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Forsvall A, Fisher J, Wagenius M, Broman C, Korkocic D, Bratt O, Linder A. Prostate biopsy quality and patient experience with the novel Forsvall biopsy needle - a randomized controlled non-inferiority trial. Scand J Urol 2021; 55:235-241. [PMID: 33999764 DOI: 10.1080/21681805.2021.1921024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transrectal prostate biopsy (TRbx) carries an increasing risk of infection. The Forsvall Needle Prototype (FNP) is a novel biopsy needle that reduces bacterial load brought across the rectum and may therefore reduce infection risk. The objective of this study was to compare biopsy length, quality and patient experience for the FNP Version 2 (FNP2) versus a standard Tru-Cut needle. METHODS We conducted a randomized, parallel-group, non-inferiority trial with twenty consecutive patients eligible for TRbx. Participants were randomized to undergo TRbx using either FNP2 or a standard Tru-Cut needle. The primary outcome was difference in mean biopsy lengths measured by the pathologist. FNP2 biopsy lengths ≤1.35 mm of the standard needle length were considered non-inferior. Secondary outcomes were biopsy length in the needle chamber and immediately after removal, biopsy quality, biopsy fragmentation, patient discomfort/pain, and complications (immediate and after 14 and 30 days). RESULTS Mean pathologist-measured FNP2 biopsy length was non-inferior compared to the standard Tru-Cut needle (0.02 mm longer, 95%CI-0.73 to 0.76 mm). Biopsy length in the needle chamber and immediately after removal were also non-inferior. Biopsy quality and patient discomfort were not significantly different for the FNP2 and the standard Tru-Cut needle. Biopsy fragmentation was more common in the FNP2 group. CONCLUSIONS The FNP2 biopsy needle is non-inferior to the Tru-Cut needle in terms of biopsy length and not significantly different in terms of biopsy quality and patient experience. Future studies will evaluate the Forsvall needle design's effect on post-biopsy infection risk.
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Affiliation(s)
- Andreas Forsvall
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Jane Fisher
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
| | - Magnus Wagenius
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden.,Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Christian Broman
- Department of Pathology, Helsingborg Hospital, Helsingborg, Sweden
| | - Dejan Korkocic
- Department of Pathology, Helsingborg Hospital, Helsingborg, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Sweden.,Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Linder
- Faculty of Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund, Sweden
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Akan S, Ediz C, Temel MC, Ates F, Yilmaz O. Correlation of the Grade Group of Prostate Cancer according to the International Society of Urological Pathology (Isup) 2014 Classification between Prostate Biopsy and Radical Prostatectomy Specimens. Cancer Invest 2021; 39:521-528. [PMID: 33522324 DOI: 10.1080/07357907.2021.1881109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ABTRACTWe aimed to assess the correlation between ISUP 2014 grades of needle biopsy (NB) and radical prostatectomy (RP) specimens and the parameters effecting this correlation. A total of 353 patients, who underwent a radical prostatectomy with diagnose of prostate cancer, were included in the study. Especially, the maximum percentage of core involved by cancer (MPCI) of upgraded group was significantly higher than those of correlated group and downgraded group. MPCI might be used as a preoperative value to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.
