Is routine prostate biopsy needed prior to radical cystectomy?

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 223-223
Author(s):  
Yasuhiro Hashimoto ◽  
Yuichiro Suzuki ◽  
Atsushi Imai ◽  
Akiko Okamoto ◽  
Hayato Yamamoto ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Invasive Bladder Cancer ◽  
Negative Group ◽  
Group I

223 Background: Prostate cancer (Pca) can be detected coincidentally in radical cystoprostatectomy (RCP) specimens for invasive bladder cancer. However, there is no uniformity of opinion on the need for prostate biopsy prior to RCP. We evaluated the necessity of preoperative prostate biopsy in invasive bladder cancer. Methods: From 1998 through 2009, of 300 patients undergoing radical cystectomy for muscle-invasive bladder cancer, 252 were male. Of these, we focused 212 patients, whose prostate-specific antigen (PSA) was measured preoperatively. Results: The median age was 66years and median follow-up period was 46 months. Thirty-five patients with PSA > 4.0 ng/mL or digital rectal examination (DRE) positive were all subjected to transrectal ultrasound (TRUS)-guided prostate biopsy (Pbx), and Pca was detected in 7 cases (20%) (Group I). Pca was also detected in 5 patients (17.9%) in RCP specimens of the 28 whose Pbx results were negative (Group II). Seventy-seven of the 177 patients with PSA ≤ 4.0ng/mL and DRE negative were underwent TRUS-guided Pbx, and Pca was detected in 1 case (1.3%) (Group III). Pca was detected in 10 patients (13.2%) out of the 76 whose Pbx results were negative (Group IV). Of the 177 patients, 100 underwent RCP without prostate biopsy, and Pca was detected in 16 cases (16%) (Group V). The average Gleason score of each Group, I, II, III, IV, and V were 6.6, 6.6, 7, 6.2, and 6.5, respectively. Tumor volumes of each Group, I, II, III, IV, and V were 3.12mL, 1.0mL, 0.65mL, 0.43mL, and 0.19mL, respectively. No patients experienced recurrence of PC, including biochemical recurrence. Conclusions: In cases with PSA ≤4.0 ng/mL and/or DRE negative, Pbx is not considered necessary. In cases with PSA > 4.0 ng/mL or DRE positive, Pca with an average volume of 3.12 mL were detected by Pbx in 20% of the patients. However, most are localized Pca, and postoperative recurrence of the Pca is not seen during follow-up period. The question of whether all patients in this group require Pbx needs to be examined through further stratification.

scholarly journals Histology results of systematic prostate biopsies by in-bore magnetic resonance imaging vs. transrectal ultrasound

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Alon Lazarovich ◽  
Gil Raviv ◽  
Yael Laitman ◽  
Orith Portnoy ◽  
Orit Raz ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Resonance Imaging ◽  
Rectal Examination ◽  
Number Of Patients ◽  
Clinically Significant

Introduction: We aimed to compare systematic biopsies (SBs) of in-bore magnetic resonance-guided prostate biopsy (MRGpB) with those performed under transrectal ultrasound (TRUS) guidance in the clinical setting. Methods: Data on all 161 consecutive patients undergoing prostate biopsy in our institution between November 2017 and July 2019 were retrospectively collected. The patients were referred to biopsy due to elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination and/or at least one Prostate Imaging Reporting and Data System (PI-RADS) lesion score of ≥3 on multiparametric magnetic resonance imaging (mpMRI). We included patients with PSA levels ≤20 ng/ml and those with 8–12 core biopsies. Histology results of SBs performed by in-bore MRGpB were compared to TRUS SBs. Chi-squared, Fischer’s exact, and multivariate Pearson regression tests were used for statistical analysis (SPSS, IBM Corporation). Results: In total, 128 patients were eligible for analysis. Their median age was 68 years (interquartile range [IQR] 61.5–72), mean prostate size 55±29 cc, and mean PSA and PSA density levels 7.6±3.5 ng/ml and 0.18±0.13 ng/ml/cc, respectively. Thirty-five patients (27.3%) had suspicious digital rectal examination findings. Both biopsy groups were similar for these parameters. Thirty-eight (62.3%) MRGpB patients had a previous biopsy vs. 5 (7.1%) TRUS-SB patients (p<0.0001). The number of patients diagnosed with clinically significant and non-significant disease was similar for both groups. High-risk disease was more prevalent in the TRUS-SB group (22.4% vs. 4.9%, p<0.01). Conclusions: Our data suggest that in-bore MRGpB is no better than TRUS for guiding SBs for the detection of clinically significant prostate cancer.

