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Objective: To determine the diagnostic accuracy of PSA density in Prostate Cancer, Benign Prostatic Hyperplasia (BPH) and Prostatitis, taking biopsy as the gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Chemical Pathology and Endocrinology Department, Armed Forces Institute of Pathology (AFIP) in collaboration with Histopathology department, AFIP, Armed Forces Institute of Urology (AFIU) and Institute of Radiology (AFIRI) Rawalpindi Pakistan from Mar 2019 to Mar 2020. Methodology: Prostate-specific antigen was analyzed on a fully automated random-access immunoassay-ADVIA® Centaur XP. Prostate volume was measured through transrectal imaging technique, and prostate density was obtained by dividing total Prostate-specific antigen by prostate volume. Specificity and sensitivity, along with the positive predictive and negative predictive value of both Prostate-specific antigen and Prostate-specific antigen density (PSAD), were calculated. In addition, the Receiver Operating Characteristic (ROC) curve was plotted for total Prostate-specific antigen and Prostate-specific antigen density PSA separately. Results: Overall, 129 subjects were registered in the study. Out of these 129 individuals, 59 (45.7%) had prostate cancer, 52 (40.3 %) were benign prostatic hyperplasia (BPH), and 14% of subjects had other prostatic disorders. Total Prostate-specific antigen (PSA) had a sensitivity of 75.61% with a specificity of 76% while Prostate-specific antigen density showed 88% sensitivity and 86% specificity. The area under the curve (AUC) for total Prostate-specific antigen was 0.66, while that for total Prostate-specific antigen density (PSAD) was 0.87. Conclusion: Prostate-specific antigen density is a better predictive and non-invasive diagnostic marker for different prostatic disorders than total Prostate-specific antigen. It has the potential to distinguish between prostate cancer and other prostatic disorders with high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of this study was to assess the feasibility of multi-parametric magnetic resonance imaging (mpMRI) in detection, localization and local staging of prostate cancer (Pca). Methods The study included 58 patients with Pca who underwent mpMRI before radical prostatectomy (RP) at two university hospitals, during the period June 2014 to April 2018. All prostatectomies were performed on the basis of preoperative transrectal ultrasound-guided prostatic biopsies. For tumor localization, the prostate in each patient was divided into six segmental regions. Biopsy specimens, for each segmental region, were evaluated for the presence of cancer. The diagnostic performance of mpMRI in tumor localization as well as extracapsular extension (ECE) and seminal vesicle (SV) invasion of the tumor was evaluated, by using the histopathological findings of RP specimens as reference standard. Results The mean age of patients was 63.45 ± 7.45 years. Of the total number of 348 segmental regions, tumor was detected in 143. From them, cancer was detected in 142 regions by mpMRI. The sensitivity and specificity of mpMRI for cancer localization were 99.30% and 97.56%. On RP specimen, nine cases had ECE and five had SV invasion. All of them were detected preoperatively by mpMRI. The sensitivity and specificity of mpMRI for detection of ECE were 100% and 97.96%. For detection of SV invasion, the sensitivity and specificity were 100% and 98.11%. Conclusions mpMRI enables localization and staging of cancer prostate with reasonable accuracy. Its combination with ultrasound should be counted on for improvement in efficacy of the prostatic biopsy procedure.

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. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound-guided transrectal prostatic biopsy is generally a well-tolerated radiological technique with low overall complication ratio. If post-biopsy rectal bleeding occurs, conservative management is effective in the majority of cases. Endoscopic or interventional treatment is rarely required.Case Presentation: We report the case of an 82-year-old white man presenting with massive rectal bleeding after ultrasound-guided prostatic biopsy. Medical and endoscopic management were not effective. Angiographic evaluation revealed a prostatic arteriovenous fistula, and definitive treatment was provided in the form of catheter-directed superselective embolotherapy.Conclusion: Transrectal prostatic biopsy may be associated with massive rectal bleeding. Transcatheter embolotherapy can be effective in definitively stopping the bleeding. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to evaluate the efficacy of local anesthetic infiltration, in decreasing the discomfort experienced by patients undergoing trans-rectal ultrasound (TRUS) guided biopsy of prostate. Materials and methods: Between January 2002 and February 2003, we investigated consecutively, asymptomatic men, suspected of having prostatic cancer. About 39 patients were randomized to receive 10 ml of 2% Lidocaine periprostatic block + intrarectal Lidocaine gel (group 1 = 20), or intarectal Lidocaine gel only (group 2 = 19) during prostatic biopsy. Immediately following the TRUS-guided biopsy, patients were asked to grade the pain they experienced using the 11-point visual analogue score (VAS). Results: The mean pain score in the patients of group 1 were significantly lower than the patients of group 2 ( P < 0.001), suggesting that periprostatic block produced a significant reduction in the perceived pain. Conclusions: Local anesthetic infiltration by TRUS-guided injection of Lidocaine is effective for decreasing pain associated with prostatic biopsy.