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Affiliation(s)
- Serkan Akan
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Caner Ediz
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - M Cihan Temel
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Ates
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Omer Yilmaz
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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3
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Takeshima Y, Yamada Y, Teshima T, Fujimura T, Kakutani S, Hakozaki Y, Kimura N, Akiyama Y, Sato Y, Kawai T, Yamada D, Kume H. Clinical significance and risk factors of International Society of Urological Pathology (ISUP) grade upgrading in prostate cancer patients undergoing robot-assisted radical prostatectomy. BMC Cancer 2021; 21:501. [PMID: 33947348 PMCID: PMC8097801 DOI: 10.1186/s12885-021-08248-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the clinical significance and risk factors of upgrading in the International Society of Urological Pathology (ISUP) Grade Group System in men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer. METHODS A total of 583 patients diagnosed with prostate cancer by systematic biopsy were treated with RARP without neoadjuvant therapy from November 2011 to December 2018. Clinicopathological data were obtained from our clinical records. ISUP grade upgrading (IGU) was defined as 'ISUP grade in prostatectomy specimen determined to be higher than that in the biopsy specimen'. Clinicopathological factors, including age, PSA, prostate volume at biopsy (PV), PSA density, clinical stage, body mass index (BMI), interval from biopsy to prostatectomy, maximum percentage of cancer involvement per core (%CI), total number of biopsy cores, percentage of cancer positive biopsy cores (%PC), and sampling density were analyzed to detect potential risk factors of IGU. Biochemical recurrence (BCR) rates were calculated to analyze the effect of IGU on cancer prognosis. RESULTS In univariate analysis, BMI was a positive predictor of IGU, while %CI, %PC, and sampling density were negative predictors of IGU. BMI and %PC were statistically significant predictors of IGU in multivariate analysis. For cases diagnosed as ISUP grade group 2 or higher at biopsy, there was a significant difference in BCR rates between cases with and without IGU. CONCLUSIONS The results from our cohort showed that elements of both high-grade cancer risk (such as BMI) and sampling efficiency (such as %PC) contribute to IGU. Excluding cases diagnosed as ISUP grade group 1 at biopsy, BCR-free rates were significantly worse in cases with IGU, highlighting the need for more accurate pathological diagnosis at biopsy.
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Affiliation(s)
- Yuta Takeshima
- Division of Innovative Cancer Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Minato-Ku, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan.
| | - Taro Teshima
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan
| | - Shigenori Kakutani
- Department of Urology, Chiba Tokushukai Hospital, Funabashi-shi, Chiba, Japan
| | - Yuji Hakozaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Naoki Kimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan
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Azal Neto W, Andrade GM, Billis A, Reis LO. Biopsy core length in white versus African descendant prostate cancer patients. Scand J Urol 2020; 54:188-193. [PMID: 32343184 DOI: 10.1080/21681805.2020.1754907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To explore whether distinct prostate cancer (PCa) prognoses between ethnicities could be explained by diverse characteristics in the prostate biopsy.Methods: Clinical, prostate biopsy and surgical single-institution data of whites and African descendants with similar access to the health system who underwent radical prostatectomy whole gland histopathology within 60 days after biopsy from 2010 to 2011 and followed for 5 years minimum were compared.Results: Among 203 included patients, 153 (75.4%) were whites and 50 (24.6%) were African descendants. The mean patients' age was 63.7 (± 6.8) years. Digital rectal examination (DRE) was suspected of cancer in 45.2% of the patients. The prostate biopsy core length was smaller in African descendants than in whites, overall 11.0 ± 3.2 vs 12.0 ± 2.9 mm, p = 0.037, and without neoplasia, 10.4 ± 3.8 vs 11.7 ± 3.1 mm, p = 0.038, respectively. Also, suspicious DRE showed smaller biopsy core length, overall 11.1 ± 3.2 mm vs 12.4 ± 2.6, p = 0.003, cancer positive 12.0 ± 4.8 mm vs 13.3 ± 3.7, p = 0.022 and negative 10.6 ± 3.6 mm vs 12.2 ± 3.0, p = 0.002. On 81 months median follow-up, more African descendants were lost to follow-up (10%, n = 5 vs 3.9%, n = 6) and the biochemical recurrence rate was the same between the groups (33.3%).Conclusion: In a PCa population with similar access to the health system, prostate biopsy core length in African descendant men is significantly smaller than in whites. This finding is new and may add to the controversial argument of PCa having a worse prognosis in African descendant patients.
