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Sextant Biopsy (sextant + biopsy)

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Medical Sciences	100%

Selected Abstracts

Pain after transrectal ultrasonography-guided prostate biopsy: the advantages of periprostatic local anaesthesia

BJU INTERNATIONAL, Issue 6 2001
H. Seymour
Objective To prospectively evaluate the efficacy and safety of periprostatic local anaesthesia (LA) during prostatic biopsy guided by transrectal ultrasonography (TRUS), as 20,65% of men report moderate to severe pain, and there is anecdotal and published evidence that periprostatic anaesthesia improves patients' tolerance. Patients and methods In all, 157 patients were prospectively recruited and sequentially randomized to receive either LA or no anaesthesia. Sextant biopsies were taken in all men but some had more than six biopsies. All were asked to complete questionnaires immediately after TRUS-guided biopsy and for the subsequent week, giving pain scores and recording any morbidity, including symptoms of infection; analgesic use was also surveyed. Results Patients given LA had significantly lower pain scores at the time of biopsy than those given no anaesthesia, with median (sd) pain scores of 1.53 (0.7) and 1.95 (0.65) (P < 0.001), respectively. In addition, there was a trend towards less analgesic use by those given LA, although this was not statistically significant. There was no difference in the amount of haematuria, haematochezia or haematospermia, or infection rate, between the groups. The additional cost and time of the procedure was minimal (£3.00 and 3 min/per patient, respectively). Conclusion Periprostatic LA infiltration is a quick and simple procedure which significantly improves immediate pain with no added morbidity; we strongly advocate its use to improve patient tolerance of TRUS-guided prostate biopsy. [source]

Can color doppler predict the uniformity of HIFU-induced prostate tissue destruction?

THE PROSTATE, Issue 4 2004
Olivier Rouvière
Abstract Background Tissue blood perfusion influences the results of some hyperthermia and thermotherapy procedures, but its role in the outcome of prostate cancer treatment by high-intensity focused ultrasound (HIFU) has not been evaluated yet. We evaluated preoperative prostate color Doppler as a predictor of the efficacy of HIFU treatment. Methods Thirty-five patients underwent pre- and post-contrast color Doppler examination of the prostate before HIFU treatment. Specific software was used to calculate, on color Doppler images, the color pixel density (CPD), and the specific flow (SF, i.e., mean velocity,×,CPD) in different regions of interest. Post-treatment sextant biopsies were obtained in 31 patients, 5.8,±,2.8 months after HIFU treatment. Results No significant correlation was found between the uniformity of HIFU-induced tissue destruction observed on control biopsies and the pre-treatment CPD/SF values in any region of interest, either before or after contrast injection. On the other hand, history of radiation therapy was significantly associated with homogeneous tissue destruction and history of hormone therapy was significantly associated with incomplete tissue destruction. Conclusions Color Doppler cannot predict the uniformity of HIFU-induced tissue destruction. History of radiation therapy was found to be a factor of favorable prognosis and history of hormone therapy was found to be a factor of poor prognosis in our population. © 2004 Wiley-Liss, Inc. [source]

Features and preliminary results of the Dutch centre of the ERSPC (Rotterdam, the Netherlands)

BJU INTERNATIONAL, Issue 2003
M.J. Roobol
OBJECTIVE To describe the preliminary results of the Dutch section of a large multicentre study of screening for prostate cancer, the European Randomized study of Screening for Prostate Cancer (ERSPC), initiated in the Netherlands and Belgium in 1991. MATERIALS AND METHODS After a series of five pilot studies which started in 1991, full-capacity screening started in 1994 with the use of a serum prostate-specific antigen (PSA) determination, a digital rectal examination (DRE) and transrectal ultrasonography (TRUS) as screening tests. Depending on the results and the screening protocol used, men were referred for further examination by sextant biopsies (extended with a seventh biopsy if TRUS showed abnormality). The protocols used, efficiency of the different screening tests, number of cancers detected in the pilot studies, initial screening round and preliminary results of the second screening round are described. RESULTS After the pilot studies it became clear that a study of prostate cancer screening was feasible in the Rotterdam area. The screening protocol was workable and the recruitment rate acceptable (39.5%). An inventory of the population registries of Rotterdam and surrounding municipalities, and the known recruitment rate, made it clear that a contribution of 40 000 men (aged 55,74 years) from the Dutch centre to the ERSPC was feasible. The initial screening round started in December 1993 and lasted until December 1999 (protocol 5,10). In all, 42 376 men were randomized and 1014 cancers detected (5.1%). During this screening the protocol was simplified. After evaluating the different screening tests abnormal results of the DRE and TRUS were omitted as an indication for a sextant biopsy. Only a serum PSA level of , 3.0 ng/mL is now used as the indication. The second screening round started in December 1997 and continues. To December 2002, 9920 men were screened for the second time, 4 years after their initial screening visit. To date 446 cancers have been detected (4.5%); this round will last to December 2003. Further evaluation of the screening regimen and characteristics of the cancers detected are constantly assessed within the Dutch ERSPC. Meanwhile a third screening round has also been initiated, which will last to December 2007. CONCLUSION A prostate cancer screening study of the projected magnitude is feasible in Rotterdam; the recruitment rate is acceptable and the screening tests well tolerated. The study has generated many scientific publications and will be of great value in determining whether prostate cancer screening should be part of general healthcare. [source]