Purpose: To compare the antibiotic prophylaxis based on quinolone administered orally with a combination of cephalosporin administered periprostatically and a fluoroquinolone orally, in terms of post-prostate bioptic infectious complication rates in those men undergoing transrectal ultrasound-guided prostate biopsy (TRUS gpb). Methods: In a prospective, randomized, double-blind study, 150 consecutive patients were randomized to receive 10 ml lidocaine 1 % in Group A and ceftriaxone 1 g diluted in a solution of 10 ml of lidocaine 1 % in Group B, before TRUS gpb. All signed the informed consent. The men were asked to grade the pain using a ten points visual analogue scale close after TRUS gpb. In a telephone interview at 3 and 6 days, they were asked about early and late complications, assessing rectal bleeding, urinary retection, fewer, haematuria, urethral bleeding and hematospermia. Results: Of the 150 men enrolled, 135, 70 in Groups A and 65 in Group B, completed the study. Four men (5.7 %) in Group A developed sepsis after TRUS gpb requiring hospital admission and intravenous antibiotic treatment, while none in Group B. Escherichia coli was the only organism isolated. The mean pain score was 2.76 ± 1.69 and 1.73 ± 1.26 for Group A and B, respectively ( p = 0.08). Complications, evaluated at 3 and 6 days after the procedure through a telephone interview, were similar in both Groups. Conclusions: The antibiotic prophylaxis based on the combination of ceftriaxone administered periprostatically and ciprofloxacin orally is able to offer a best control on infections caused by fluoroquinolone-resistant E. coli. [ABSTRACT FROM AUTHOR]

The functional relationship between parathyroid glands and prostatic gland is commonly very well known. The aim of our study was to investigate the relationship between serum levels of PTH and serum levels of PSA in patients with pathological finding of BPH. According to 261 transrectal ultrasound-guided prostatic biopsies performed from March 2009 to March 2010, 75 patients, responding to our inclusion criteria, were selected. 26 patients (34.6%) ended the study. All patients with high serum levels of PSA (>4 ng/mL), with histological diagnosis of benign prostatic hyperplasia, underwent the assay of serum levels of PTH. We observed high levels of PTH (> 66 pg/mL) in 9 patients (35.2%). [ABSTRACT FROM AUTHOR]

Introduction: Cancer of the prostate (PCa) is now recognized as one of the most important medical problems facing the male population. In Europe, PCa is the most common solid neoplasm, with an incidence rate of 214 cases per 1000 men, outnumbering lung and colorectal cancer (1). According to the EAU guidelines, the main diagnostic tools to obtain evidence of PCa include DRE, serum concentration of PSA and transrectal ultrasonography (TRUS). But, does TRUS affect the diagnostic process? Material and Methods: Between March 2007 and March 2011 we performed 441 prostate biopsies to compare the results with clinical, laboratory and ultrasonographic features of every patient. We investigated sensitivity, specificity, accuracy, positive and negative predictive value and likelihood ratio about every diagnostic tool (PSA, DRE and TRUS). Results: The transrectal ultrasonography has a low diagnostic accuracy for prostate cancer because it shows: low sensitivity and specificity (higher incidence of false positives than true positives); variability of ultrasound situations within which the tumor occurs. Conclusions: In our opinion TRUS may be considered only a complement to PSA and DRE. [ABSTRACT FROM AUTHOR]

