Objective:To explore the effect of 3-dimensional(3D)printing-assisted cognitive fusion on improvement of the positive rate in prostate biopsy.Methods:From August to December 2014,16 patients with suspected prostatic l...Objective:To explore the effect of 3-dimensional(3D)printing-assisted cognitive fusion on improvement of the positive rate in prostate biopsy.Methods:From August to December 2014,16 patients with suspected prostatic lesions detected by multiparametric magnetic resonance imaging(MRI)were included.Targeted prostate biopsy was performed with the use of prostate 3D reconstruction modeling,computersimulated biopsy,3D printing,and cognitive fusion biopsy.All patients had received 3.0 T multiparametric MRI before biopsy.The DICOM MRI files were imported to medical imaging processing software for 3D reconstruction modeling to generate a printable.stl file for 3D printing with use of transparent resin as raw material.We further performed a targeted 2-to 3-core biopsy at suspected lesions spotted on MRI.Results:For the 16 patients in the present study,3D modeling with cognitive fusion-based targeted biopsy was successfully performed.For a single patient,1e2 lesions(average:1.1 lesions)were discovered,followed by 2-6 cores(average:2.4 cores)added as targeted biopsy.Systematic biopsies accounted for 192 cores in total,with a positive rate of 22.4%;targeted biopsies accounted for 39 cores in total,with a positive rate of 46.2%.Among these cases,10 patients(62.5%)were diagnosed with prostate adenocarcinoma,in which seven were discovered by both systematic and targeted biopsy,one was diagnosed by systematic biopsy only,and two were diagnosed by targeted biopsy only.For systematic biopsy,Gleason score ranged from 6 to 8(average:7),while that for targeted biopsy ranged from 6 to 9(average:7.67).Among the seven patients that were diagnosed by both systematic and targeted biopsy,three(42.8%)were reported with a higher Gleason score in targeted therapy than in systematic biopsy.Conclusion:3D printing-assisted cognitive fusion technique markedly promoted positive rate in prostate biopsy,and reduced missed detection in high-risk prostate cancer.展开更多
Objective:Multiparametric magnetic resonance imaging(MP-MRI)helps to identify lesion of prostate with reasonable accuracy.We aim to describe the various uses of MP-MRI for prostate biopsy comparing different technique...Objective:Multiparametric magnetic resonance imaging(MP-MRI)helps to identify lesion of prostate with reasonable accuracy.We aim to describe the various uses of MP-MRI for prostate biopsy comparing different techniques of MP-MRI guided biopsy.Materials and methods:A literature search was performed for“multiparametric MRI”,“MRI fusion biopsy”,“MRI guided biopsy”,“prostate biopsy”,“MRI cognitive biopsy”,“MRI fusion biopsy systems”,“prostate biopsy”and“cost analysis”.The search operation was performed using the operator“OR”and“AND”with the above key words.All relevant systematic reviews,original articles,case series,and case reports were selected for this review.Results:The sensitivity of MRI targeted biopsy(MRI-TB)is between 91%e93%,and the specificity is between 36%e41%in various studies.It also has a high negative predictive value(NPV)of 89%e92%and a positive predictive value(PPV)of 51%e52%.The yield of MRI fusion biopsy(MRI-FB)is similar,if not superior to MR cognitive biopsy.In-bore MRI-TB had better detection rates compared to MR cognitive biopsy,but were similar to MR fusion biopsy.Conclusions:The use of MRI guidance in prostate biopsy is inevitable,subject to availability,cost,and experience.Any one of the three modalities(i.e.MRI cognitive,MRI fusion and MRI in-bore approach)can be used.MRI-FB has a fine balance with regards to accuracy,practicality and affordability.展开更多
<strong>Background:</strong> Transrectal prostate biopsy is a major prostate cancer diagnosis procedure that can cause infectious complications. Osteoarticular localization is uncommon. <strong>Aim:&...<strong>Background:</strong> Transrectal prostate biopsy is a major prostate cancer diagnosis procedure that can cause infectious complications. Osteoarticular localization is uncommon. <strong>Aim:</strong> To report a case of spondylodiscitis due to a transrectal prostate biopsy and highlight therapeutical principles. <strong>Case Presentation: </strong>A 60-year-old male underwent transrectal prostate biopsy performed because of high PSA level, and presented 48 hours later with back pain, fever at 40<span style="white-space:nowrap;">°</span>C associated with an obnubilation. He was treated for malaria without favorable evolution. Persistance of pain and occurrence of neurologic manifestations motivated dorso-lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which permitted diagnosis of spondylodiscitis. The treatment was made by triple antibiotic therapy combining Imipenem 500 mg/8h (IV);Ofloxacin 200 mg/12h (IV) and Metronidazole 500 mg/8h (IV) over four weeks. Evolution under treatment was favorable. <strong>Conclusion:</strong> Spondylodiscitis is an exceptional complication of transrectal prostate biopsy. It may be evocated in case of bones pain after prostate biopsy.展开更多