Effect of detecting asymptomatic recurrence after radical cystectomy on prognosis in patients with muscle invasive bladder cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 428-428
Author(s):  
Shingo Hatakeyama ◽  
Ayumu Kusaka ◽  
Hirotake Kodama ◽  
Noriko Tokui ◽  
Hayato Yamamoto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Regression Analysis ◽  
Radical Cystectomy ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Muscle Invasive

428 Background: The prognostic benefit of oncological follow-up to detect asymptomatic recurrence after radical cystectomy (RC) remains unclear. We aimed to assess whether routine follow-up to detect asymptomatic recurrence after RC improves patient survival. Methods: We retrospectively analyzed 581 RC cases for muscle invasive bladder cancer at four hospitals between May 1996 and February 2017. All patients had regular follow-up examinations with urine cytology, blood biochemical tests, and computed tomography after RC. We investigated the first site and date of tumor recurrence. Overall survival in patients with recurrence stratified by the mode of recurrence (asymptomatic group vs. symptomatic group) was estimated using the Kaplan–Meier method with the log–rank test. Cox proportional hazards regression analysis via inverse probability of treatment weighting (IPTW) was used to evaluate the impact of the mode of diagnosing recurrence on survival. Results: Of the 581 patients, 175 experienced relapse. Among those, 12 without adequate data were excluded. Of the remaining 163 patients, 76 (47%) were asymptomatic and 87 (53%) were symptomatic at the time of diagnosis. The most common recurrence site and symptom were lymph nodes (47%) and pain (53%), respectively. Time of overall survival after RC and from recurrence to death were significantly longer in the asymptomatic group than symptomatic group. A multivariate Cox regression analysis using IPTW showed that in the patients with symptomatic recurrence was an independent risk factor for overall survival after RC and survival from recurrence to death. Conclusions: Routine oncological follow-up for detection of asymptomatic recurrence contributes to a better prognosis after RC.

scholarly journals Evaluation of Complications of Intra-Prostatic Local Anaesthesia and Periprostatic Local Anaesthesia for Trus Guided Prostate Biopsy

2020 ◽  
Vol 17 (2) ◽  
pp. 82-86
Author(s):  
Am Anamur Rashid Choudhury ◽  
Md Waliul Islam ◽  
Md Golam Mowla Chowdhury ◽  
Tasmina Parveen ◽  
Parveen Sultana
Keyword(s):  
Prostate Biopsy ◽  
Local Anaesthesia ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Visual Disturbance ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Group I ◽  
Group Ii

Objectives : To evaluate complications in Intra-prostatic local Anaesthesia and Periprostatic local Anaesthesia for TRUS Guided 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, evaluate complications between periprostatic with intraprostatic local anaesthesia for transrectal prostate biopsy. 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. Result : 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. No systemic lidocaine toxicity was observed in group II. But only dizziness were found in 2 cases (6.7%) and visual disturbance were found in 1 (3.3%) case respectively in group I. Urinary tract infection was found 2(6.7%) in group I and 1(3.3%) in group II patients. Hematuria was found 23(76.7%) in group I and 19(63.3%) in group II. Rectal bleeding was found 14(46.7%) in group I and 11(36.7%) in group II. The statistically not significant (p>0.05) between two groups in chi square and fisher exact test 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. Complications wer4e less in intra-prostatic local anaesthesia than periprostatic local anaesthesia for TRUS guided prostate Biopsy. Bangladesh Journal of Urology, Vol. 17, No. 2, July 2014 p.82-86

scholarly journals Tumor-Associated Release of Prostatic Cells into the Blood after Transrectal Ultrasound-Guided Biopsy in Patients with Histologically Confirmed Prostate Cancer