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Affiliation(s)
- Wilmar Azal Neto
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Guilherme Miranda Andrade
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Athanase Billis
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
| | - Leonardo O Reis
- UroScience, Department of Urology, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, SP, Brazil
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van der Slot MA, Leijte JAP, van der Schoot DKE, Oomens EHGM, Roemeling S. End-fire versus side-fire: a randomized controlled study of transrectal ultrasound guided biopsies for prostate cancer detection. Scand J Urol 2020; 54:101-104. [PMID: 32162567 DOI: 10.1080/21681805.2020.1738544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To compare prostate cancer detection rates between end-fire and side-fire ultrasound guided prostate biopsy techniques.Methods: A prospective randomized controlled trial was performed in patients who underwent prostate biopsy between 2009 and 2014. Patients were randomly assigned to the end-fire or side fire biopsy groups and underwent transrectal ultrasound guided prostate biopsy. The overall prostate cancer detection rate was compared between the two probe configurations. Trial was registered at Clinical Trials.gov with identifier: NCT00851292.Results: A total of 730 patients were included and randomized, 371 patients underwent prostate biopsy with side-fire probe and 359 patients with the end-fire probe. Prostate cancer detection rates were 52.4% in the end fire group and 45.6% in the side fire group (p = .066).Conclusions: No significant difference was found in detection rate of prostate cancer between the end-fire and side-fire probe in transrectal ultrasound guided prostate biopsy, neither for detection rate of prostate cancer in the apex.
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Affiliation(s)
| | | | | | | | - Stijn Roemeling
- Urology, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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The Biopsychosocial Burden of Prostate Biopsy at the Time of Its Indication, Procedure, and Pathological Report. Prostate Cancer 2019; 2019:2653708. [PMID: 31057971 PMCID: PMC6463558 DOI: 10.1155/2019/2653708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/25/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To explore the burden of prostate biopsy at the time of its indication, procedure, and pathological report in the prostate cancer-screening scenario that is neglected and underestimated in the literature. Methods Prostate biopsy was offered to 47 consecutive patients with prostate-specific antigen (PSA) over 4 ng/dl or suspicious digital rectal examination (DRE) of whom 16 had undergone a biopsy. Comprehensive validated questionnaires at Time 0 (prebiopsy), Time 1 (before diagnosis, 20 days after biopsy), and Time 2 (after diagnosis, 40 days after biopsy) accessed patients' erectile (IIEF-5) and voiding (IPSS) functions, Beck scales measured anxiety (BAI), hopelessness (BHS), and depression (BDI), added to the emotional thermometers including five visual analog scales for distress, anxiety, depression, anger, and need for help. The Mann-Whitney or Friedman tests were obtained among times and studied variables. Results Prostate biopsy did not significantly impact patients' erectile and voiding functions while a higher Beck anxiety index (BAI) was observed at Time 0 (6.89 ± 6.33) compared to Time 1 (4.83 ± 2.87), p=0.0214, and to Time 2 (4.22 ± 4.98), p=0.0178. At Time 0, patients that experienced a previous biopsy presented higher distress (3.1 ± 3.0 vs. 1.6 ± 2.3), p=0.043, and emotional suffering thermometer scores (2.3 ± 3.3 vs. 0.9 ± 2.4) compared to those undergoing the first biopsy, p=0.036. At Time 2, patients with positive biopsies compared with those with negative ones showed no significant difference in outcome scores. The sample power was >90%. Conclusions To be considered in patients' counseling and care, the current study supports the hypothesis that the peak burden of prostate biopsy occurs at the time of its indication and might be higher for those experiencing rebiopsy, significantly impacting patients' psychosocial domains. Trial Approval This trial is registered under number NCT03783741.