BACKGROUND Routinely, after receiving prostate specific antigen (PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ul...BACKGROUND Routinely, after receiving prostate specific antigen (PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Nowadays, a variety of diagnostic methods and more sensitive diagnostic methods, such as multi-parameter prostate magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) can be applied clinically. Furthermore, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So maybe it is time to reconsider the necessary to perform prostate biopsy before radical prostatectomy. AIM To explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques. METHODS From June 2014 to November 2018, 11 cases of laparoscopic radical prostatectomy without prostate biopsy were performed at the three tertiary medical centers involved in this study. All patients received prostate magnetic resonance imaging and prostate cancer was suspected, including six patients with positive 68Ga- PSMA PET/CT results. Laparoscopic radical prostatectomy and pelvic lymph node dissection were performed for all patients. RESULTS All surgeries were accomplished successfully. The mean age was 69 ± 7.7 year, the mean body mass index was 24.7 ± 1.6 kg/m2, the range of serum PSA was 4.3 to >1000 ng/mL, and the mean prostate volume was 40.9 ± 18.3 mL. The mean operative time was 96 ± 23.3 min, the mean estimated blood loss was 90 ± 90.9 mL, and the median duration of catheter placement was 14 d. The final pathology confirmed that all specimens were prostate cancer except one case of benign prostatic hyperplasia. No major complications occurred in 90 d postoperatively. CONCLUSION The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques. Radical prostatectomy could be carried out without the evidence of malignancy. Large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.展开更多
Aim: To evaluate the diagnostic value of the 10 systematic transrectal ultrasound-guided (TRUS) prostate biopsy compared with the sextant biopsy technique for patients with suspected prostate cancer. Methods: One hund...Aim: To evaluate the diagnostic value of the 10 systematic transrectal ultrasound-guided (TRUS) prostate biopsy compared with the sextant biopsy technique for patients with suspected prostate cancer. Methods: One hundred and fifty-two patients with suspected prostate cancer were included in the study. Patients were entered in the study because they presented with high levels of prostate specific antigen (PSA) (over 4ng/mL) and/or had undergone an abnormal digital rectal examination (DRE). In addition to sextant prostate biopsy cores, four more biopsies were obtained from the lateral peripheral zone with additional cores from each suspicious area revealed by transrectal ultrasound. Sextant, lateral peripheral zone and suspicious area biopsy cores were submitted separately to the pathological department. Results: Cancer detection rates were 27.6%(42/152) and 19.7%(30/152) for the 10-core and sextant core biopsy protocols, respectively. Adding the lateral peripheral zone (PZ) to the sextant prostate biopsy showed a 28.6%(12/42) increase in the cancer detection rate in patients with positive prostate cancer (P<0.01).The cancer detection rate in patients who presented with elevated PSA was 29.3%(34/116). When serum PSA was 4-10ng/mL TRUS-guided biopsy detected cancer in 20.6%, while the detection rate was 32.4% and 47.0% when serum PSA was 10-20ng/mL and above 20ng/mL, respectively. Conclusion: The 10 systematic TRUS-guided prostate biopsy improves the detection rate of prostate cancer by 28.6% when compared with the sextant biopsy technique alone, without increase in the morbidity. We therefore recommend the 10-core biopsy protocol to be the preferred method for early detection of prostate cancer.展开更多
Objective To explore the clinical value of ultrasound shear wave elastography(SWE)and contrast-enhanced ultrasound(CEUS)in transrectal prostate biopsy.Methods A total of 54 patients(average age:67.79±12.01 years)...Objective To explore the clinical value of ultrasound shear wave elastography(SWE)and contrast-enhanced ultrasound(CEUS)in transrectal prostate biopsy.Methods A total of 54 patients(average age:67.79±12.01 years)in the experimental group underwent transrectal prostate biopsy under the guidance of SWE,while 46 patients(average age:69.22±11.54 years)in the control group underwent transrectal prostate biopsy guided by CEUS.Results There were a total of 451 needles,with an average of 8.35±1.67 needles per patient in the experimental group,and a total of 462 needles,with an average of 10.04±1.33 needles per patient in the control group.The difference in puncture times between the two groups was statistically significant(P<0.05).There was no significant difference in the positive detection rate,sensitivity or specificity between the two groups(P>0.05),but there was a significant difference in the diagnostic accuracy between the two groups(P<0.05).The E_(mean)and E_(max)of prostate cancer were significantly higher in the experimental group than in benign prostatic hyperplasia(P<0.05).The receiver operating characteristic curve(ROC)analysis showed that the area under the ROC curve(AUC)of E_(mean)was 0.752(S.E.=0.072,95%CI=0.611-0.894,P=0.007),and the best cutoff value was 47.005 kPa.Conclusion In summary,both SWE-and CEUS-guided transrectal prostate biopsy can help find the focus and guide the puncture,and improve the positive detection rate.展开更多
Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case...Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case of life-threatening rectal bleeding following this procedure,which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding.This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy.Additionally,current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure,are described.展开更多
Objective:To configure and validate a novel prostate disease nomogram providing prostate biopsy outcome probabilities from a prospective study correlating clinical indicators and diagnostic parameters among Filipino a...Objective:To configure and validate a novel prostate disease nomogram providing prostate biopsy outcome probabilities from a prospective study correlating clinical indicators and diagnostic parameters among Filipino adult male with elevated serum total prostate specific antigen(PSA)level.Methods:All men with an elevated serum total PSA underwent initial prostate biopsy at our institution from January 2011 to August 2014 were included.Clinical indicators,diagnostic parameters,which include PSA level and PSA-derivatives,were collected as predictive factors for biopsy outcome.Multiple logistic-regression analysis involving a backward elimination selection procedure was used to select independent predictors.A nomogram was developed to calculate the probability of the biopsy outcomes.External validation of the nomogram was performed using separate data set from another center for determination of sensitivity and specificity.A receiver-operating characteristic(ROC)curve was used to assess the accuracy in predicting differential biopsy outcome.展开更多
Prostate biopsy is a very common procedure performed worldwide which still represents the only way for prostate cancer diagnosis and reference point for subsequent treatments. Even if transrectal prostate biopsy is co...Prostate biopsy is a very common procedure performed worldwide which still represents the only way for prostate cancer diagnosis and reference point for subsequent treatments. Even if transrectal prostate biopsy is considered a safe procedure, it may be accompanied by infective complications, ranging from asymptomatic bacteriuria to symptomatic urinary tract infections and sepsis. During the recent decade we observed an increasing number of infectious complications and subsequent hospitalizations after and transrectal prostate biopsy. The most probable reason for the increasing rate of infectious complications after prostate biopsy is the increasing antimicrobial resistance, especially to the current first-line recommended fluoroquinolone antibiotics. We believe the time has come to re-think our current practice of diagnosing prostate cancer. We need to focus on the selection of patients at higher risk of infective complications, on microbiological sampling of the faecal flora prior to biopsy to identify resistance to specific agents, on the number of biopsy cores, on the biopsy route(perineal or transrectal approach) and, finally, consider alternative antibiotics with improved susceptibility to be used for prophylaxis.展开更多
Objective: We investigated rates of prostate cancer (PCa), high-grade prostatic intraepithelial neoplaisa (HGPIN) and atypical small acinar proliferation (ASAP) in a multiethnic cohort. Methods: We evaluated prostate ...Objective: We investigated rates of prostate cancer (PCa), high-grade prostatic intraepithelial neoplaisa (HGPIN) and atypical small acinar proliferation (ASAP) in a multiethnic cohort. Methods: We evaluated prostate biopsy outcomes in men enrolled in the San Antonio Center of Biomarkers of Risk for prostate cancer (SABOR) prospective, observational study. PCa-free men underwent annual PSA testing over nearly 14 years with biopsies based on community standards. We investigated biopsy outcomes with a special interest in rates of cancer, HGPIN, and ASAP. Results: We identified 975 prostate biopsies in 801 subjects from 3/1/2001 to 1/9/2014. PCa, HGPIN, or ASAP was encountered in 28.8% (281/975), 10.1% (98/975), and 5.2% (51/975) of prostate biopsy specimens, respectively. The most significant risk factor for a PCa diagnosis was African American race (OR 5.0, 95% CI: 2.2 - 11.4, p < 0.001). HGPIN and ASAP occurred more commonly in association with PCa (both p < 0.001). We identified 57% (24/42) of men diagnosed with a “pre-malignant” lesion on prostate biopsy and had a subsequent biopsy. Of those only 8% (2/24) were diagnosed with prostate cancer (both Gleason 3 + 3) within 1 year of the initial biopsy. Conclusion: We note a 5-fold increased risk of PCa for African American men. The incidence of HGPIN and ASAP are consistent with previously reported incidence. If diagnosed in isolation, repeat biopsy within one year could be delayed or eliminated as it may not change prostate cancer outcomes.展开更多