2019 ◽  
Vol 66 (1) ◽  
pp. 161-168 ◽  
Author(s):  
Simon A Joosse ◽  
Burkhard Beyer ◽  
Christin Gasch ◽  
Paulina Nastały ◽  
Andra Kuske ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Tumor Cells ◽  
Prostate Biopsy ◽  
Standard Procedure ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Ultrasound Guided ◽  
Systemic Spread

Abstract BACKGROUND Transrectal ultrasound-guided prostate biopsy (TRUS) is a standard procedure for prostate cancer diagnosis. Because prostate cancer is a multifocal disease in many patients, multiple sampling (n ≥ 10) is required, which may bear the risk of systemic spread of cancer cells. DESIGN Using the standardized CellSearch® system that allows for the detection of single epithelial cell adhesion molecule-positive circulating tumor cells (CTCs) in blood, we investigated whether prostate biopsy is associated with release of prostatic tumor cells into the circulation. Peripheral blood was obtained before and within 30 min after performing prostate biopsy from 115 men with increased serum prostate-specific antigen. RESULTS The number of CTCs significantly increased after biopsy in men with histologically confirmed prostate cancer (odds ratio, 7.8; 95% CI, 4.8–12.8), whereas no biopsy-related changes could be detected in men without confirmed prostate cancer. Multivariable analysis showed that biopsy-related increase of CTCs was significantly correlated with a worse progression-free survival (hazard ratio, 12.4; 95% CI, 3.2–48.6) within the median follow-up of 41 months. CONCLUSIONS Prostate biopsies may lead to a tumor-associated release of CTCs into the blood circulation. Larger confirmatory trials with longer follow-up periods are required before any change in clinical practice can be recommended.

Neoadjuvant chemotherapy in muscle invasive bladder cancer: Real world data on safety and outcome.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17036-e17036
Author(s):  
Sree Vamsee Chetana Panthula ◽  
Arun Philip ◽  
Pavithran Keechilat ◽  
Wesley Mannirathil Jose
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Invasive Bladder Cancer ◽  
Definitive Treatment ◽  
Muscle Invasive Bladder Cancer ◽  
Female Ratio ◽  
Radiological Response ◽  
Muscle Invasive

e17036 Background: The standard treatment for Muscle Invasive bladder cancer (MIBC),Radical Cystectomy and Neoadjuvant chemotherapy (NACT) has shown to improve survival. Data from Indian population is scarce, and we sought to explore the efficacy, tolerability and factors affecting the outcome of Neoadjuvant chemotherapy in our population. Methods: This was a Retrospective Observational study conducted at a tertiary care centre. Patients of MIBC treated between 2008 and 2019 were included in the analysis. The NACT consisted of Gemcitabine + Cisplatin (GC) or Gemcitabine + Carboplatin (GCa). The prognostic significance of the various clinico-laboratory parameters was assessed by the log rank test. The survival analysis was done by the Kaplan Meier method. Results: Total of 40 patients received NACT from 2008-2019. The median age of study group was 62 years. Male to Female ratio was 5:1. Out of 40 patients, 26 were treated with GC and the remaining 14 received GCa. Majority (80%) patients were administered either 3 or 4 cycles of NACT. Among 18 patients who demonstrated good radiological response after NACT completion, 13 had received Cisplatin. After NACT, 32 (80%) underwent Radical Cystectomy and 3 were treated with CTRT. The remaining 5 did not receive definitive treatment. Pathological complete response (PCR) was achieved in 10 out of 32 patients (31%). Out of 10 patients with PCR, 9 belonged to Cisplatin group and only 1 in Carboplatin group. In patients with PCR, 80% remained progression free at last follow up. Grade 3/4 toxicities were minimal. However, achieving a pathological CR did not translate into significant survival benefit in our study (p value 0.10). Median follow up time and overall survival for the cohort was 29.5 and 54 months respectively. Conclusions: Gemcitabine/Cisplatin as NACT resulted in superior radiological response, PCR, PFS and OS when compared to Gemcitabine/Carboplatin in MIBC. This regimen is well tolerated and we advocate for further prospective studies with GC in this setting. [Table: see text]

