanced or metastatic non-castration-resistant PCa, Sequential prostatic biopsies may provide tissue for tumor profiling to yield mechanistic or prognostic insights relating to novel systemic anticancer therapies.

Urinary tract symptoms and erectile function in patients at risk of prostate cancer.

INTRODUCTION AND OBJECTIVE: We estimate that more tan 63000 prostate biopsies are performed in our country each year. There are no functional status data of those patients and if there is a relationship between biopsy result and functional status. In order to solve that question we have performed this study. MATERIAL AND METHOD: 1,128 prostate biopsies were included. Patients fill in the IPSS, IIEF-5 and ICIQ-SF questionnaires before the prostate biopsy was performed. A prospective data collection of clinical, pathological and questionnaires results was done. A descriptive analysis was carried out. IPSS and IIEF-5 results were categorized. Results were compared depending on the biopsy result. In the subgroup of patients with prostate cancer, questionnaires results were stratify according to the clinical risk group. RESULTS: The mean age of the sample was 65. Prostate cancer detection rate was 32,71%, 52,2% of the sample had mild lower urinary tract symptoms (LUTS) and 13,4% had severe LUTS at the time of the biopsy. Regarding the impact of LUTS on quality of life (QOL), only 12,6% showed a perfect QOL. More than 50 percent of patients suffered from some degree of erectile dysfunction at the time of the biopsy. According to ICIQ-SF, 24% of the sample experienced some kind of urinary incontinence, although it is true that most of them classified it as small amount. Patients with a positive biopsy had a lower IPSS and IIEF-5 average score. There were no differences in the prostate cancer detection rate stratified by the severity of LUTS. CONCLUSIONS: Patients undergoing prostate biopsy have, with a high probability, LUTS. Approximately 50% suffer from some degree of erectile dysfunction and 24% had some kind of urinary leakage.

Actualización en cáncer de próstata: generalidades y diagnóstico / Update in prostate cancer: overview and diagnosis

Resumen: El cáncer de próstata es una enfermedad clínicamente caracterizada por un periodode latencia largo y un crecimiento tumoral lento. En la actualidad, es un problema de granimportancia para la salud pública, pues es el segundo cáncer más frecuentemente diagnosticadoy corresponde a la sexta causa de muerte por cáncer en hombres en el mundo. Se caracteriza poruna gran heterogeneidad clínica y molecular. Su diagnóstico se basa en el uso de tres pruebasfundamentales: el examen del tacto rectal y la medición de los niveles séricos del antígenoespecífico de próstata (AEP), los cuales se usan frecuentemente en el tamizaje, y la biopsiaprostática, mediante la cual se confirma el diagnóstico de cáncer de próstata. Actualmente, el AEPse ha constituido en la principal herramienta tamiz para el cáncer de próstata; no obstante, existeuna gran controversia en torno a su uso. Por ello, están siendo ampliamente estudiados nuevosbiomarcadores, a fin de disponer de pruebas diagnósticas más sensibles y específicas. Dado queel AEP es una prueba ampliamente utilizada internacionalmente y que han surgido biomarcadoresadicionales para el diagnóstico temprano del cáncer de próstata, es de fundamental importanciaque el personal de la salud en general y el personal de laboratorio en particular puedan contarcon información con respecto al uso de éstas y su relación con otras herramientas diagnósticas,además de otros aspectos generales del cáncer de próstata.

Abstract: Prostate cancer is a disease clinically characterized by a long latency period and slow tumorgrowth rate. Prostate cancer is currently a major public health problem because it is the second mostcommonly diagnosed cancer, and the sixth major cause of cancer-related death in men in the world.It is characterized by clinical and molecular heterogeneity. Diagnosis is based on the use of threebasic tests: digital rectal examination, measurement of prostate-specific antigen (PSA) serum levels,frequently used in screening, and prostate biopsy, which confirms the diagnosis of prostate cancer.Nowadays, PSA has become the main testing way for prostate cancer screening, although there ismuch controversy about its use. Therefore, new biomarkers are being widely researched, in order toprovide more sensitive and more specific diagnostic tests. Provided that PSA is a globally used test,and additional tests for early diagnosis of prostate cancer have aroused, is it essential that healthpersonnel, and particularly laboratory personnel, are granted with information about their use, andtheir relationship with further diagnostic techniques, besides other general aspects of prostate cancer.

Meta-analysis of antibiotic prophylaxis use in transrectal prostatic biopsy / 中南大学学报(医学版)

