Science.gov

Sample records for 20-core prostate biopsy

  1. Prostate biopsy

    MedlinePlus

    ... prostate biopsy; Fine needle biopsy of the prostate; Core biopsy of the prostate; Targeted prostate biopsy; Prostate biopsy - transrectal ultrasound (TRUS); Stereotactic transperineal prostate biopsy (STPB)

  2. Optimization of prostate biopsy

    NASA Astrophysics Data System (ADS)

    Bauer, John J.; Zeng, Jianchao; Weir, James; Zhang, Wei; Sesterhenn, Isabell A.; Connelly, Roger R.; Moul, Judd W.; Mun, Seong K.

    1999-05-01

    Urologists routinely use the systematic sextant needle biopsy technique to detect prostate cancer. However, recent evidence suggests that this technique has a significant sampling error. We have developed a novel 3D computer assisted prostate biopsy simulator based upon 201 whole- mounted step-sectioned radical prostatectomy specimens to compare the diagnostic accuracy of various prostate needle biopsy protocols. Computerized prostate models have been developed to accurately depict the anatomy of the prostate and all individual tumor foci. We obtained 18-biopsies of each prostate model to determine the detection rates of various biopsy protocols. As a result, the 10- and 12- pattern biopsy protocols had a 99.0 percent detection rate, while the traditional sextant biopsy protocol rate was only 72.6 percent. The 5-region biopsy protocol had a 90.5 percent detection rate. the lateral sextant pattern revealed a detection rate of 95.5 percent, whereas the 4-pattern lateral biopsy protocol had a 93.5 percent detection rate. Our results suggest that all the biopsy protocols that use laterally placed biopsies based upon the five region anatomical model are superior to the routinely used sextant prostate biopsy pattern. Lateral biopsies in the mid and apical zones of the gland are the most important.

  3. Simulated prostate biopsy: prostate cancer distribution and clinical correlation

    NASA Astrophysics Data System (ADS)

    Bauer, John J.; Zeng, Jianchao; Zhang, Wei; Sesterhenn, Isabell A.; Dean, Robert; Moul, Judd W.; Mun, Seong K.

    2000-04-01

    Our group has recently obtained data based upon whole- mounted step-sectioned radical prostatectomy specimens using a 3D computer assisted prostate biopsy simulator that suggests an increased detection rate is possible using laterally placed biopsies. A new 10-core biopsy pattern was demonstrated to be superior to the traditional sextant biopsy. This patter includes the traditional sextant biopsy cores and four laterally placed biopsies in the right and left apex and mid portion of the prostate gland. The objective of this study is to confirm the higher prostate cancer defection rate obtained using our simulated 10-core biopsy pattern in a small clinical trial. We retrospectively reviewed 35 consecutive patients with a pathologic diagnosis of prostate cancer biopsied by a single urologist using the 10-core prostate biopsy patterns were compared with respect to prostate cancer detection rate. Of the 35 patients diagnosed with prostate cancer, 54.3 percent were diagnosed when reviewing the sextant biopsy data only. Review of the 10-core pattern revealed that an additional 45.7 percent were diagnosed when reviewing the sextant biopsy data only. Review of the 10-core pattern revealed that an additional 45.7 percent of patients were diagnosed solely with the laterally placed biopsies. Our results suggest that biopsy protocols that use laterally placed biopsies based upon a five region anatomical model are superior to the routinely used sextant prostate biopsy pattern.

  4. A Prospective Randomized Trial of Two Different Prostate Biopsy Schemes

    ClinicalTrials.gov

    2016-07-03

    Prostate Cancer; Local Anesthesia; Prostate-Specific Antigen/Blood; Biopsy/Methods; Image-guided Biopsy/Methods; Prostatic Neoplasms/Diagnosis; Prostate/Pathology; Prospective Studies; Humans; Male; Ultrasonography, Interventional/Methods

  5. Adequate histologic sectioning of prostate needle biopsies.

    PubMed

    Bostwick, David G; Kahane, Hillel

    2013-08-01

    No standard method exists for sampling prostate needle biopsies, although most reports claim to embed 3 cores per block and obtain 3 slices from each block. This study was undertaken to determine the extent of histologic sectioning necessary for optimal examination of prostate biopsies. We prospectively compared the impact on cancer yield of submitting 1 biopsy core per cassette (biopsies from January 2010) with 3 cores per cassette (biopsies from August 2010) from a large national reference laboratory. Between 6 and 12 slices were obtained with the former 1-core method, resulting in 3 to 6 slices being placed on each of 2 slides; for the latter 3-core method, a limit of 6 slices was obtained, resulting in 3 slices being place on each of 2 slides. A total of 6708 sets of 12 to 18 core biopsies were studied, including 3509 biopsy sets from the 1-biopsy-core-per-cassette group (January 2010) and 3199 biopsy sets from the 3-biopsy-cores-percassette group (August 2010). The yield of diagnoses was classified as benign, atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, and cancer and was similar with the 2 methods: 46.2%, 8.2%, 4.5%, and 41.1% and 46.7%, 6.3%, 4.4%, and 42.6%, respectively (P = .02). Submission of 1 core or 3 cores per cassette had no effect on the yield of atypical small acinar proliferation, prostatic intraepithelial neoplasia, or cancer in prostate needle biopsies. Consequently, we recommend submission of 3 cores per cassette to minimize labor and cost of processing. PMID:23764163

  6. [Prostate biopsy: Procedure in the clinical routine].