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7
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Are 10-, 10–12-, or > 12-mm prostate biopsy core quality control cutoffs reasonable? World J Urol 2018; 36:1055-1058. [PMID: 29497860 DOI: 10.1007/s00345-018-2242-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022] Open
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8
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Reis LO. Editorial Comment. Urology 2018; 111:134. [PMID: 29162330 DOI: 10.1016/j.urology.2017.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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The impact of core length on prostate cancer diagnosis during a standard 14-core prostate biopsy scheme. Urologia 2016; 83:186-189. [PMID: 27716886 DOI: 10.5301/uro.5000199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Even if many studies in the literature purposed to evaluate the improvement of the prostate biopsy (PBx), few studies assessed the diagnostic value of core length in PBx. In this study, we evaluated the length of needle cores sampled during transrectal PBx (TRUSBx) and its impact on cancer diagnosis in a standard 14-core scheme. METHODS Medical records of 573 patients who underwent an initial TRUSBx with 14-cores scheme for suspicious prostate cancer (PCa) at our Department were reviewed. The PBx procedure and pathological evaluation were standardized. Cores lengths were compared in patients with versus without cancer, and were divided into group A and B, respectively. Statistical analysis was done to define an acceptable cut-off for biopsy length. RESULTS The mean age of the entire cohort was 62.1 ± 7.2 years, while median total prostate-specific antigen (PSA) and prostate volume were 4.2 ng/ml and 44.7 ml, respectively. PCa was showed in 33.3% of patients. Mean core length in group A versus B was 11.9 ± 3.9 versus 11.1 ± 3.2 mm (p = 0.016). Thus, core lengths were significantly longer in patients with cancer. There were no statistically significant differences when we considered the whole length of cores sampled from the right lobe (p = 0.58) and left lobe (p = 0.34). CONCLUSIONS The cancer detection rates in cores may be increased by core length in PCa patients during a TRUSBx. Our results suggest a core length of greater than 11.8 mm as a cut-off for quality warranty.
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10
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Winters BR, Wright JL, Holt SK, Lin DW, Ellis WJ, Dalkin BL, Schade GR. Extreme Gleason Upgrading From Biopsy to Radical Prostatectomy: A Population-based Analysis. Urology 2016; 96:148-155. [PMID: 27313123 DOI: 10.1016/j.urology.2016.04.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/14/2016] [Accepted: 04/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the risk factors associated with the odds of extreme Gleason upgrading at radical prostatectomy (RP) (defined as a Gleason prognostic group score increase of ≥2), we utilized a large, population-based cancer registry. MATERIALS AND METHODS The Surveillance, Epidemiologic, and End Results database was queried (2010-2011) for all patients diagnosed with Gleason 3 + 3 or 3 + 4 on prostate needle biopsy. Available clinicopathologic factors and the odds of upgrading and extreme upgrading at RP were evaluated using multivariate logistic regression. RESULTS A total of 12,459 patients were identified, with a median age of 61 (interquartile range: 56-65) and a diagnostic prostate-specific antigen (PSA) of 5.5 ng/mL (interquartile range: 4.3-7.5). Upgrading was observed in 34% of men, including 44% of 7402 patients with Gleason 3 + 3 and 19% of 5057 patients with Gleason 3 + 4 disease. Age, clinical stage, diagnostic PSA, and % prostate needle biopsy cores positive were independently associated with odds of any upgrading at RP. In baseline Gleason 3 + 3 disease, extreme upgrading was observed in 6%, with increasing age, diagnostic PSA, and >50% core positivity associated with increased odds. In baseline Gleason 3 + 4 disease, extreme upgrading was observed in 4%, with diagnostic PSA and palpable disease remaining predictive. Positive surgical margins were significantly higher in patients with extreme upgrading at RP (P < .001). CONCLUSION Gleason upgrading at RP is common in this large population-based cohort, including extreme upgrading in a clinically significant portion.