Background: In the diagnosis of prostatic diseases, the need for markers other than prostate specific antigen (PSA) has been increasing in recent years. So, we aimed to determine the predictive value, the neutrophil l...Background: In the diagnosis of prostatic diseases, the need for markers other than prostate specific antigen (PSA) has been increasing in recent years. So, we aimed to determine the predictive value, the neutrophil lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume before prostate biopsy in predicting the results of pathology. Transrectal ultrasound-guided biopsy of the prostate was performed because of high PSA values and compared values of these parameters to predict of pathology results. Methods: 2715 patients who underwent 10 - 12 quadrant transrectal ultrasound-guided prostate biopsies between January 2008 and January 2018 have been evaluated retrospectively. Patients were divided into groups according to the biopsy pathology results by benign (group 1), atypical small acinar proliferation (ASAP) (group 2) and prostate cancer (group 3). A total of 204 patients who were benign prostate hyperplasia in 71 patients (34.8%), atypical small acinar proliferation in 80 (39.21%) and prostate adenocarcinoma (PCa) in 53 patients (25.98%) were included in the study by systematic sampling. Before the biopsy total PSA (tPSA), free PSA (fPSA), rate of percentage of free to total prostate specific antigen (f/tPSA) rate, PSA density (PSA-D), white blood cell (WBC) count, blood neutrophil count (NC), blood lymphocyte count (LC), neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV), platelet count (PLT) and platelet-to-lymphocyte ratio (PLR) were measured and compared in all groups. Differences in continuous variables were assessed using the ANOVA. Logistic regression was used to analyze the linear relationship between predictive variables and pathology results. P < 0.05 was considered statistically significant. Results: NLR and PLR values were lower in group 1 than group 2 and were found statistically significant between in group 1 and group 2 (p: 0.03 and p: 0.02, respectively). MPV value was found 1.7 times higher in patients who were diagnosed with ASAP pathology than those with benign pathologies. Although there was statistically significant increase in MPV values in logistic regression results, no statistically significant diagnostic value was found. In addition MPV value was found 0.5 times higher in patients who were diagnosed patients with ASAP than prostate cancer group. ROC analysis showed that the optimal threshold was 7.65 femtoliter (sensitivity: 51%;specificity: 30%) and was found to be a statistically significant diagnostic value to distinguish groups 2 and 3. The lowest value of MPV was found in group 3. Conclusions: In cases where the PSA value is insufficient in predicting the pathology result, the effect of NLR, PLR and MPV on differential diagnosis can be kept in mind. While NLR and PLR are more useful in the diagnosis of ASAP, MPV is more effective in the diagnosis of malignancy.展开更多
Background: The incidence of infection associated with transrectal prostate biopsy has been increasing largely due to fluoroquinolone resistance (FQR). Purpose: To identify the antibiotic prescribing patterns employed...Background: The incidence of infection associated with transrectal prostate biopsy has been increasing largely due to fluoroquinolone resistance (FQR). Purpose: To identify the antibiotic prescribing patterns employed when men seek medical professionals due to infectious complications of prostate biopsy, and employ a quality improvement initiative to improve antibiotic selection. Methods: A retrospective review determined the percentage of patients who presented to the emergency department (ED) after TRUS biopsy, and whether they were given appropriate antibiotic therapy. Prospective quality improvement was initiated by obtaining cultures via rectal swab at the time of transrectal biopsy in order to allow culture results and fluoroquinolone sensitivities to be available in the electronic medical record. The provider to guide antibiotic selection if the patient returned with infection symptoms could utilize the data. Findings: From 10/2009 to 6/2014, 0.5% (9/1724) of patients who underwent TRUS prostate biopsy returned to the ED with infection. Seven patients had complete data and 4 (0.57%) were given appropriate initial antibiotic treatment. To improve antibiotic selection, the 119 men who underwent rectal swab culture prior to biopsy 19.3% (23/119) showed FQR on rectal culture. 4% (5/119) were hospitalized with infection, demonstrating a significant increase in infection incidence from retrospective chart review (0.5% to 4%, p = 0.0013). Of these 5 men, 60% (3/5) had FQR on rectal culture. Conclusions: Rectal culture at the time of biopsy may lead to faster recognition of resistant bacteria when presented with prostate biopsy infection.展开更多
Background: Diagnosis of prostate cancer is certified by histology true prostate biopsies. The aim of our study was to evaluate our prostate biopsy method. Material and Methods: It was a prospective study including pa...Background: Diagnosis of prostate cancer is certified by histology true prostate biopsies. The aim of our study was to evaluate our prostate biopsy method. Material and Methods: It was a prospective study including patients underwent prostate biopsy. Inclusion criteria were prostate specific antigen (PSA) level up to 4ng/ml and/or abnormal prostate at digital rectal examination. Patients who had risk factors of bleeding have been excluded of the study. The preparation before biopsy included antibioprophylaxy (Ciprofloxacine-Tinidazole) and rectal hypertonic cleaning (Normacol*). Twelve cores have been taken in each prostate by transrectal digital-guided way, using Biopty Gun 18 Gauge. Local anesthesia has been done previously by intrarectal application of 20 