Prostate biopsy: a survey of practice among Nigerian urologists

Background Prostate biopsy is a commonly performed outpatient procedure in urology. It is a rapidly changing field with wide variation in practice pattern. The aim of this study is to document the current practice of prostate biopsy among Nigerian urologists. Methods A prospectively designed, self-administered, 16-item survey questionnaire was distributed among urologists and trainees at the 24th Annual General Meeting and Scientific Conference of the Nigerian Association of Urological Surgeons (NAUS). The survey covers various aspect of prostate biopsy including indications for biopsy, prophylactic antibiotic regimen use, methods of bowel preparation, number of biopsy cores taken, complications among others. Results Fifty-one completed questionnaires were returned, out of 76 distributed, giving a response rate of 67%. Majority of the respondents were Consultant urologist 47 (92%), most of them practice in the public health system 46 (90.2%), and performed more than 5 prostate needle biopsy per month 37 (72.5%). All respondents administer prophylactic antibiotics prior to biopsy, with intravenous Gentamycin being the most commonly administered prophylactics 14 (27.5%), only a few perform bowel preparations prior to biopsy 8 (15.7%) with Dulcolax suppository being the most commonly employed agents 5 (63%). Most of the biopsy were done under transrectal ultrasound guidance 29 (56.9%). None of the respondents performed MRI-guided transrectal biopsy. Most respondents take 8–12 core biopsy 20 (39.2%), using 18G trucut biopsy needle 31 (60.8%), with the patient in left lateral decubitus position 26 (51%), under 2% intrarectal xylocaine instillation 28 (54.9%). The commonest complication after the procedure was bleeding per rectum 20 (39.2%), followed by haematuria 9 (17.6%), and infection 8 (15.7%). Conclusion There is universal use of prophylactic antibiotic prior to biopsy. However, bowel preparation prior to biopsy is not common among Nigerian urologist, and MRI-guided biopsy is very rarely done for prostate biopsy. There is need for a prostate biopsy guideline among Nigerian urologists to ensure uniformity of practice, and enhance standardized service delivery.

Embryonal Rhabdomyosarcoma of the Prostate in Adults: A Case Report

Rhabdomyosarcomas (RMS) are malignant tumors that develop from normal skeletal muscle tissue. It is a rare soft tissue cancer in adults. We report the case of a 26-year-old patient with an embryonal RMS from the prostate extended to the bladder with pelvic lymph node involvement. He is received for erectile dysfunction, lower back pain on his right side, pollakiuria, urgent urination and decreased urine output. The clinical examination revealed a prostate tumor. A CT scan shows a pelvic mass developing at the expense of the early-enhanced prostate, with irregular contours, invading the posterior wall of the bladder. Pelvic MRI gave similar results. Standard histology with immunostaining of the pieces of the transrectal biopsy concluded in an RMS of the embryonal type. No distant metastasis is detected on the extension workup. The tumor was classified as T2bN1M0 stage 3, group III. Neo-adjuvant multidrug therapy is administered in six courses and a complete response results. The patient then refuses surgery. Radiotherapy using a three-dimensional conformational technique (RC3D) is delivered to the entire pelvis with overprinting on the initial prostate lesion up to a total dose of 70Gy. The patient is in remission 16 months after his diagnosis. Embryonal prostate RMS is a rare disease in adults. The treatment is multidisciplinary by neo-adjuvant chemotherapy then surgery and / or radiotherapy.

A pelvic mass 21 years after a Wilms tumour: late recurrence or new tumour?

Introduction: Late Wilms tumour (WT) recurrences are rare events with poorly understood pathogenesis. They could be induced by previous chemo- and radiotherapy regimens, which can also prompt a rhabdomyomatous differentiation. Prostatic embryonal rhabdomyosarcoma (PER) is an extremely rare disease in adults, with an aggressive behaviour and abysmal prognosis. Radio-induced PER have been described. Case description: We report the case of a 29 years old man, with a history of WT, diagnosed with a symptomatic prostatic mass. Blastemic elements were shown at the transrectal biopsy, suggesting the possibility of a late WT recurrence. After laparoscopic resection, an unexpected pathologic diagnosis was reached: PER. Conclusion: We retrace and analyse the diagnostic and therapeutic path of the case that represents a mixture of two different conditions which might be unrelated or intertwined in a causal relationship. Among the differential diagnosis of a prostatic mass, the possibility of a prostatic sarcoma should not be overlooked, in presence of blastemic elements, even in a patient with a WT history.