A comprehensive and novel predictive modeling technique using detailed pathology factors in men with localized prostate carcinoma

CANCER, Issue 7 2002
Louis Potters M.D.
Abstract BACKGROUND The purpose of the current study was to evaluate modeling strategies using sextant core prostate biopsy specimen data that would best predict biochemical control in patients with localized prostate carcinoma treated with permanent prostate brachytherapy (PPB). METHODS One thousand four hundred seventy,seven patients underwent PPB between 1992 and 2000. The authors restricted analysis to those patients who had sextant biopsies (n = 1073). A central pathology review was undertaken on all specimens. Treatment consisted of PPB with either I-125 or Pd-103 prescribed to 144 Gy or 140 Gy, respectively. Two hundred twenty,eight patients (21%) received PPB in combination with external radiotherapy and 333 patients (31%) received neoadjuvant hormones. In addition to clinical stage, biopsy Gleason sum, and pretreatment prostate specific antigen (pretx-PSA), the following detailed biopsy variables were considered: mean percentage of cancer in an involved core; maximum percentage of cancer; mean primary and secondary Gleason grades; maximum Gleason grade (primary or secondary); percentage of cancer in the apex, mid, and base; percent of cores positive; maximum primary and secondary Gleason grades in apex, mid, and base; maximum percent cancer in apex, mid, and base; maximum Gleason grade in apex, mid, and base; maximum primary Gleason grade; and maximum secondary Gleason grade. In all, 23 biopsy variables were considered. Four modeling strategies were compared. As a base model, the authors considered the pretx-PSA, clinical stage, and biopsy Gleason sum as predictors. For the second model, the authors added percent of cores positive. The third modeling strategy was to use stepwise variable selection to select only those variables (from the total pool of 26) that were statistically significant. The fourth strategy was to apply principal components analysis, which has theoretical advantages over the other strategies. Principal components analysis creates component scores that account for maximum variance in the predictors. RESULTS The median followup of the study cohort was 36 months (range, 6,92), and the Kattan modification of the American Society for Therapeutic Radiology and Oncology (ASTRO) definition was used to define PSA freedom from recurrence (PSA-FFR). The four models were compared in their ability to predict PSA-FFR as measured by the Somers D rank correlation coefficient. The Somers D rank correlation coefficients were then corrected for optimism with use of bootstrapping. The results for the four models were 0.32, 0.34, 0.37, and 0.39, respectively. CONCLUSIONS The current study shows that the use of principal components analysis with additional pathology data is a more discriminating model in predicting outcome in prostate carcinoma than other conventional methods and can also be used to model outcome predictions for patients treated with radical prostatectomy and external beam. Cancer 2002;95:1451,6. © 2002 American Cancer Society. DOI 10.1002/cncr.10869 [source]

Lower urinary tract symptoms and risk of prostate cancer in Japanese men

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2006
AKIO MATSUBARA
Aim: Our aim was to investigate whether or not men with lower urinary tract symptoms are at increased risk of prostate cancer. Methods: A total of 3511 men aged 50,79 years who underwent mass screening for prostate cancer between 2002 and 2004 for the first time, and completed the International Prostate Symptom Score (IPSS) questionnaire at the time of the prostate specific antigen (PSA) test, were enrolled in the present study. All men with PSA values greater than 4.0 ng/mL were advised and encouraged to undergo transrectal systematic sextant biopsy. The number of cancers subsequently detected was compared between men with IPSS scores of 0,7 and 8,35. Results: Of the 3511 men, 219 (6.2%) had PSA values greater than 4 ng/mL, 178 (5.1%) underwent biopsy, and 51 (1.5%) were found to have prostate cancer. Although the PSA positivity rate for men with IPSS scores of 8,35 was significantly higher than that in the 0,7 group, there were no significant intergroup differences in the cancer detection rates for biopsied men and for total screened subjects. Multivariate logistic regression analysis revealed that prostate volume was the dominant predictor for the detection of prostate cancer, followed by PSA level, but the IPSS made no significant contribution. No significant difference was noted in the IPSS scores between men with cancer and the others of the same age group. Conclusions: Symptomatic Japanese men are not at higher risk of prostate cancer despite their higher PSA values compared with asymptomatic men of the same age group. [source]

Transrectal ultrasound-guided biopsy of prostate voxels identified as suspicious of malignancy on three-dimensional 1H MR spectroscopic imaging in patients with abnormal digital rectal examination or raised prostate specific antigen level of 4,10 ng/ml