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Purpose: To determine the effect of washing the biopsy needle with povidone-iodine solution on infection rates after transrectal ultrasonography-guided prostate biopsy. Patients and Methods: 180 patients with transrectal prostate biopsy were included. Infection was excluded with midstream urine culture before biopsy, and patients were divided into two groups. In group 1 (n = 84), the needle was washed with povidone-iodine after each material reception during biopsy, and in group 2 (n = 96), it was not. At day 3 and 2 weeks after the biopsy, patients were checked. On day 3, midstream urine was cultured and patients were checked for fever, hematuria, rectal hemorrhagia, hematospermia and urinary retention. Also, the effect of rectal preparation on infection rate was evaluated. Results: There was no significant difference between the patients' ages, PSA levels and prostate volumes. In total, 11 patients (6.1%; 4 from group 1 and 7 from group 2) developed infectious complications. There was no statistically significant difference between the groups. Fever, asymptomatic bacteriuria and urinary system infection rates were also not statistically different between the groups. The most frequent complication was hematuria with 83 cases (46.1%), but they did not need hospitalization and no patient had acute urinary obstruction. Conclusions: Washing the biopsy needle with povidone-iodine did not have an effect on the infection rates. Antibiotic prophylaxis and cleaning the biopsy equipment is adequate for low infection rates. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Common complications related to transrectal ultrasound (TRUS) guided prostatic needle biopsy are hematuria, hematospermia, and hematochezia. To the best of our knowledge, we report the second case of a very large hematoma extending from the pelvis into the retroperitoneal space in literature. A 66-year-old man with a serum prostate-specific antigen (PSA) of 5.4 ng/ml was admitted to our department for a TRUS-guided prostatic needle biopsy. Laboratory values on the day before biopsy, including coagulation studies, were all normal. The patients did not take any anticoagulant drugs. No immediate complications were encountered. Nevertheless, 7 hours after the biopsy, the patient reached our emergency department with severe diffuse abdominal pain, hypotension, tachycardia, and confusional state. He underwent an ultrasonography and then a computed tomography (CT) scan that showed "a blood collection in the pelvis that extending to the lower pole of left kidney associated with a focus of active contrast extravasation, indicating active ongoing prostate bleeding." Consequently, he underwent a diagnostic angiography that showed no more contrast extravasation, without the need of embolization. Management of hematoma has been conservative and hematoma was completely reabsorbed 4 months later. [ABSTRACT FROM AUTHOR]

The article reports on results of a study of the role of repeated biopsy of the prostate in predicting disease progression in patients with prostate cancer on active surveillance. A description of the experimental set-up and measurement method is provided. The study concludes that negative re-biopsy in patients with prostate cancer on active surveillance is associated with low-volume disease.

This meta-analysis evaluated the efficacy and safety of periprostatic nerve block (PPNB) and intrarectal local anesthestic (IRLA) gel in alleviating pain during prostate biopsy. Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE were searched to identify all randomized controlled trials comparing PPNB with periprostatic placebo injection, no injection or with IRLA. Studies for inclusion were identified and extracted by two authors independently. The main outcome measure was patients' assessment of mean pain scores on a 10-point scale at the end of the biopsy procedure. Secondary outcomes were complications and adverse events. Continuous data from the trials were combined by calculating the weighted mean difference (WMD) with its 95% confidence interval. In total, 25 studies met the inclusion criteria. Twenty studies involving 1685 patients compared PPNB with either no anesthesia or with placebo injection controls, showing a significant reduction in pain score in the anesthetic group (WMD −2.09, 95% CI −2.44 to −1.75, P<0.00001). Five studies with 466 patients compared IRLA and control. Although IRLA was associated with pain reduction, the effect size was not statistically significant (WMD −0.22, 95% CI −0.56 to 0.12). Six studies with 872 patients compared PPNB with IRLA, showing a significant pain reduction in the former group (WMD −1.53, 95% CI −2.67 to −0.39, P=0.008). No trials reported an increase in complications in the treatment arms. In conclusion, the evidence from randomized controlled trials shows that local anesthetic given as a PPNB, but not as an intrarectal instillation, is effective and safe in alleviating pain from transrectal ultrasound biopsy of the prostate.Prostate Cancer and Prostatic Diseases (2007) 10, 127–136. doi:10.1038/sj.pcan.4500935; published online 9 January 2007 [ABSTRACT FROM AUTHOR]

Objective: New prostatic biopsy protocols suggest to increase the core numbers to enhance detection. Additional cores are usually sampled from the lateral part of the p-zone. We direct the sextant biopsy to the most lateral part of the p-zone, therefore we investigated if there is a gain by adding 4 median biopsy cores. Material and Methods: The prospective randomized trial (n = 200) compared our modified sextant biopsy to a 10-core strategy with 2 additional median cores on both sides. Directed biopsies to suspicious areas were allowed in both groups. Morbidity was assessed by a self-administered questionnaire. Results: PC detection was 32% for 6 cores and 40% for 10 cores. Four patients were detected only by median biopsies. Using the binomial distribution table the gain of 4% is statistically significant. There was no statistical difference in morbidity, but a trend towards a higher rate of side effects in the 10-core group. Conclusions: The gain in prostate cancer detection rate by additional median biopsies is low, but statistically significant. There is no difference in morbidity and patient acceptance is high, therefore we favor the 10-core biopsy in our patients. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: The standard sextant prostatic biopsy is a safe procedure associated with low morbidity. Newer biopsy protocols suggest an increase in core numbers or sampling in distinct areas. In this respect we investigated the morbidity of different biopsy regimens.Methods: Morbidity was assessed using self-administered questionnaires 1 week and 1 month after biopsy in a prospective randomized trial of 405 men with three different biopsy protocols. We compared a sextant biopsy regimen to a 10-core biopsy strategy, as well as patients with a re-biopsy including t-zone sampling. We investigated pain during and after biopsy, gross hematuria, rectal bleeding, hematospermia, fever and chills.Results: There is a trend towards a more painful biopsy and higher rate of side effects if the number of core samples is increased, this difference did not reach statistical significance. There was no increase in severity of side effects. Regarding the rate and severity of side effects of biopsy strategies to different areas of the prostate we could not find a difference. About 95% of patients would accept a repeat biopsy based on their experience on first biopsy.Conclusions: Morbidity of transrectal prostatic biopsy is low and increasing the number of cores correlates with a minor and statistically not significant increase in the rate of side effects. Transrectal sextant prostatic biopsy and extensive biopsy protocols are generally well tolerated and widely accepted from patients. [Copyright &y& Elsevier]