Comparing tolerability of local anaesthetic transperineal and transrectal prostate biopsies

Objectives: Local anaesthetic transperineal prostate biopsies have been demonstrated as tolerable. However, to date, the tolerability has not been directly compared to the standard of care for transrectal biopsy. We set out to prospectively compare the tolerability of local anaesthetic transperineal and transrectal prostate biopsies. Patients and methods: All patients between 3 April 2019 to 6 December 2019 undergoing local anaesthetic transperineal / transrectal ultrasound biopsy were prospectively asked to complete a questionnaire using visual analogue scales assessing the tolerability of their biopsy. Results: 108 patients were included. Baseline characteristics (mean): age 66.4 years, prostate-specific antigen 13.7 ng/dl, prostate volume 48 ml. Of the patients 51% had ⩾ Gleason 3+4 prostate cancer. 56 patients had transperineal and 52 patients had transrectal biopsy. Median visual analogue scale scores (0–9: transperineal vs transrectal) for probe insertion, probe presence, local anaesthetic injection and taking biopsy were 3 vs 4 ( p=0.66), 3 vs 3 ( p=0.91), 3 vs 2 ( p=0.15) and 3 vs 3 ( p=0.18), respectively. Median visual analogue scale scores (0–3) for overall pain, embarrassment and how they would describe it to a friend were 1 vs 1 ( p=0.17), 0 vs 0 ( p=0.34) and 1 vs 1 ( p=0.2), respectively (transperineal vs transrectal ultrasound). 42 of the 56 patients in the transperineal group had prior transrectal biopsy. 24/42 patients described local anaesthetic transperineal biopsy as the same or better than transrectal; 15/42 described it as a little worse. Conclusion: Tolerability of local anaesthetic transperineal biopsy is comparable to transrectal biopsy. As such, we advocate the routine use of transperineal biopsy and to phase out the transrectal approach where possible. Level of evidence: 2b

Multi-Parameter Magnetic Resonance Imaging Fusion Technology Assists in Bone Diagnosis and Rehabilitation of Prostate Cancer

Multi-parameter magnetic resonance imaging has been widely used in the diagnosis and evaluation of prostate cancer, and has important guiding significance for clinical diagnosis of prostate cancer and their treatment. This article studies the value of transrectal multiparametric ultrasound (mpUSS) in the diagnosis of clinically meaningful prostate cancer. 102 patients with high risk factors for prostate cancer were examined by mpUSS and mpMRI. The transrectal biopsy (SB) results of the prostate system were regarded as the excellent standard, and the diagnostic value of mpUSS, mpMRl and mpUSS combined with mpMRl examination for clinically meaningful prostate cancer was analyzed. The results showed that 58 of the 102 patients with SB were diagnosed with prostate cancer. Among them, 43 cases were detected by mpUSS, 50 cases were detected by mpMRl, 42 cases were detected by mpUSS combined with mpMRI (series), and 56 cases were detected by mpUSS combined with mpMRl (parallel). Grouped by Gleason score, the detection rate of mpUSS for clinically significant prostate cancer was 83.74%, and the detection rate of mpMRl was 93.5%. The comparison between the two was not statistically significant (P > 0.05), but when the two inspection methods were combined. The detection rate was 97.8%, which was significantly higher than the two inspection methods alone. Therefore, we conclude that mpUSS can be used as an imaging test for the diagnosis of prostate cancer. In addition, mpUSS has a high application value in the diagnosis of prostate cancer. The detection rate of mpUSS combined with mpMRl examination for clinically meaningful prostate cancer is significantly higher than that of mpMRl examination alone, which can be used as a diagnostic technique for early diagnosis of meaningful prostate cancer and can be used as a guide clinicians’ early diagnosis and treatment of meaningful prostate cancer.

A Comparison of Infectious Outcomes Between In-Office Transperineal Prostate Biopsies Without Antibiotic Prophylaxis and Transrectal Prostate Biopsies

Background: To describe our experience with office-based transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. Methods: In our retrospective review, we compared the TPB to TRB in our institution for in-office prostate biopsies with local anesthesia from 06/2017-06/2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI. Results: Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. Conclusion: In-office TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes.

Rectal Granular Cell Carcinoma Requiring Abdominoperineal Resection

Background Granular cell tumors, derived from neural crest cells, are rare tumors infrequently located in the colon or rectum. We will discuss a patient with a rectal granular cell tumor invading the anal sphincters requiring an abdominoperineal resection. Methods A 56-year-old male, with anal pain, was found to have a perirectal mass. Pathology from ultrasound-guided transrectal biopsy demonstrated low grade granular cell tumor. The patient underwent a laparoscopic abdominoperineal resection with perineum reconstruction. Results Pathology demonstrated a granular cell tumor of 4.5 centimeters with tumor invasion of the anal sphincters. Surgical margins were free of neoplasm. Discussion This is the only documented case of a colorectal granular cell tumor that has required an abdominoperineal resection. On histology, it was considered low grade but its behavior was more consistent with a malignant process. Additional research on malignant granular cell tumors is necessary to help improve treatment options, prevent recurrence, and improve overall survival. His medical course will be followed for disease progression or metastasis.