ml of gel of Lidoca?ne. Two other cores were taken into each abnormal area at rectal examination. The follow-up have been done during twelve weeks. Results: Eighty patients of 65 years of age were included. Nine patients had familial history of prostate cancer. PSA levels ranged from 5 to 6400 ng/ml with a median of 26.77 ng/ml ± 11.2. Complications occurred in 11.25% of patients, principally infectious complications which caused death of one patient by septicemia. The rate of cancer detection was 20%. Prostate abnormality at digital rectal examination and the presence of familial history of prostate cancer were not predictive factors of the presence of cancer on cores. Conclusion: Our prostate biopsy method is limited by the lack of ultrasonographic guidance and is at important risk of infectious complications.展开更多
文摘Objective:To explore the effect of 3-dimensional(3D)printing-assisted cognitive fusion on improvement of the positive rate in prostate biopsy.Methods:From August to December 2014,16 patients with suspected prostatic lesions detected by multiparametric magnetic resonance imaging(MRI)were included.Targeted prostate biopsy was performed with the use of prostate 3D reconstruction modeling,computersimulated biopsy,3D printing,and cognitive fusion biopsy.All patients had received 3.0 T multiparametric MRI before biopsy.The DICOM MRI files were imported to medical imaging processing software for 3D reconstruction modeling to generate a printable.stl file for 3D printing with use of transparent resin as raw material.We further performed a targeted 2-to 3-core biopsy at suspected lesions spotted on MRI.Results:For the 16 patients in the present study,3D modeling with cognitive fusion-based targeted biopsy was successfully performed.For a single patient,1e2 lesions(average:1.1 lesions)were discovered,followed by 2-6 cores(average:2.4 cores)added as targeted biopsy.Systematic biopsies accounted for 192 cores in total,with a positive rate of 22.4%;targeted biopsies accounted for 39 cores in total,with a positive rate of 46.2%.Among these cases,10 patients(62.5%)were diagnosed with prostate adenocarcinoma,in which seven were discovered by both systematic and targeted biopsy,one was diagnosed by systematic biopsy only,and two were diagnosed by targeted biopsy only.For systematic biopsy,Gleason score ranged from 6 to 8(average:7),while that for targeted biopsy ranged from 6 to 9(average:7.67).Among the seven patients that were diagnosed by both systematic and targeted biopsy,three(42.8%)were reported with a higher Gleason score in targeted therapy than in systematic biopsy.Conclusion:3D printing-assisted cognitive fusion technique markedly promoted positive rate in prostate biopsy,and reduced missed detection in high-risk prostate cancer.
文摘Objective:Multiparametric magnetic resonance imaging(MP-MRI)helps to identify lesion of prostate with reasonable accuracy.We aim to describe the various uses of MP-MRI for prostate biopsy comparing different techniques of MP-MRI guided biopsy.Materials and methods:A literature search was performed for“multiparametric MRI”,“MRI fusion biopsy”,“MRI guided biopsy”,“prostate biopsy”,“MRI cognitive biopsy”,“MRI fusion biopsy systems”,“prostate biopsy”and“cost analysis”.The search operation was performed using the operator“OR”and“AND”with the above key words.All relevant systematic reviews,original articles,case series,and case reports were selected for this review.Results:The sensitivity of MRI targeted biopsy(MRI-TB)is between 91%e93%,and the specificity is between 36%e41%in various studies.It also has a high negative predictive value(NPV)of 89%e92%and a positive predictive value(PPV)of 51%e52%.The yield of MRI fusion biopsy(MRI-FB)is similar,if not superior to MR cognitive biopsy.In-bore MRI-TB had better detection rates compared to MR cognitive biopsy,but were similar to MR fusion biopsy.Conclusions:The use of MRI guidance in prostate biopsy is inevitable,subject to availability,cost,and experience.Any one of the three modalities(i.e.MRI cognitive,MRI fusion and MRI in-bore approach)can be used.MRI-FB has a fine balance with regards to accuracy,practicality and affordability.
文摘<strong>Background:</strong> Transrectal prostate biopsy is a major prostate cancer diagnosis procedure that can cause infectious complications. Osteoarticular localization is uncommon. <strong>Aim:</strong> To report a case of spondylodiscitis due to a transrectal prostate biopsy and highlight therapeutical principles. <strong>Case Presentation: </strong>A 60-year-old male underwent transrectal prostate biopsy performed because of high PSA level, and presented 48 hours later with back pain, fever at 40<span style="white-space:nowrap;">°</span>C associated with an obnubilation. He was treated for malaria without favorable evolution. Persistance of pain and occurrence of neurologic manifestations motivated dorso-lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) which permitted diagnosis of spondylodiscitis. The treatment was made by triple antibiotic therapy combining Imipenem 500 mg/8h (IV);Ofloxacin 200 mg/12h (IV) and Metronidazole 500 mg/8h (IV) over four weeks. Evolution under treatment was favorable. <strong>Conclusion:</strong> Spondylodiscitis is an exceptional complication of transrectal prostate biopsy. It may be evocated in case of bones pain after prostate biopsy.