Objectives: External beam radiotherapy and seed implantation are treatment options for clinically localized prostate cancer. Post-radiation biopsies may assess the efficacy of radiation in locally eradicating prostate cancer cells. Aim of this overview was to analyze the role of prostate rebiopsies after radiation to evaluate treatment success.Methods: A Medline search was performed from 1980 to 2001 for articles in English.Results: Based on the available data a positive prostate rebiopsy can be found in 18–90% for patients with stage T1–T3. Pretreatment PSA, pretreatment Gleason score, clinical stage and digital rectal examination (DRE) after radiotherapy correlate with biopsy results. A positive post-treatment biopsy is associated with a higher nadir PSA serum level and a higher rate of local recurrence compared to patients with negative biopsies. However, systematic prostate biopsies after radiation therapy are not necessary in the standard follow-up because a rising PSA after radiation therapy is a more rigorous end-point for evaluation of treatment efficacy. However, patients with rising PSA after irradiation without evidence of systematic disease and positive prostate biopsies may be candidates for salvage treatment.Conclusions: Prostate biopsies after radiation therapy are not necessary as a standard procedure for follow-up. Prostate rebiopsies may be an important research tool to evaluate histological changes within the prostate and may indicate local recurrence. [Copyright &y& Elsevier]

Objectives: Prostatic biopsy is a minor diagnostic procedure; despite the simplicity of execution this procedure can determine a high patients’ discomfort.Methods: We analyzed the experience reported in the literature concerning the pain and the anxiety, the role of local or intrarectal anesthesia and the complications related to prostatic biopsy. Key words used for the Medline search included: prostate cancer, biopsy, transrectal ultrasound anesthesia, complications.Results: The reduction of patients’ pre biopsy anxiety may help the physician to perform a better prostate biopsy. While the use of pre biopsy enemas seems questionable, the use of antibiotic prophylaxis is mandatory when the biopsy is transrectal and could be useful if the approach is transperineal. The use of anaesthesia (periprostatic local injection of lidocaine or intrarectal administration of lidocaine gel) seems to reduce patients’ discomfort. The higher is the number of biopsy cores, the greater is the need for anaesthesia.Conclusions: Trans-rectal ultrasound (TRUS) prostatic biopsy with a correct patient’s preparation has a limited impact on patient’s well-being. [Copyright &y& Elsevier]

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.、.

OBJECTIVES: The objective of the study was to evaluate the efficacy of local anesthetic infiltration, in decreasing the discomfort experienced by patients undergoing transrectal ultrasound (TRUS) guided biopsy of prostate. MATERIALS AND METHODS: Between January 2002 and February 2003, we investigated consecutively, asymptomatic men, suspected of having prostatic cancer. About 39 patients were randomized to receive 10 ml of 2% Lidocaine periprostatic block + intrarectal Lidocaine gel (group 1 = 20), or intarectal Lidocaine gel only (group 2 = 19) during prostatic biopsy. Immediately following the TRUS-guided biopsy, patients were asked to grade the pain they experienced using the 11-point visual analogue score (VAS). RESULTS: The mean pain score in the patients of group 1 were significantly lower than the patients of group 2 (P<0.001), suggesting that periprostatic block produced a significant reduction in the perceived pain. CONCLUSIONS: Local anesthetic infiltration by TRUS-guided injection of Lidocaine is effective for decreasing pain associated with prostatic biopsy. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB). Patients and methods Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB. Results Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5°C or drug-related side-effects. Conclusions This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration. [ABSTRACT FROM AUTHOR]