scholarly journals Importance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients

Medicina ◽  
2007 ◽  
Vol 43 (11) ◽  
pp. 843
Author(s):  
Kęstutis Vaičiūnas ◽  
Stasys Auškalnis ◽  
Aivaras Matjošaitis ◽  
Antanas Mickevičius ◽  
Ramūnas Mickevičius ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Antigen Level ◽  
Ultrasound Guided ◽  
High Risk Patients ◽  
Prostate Biopsies ◽  
Risk Patients ◽  
Detect Prostate Cancer

Our purpose was to evaluate the relevance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients. Material and methods. Our study included 195 men at high risk for prostate cancer (elevated prostatespecific antigen level and/or abnormal prostate detected by digital rectal examination). We consulted the patients in outpatient department of Kaunas University of Medicine Hospital during 2003–2007. We performed transrectal ultrasound-guided laterally directed sextant prostate biopsy in every patient. For the patients with benign histological findings and increased risk of prostate cancer, laterally directed sextant biopsies were repeated. Results. Prostate cancer was detected in 30.3% of patients (59/195) on the first prostate biopsy, in 13.1% (11/84) on the second prostate biopsy, in 10.3% (4/39) on the third, and in 7.7% (1/13) on the forth biopsy. After all biopsies, prostate cancer was detected in 38.5% (75/195) of patients, and it differed significantly from the percentage of prostate cancer cases detected on the first biopsy (30.3%, P=0.04). We detected 78.7% (59/75) of all prostate cancer cases by the first laterally directed sextant prostate biopsy. The rest 21.3% (16/75) of cases we detected by repeat biopsies. The second laterally directed sextant prostate biopsy revealed additional 14.6% (n=11) of prostate cancer cases and increased the detection of prostate cancer to 93.3% (70/75). At the time of the first prostate biopsy, prostate cancer was diagnosed most frequently when patients had both risk factors: elevated prostate-specific antigen level and abnormal digital prostate examination; prostate cancer was diagnosed in 45.3% of these patients. The odds ratio to detect prostate cancer by the first biopsy in patients with elevated prostate-specific antigen level and abnormal digital prostate examination was 3.7, and odds ratio to detect prostate cancer by repeat biopsies was 4.7. Conclusions. Repeat ultrasound-guided laterally directed sextant prostate biopsies reveal more cases of prostate cancer as compared to the first prostate biopsy. The majority of prostate cancer cases (93.3%) are detected by the first and second laterally directed sextant prostate biopsies. After the first negative prostate biopsy, we recommend to repeat prostate biopsy in high-risk patients.

scholarly journals Quantifying the ki-67 heterogeneity profile in prostate cancer.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 73-73
Author(s):  
Mitchell Kamrava ◽  
Shane Mesko ◽  
Robyn Banerjee ◽  
Jiaoti Huang ◽  
D. Jeffrey Demanes ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Prostate Biopsy ◽  
Risk Groups ◽  
Tumor Diameter ◽  
Ki 67 ◽  
High Risk Patients ◽  
Prostate Biopsies ◽  
Positive Biopsy ◽  
Risk Patients

73 Background: Ki-67 is a robust predictive/prognostic marker in prostate cancer however tumor heterogeneity may compromise its clinical utility when Ki-67 is determined off of prostate biopsy samples. We examined the variation of Ki-67 in prostate biopsy samples by NCCN risk groups and the location of the highest Ki-67 relative to the most dominant lesion on multiparametric (MP) MRI. Methods: An IRB approved retrospective analysis was done on 77 consecutive men whose prostate biopsies revealed cancer. Using a MRI/US fusion device (Artemis), biopsy cores were obtained systematically and when MRI indicated a lesion, by targeting. Ki-67 staining was determined by a manual semi-quantitative method and reported as % of positive cells. The highest Ki-67 per patient was used to determine inter-prostatic variation. Ki-67 range (highest Ki-67 minus lowest Ki-67 value) was used to determine intra-prostatic variation on a subset of 47 patients with ≥2 positive biopsy cores. Ki-67 range was also used to evaluate intra-lesion variation on 31 MP MRI defined lesions with > 1 targeted positive biopsy core. The relationship of the dominant lesion (lesion with the largest tumor diameter) to the highest Ki-67 in the entire prostate was examined for 10 patients with ≥2 distinct lesions on MP MRI. Analysis of variance (ANOVA) was used to evaluate differences between the means of NCCN-defined risk groups. Results: Inter-prostatic Ki-67 mean±standard deviation (SD) values for low, intermediate and high risk patients were 5.1% ± 3.8%, 7.4% ± 6.8%, and 12.0% ± 12.4% (ANOVA p=0.01). Intra-prostatic mean±SD Ki-67 ranges in low, intermediate, and high risk patients were 2.6% ± 3.4%, 4.6% ± 6.4%, 9.5% ± 10.6% (ANOVA p = 0.0246). Intra-lesion mean±SD Ki-67 ranges in low, intermediate and high risk patients were 1.0%±1.0%, 4.0%±4.29%, and 6.7%±11.51% (ANOVA p=0.39). The dominant lesion harbored the highest Ki-67 30% of the time. Conclusions: High risk patients have significantly higher inter- and intra-prostatic Ki-67 heterogeneity profiles than men with low/intermediate risk disease. The highest Ki-67 is often not located in the dominant MRI defined lesion. This data can inform future biopsy strategies when integrating Ki-67 into clinical practice.