    PubMed

    Enzmann, T; Tokas, T; Korte, K; Ritter, M; Hammerer, P; Franzaring, L; Heynemann, H; Gottfried, H-W; Bertermann, H; Meyer-Schwickerath, M; Wirth, B; Pelzer, A; Loch, T

    2015-12-01

    Over the last decade there has been a 25% decrease in the mortality rates for prostate cancer. The reasons for this significant decrease are most likely associated with the application of urological screening tests. The main tools for early detection are currently increased public awareness of the disease, prostate-specific antigen (PSA) tests and transrectal ultrasound (TRUS) guided topographically assignable biopsy sampling. Together with the histopathological results these features provide essential information for risk stratification, diagnostics and therapy decisions. The evolution of prostate biopsy techniques as well as the use of PSA testing has led to an increased identification of asymptomatic men, where further clarification is necessary. Significant efforts and increased clinical research focus on determining the appropriate indications for a prostate biopsy and the optimal technique to achieve better detection rates. The most widely used imaging modality for the prostate is TRUS; however, there are no clearly defined standards for the clinical approach for each individual biopsy procedure, dealing with continuous technical optimization and in particular the developments in imaging. In this review the current principles, techniques, new approaches and instrumentation of prostate biopsy imaging control are presented within the framework of the structured educational approach. PMID:26704284

  7. Prevention of sepsis prior to prostate biopsy

    PubMed Central

    Toner, Liam; Bolton, Damien M

    2016-01-01

    Purpose Urosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%–3% in contemporary series. Historically, fluoroquinolones have been effective antibiotic prophylaxis to prevent infective complications but antibiotic resistance is increasing. The increase in antibiotic resistance may contribute to reported increases in urosepsis and hospitalization after transrectal biopsy. This article will review other methods clinicians may employ to reduce the incidence of infective complications after prostate biopsy. Materials and Methods A systematic review of the literature was conducted using literature databases PubMed and Ovid MEDLINE in August 2015 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria. Results Effective strategies to reduce infective complications after transrectal prostate biopsy include augmented prophylaxis with other antibiotics, rectal swab culture directed antibiotic prophylaxis or a transperineal biopsy approach. Needle disinfection, minimizing the number of biopsy needles and rectal disinfectants may also be of use. These methods may be of particular utility in patients with risk factors for developing urosepsis such as recent antibiotic use and overseas travel. Conclusions The scientific literature describes various techniques designed to reduce infective complications caused by prostate biopsy. Clinicians should consider incorporating these novel techniques into their contemporary practice. PMID:26981590

  8. PET-directed, 3D Ultrasound-guided prostate biopsy

    PubMed Central

    Fei, Baowei; Nieh, Peter T; Schuster, David M; Master, Viraj A

    2013-01-01

    Multimodatity imaging is a promising approach for improving prostate cancer detection and diagnosis. This article describes various concepts in PET-directed, ultrasound-guided biopsies and highlights a new PET/ultrasound fusion targeted biopsy system for prostate cancer detection. PMID:25392702

  9. Recent advances in image-guided targeted prostate biopsy.

    PubMed

    Brown, Anna M; Elbuluk, Osama; Mertan, Francesca; Sankineni, Sandeep; Margolis, Daniel J; Wood, Bradford J; Pinto, Peter A; Choyke, Peter L; Turkbey, Baris

    2015-08-01

    Prostate cancer is a common malignancy in the United States that results in over 30,000 deaths per year. The current state of prostate cancer diagnosis, based on PSA screening and sextant biopsy, has been criticized for both overdiagnosis of low-grade tumors and underdiagnosis of clinically significant prostate cancers (Gleason score ≥7). Recently, image guidance has been added to perform targeted biopsies of lesions detected on multi-parametric magnetic resonance imaging (mpMRI) scans. These methods have improved the ability to detect clinically significant cancer, while reducing the diagnosis of low-grade tumors. Several approaches have been explored to improve the accuracy of image-guided targeted prostate biopsy, including in-bore MRI-guided, cognitive fusion, and MRI/transrectal ultrasound fusion-guided biopsy. This review will examine recent advances in these image-guided targeted prostate biopsy techniques. PMID:25596716