文摘BACKGROUND Routinely, after receiving prostate specific antigen (PSA) testing and digital rectum examination, patients with suspected prostate cancer are required to undergo prostate biopsy. However, the ability of ultrasound-guided prostate biopsy to detect prostate cancer is limited. Nowadays, a variety of diagnostic methods and more sensitive diagnostic methods, such as multi-parameter prostate magnetic resonance imaging (mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) can be applied clinically. Furthermore, laparoscopic/robot-assisted prostatectomy is also a safe and effective procedure for the treatment of benign prostatic hyperplasia. So maybe it is time to reconsider the necessary to perform prostate biopsy before radical prostatectomy. AIM To explore the feasibility of radical prostatectomy without prostate biopsy in the era of new imaging technology and minimally invasive techniques. METHODS From June 2014 to November 2018, 11 cases of laparoscopic radical prostatectomy without prostate biopsy were performed at the three tertiary medical centers involved in this study. All patients received prostate magnetic resonance imaging and prostate cancer was suspected, including six patients with positive 68Ga- PSMA PET/CT results. Laparoscopic radical prostatectomy and pelvic lymph node dissection were performed for all patients. RESULTS All surgeries were accomplished successfully. The mean age was 69 ± 7.7 year, the mean body mass index was 24.7 ± 1.6 kg/m2, the range of serum PSA was 4.3 to >1000 ng/mL, and the mean prostate volume was 40.9 ± 18.3 mL. The mean operative time was 96 ± 23.3 min, the mean estimated blood loss was 90 ± 90.9 mL, and the median duration of catheter placement was 14 d. The final pathology confirmed that all specimens were prostate cancer except one case of benign prostatic hyperplasia. No major complications occurred in 90 d postoperatively. CONCLUSION The current practice of mandating a prostatic biopsy before prostatectomy should be reconsidered in the era of new imaging technology and minimally invasive techniques. Radical prostatectomy could be carried out without the evidence of malignancy. Large-sample randomized controlled trials are definitely required to confirm the feasibility of this new concept.
文摘Aim: To evaluate the diagnostic value of the 10 systematic transrectal ultrasound-guided (TRUS) prostate biopsy compared with the sextant biopsy technique for patients with suspected prostate cancer. Methods: One hundred and fifty-two patients with suspected prostate cancer were included in the study. Patients were entered in the study because they presented with high levels of prostate specific antigen (PSA) (over 4ng/mL) and/or had undergone an abnormal digital rectal examination (DRE). In addition to sextant prostate biopsy cores, four more biopsies were obtained from the lateral peripheral zone with additional cores from each suspicious area revealed by transrectal ultrasound. Sextant, lateral peripheral zone and suspicious area biopsy cores were submitted separately to the pathological department. Results: Cancer detection rates were 27.6%(42/152) and 19.7%(30/152) for the 10-core and sextant core biopsy protocols, respectively. Adding the lateral peripheral zone (PZ) to the sextant prostate biopsy showed a 28.6%(12/42) increase in the cancer detection rate in patients with positive prostate cancer (P<0.01).The cancer detection rate in patients who presented with elevated PSA was 29.3%(34/116). When serum PSA was 4-10ng/mL TRUS-guided biopsy detected cancer in 20.6%, while the detection rate was 32.4% and 47.0% when serum PSA was 10-20ng/mL and above 20ng/mL, respectively. Conclusion: The 10 systematic TRUS-guided prostate biopsy improves the detection rate of prostate cancer by 28.6% when compared with the sextant biopsy technique alone, without increase in the morbidity. We therefore recommend the 10-core biopsy protocol to be the preferred method for early detection of prostate cancer.
基金The study was funded by Inner Mongolia Natural Science Foundation(2020MS08047).
文摘Objective To explore the clinical value of ultrasound shear wave elastography(SWE)and contrast-enhanced ultrasound(CEUS)in transrectal prostate biopsy.Methods A total of 54 patients(average age:67.79±12.01 years)in the experimental group underwent transrectal prostate biopsy under the guidance of SWE,while 46 patients(average age:69.22±11.54 years)in the control group underwent transrectal prostate biopsy guided by CEUS.Results There were a total of 451 needles,with an average of 8.35±1.67 needles per patient in the experimental group,and a total of 462 needles,with an average of 10.04±1.33 needles per patient in the control group.The difference in puncture times between the two groups was statistically significant(P<0.05).There was no significant difference in the positive detection rate,sensitivity or specificity between the two groups(P>0.05),but there was a significant difference in the diagnostic accuracy between the two groups(P<0.05).The E_(mean)and E_(max)of prostate cancer were significantly higher in the experimental group than in benign prostatic hyperplasia(P<0.05).The receiver operating characteristic curve(ROC)analysis showed that the area under the ROC curve(AUC)of E_(mean)was 0.752(S.E.=0.072,95%CI=0.611-0.894,P=0.007),and the best cutoff value was 47.005 kPa.Conclusion In summary,both SWE-and CEUS-guided transrectal prostate biopsy can help find the focus and guide the puncture,and improve the positive detection rate.