scholarly journals Importance of prostate volume for detection of prostate cancer by first sextant biopsy in high-risk patients

Medicina ◽  
2007 ◽  
Vol 43 (4) ◽  
pp. 285 ◽  
Author(s):  
Kęstutis Vaičiūnas ◽  
Stasys Auškalnis ◽  
Aivaras Matjošaitis ◽  
Darius Trumbeckas ◽  
Mindaugas Jievaltas
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Transition Zone ◽  
Prostate Biopsy ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Transitional Zone ◽  
Antigen Level ◽  
Sextant Biopsy

The aim of this study was to evaluate the relevance of prostate gland volume, transitional zone volume, and transitional zone index for the detection of prostate cancer by the first sextant biopsy. Material and methods. A total of 121 men with high risk of prostate cancer were included in our study (prostate-specific antigen level higher than 4 ng/mL and/or pathological digital rectal examination). We consulted the patients in Outpatient Department of Kaunas University of Medicine Hospital during 2003–2006. Total prostate volume and transition zone volume were measured, and all patients underwent transrectal ultrasoundguided sextant biopsy of the prostate. According to histological results of prostate biopsy, patients were divided into two groups: benign group (benign prostate hyperplasia and high-grade intraepithelial neoplasia) and prostate cancer group. Statistical analysis was made by SPSS (Statistical Package for Social Sciences) 12.0.1 for Windows. Results. After histological examination, prostate cancer was detected in 20.7% of patients (n=25). Prostate cancer was found in 24.6% of patients with a total prostate volume of less than 60 cm3 and only in 8.2% of patients with a total prostate volume greater than 60 cm3 (P=0.026). Prostate cancer was found in 27.1% of patients with transition zone volume smaller than 30 cm3 and only in 7.5% of patients with transition zone volume greater than 30 cm3 (P=0.007). A statistically significant difference was found when patients were divided into the groups according to transition zone index: when transition zone index was lower than 0.45, prostate cancer was detected in 37.1% of patients, and when transition zone index was higher than 0.45, prostate cancer was observed in 9.1% of patients (P=0.001). The possibility to detect prostate cancer was 5.9 times higher in patients with transition zone index lower than 0.45. Conclusions. Prostate cancer detection rate by first sextant prostate biopsy in patients with elevated prostate-specific antigen level and/or pathological digital rectal examination was higher when total prostate volume was less than 60 cm3, transition zone was less than 30 cm3, and transition zone index was less than 0.45.

scholarly journals Is clinical stage T2C prostate cancer intermediate- or high-risk disease?

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 110-110
Author(s):  
Zachary Klaassen ◽  
Abhay A Singh ◽  
Lauren Howard ◽  
Martha K. Terris ◽  
William J Aronson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Rank Test ◽  
Intermediate Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Better Than

