Introduction and Objectives
Trans-rectal ultrasound guided prostatic biopsy (TRUSgPB) is the most commonly used system for diagnosis of prostate cancer (PC). The indications are suspicious digital rectal examination (DRE), increased PSA and PSA velocity (>0.75–1.0 ng/dL/yr), low ratio F/T PSA, prior initiation therapy of 5α-reductase inhibitors, follow-up biopsy (3–6 mo) after diagnosis of high-grade PIN or ASAP, to diagnose failed radiation therapy before use of second-line therapy. The aim of this study was to analyze our rate of PC detection, its Gleason score and volume on biopsy and extracapsular extension (ECE), which are the most important prognostic factors.
Material and Methods
We have analyzed 190 patients retrospectively from 01.09.2008 to 01.06.2009, to whom we have performed extended TRUSgPB with local prostatic block analgesia and oral antibiotic prophylaxis. It was their first biopsy. The average age of the patients was 65.5 years (44–85).
Results
The indications for this procedure were abnormal DRE (98pts-51.57%) and only rising PSA level (92pts-47.89%). Of the 190 biopsies that have been done 86 (44.21%) were with Adenocarcinoma of the prostatae results; 67 (35.2%) - Prostatitis chr; 22 (11.5%) Hyperplasia prostatae; 19 (10%) – PIN High grade and ASAP. PC was found in the following age periods: 40–49 years old 3(1.57%); 50–59 −29(15.26%); 60–69 62(32.63%); 70–79 – 68 (35.7%) and over 80 years old −18 (9.47%). The PSA values of 0–4 had 5 patients (7.2%) and 2 pts had ACP-2.32%; 4–10 −86 pts (45.26%) had ACP 25 pts -29.06%; 10–20 −51 (26.84%) and 27 had ACP -31.39%; above 20 −35pts (18.42%) and 32 had ACP −37.2%. Complications were hematospermia in 62 pts (32.63%); Bleeding from urethra and bladeer in 31 pts (16.3%); rectal bleeding in 8 pts (4.21%); fever in 4 pts (2.1%); urosepsis in 2 pts (1.05%).
Conclusions
TRUSgPB is the gold standard for diagnosis of prostate cancer, which is the most common male cancer in developed countries. The use of PSA testing in serum and TRUSgPB allows us to detect the prostate cancer at a potentially curable stage, 5–10 years before giving rise to symptoms and on averagely 17 years before causing the death of the patient. Massive usage of TRUSgPB and PSA have also led to overdiagnosis detection clinically not significant cancers. Our everyday-task with the help of diagnostic tools, staging procedures and prognostic factors recognizes not only diagnosis of PC nor cases that should not be treated and group of patients who will benefit the most from early and active therapy. It's still a very controversial issue because PC is a histologicaly heterogeneous and multifocal disease.
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
