THE ROLE OF THE APPARENT DIFFUSION COEFFICIENT OF THE BIPARAMETRIC MRI AS AN IMAGING MARKER OF PROSTATE CANCER

Prostate cancer (PCa) is the most common malignancy in men. The role of the apparent diffusion coefficient (ADC) of biparametric MRI (biMRI) which is a study without the use of dynamic contrast enhancement (DCE), in detection of PCa is still not comprehensively investigated. Objective. The goal of the study was to assess the role of ADC of biMRI as an imaging marker of clinically significant PCa Materials and methods. The study involved 78 men suspected of having PCa. All patients underwent a comprehensive clinical examination, which included multiparametric MRI of the prostate, a component of which was biMRI. The MRI data was evaluated according to the PI-RADS system version 2.1. Results. The distribution of patients according to the PI-RADS system was as follows: 1 point – 9 (11.54 %) patients, 2 points – 12 (15.38 %) patients, 3 points – 25 (32.05 %) patients, 4 points – 19 (24.36 %) patients and 5 points – 13 (16.67 %) patients. In a subgroup of patients with 5 points, clinically significant PCa was detected in 100 % of cases. In the subgroup of patients with tumors of 4 points clinically significant PCa was diagnosed in 16 of 19 (84.21 %) cases, and in 3 (15.79 %) patients – clinically insignificant tumor. In the subgroup of patients with 3 points, clinically significant PCa was diagnosed in 11 of 25 (44.0 %) cases, in 8 (32.0 %) patients – clinically insignificant tumor and in 6 (24.0 %) patients – benign prostatic hyperplasia. PCa with a score of ≥ 7 on the Gleason scale showed significantly lower mean values of ADC of the diffusion-weighted MRI images compared to tumors with a score of < 7 on the Gleason scale: (0.86 ± 0.07) x 10-3 mm2/s vs (1.08 ± 0.04) x 10-3 mm2/s (р < 0.05). Conclusions. The obtained results testify to the high informativeness of biMRI in the diagnosis of prostate cancer. The use of ADC allowed to differentiate clinically significant and insignificant variants of the tumor, as well as benign changes in prostate tissues and can be considered as a potential imaging marker of PCa. Key words: prostate cancer, diagnosis, biparametric MRI, marker, apparent diffusion coefficient, PI-RADS.

mpMRI/TRUS fusion, saturation, standard and cognitive transrectal prostate biopsy: what? whom? when?

The aim of this literature review was to demonstrate the pluses and minuses of each kind of biopsy, which can be helpful for preparing an algorithm and determining the indications and contraindications for each prostate biopsy (PB). Prostate biopsy is the main method of diagnosing prostate cancer (PC), and it remains relevant even in spite of the appearance of a number of new diagnostic tests and methods. Transrectal 12-core biopsy without pre-biopsy mpMRI remains a routine sampling of prostate material. But with the appearance of a great variety of PB and their introduction into practice, there arises the need to compare these methods with each other. At present, all available studies dealing with the informativity of some biopsy method or another, were conducted in different time periods and cannot reliably reflect their informativity for making a comparison. In our opinion, further research into this problem is required and research works should study the informativity of various kinds of biopsy depending on visualization of a pathological site for suspected prostate cancer, in TRUS and its location coincidence in mpMRI, in Pi-RADSv2.1 classification. Key words: prostate biopsy, prostate cancer, transrectal ultrasound

Age related volume of cadaver-prostates in Bangladesh

Pathological changes in the prostate gland occur commonly with advancing age including inflammation, atrophy, hyperplasia and carcinoma and a change in volume is also evident. Estimation of volume of prostate may be useful in a variety of clinical settings. A cross-sectional descriptive study was designed to see the changes in volume of the prostate with advancing age and done in the Department of Anatomy, Dhaka Medical College, Dhaka from August 2006 to June 2007. The study was performed on 70 post-mortem human prostates collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age groups; group A (10-20 years), group B (21-40 years) and group C (41-70 years). Volume of the sample was measured by using the ellipsoid formula. The mean ± SD volume of prostate was 7.68 ± 3.64 cm3 in group A, 10.61 ± 3.99 cm3 in group B and 15.40 ± 6.31 cm3 in group C. Mean difference in volume between group A and group C, group B and group C were statistically significant (p<0.001). Statistically significant positive correlation was found between age and volume of prostate (r = + 0.579, p < 0.001). Key Words: Prostate; volume; Bangladeshi. DOI: 10.3329/imcj.v4i2.6501Ibrahim Med. Coll. J. 2010; 4(2): 74-77

VIDEO TURP: SURPASSING THE GOLD STANDARD

Objectives: To compare the resection time and resected volume of the prostate in patients who weresubjected to video Trans-urethral resection of prostate (TURP) and conventional TURP, and to determinethe difference in the duration of bladder irrigation during post-operative period for conventional TURP andvideo TURP. Study Design: Comparative randomized control study. Methods: The study was conducted in the Department of Urology at Pakistan Institute of Medical Sciences(PIMS) Islamabad from Is' March 2002 to 28,h February 2003. Total number of 100 patients were equally Kdivided into two groups. Group ’A’ comprising of 50 patients (Control) were subjected to ConventionalTURP and Group 'B' comprising of 50 patients (Case) were subjected to video TURP respectively. Thesample was randomized by the last digit of the hospital admission number, Even number was allocated togroup 'A' and Odd number to group 'B'. The data was recorded on structured proforma and was analyzed onSPSS. ' ; Results: The mean age of the patients was 65.5 years with the range of 42-96 years. The Mean resection timefor conventional TURP was 36.03 minutes and for video TURP was 37.27 minutes ( P value = 0.068 ). Themean resected volume for conventional TURP was 18.5 gm and for video TURP was 23.65gm ( P value =0.01 ). The post operative irrigation of the bladder with 0.9% saline was required for 3.32 days inconventional TURP, while it was required for 1.57 days in video TURP ( P < 0.05 ). There was no TURPsyndrome recorded in both the groups and the mean hospital stay for both the group was equal i.e. 4th Postoperative day as per protocol of our department. Conclusion: The video TURP has opened up a new Approach in endourology. It is more effective inresection than conventional TURP and bears the same safety of resection time as conventional TURP. Key Words: Prostate,TURP, Endourology, Video TURP