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

2020 ◽  
Vol 15 (2) ◽  
pp. 33-39
Author(s):  
AM Anamur Rashid Choudhury ◽  
Md waliul Islam ◽  
Sharif Shahjamal ◽  
Kazi Rafiqul Abedin ◽  
Abu Bakar Siddique ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Prostatic Biopsy ◽  
Medical College ◽  
Group I ◽  
Transrectal Prostate Biopsy ◽  
The Mean ◽  
Group Ii

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

scholarly journals Complications of Transrectal Prostate Biopsy

2014 ◽  
Vol 14 (1) ◽  
pp. 27-32 ◽  
Author(s):  
P. Cech ◽  
J. Luptak
Keyword(s):  
Prostate Biopsy ◽  
Core Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Infectious Complications ◽  
Antibacterial Prophylaxis ◽  
Close Monitoring ◽  
Intramuscular Dose ◽  
Arterial Bleeding

Abstract Objective: The aim of our study is to evaluate complications In patients who underwent a Transrectal Ultrasound Guided Prostate Biopsy (TRUS BP) at the Department of Urology of JFM CU and UHM in 2007-2008 and at the Department of Urology in Bojnice Hospital in 2009-2012. Methodology, disclosures: In our study, patients with positive digital rectal examination (DRE) and/or with hig- her prostate specific antigen (PSA) levels (>4 ng/ml) are included. We excluded patients with PSA levels greater than 50ng/ml. as well as patients with less than 8 biopsy cores. The number of examined patients fulfilling the criteria was 474. An average age of them was 66.3 years (SD±8.3years). As an antibacterial prophylaxis, the patients were given fluoroquinolons in a dose of 500mg twice a day during a 3-day course of antibiotics, while the first dose was given one day before the procedure. In high risk patients, we used a single intramuscular dose of gentamycin 160mg right before the procedure followed by fluoroquinolons for the next five days. Results: The most severe complication was vasovagal reaction, which occurred in 9 (1.9%) cases. Haematuria occurred in 122 (25.7%) cases up to 3 days and in 10 (2.1%) patients up to 7 days. Six patients (1.3%) required hospital admission for severe haematuria. Dysuria occurred in 71 patients (15%). Rectal bleeding occurred in 90 (19%) cases with an average 2 days of bleeding, from which 7 patients were admitted to hospital and administered haemostyptics. From the mentioned count. 2 (0.4%) patients underwent a rectal tamponade and one (0.2%) patient with arterial bleeding underwent an arterial ligation of a stricken artery. Haemospermia occurred in 71 (15%) cases. 23 (4.9%) patients suffered fever above 38°C. within whom in 7 (1.5%) cases was microscopicaly proven uri- nary tract infection requiring hospitalisation lasting 7 days on average. Sepsis occurred in 3 (0.6%) patients, symp- tomatic bacterial prostatitis in 6 (1.2%) cases and urinary retention occurred in one (0.2%) patient. There was not arty significant higher amount of complications in between 8-core and 10-core biopsy (P=0.26), not even in betwe- en 8-core and 12-core biopsy (P=0.32). Conclusion: TRUS PB is a sale procedure with quite a low risk of complications. An important moment is a close monitoring right after the procedure. The most of the complications may persist for around two weeks and are trea- ted conservatively without persistent effects. Prophylaxis with broad spectrum antibiotics may provide an adequa- te coverage and lowers the risk of infectious complications.

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