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Ultrasonically guided puncture of the prostate was carried out in 10 patients with prostatic disease. Biopsy of the aiming portion of the prostate was performed with more certainty and safety by this method than the conventional blind procedure. In the 15 cases having the suspicion of seminal vesicle disorder, the seminal vesicle was punctured under ultrasound control. By this procedure, the seminal vesicle fluid was safely and accurately obtained.

Transperineal prostate biopsy performed with continuous sonographic monitoring by a real-time rectal endoscopic probe, using a longitudinal linear array which offered complete visualization of the needle from the perineum into suspected abnormal areas within the prostate, was performed in 25 patients with clinically suspected prostate disease. Clinically suspected nodules in 13 patients were more accurately biopsied using sonographic guidance as opposed to conventional manual, digital guidance. Subclinical carcinomas in three patients and areas of atypical histology in three patients were also identified and biopsied using transrectal sonographic guidance.

Reports on large series of prostatic needle biopsies have revealed many and varied complications but none has described anaerobic bacteremia as a complication. Herein are reported 2 such cases, with a discussionof theetiology, various altered host factors and therapeutic modalities important to anaerobic infections. The consideration of anaerobic infection in the febrile patient after transrectal prostatic biopsy is emphasized.

The interpretation of prostatic biopsy specimens to diagnose cancer has been a longstanding source of anxiety and confusion for practicing surgical pathologists. 1,2,3 Anyone who has been confronted with this task can appreciate the difficulties presented by the presence of a few “suspicious” glands in one level of a needle biopsy. Unlike other organs in which the diagnosis of cancer can be arrived at by strictly adhering to established criteria, the diagnosis of prostatic carcinoma is often a much more subjective exercise, which is the culmination of years of personal experience. This is especially disquieting to those pathologists who see prostatic biopsy specimens infrequently, and who, therefore, do not receive daily reinforcement. Certainly, unambiguous criteria to assist in the diagnosis of prostatic carcinoma would be welcomed.

The urinary bladder, the seminal vesicles and the prostate can be visualized by abdominal ultrasonic scanning. However, when detailed information about the prostate and its surroundings is required this approach is inferior to the transrectal.

Pelvic hematomas following prostatic biopsy are rare. We describe 2 cases of hematomas occurring in the prevesical space (space of Retzius) following transrectal biopsy. Computed tomography (CT) was useful in defining the extent of the hematoma and showing density changes related to the age and suppuration of the hematoma. While cystography has been used to diagnose prevesical hematomas, CT better assesses the size of the hematoma and changes that may occur over time.

Congenital arteriovenous malformations in the true pelvis are extremely rare: only 7 cases have been described in male patients. We report on a patient who presented with massive hemorrhage after transrectal prostatic biopsy and transurethral resection of the prostate. Diagnosis was established by means of magnetic resonance imaging and confirmed by arteriography. Our attempt at management by embolization and subsequent surgical ligation is described. A literature review and discussion of arteriovenous anomalies are presented.

Transrectal biopsy is usually taken with the patient in the simple or exaggerated lithotomy position, although some British urologists take the biopsy with the patient in the left lateral position. We present our experience of 90 transrectal prostatic core biopsies performed with the patient in the genucubital (knee-chest) position

Acid phosphatase values in normal children were incorrectly assumed to be within the same range of adult levels. The enzyme was found to be elevated in 25 boys less than 14 years old and did not return to adult levels until after puberty. It is emphasized that extensive genitourinary investigation and prostatic biopsy are not indicated on the basis of elevated enzyme levels in the prepuberal age group.

Prostatic needle biopsy guided by transrectal ultrasonography using a real-time linear scanner was performed on 257 cases in our outpatient clinic and mass screening program for prostatic diseases. The success rate was 99.2 per cent, and complications occurred in only 2 cases (0.8%a) after biopsy. This newly developed method is recommended as being safer and more accurate than conventional ones.

Transitional cell carcinoma was found in biopsies of grossly normal-appearing prostates in 4 of 40 patients with recurrent carcinoma in situ of the bladder. In selected patients prostatic biopsy may be warranted if conservative therapy does not control the bladder tumors and if cystectomy is contemplated.

The advent of prostatic biopsy — whether performed as needle biopsy or needle aspiration biopsy — has made it possible preoperatively to diagnose prostatic diseases with acceptable accuracy. It has also made it possible, at least theoretically, to follow histologically the effect of a specific treatment by performing serial prostatic biopsies. The diagnosis of benign prostatic hypertrophy is largely a clinical one, whereas the final diagnosis of prostatic cancer is a microscopic one. The diagnostic value of needle biopsy for the diagnosis of cancer of the prostate has been discussed in the preceding chapter.

Only a few reports were found in the literature about pelvic hematoma complicating prostatic biopsy. Herein is a presentation of such a case, with a few words of caution about avoiding this mishap.

Summary As the digital diagnosis of carcinoma of the prostate is open to a significant error, oestrogen therapy or radical surgery should not be begun on this evidence alone. Some confirmatory evidence should be obtained. Trocar perineal biopsy is a useful method of confirming the diagnosis in: (a) Cases in within carcinoma is suspected clinically. (b) Hard nodules in the prostate. (c) Cases with extensive osteosclerotic lesions in which the prostate is not unduly hard. The Veenema trocar gives a simple and effective method of performing this with a good degree of accuracy and a minimum of complications.

Transrectal prostatic biopsy specimens were taken from 218 patients with prostatic symptoms—138 by the Franzen aspiration technique without anaesthesia as outpatients and 80 by the Silverman technique under general anaesthesia. A reliable diagnosis was obtained in 82% of the former and 95% of the latter.

The aim of this study was to analyse the individual variations of total and percent free serum prostatic specific antigen (PSA) and to evaluate whether they could change the indication for prostatic biopsy. Prostatic needle biopsy was indicated in 63 patients with serum PSA between 4.0 and 10 ng/ml. A new determination of total and free PSA was done before the biopsy procedure. The time between the determinations ranged from 29 to 59 days. The total and free serum PSA determinations were performed by a double monoclonal antibody radioimmunoassay Tandem and Tandem free PSA. The median coefficient of variation for serum PSA was 12.9 in cancer free patients and 18.8 when cancer was detected, it was 32.6 and 42.2 respectively for percent free serum PSA. A 22.8% rate of discrepancy between the determinations was found when prostatic biopsy was indicated only by percent free PSA lower than 25. Sensitivity ranged from 93.3% to 100, and reduction of unnecessary biopsies between 15.2 and 21.8%. We conclude that individual variations in total and percent free serum PSA could have clinical implications because of the possibility that it changes the indication for a prostatic biopsy.

A dependable and disposable one-handed perineal prostatic biopsy needle has been developed. The needle makes it relatively easy to obtain Multiple, good cores of tissue from the desired areas of the prostate gland without contamination of the needle or field by the rectal finger or hand.

Malignant seeding on the needle tract of a perineal prostatic biopsy is a rare complication. A review of the literature revealed only 7 cases. Herein another case is reported. Our patient, like all other cases reported, suffered from high-grade, high-stage disease and the perineal extension did not upstage his disease. We believe that perineal seeding is a reflection of the malignant potential of the prostatic malignancy and in no way detracts from the usefulness of this tool in the diagnosis and staging of the disease.

Description d'un nouvel instrument permettant la ponction-biopsie de prostate par voie transrectale, au moyen d'un doigt