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Affiliation(s)
- Brian R Winters
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - William J Ellis
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Bruce L Dalkin
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - George R Schade
- Department of Urology, University of Washington School of Medicine, Seattle, WA
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Pichon A, Neuzillet Y, Botto H, Raynaud JP, Radulescu C, Molinié V, Herve JM, Lebret T. Preoperative low serum testosterone is associated with high-grade prostate cancer and an increased Gleason score upgrading. Prostate Cancer Prostatic Dis 2015; 18:382-7. [PMID: 26439747 DOI: 10.1038/pcan.2015.44] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/06/2015] [Accepted: 08/25/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND To compare histological feature of prostate cancer (PCa) according androgenic status in patients who underwent radical prostatectomy (RP). METHODS Between March 2007 and September 2013, we prospectively analysed 937 patients who were referred to our centre for RP. Clinical, pathological and biological data have been prospectively collected. Preoperative total testosterone (TT) and bioavailable testosterone (BT) serum determinations were carried out. The threshold for low serum testosterone was set at TT<3 ng/ml. Preoperative PSA value was registered. Gleason score (GS) and predominant Gleason pattern were determined in prostate biopsies and in prostate tissue specimens, crosschecked by two uro-pathologists. RESULTS Nine hundred and thirty-seven consecutive patients were included. In all, 14.9% patients had low TT in the population. An exact match between biopsy and prostate specimens in GS grading was observed for 50.6% patients (n=474). Also, 40.9% of all patients were upgraded (n=383): 45.3% (n=63) in low serum testosterone patients and 40.1% (n=320) in normal serum testosterone patients. For prostate specimens, the proportion of patients with predominant Gleason pattern 4 was higher in patients with low TT compared with normal TT (41.7% vs 29.1%, P=0.0029). In all, 20.1% were upgraded from predominant Gleason pattern 3 on biopsies specimen to predominant Gleason 4 pattern on the prostate specimen in patients with low TT, whereas 11.6% were upgraded for normal TT patients (P=0.002). CONCLUSIONS Low serum testosterone is an independent risk factor for predominant Gleason pattern 4 on prostate specimen after RP and for upgrading from low- to high-grade cancer between prostate needle biopsies and RP specimen. This observation should be taken into account in localised PCa management, especially for active surveillance or when a nerve-sparing approach is considered.
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Affiliation(s)
- A Pichon
- Department of Urology, Foch Hospital, Suresnes, France
| | - Y Neuzillet
- Department of Urology, Foch Hospital, Suresnes, France
| | - H Botto
- Department of Urology, Foch Hospital, Suresnes, France
| | - J-P Raynaud
- Department of Physiology, University Pierre and Marie Curie, Paris, France
| | - C Radulescu
- Department of Pathology, Foch Hospital, Suresnes, France
| | - V Molinié
- Department of Pathology, CHU de Fort-de-France, Fort-de-France, France
| | - J-M Herve
- Department of Urology, Foch Hospital, Suresnes, France
| | - T Lebret
- Department of Urology, Foch Hospital, Suresnes, France
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Temiz MZ, Kandirali E, Colakerol A, Tuken M, Semercioz A. Local anesthesia type affects cancer detection rate in transrectal ultrasound guided prostate biopsy. Int Braz J Urol 2015; 41:859-63. [PMID: 26689511 PMCID: PMC4756962 DOI: 10.1590/s1677-5538.ibju.2014.0337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Studies about the anesthesia techniques during transrectal ultrasound guided prostate biopsy (TRUS-Bx) are usually focused on pain relief. Although patients' tolerance is an important issue in TRUS-Bx, cancer detection rate (CDR) must not be ignored. In this study, we compared the impact of intrarectal lidocaine gel anesthesia (IRLA) and periprostatic nerve blockade (PNB) techniques on CDR. MATERIALS AND METHODS A total of 422 patients underwent 10 core-TRUS-Bx because of elevated serum prostate specific antigen (PSA) level (>2.5ng/mL) and/or suspicious digital rectal examination findings. Patients were divided into two groups according to the applied anesthesia technique: IRLA group and PNB group. Age, serum PSA level, prostate volume, visual analogue scale (VAS) score and CDR were recorded and compared statistically with chi square and unpaired t-tests. RESULTS Of the patients 126/422 (29.9%) underwent TRUS-Bx by using IRLA whereas 296/422 (70.1 %) by PNB technique. The mean, age, serum PSA level and prostate volume were similar between the two groups. CDR was 19.8% and 25.4% in IRLA and PNB groups, respectively (p=0.001). The mean VAS score of the PNB group (1.84±0.89) was significantly lower than that for IRLA group (3.62±1.06) (p=0.001). CONCLUSIONS Our results revealed that PNB is superior to IRLA in terms of CDR. Further studies are required to confirm our findings.
