Correlation between serum PSA, gleason score and histopathological grading of adenocarcinoma of prostate in patients undergoing TRUS guided prostatic biopsy in a tertiary care centre of Southern India

Background Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths worldwide. Serum psa, a glycoprotein and a serine protease, which is increased in all prostatic diseases but markedly elevated levels are indicative of carcinoma prostate. The present study was done to evaluate the histopathologyof carcinoma of prostate in trus guided prostatic biopsy specimens and correlate serum psa levels with gleason score and grade groups. Methods A hundred patients presented with luts and suspicious of carcinoma prostate underwent trus guided 16 core prostatic biopsy. Histopathological examination, gleason scores and grades of biopsies were obtained. Based on the gleason scores, patients with carcinoma of the prostate were divided into five-grade groups. Mean serum psa levels were calculated and correlated with gleason score and grade groups. Results Malignancy was found in 69 per cent of cases, of which 68 patients were found to have adenocarcinoma of the prostate, one patient found to have undifferentiated carcinoma of the prostate. The total number of patients in each gleason grade groups were obtained, and the mean serum psa levels of these patients in each group were calculated. Mean serum psa levels in each group are group 1 (21.3 ng/ml), group 2 (58.4 ng/ml), group 3 (73.6 ng/ml), group 4 (118.4 ng/ml), group 5 (96.3 ng/ml). Conclusion Serum psa is a highly sensitive tumour marker with low specificity, and its levels are increased in many benign and iatrogenic conditions. Psa has a high negative predictive value which is essential in ruling out malignancy. In our study, higher serum psa levels were correlated with higher gleason score and grades.

Malakoplakia prostate presenting as urinary retention: a report of two cases and review of the literature

Malakoplakia is a rare chronic inflammatory condition, which primarily occurs in genitourinary tract, with prostatic malakoplakia being extremely rare. We present two cases of acute urinary retention, with clinically firm nodular prostate and a raised serum prostate-specific antigen. Transrectal ultrasound-guided prostatic biopsy showed features of malakoplakia. There was a significant reduction of size of prostate on transrectal ultrasonography after 4 weeks of antibiotics. However, one patient had failed trial without catheter and was subjected to transurethral resection of prostate. The biopsy of the prostatic chips also showed features of malakoplakia. Other patient improved symptomatically after antibiotics and was managed conservatively. Both the patients are on regular follow-up and are asymptomatic. Prostatic malakoplakia presenting as urinary retention is very uncommon with around 12 cases in the literature. Recognition of prostatic malakoplakia is important because clinically it can masquerade prostatic malignancy. Treatment with antibiotics is necessary before subjecting the patients for surgery in patients with obstructive symptoms.

Effect of different manipulations on serum PSA in patients with benign prostatic hyperplasia.

Objectives: To evaluate the effect of different urological manipulations on the serum PSA level in patients with benign prostatic hyperplasia. Study Design: Quasi-experimental study. Setting: Department of Urology, Nawaz Sharif Social Security Hospital, Lahore. Period: January 2018 to December 2018. Material & Methods: A series of 60 patients were included in the study who fulfill the inclusion criteria. All the patients were above 50 years of age and presented with symptoms of benign prostatic hyperplasia. These patients were divided into four groups equally. In group A digital rectal examination, in group B transurethral resection of prostate, in group C Foley’s catheterization and in group D Trans rectal ultrasound guided prostatic biopsy was done. Pre-manipulation and post-manipulation blood samples for serum PSA were taken after 30 minutes, 72 hours and one week. Results: Trans urethral resection of prostate, Foley's catheterization and trans rectal ultrasound guided prostatic biopsy caused a statistically significant rise in serum PSA level (p < 0.05) while digital rectal examination did not raise serum PSA level significantly. Conclusion: Different manipulations do cause alteration in the serum PSA level which may change the management plan.

A non-randomized prospective study on the diagnostic performance of perineal prostatic biopsy, directed via diffusion nuclear resonance, in patients with suspected prostate cancer and previous negative transrectal prostate biopsy

Background: A definition of the best strategy is necessary to optimize the follow-up of patients with previous negative transrectal guided ultrasound biopsy (TRUS-GB) and the persistence of raised prostate-specific antigen (PSA).The purpose of this study was to evaluate the prostate cancer (PCa) diagnostic rate of targeted transperineal ultrasound guided biopsy (TPUS-GB) with cognitive multiparametric magnetic resonance imaging (mpMRI) registration with concurrent systematic biopsy in patients with previous negative systematic TRUS-GB and persistently elevated PSA levels. Materials and methods: In this prospective study conducted at the University Infanta Sofia Hospital from April 2016 to November 2017, patients with one previous negative systematic TRUS-GB and persistently high PSA levels were referred for mpMRI prostate scans. All patients underwent systematic TPUS-GB and those patients with suspicious findings on mpMRI scans, Pirads 3 and 4-5, underwent a subsequent cognitive guidance mpMRI-TPUS-GB. Results: In total, 71 patients were included in this study. Suspicious findings on mpMRI scans prior to TPUS-GB were found in 50 patients (70.4%). 16 patients were diagnosed with prostate cancer (22.5%), of whom 14 (87.5%) had a mpMRI scan with Pirads 3 or Pirads 4-5. Patients with Pirads 3, 4 or 5 showed negative results in almost all cores taken by concurrent systematic TPUS-GB. Conclusions: Cognitive mpMRI-TPUS fusion biopsy is a useful tool to diagnose PCa in patients with previous negative prostate biopsy. The samples obtained from the suspicious areas in the mpMRI detect more cases of intermediate and high risk PCa compared to the samples obtained at random or from non-suspicious areas.