110 Background: Clinical stage T2c (cT2c) is an indeterminate factor in the algorithm for prostate cancer (CaP) risk stratification. According to the D’Amico risk stratification and the American Urological Association (AUA) guidelines, cT2c is high−risk, whereas the National Comprehensive Cancer Network (NCCN) and EUA classify cT2c as intermediate−risk. Since determining whether cT2c is intermediate- or high-risk has implications for treatment, it is important to define what exact risk cT2c portends. Thus, we sought to assess whether cT2c tumors, without associated other high−risk factors (cT2c not otherwise specified (cT2c−nos)), behave as intermediate− or high−risk by analyzing biochemical recurrence (BCR) after radical prostatectomy (RP). Methods: We retrospectively analyzed 2,759 men who underwent RP from 1988 to 2011 from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Comparisons in time to BCR between cT2c−nos patients and intermediate−risk (prostate-specific antigen [PSA] 10 to 20 ng/ml or Gleason sum (GS) =7 or cT2b), and high−risk (PSA greater than 20 ng/ml, GS 8 to 10, cT3) patients was performed using log−rank test and Cox proportional hazards analyses. Given changes in CaP, we adjusted for year of surgery (continuous) and to adjust for case mix among centers contributing to SEARCH we included a categorical term for center. Results: A total of 99 men (4%) were classified as cT2c−nos. During a median follow-up of 66 months (IQR: 34−101 months), cT2c−nos patients had similar BCR risk as intermediate-risk (p=0.27), but significantly lower BCR risk versus high-risk patients (p<0.001, Figure). After adjusting for year and center and compared to low-risk disease, the HRs for cT2c−nos patients was similar to those with intermediate-risk (HR 1.90 vs. 2.28). When specifically compared to intermediate-and high-risk patients, and after adjusting for year and center, cT2c−nos patients had outcomes comparable to intermediate−risk (p=0.44), but significantly better than high-risk patients (HR 0.55; 95%CI 0.38,0.78; p=0.001). Conclusions: BCR risk for patients with clinical stage T2c was comparable to men who had intermediate-risk disease and significantly better than men with high-risk CaP. These findings suggest men with cT2c disease should be offered treatment options for intermediate-risk CaP.

Prostate Cancer Diagnosis in High Risk Patients – The Finasteride Challenge Trial

2008 ◽  
Vol 01 (03) ◽  
Author(s):  
Bernd J Schmitz-Dräger ◽  
Arndt Hartmann ◽  
Gert Hüsgens ◽  
Jack Groskopf ◽  
Jochen Gleissner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Cancer Diagnosis ◽  
Prostate Cancer Diagnosis ◽  
High Risk Patients ◽  
Risk Patients

Impact of prostate needle biopsy on erectile function: A prospective study

2019 ◽  
Vol 86 (3) ◽  
pp. 145-147
Author(s):  
Koosha Kamali ◽  
Mostafa Nabizadeh ◽  
Mojtaba Ameli ◽  
Maryam Emami ◽  
Mohadese Mahvari-Habibabadi ◽  
...  
Keyword(s):  
Erectile Dysfunction ◽  
Prostate Specific Antigen ◽  
Prostate Biopsy ◽  
Needle Biopsy ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Prostate Specific Antigen Level ◽  
Antigen Level ◽  
Ultrasound Guided ◽  
The Mean

Background: Needle biopsy of the prostate is a diagnostic method for prostate cancer which is a relatively safe method with low risk of serious complications. The evidences regarding the occurrence of erectile dysfunction following prostate biopsy are controversial. Herein, we aimed at determining the rate of erectile dysfunction in those undergoing transrectal ultrasound-guided prostate biopsy. Method: All candidates for prostate biopsy were enrolled. The International Index of Erectile Function-5 was completed 1 m before and 1, 3, and 6 months after ultrasound-guided prostate biopsy by each patient for erectile dysfunction. Patients with a previous history of erectile dysfunction which due to a positive pathology had received any type of treatment were excluded from the study. Results: Eighty patients with the mean age of 64.8 years, the mean prostate-specific antigen level of 11.64 ng/dL, and the mean prostate volume of 62.43 cc were included. The prostate biopsy result was positive in 38.8% of the cases. No significant relationship was found between erectile dysfunction and prostate-specific antigen level, prostate volume, and the pathology result (P = 0.320, 0.509, and 0.131). The mean questionnaire score 1 month before and after the biopsy was 23 and 18, respectively; it demonstrated a significant difference (P < 0.001). The same score was 17 and 14.5 three and six months after biopsy. The mean score 1 m before and 3 m after biopsy also revealed a significant difference (P < 0.001). Conclusion: Transrectal ultrasound-guided needle biopsy of the prostate causes progressive erectile dysfunction in these patients. This relationship is not affected by the biopsy result, prostate volume, or the prostate-specific antigen level.

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