文摘Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case of life-threatening rectal bleeding following this procedure,which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding.This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy.Additionally,current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure,are described.
基金sponsored by the Institution where the study was conductedit was also awarded with research grant from the Philippine Urological Association,Inc.
文摘Objective:To configure and validate a novel prostate disease nomogram providing prostate biopsy outcome probabilities from a prospective study correlating clinical indicators and diagnostic parameters among Filipino adult male with elevated serum total prostate specific antigen(PSA)level.Methods:All men with an elevated serum total PSA underwent initial prostate biopsy at our institution from January 2011 to August 2014 were included.Clinical indicators,diagnostic parameters,which include PSA level and PSA-derivatives,were collected as predictive factors for biopsy outcome.Multiple logistic-regression analysis involving a backward elimination selection procedure was used to select independent predictors.A nomogram was developed to calculate the probability of the biopsy outcomes.External validation of the nomogram was performed using separate data set from another center for determination of sensitivity and specificity.A receiver-operating characteristic(ROC)curve was used to assess the accuracy in predicting differential biopsy outcome.
文摘Prostate biopsy is a very common procedure performed worldwide which still represents the only way for prostate cancer diagnosis and reference point for subsequent treatments. Even if transrectal prostate biopsy is considered a safe procedure, it may be accompanied by infective complications, ranging from asymptomatic bacteriuria to symptomatic urinary tract infections and sepsis. During the recent decade we observed an increasing number of infectious complications and subsequent hospitalizations after and transrectal prostate biopsy. The most probable reason for the increasing rate of infectious complications after prostate biopsy is the increasing antimicrobial resistance, especially to the current first-line recommended fluoroquinolone antibiotics. We believe the time has come to re-think our current practice of diagnosing prostate cancer. We need to focus on the selection of patients at higher risk of infective complications, on microbiological sampling of the faecal flora prior to biopsy to identify resistance to specific agents, on the number of biopsy cores, on the biopsy route(perineal or transrectal approach) and, finally, consider alternative antibiotics with improved susceptibility to be used for prophylaxis.
文摘Objective: We investigated rates of prostate cancer (PCa), high-grade prostatic intraepithelial neoplaisa (HGPIN) and atypical small acinar proliferation (ASAP) in a multiethnic cohort. Methods: We evaluated prostate biopsy outcomes in men enrolled in the San Antonio Center of Biomarkers of Risk for prostate cancer (SABOR) prospective, observational study. PCa-free men underwent annual PSA testing over nearly 14 years with biopsies based on community standards. We investigated biopsy outcomes with a special interest in rates of cancer, HGPIN, and ASAP. Results: We identified 975 prostate biopsies in 801 subjects from 3/1/2001 to 1/9/2014. PCa, HGPIN, or ASAP was encountered in 28.8% (281/975), 10.1% (98/975), and 5.2% (51/975) of prostate biopsy specimens, respectively. The most significant risk factor for a PCa diagnosis was African American race (OR 5.0, 95% CI: 2.2 - 11.4, p < 0.001). HGPIN and ASAP occurred more commonly in association with PCa (both p < 0.001). We identified 57% (24/42) of men diagnosed with a “pre-malignant” lesion on prostate biopsy and had a subsequent biopsy. Of those only 8% (2/24) were diagnosed with prostate cancer (both Gleason 3 + 3) within 1 year of the initial biopsy. Conclusion: We note a 5-fold increased risk of PCa for African American men. The incidence of HGPIN and ASAP are consistent with previously reported incidence. If diagnosed in isolation, repeat biopsy within one year could be delayed or eliminated as it may not change prostate cancer outcomes.