Intra-prostatic Local Anaesthesia for Ultrasonoguided Transrectal Prostate Biopsy - A Review Literature

Carcinoma prostate is a common disease in urological aspect. Diagnosis of prostate cancer has evolved through the past century. In additions to estimations of serum PSA which has more predictive value than diagnostic value. In previous days diagnosis of prostatic cancer relied on three measures - DRE, needle biopsy and open biopsy. With development of medical science different biopsy techniques have evolved for prostatic biopsy. Each techniques has its own merits and demerits. This review article presented here discusses on ultrasonoguided transrectal prostatic biopsy following intraprostatic local anaesthesia. A thorough review literature search was done to resolve theses issues and finally a recommendation is drawn to develop a recommendated policy of biopsy for accurate diagnosis of prostatic cancer. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.57-62

Comparative study on Periprostatic local anesthesia with Intraprostatic local anesthesia for ultrasonoguided transrectal prostatic biopsy

Objectives: To compare pain, systemic lidocaine toxicity and complications between periprostatic with intraprostatic local anaesthesia for transrectal prostate biopsy. Methods: This study was carried out in the Department of Urology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College (DMCH) and Comfort Nursing Home, Dhaka during the period of January 2009 to October 2009, For this purpose, a total number of 60 consecutive patients having increased prostate specific antigen (PSA >4.0ng/ml), abnormal DRE/transrectal ultrasound were admitted in the above mentioned hospitals were enrolled in this study for surgical management. Results: The age ranged from 50 to 90 years and the maximum number was found in the age group of 61-70 years in both groups. The mean(±SD) age was 68.5±7.5 years and 70.3±8.2 years in group I and group II respectively. The mean(±SD) PSA was 17.0±12.8ng/ ml with their PSA ranged from 5.9- 62.8ng/ml in group I and in group II was 17.2±17.3ng/ml with their PSA ranged from 4.6 – 55.1ng/ml, which was not significant (p>0.05) between two groups. Normal digital rectal was found 14(46.7%) and 16(53.3%) in group I and group II respectively. Carcinoma was found 13(43.3%) and 14(46.7%) in group I and group II respectively and rest of them were benign in group I and group II respectively. The mean(±SD) pain degree during biopsy was 2.6±1.1 and 2.0±1.2 in group I and group II respectively according to allocated pain score. Pain degree after 30 minutes of biopsy, most of the patients had no pain in both groups. Pain during anesthesia it was found that 4(13.3%) and 13(43.3%) of the patients had no pain in group I and group II respectively. The mean(±SD) pain degree during anesthesia was 2.7±1.2 and 2.1±1.2 in group I and group II respectively. Conclusion: It is a simple and safe method that is less painful and it should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy. The decreased discomfort of this procedure may enable more core biopsies to be taken in patients at high risk for prostate cancer or in those with an enlarged prostate Bangladesh Journal of Urology, Vol. 15, No. 2, July 2012 p.33-39

Prognostic value of perineural invasion in prostate needle biopsies: a population-based study of patients treated by radical prostatectomy

AimsDespite being one of the major pathways for the spread of malignant tumours, perineural invasion (PNI) has not conclusively been shown to have an independent prognostic value for prostate cancer. Prostatic biopsy constitutes the major pathology workload in prostate cancer and is the foundation for primary treatment decisions and for this reason we aimed to estimate the prognostic value of PNI in biopsies.MethodsWe followed 918 men who underwent radical prostatectomy (RP) from the prospective and population based STHLM3 study until biochemical recurrence with a median follow-up of 4.1 years. To strengthen the evidence, we combined the estimates from the largest studies targeting the prognostic value of PNI in the biopsy. We also estimated the OR of advanced stage as radical prostatectomy for PNI positive and negative men.ResultsThe estimated prognostic value based on our data suggested an approximately 50% increased risk of biochemical recurrence if PNI was present in the biopsy (p=0.06). Even though not statistically significant on the 5% level, this estimate is consistent with similar studies, and by combining the estimates there is in fact strong evidence in support of an independent prognostic value of PNI in the biopsy (p<0.0001). There was also an independent increased risk of advanced stage at RP for positive men (OR 1.85, p=0.005).ConclusionsThe evidence supporting a clinically relevant and independent prognostic value of PNI is strong enough to be considered for pathology reporting guidelines.