NMR IN BIOMEDICINE, Issue 1 2007
Virendra Kumar
Abstract Results of the evaluation of transrectal ultrasound (TRUS) guided needle biopsy of voxels identified as suspicious of malignancy on magnetic resonance spectroscopic imaging (MRSI) in a large cohort of men (n,=,83) with abnormal digital rectal examination (DRE) [prostate specific antigen (PSA) 0,4,ng/ml] or PSA less than 10,ng/ml, are reported. Three-dimensional 1H MRSI was carried out at 1.5 T using a pelvic-phased array coil in combination with an endorectal surface coil. Voxels were classified as suspicious of malignancy based on Cit/(Cho,+,Cr) metabolite ratio. TRUS-guided biopsy of suspicious voxels was performed using the z - and x -coordinates obtained from MR images and two to three cores were taken from the suspected site. A systematic sextant biopsy was also carried out. MRSI showed voxels suspicious of malignancy in 44 patients while biopsy revealed cancer in 11 patients (25%). Patients who were negative for malignancy on MRSI were also negative on biopsy. An overall sensitivity of 100%, specificity of 54%, negative predictive value of 100% and accuracy of 60% were obtained. The site of biopsy was confirmed (n,=,20) as a hypo-intense area on repeat MRI while repeat MRSI revealed high choline and low citrate. The overall success rate of MRI-directed TRUS-guided biopsy of 25% was higher compared with a 9% success rate achieved without MR guidance in another group of 120 patients. Our results indicate that TRUS-guided biopsy of suspicious area identified as malignant from MRSI can be performed using the coordinates of the voxel derived from MR images. This increases the detection rate of prostate cancer in men with PSA level <10,ng/ml or abnormal DRE and also demonstrates the potential of MR in routine clinical practice. Copyright © 2006 John Wiley & Sons, Ltd. [source]

The effect of sampling more cores on the predictive accuracy of pathological grade and tumour distribution in the prostate biopsy

BJU INTERNATIONAL, Issue 3 2004
A.A. Makhlouf
The technique for taking prostatic biopsies has received a major evaluation from many departments around the world in terms of the number of cores, site of biopsy, complications, need for local anaesthesia or sedation, etc., and the authors from Charlottesville review their technique. They present data confirming the impression that increasing the number of cores increases diagnostic sensitivity. Authors from Chapel Hill have performed a pilot study into the concept that cyclooxygenase (COX)-2 inhibitors inhibit tumour growth in prostate cancer, both in vivo and in vitro. In a few patients they found evidence to suggest that COX-2 inhibitors may be of value in patients with prostate cancer, concluding that a large trial is indicated. Vascular endothelial growth factor (VEGF) is known to be an important angiogenic factor. The authors from Sweden assessed its value as a marker in renal cancer cells. They found it to be present in most such cells, and found that the correlation between VEGF expression and tumour stage and prognosis was valuable in terms of progression of renal cancer. OBJECTIVE To determine if increasing the number of cores at biopsy improves the predictive accuracy of the Gleason score or aids in anticipating the location and volume of prostate tumour. PATIENTS AND METHODS The charts of 75 consecutive patients who underwent radical retropubic prostatectomy for clinical T1,2 adenocarcinoma of the prostate were reviewed retrospectively; 31 patients had a sextant biopsy (group 1) and 44 had ,,8 cores taken (group 2). The concordance between biopsy data and final prostatectomy Gleason score, tumour location and volume was determined for each group. RESULTS There were no differences in mean age, prostate-specific antigen level before biopsy or biopsy Gleason score for the two groups; 58% of group 1 had their final pathological grade changed after prostatectomy, vs 29% of group 2 (P < 0.05). In neither group was there a significant correlation between the percentage of cores positive for tumour and the percentage volume of prostate involved with cancer, or the ability of the biopsy to predict tumour location. CONCLUSION Taking ,,8 biopsy cores improved the pathological grading accuracy, which may be valuable in choosing a treatment for the patient with newly diagnosed prostate cancer. [source]

Features and preliminary results of the Dutch centre of the ERSPC (Rotterdam, the Netherlands)

Sacral distribution of prostatic lymph nodes visualized on spiral computed tomography with three-dimensional reconstruction

BJU INTERNATIONAL, Issue 1 2002
C. Brössner
Objective To evaluate the involvement of sacral lymph nodes in prostatic lymphatic drainage, using contemporary radiological imaging techniques. Patients and methods The study included six patients (mean age 61.8 years, range 51,75) with suspected prostate cancer. First, an oil-based contrast medium was injected into the prostate under transrectal ultrasonographic and fluoroscopic guidance, after which a standard ultrasound-guided sextant biopsy was taken. Before injecting the contrast medium, and 20 min and 24 h thereafter, the patients underwent spiral computed tomography of the pelvic region with three-dimensional reconstruction. Results In all patients the prostate drained via the sacral lymphatic region. Compared with the iliac lymphatic drainage system, there were fewer and narrower sacral lymph nodes. Prostatic sacral lymph nodes were located at S2 to S5, with an emphasis on S3,4. Lymph nodes were detected as presacral and in the sacral foramen, suggesting a direct lymphatic connection to the bony pelvis. Conclusion These results suggest that sacral prostatic lymphatics are a potential route of spread of prostate cancer cells. [source]