ObjectiveTo determine whether antibiotic prophylaxis can reduce the risk of postoperative infective complications in men undergoing transrectal prostatic biopsy (TPB) who had sterile preoperative urine.MethodsMEDLINE, EMBASE, Cochrane Collaboration Reviews, Chinese Medical Current Contents (CMCC), and National Knowledge Infrastructure (CNKI) were searched for rando-mized controlled trials that compared the effect of antibiotic prophylaxis with placebo or active controls for men undergoing TPB with preoperative sterile urine. Two reviewers independently extracted the data of patient characteristics and outcomes based on a prospectively developed protocol.ResultsA total of 12 trials (3 placebo controlled, 3 non-treatment controlled, and 6 activly controlled) involving 1 987 patients, met the inclusion criteria. Prophylactic antibiotic use in patients at low risk undergoing TPB significantly decreased bacteriuria and middle degree fever incidence, but could not decrease the incidence of bacteremia. The relative risk for post-TPB bacteriuria, middle degree fever, and bacteremia were 0.32 (95% CI 0.23 to 0.46), 0.37 (95% CI 0.17 to 0.77), and 0.96 (95% CI 0.61 to 1.50), respectively. Effective antibiotic classes included quinolone, co-quinolone and nitroimidazole, and co-trimethoprim and sulfamethoxazole. Treatment protocols of any duration were effective.ConclusionAntibiotic prophylaxis obviously decreases the incidence of bacteriuria and middle degree fever but not bacteremia in men with preoperative sterile urine undergoing TPB. A significant decrease in bacteriuria incidence can be achieved with a range of antibiotic agents, including quinolones and co-quinolone and nitroimidazole. Treatment protocols of any duration are effective with no heterogeneity.

Dolor trans biopsia de próstata guiada por ultrasonografía transrectal: comparación del uso o no de xilocaína gel como anestésico local: Instituto Especializado de Enfermedades Neoplásicas: Lima-Perú 2006 / Pain during transrectal ultrasound guided needle biopsy of the prostate: comparison of the use or not of lidocaine: Instituto Especializado de Enfermedades Neoplásicas: Lima-Perú

Desde julio de 2004 hasta marzo de 2005 se reclutaron 114 pacientes con indicación de biopsia de próstata bajo guía ecográfica los cuales se dividieron en dos grupos según la colocación o no de xilocaína gel al 2 por ciento intrarrectal antes del procedimiento. Se comparó el dolor que sintieron durante la biopsia a través de una escala de dolor. No hubo diferencia estadísticamente significativa entre los pacientes a quienes se colocó anestésico local frente a quienes no se les colocó. Por otro lado, el dolor fue mayor cuando se usó una aguja esterilizada que cuando se usó una aguja nueva.

From July 2004 until March 2005 we prospectively studied 114 patients who underwent transrectal ultrasound guided needle biopsy of the prostate. Patients were divided in two groups: intrarectal 2 percent lidocaine gel was used prior to biopsy in one of the groups. We compared the pain that patients felt during the procedure using a pain scale. We did not find differences between both groups, but the patients in whom we used a new needle felt less pain than the patients in whom we used a reesterilized one.

¿Es necesario el enema rectal en la biopsia de próstata? / Is it necessary to perform rectal enema for prostate biopsies?

Nuestro objetivo fue evaluar la necesidad real de enema rectal previo a la realización de biopsia prostática y su implicación en posibles complicaciones infecciosas asociadas al procedimiento. Material y Métodos. Entre Enero y Junio del 2006, 128 pacientes recibieron biopsia prostática. Fueron asignados a dos grupos, recibiendo o no enema rectal. De estos, 90 pacientes presentaron información evaluable y constituyeron la población de estudio. Resultados. No se verificaron diferencias significativas entre los dos grupos de estudio. Conclusiones. El presente trabajo demuestra la utilidad limitada que tiene el enema rectal previo a biposia prostática.

We aimed to evaluate the real usefulness of rectal enema previous to transrectal prostatic biopsy and its possible implications in infectious complications. Methods. Between January and June 2006, 128 consecutive patients underwent transrectal prostatic biopsy at our institution. Patients were assigned to two groups’ receiving rectal enema or not. Of these, 90 patient shad complete available information and constituted the population of study. Results. No significant differences were verified between the two groups of study. Conclusions. Present manuscript shows the limited usefulness of rectal enema previous a transrectal prostate biopsy.

Clinical 0bservation on 48 Cases of Transrectal Prostatic Biopsy / 대한비뇨기과학회지

Diagnosis of adenocarcinoma of the prostate based purely on digital rectal examination will be correct in only 70% of cases. Transitional cell carcinoma also arises in the prostate, as may more rarely sarcoma. The fibrous prostate, granulomatous prostatitis and stone may also result in a prostate that feels firmer than normal. Estrogen or orchiectomy will be of no benefit in these condition and may cause harm. Histological or cytological proof of the diagnosis is essential. Examination of prostatic tissue obtained by biopsy has been used to confirm malignancy or any type, judge the response of a tumor to either hormonal or cytotoxic manipulation and bacteriologic confirmation. The transrectal prostatic biopsy was performed on 48 cases of oriental, from May 1979 to February 1982. The results are as follows. 1. The patients ranged in age from 25 to 82 years old and the percentage of patients more than 50 years old is 85.4% (38 cases). 2. The highest reason of referral for prostatic biopsy is obstructive symptoms (62.5% - 30 cases). 3. As shown in table 3, only in 2 cases the specimens obtained with Silverman needle proved inadequate for a reliable diagnosis even though in 46 cases the specimens were thought to be adequate. In 46 cases, the highest disease is B.P.H. (73.9% - 34 cases), 2nd prostatic adenocarcinoma (17.5% - 8 cases), 3fd chronic prostatitis (4.3% - 2 cases) and normal prostate (4.3% - 2 cases). 4. There were 7 complications of transrectal prostatic biopsy and the hematuria (4 cases) was the most common.