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Affiliation(s)
- Mustafa Zafer Temiz
- Department of Urology, Bitlis State Hospital, Besminare, Bitlis, Turkey
- Correspondence address: Mustafa Zafer Temiz, MD, Department of Urology, Bitlis State Hospital, Besminare Mahallesi 13000, Besminare, BITLIS, Turkey, Fax: + 90 434 246-8424, E-mail:
| | - Engin Kandirali
- Department of Urology, Bagcilar Training and Research Hospital, 6. Sokak, Bagcilar/Istanbul, Turkey
| | - Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, 6. Sokak, Bagcilar/Istanbul, Turkey
| | - Murat Tuken
- Department of Urology, Bagcilar Training and Research Hospital, 6. Sokak, Bagcilar/Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, Bagcilar Training and Research Hospital, 6. Sokak, Bagcilar/Istanbul, Turkey
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Reis LDO, Carter HB. The Mind: Focal Cryotherapy in Low-Risk Prostate Cancer: Are We Treating the Cancer or the Mind? Int Braz J Urol 2015; 41:10-4. [PMID: 25928505 DOI: 10.1590/s1677-5538.ibju.2015.01.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Leonardo de Oliveira Reis
- Department of Urology, Johns Hopkins Hospital, Baltimore, MD, USA.,Faculty of Medicine (Urology) Center for Life Sciences, Pontifical Catholic University of Campinas(PUC-Campinas) Campinas, SP, Brazil.,Department of Surgery, Division of Urology, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, SP, Brazil
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14
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Yilmaz H, Ciftci S, Ustuner M, Yavuz U, Saribacak A, Muezzinoglu B, Dillioglugil O. Minimum 6 mm core length is strongly predictive for the presence of glandular tissue in transrectal prostate biopsy. World J Urol 2015; 33:1715-20. [PMID: 25777278 DOI: 10.1007/s00345-015-1536-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Prostate biopsy guidelines recommend that a prostate biopsy not containing glandular prostate tissue should be reported as inadequate. In the literature, there is a lack of any study that addresses the relationship between the length of biopsy cores and the absence of glandular prostate tissue. In this study, we aimed to determine whether a relationship exists between these parameters. MATERIALS AND METHODS We retrospectively evaluated 1,712 consecutive initial transrectal 12-core prostate biopsies. Individual cores were histologically categorized as glandular (benign or malignant) and non-glandular (rectal mucosa, periprostatic adipose tissue, prostatic or periprostatic fibromuscular tissue). Total number of evaluable cores ≤9, highly fragmented, incorrectly numbered or dried biopsies, patients with 5-α reductase inhibitory treatment were excluded. RESULTS We analyzed remaining 1,584 patients; 41.7 % had adenocarcinoma. A total of 19,144 cores were sampled. Non-glandular cores were found significantly shorter than glandular cores (p < 0.0001). The percentages of non-glandular cores were significantly higher at the base, apex and lateral biopsy sites (p < 0.0001). We found a 6-mm cutoff value for accurate prediction of glandular sampling with 80.2 % sensitivity and 78.7 % specificity. The risk of non-glandular sampling increased 15-fold in cores ≤6 mm (OR 14.91, 95% CI 13.20-16.83, p < 0.0001). CONCLUSIONS Non-glandular sampling was directly associated with shorter core lengths. They were found significantly higher at the base, apex and lateral localizations. We found a 6-mm cutoff value for the prediction of non-glandular samples before the histologic evaluation. Below this value, the risk of non-glandular sampling increased 15-fold. We suggest it for prompt additional sampling during biopsy procedure.
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Affiliation(s)
- Hasan Yilmaz
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Seyfettin Ciftci
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey.
| | - Murat Ustuner
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Ufuk Yavuz
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Ali Saribacak
- Department of Urology, Izmit Konak Hospital, Kocaeli, Turkey
| | - Bahar Muezzinoglu
- Department of Pathology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
| | - Ozdal Dillioglugil
- Department of Urology, School of Medicine, University of Kocaeli, Kocaeli, Turkey
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