文摘Background: In the diagnosis of prostatic diseases, the need for markers other than prostate specific antigen (PSA) has been increasing in recent years. So, we aimed to determine the predictive value, the neutrophil lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume before prostate biopsy in predicting the results of pathology. Transrectal ultrasound-guided biopsy of the prostate was performed because of high PSA values and compared values of these parameters to predict of pathology results. Methods: 2715 patients who underwent 10 - 12 quadrant transrectal ultrasound-guided prostate biopsies between January 2008 and January 2018 have been evaluated retrospectively. Patients were divided into groups according to the biopsy pathology results by benign (group 1), atypical small acinar proliferation (ASAP) (group 2) and prostate cancer (group 3). A total of 204 patients who were benign prostate hyperplasia in 71 patients (34.8%), atypical small acinar proliferation in 80 (39.21%) and prostate adenocarcinoma (PCa) in 53 patients (25.98%) were included in the study by systematic sampling. Before the biopsy total PSA (tPSA), free PSA (fPSA), rate of percentage of free to total prostate specific antigen (f/tPSA) rate, PSA density (PSA-D), white blood cell (WBC) count, blood neutrophil count (NC), blood lymphocyte count (LC), neutrophil lymphocyte ratio (NLR), mean platelet volume (MPV), platelet count (PLT) and platelet-to-lymphocyte ratio (PLR) were measured and compared in all groups. Differences in continuous variables were assessed using the ANOVA. Logistic regression was used to analyze the linear relationship between predictive variables and pathology results. P < 0.05 was considered statistically significant. Results: NLR and PLR values were lower in group 1 than group 2 and were found statistically significant between in group 1 and group 2 (p: 0.03 and p: 0.02, respectively). MPV value was found 1.7 times higher in patients who were diagnosed with ASAP pathology than those with benign pathologies. Although there was statistically significant increase in MPV values in logistic regression results, no statistically significant diagnostic value was found. In addition MPV value was found 0.5 times higher in patients who were diagnosed patients with ASAP than prostate cancer group. ROC analysis showed that the optimal threshold was 7.65 femtoliter (sensitivity: 51%;specificity: 30%) and was found to be a statistically significant diagnostic value to distinguish groups 2 and 3. The lowest value of MPV was found in group 3. Conclusions: In cases where the PSA value is insufficient in predicting the pathology result, the effect of NLR, PLR and MPV on differential diagnosis can be kept in mind. While NLR and PLR are more useful in the diagnosis of ASAP, MPV is more effective in the diagnosis of malignancy.
文摘Background: The incidence of infection associated with transrectal prostate biopsy has been increasing largely due to fluoroquinolone resistance (FQR). Purpose: To identify the antibiotic prescribing patterns employed when men seek medical professionals due to infectious complications of prostate biopsy, and employ a quality improvement initiative to improve antibiotic selection. Methods: A retrospective review determined the percentage of patients who presented to the emergency department (ED) after TRUS biopsy, and whether they were given appropriate antibiotic therapy. Prospective quality improvement was initiated by obtaining cultures via rectal swab at the time of transrectal biopsy in order to allow culture results and fluoroquinolone sensitivities to be available in the electronic medical record. The provider to guide antibiotic selection if the patient returned with infection symptoms could utilize the data. Findings: From 10/2009 to 6/2014, 0.5% (9/1724) of patients who underwent TRUS prostate biopsy returned to the ED with infection. Seven patients had complete data and 4 (0.57%) were given appropriate initial antibiotic treatment. To improve antibiotic selection, the 119 men who underwent rectal swab culture prior to biopsy 19.3% (23/119) showed FQR on rectal culture. 4% (5/119) were hospitalized with infection, demonstrating a significant increase in infection incidence from retrospective chart review (0.5% to 4%, p = 0.0013). Of these 5 men, 60% (3/5) had FQR on rectal culture. Conclusions: Rectal culture at the time of biopsy may lead to faster recognition of resistant bacteria when presented with prostate biopsy infection.
文摘Background: Diagnosis of prostate cancer is certified by histology true prostate biopsies. The aim of our study was to evaluate our prostate biopsy method. Material and Methods: It was a prospective study including patients underwent prostate biopsy. Inclusion criteria were prostate specific antigen (PSA) level up to 4ng/ml and/or abnormal prostate at digital rectal examination. Patients who had risk factors of bleeding have been excluded of the study. The preparation before biopsy included antibioprophylaxy (Ciprofloxacine-Tinidazole) and rectal hypertonic cleaning (Normacol*). Twelve cores have been taken in each prostate by transrectal digital-guided way, using Biopty Gun 18 Gauge. Local anesthesia has been done previously by intrarectal application of 20 ml of gel of Lidoca?ne. Two other cores were taken into each abnormal area at rectal examination. The follow-up have been done during twelve weeks. Results: Eighty patients of 65 years of age were included. Nine patients had familial history of prostate cancer. PSA levels ranged from 5 to 6400 ng/ml with a median of 26.77 ng/ml ± 11.2. Complications occurred in 11.25% of patients, principally infectious complications which caused death of one patient by septicemia. The rate of cancer detection was 20%. Prostate abnormality at digital rectal examination and the presence of familial history of prostate cancer were not predictive factors of the presence of cancer on cores. Conclusion: Our prostate biopsy method is limited by the lack of ultrasonographic guidance and is at important risk of infectious complications.