  10. The relationship between prostate-specific antigen and prostate cancer risk: the Prostate Biopsy Collaborative Group

    PubMed Central

    Vickers, Andrew J.; Cronin, Angel M.; Roobol, Monique J.; Hugosson, Jonas; Jones, J. Stephen; Kattan, Michael W.; Klein, Eric; Hamdy, Freddie; Neal, David; Donovan, Jenny; Parekh, Dipen J.; Ankerst, Donna; Bartsch, George; Klocker, Helmut; Horninger, Wolfgang; Benchikh, Amine; Salama, Gilles; Villers, Arnauld; Freedland, Steve J.; Moreira, Daniel M.; Schröder, Fritz H.; Lilja, Hans

    2010-01-01

    PURPOSE The relationship between prostate specific antigen (PSA) level and prostate cancer risk remains subject to fundamental disagreements. We hypothesize that the risk of prostate cancer on biopsy for a given PSA level is affected by identifiable characteristics of the cohort under study. EXPERIMENTAL DESIGN We used data from 5 European and 3 US cohorts of men undergoing biopsy for prostate cancer; six were population-based studies and two were clinical cohorts. The association between PSA and prostate cancer was calculated separately for each cohort using locally-weighted scatterplot smoothing. RESULTS The final data set included 25,772 biopsies and 8,503 cancers. There were gross disparities between cohorts with respect to both the prostate cancer risk at a given PSA level and the shape of the risk curve. These disparities were associated with identifiable differences between cohorts: for a given PSA level, a greater number of biopsy cores increased risk of cancer (odds ratio for >6 vs. 6 core biopsy 1.35; 95% C.I. 1.18, 1.54; p<0.0005); recent screening led to a smaller increase in risk per unit change in PSA (p=0.001 for interaction term) and US cohorts had higher risk than the European cohorts (2.14; 95% C.I. 1.99, 2.30; p<0.0005). CONCLUSIONS Our results suggest that the relationship between PSA and risk of a positive prostate biopsy varies, both in terms of the probability of prostate cancer at a given PSA value and the shape of the risk curve. This poses challenges to the use of PSA-driven algorithms to determine whether biopsy is indicated. PMID:20736330

  11. Strategies for prevention of ultrasound-guided prostate biopsy infections

    PubMed Central

    Lu, Diane D; Raman, Jay D

    2016-01-01

    Prostate cancer is the most common cancer in male patients and the second leading cause of cancer-related mortality in males. To confirm the diagnosis of prostate cancer, an ultrasound-guided needle biopsy is necessary to obtain prostate tissue sufficient for histologic analysis by pathologists. Ultrasound-guided prostate needle biopsy can be accomplished via a transperineal or transrectal approach. The latter biopsy technique involves placing an ultrasound probe into the rectum, visualizing the prostate located just anterior to it, and then obtaining 12–14 biopsies. Each biopsy core requires piercing of the rectal mucosa which can inherently contribute to infection. The increasing infectious risk of prostate needle biopsy requires refinement and re-evaluation of the process in which the technique is performed. Such processes include (but are not limited to) prebiopsy risk stratification, antibiotic prophylaxis, use of rectal preparations, and equipment processing. In the subsequent review, we highlight the current available information on different strategies to reduce the risk of infection following prostate needle biopsy. PMID:27468242

  12. Is magnetic resonance/ultrasound fusion prostate biopsy better than systematic prostate biopsy? an updated meta- and trial sequential analysis

    PubMed Central

    Xie, Bo; Wang, Xiao; Zhu, Yi; Wang, Junyuan; Yu, Yasai; Zheng, Xiangyi; Liu, Ben; Xie, Liping

    2015-01-01

    We systematically reviewed the literature to determine whether Magnetic Resonance/Ultrasound (MR/US) fusion prostate biopsy is better than systematic biopsy for making a definitive diagnosis of prostate cancer. The two strategies were also compared for their ability to detect lesions with different degrees of suspicion on MRI and clinically significant prostate cancer, and the number of cores needed for diagnosis. The Cochrane Library, Embase, Web of Knowledge, and Medline were searched from inception until May 1, 2015. Meta-analysis was conducted via RevMan 5.2 software. Data was expressed as risk ratio (RR) and 95% confidence interval. Trial sequential analysis was used to assess risk of random errors. Fourteen trials were included, encompassing a total of 3105 participants. We found that MR/US fusion biopsy detected more prostate cancers than systematic biopsy (46.9% vs. 44.2%, p=0.03). In men with moderate/high MRI suspicion, MR/US fusion biopsy did better than systematic biopsy (RR = 1.46; p < 0.05) for making a diagnosis. Moreover, MR/US fusion biopsy detected more clinically significant cancers than systematic biopsy (RR = 1.19; p < 0.05). We recommend that MR/US fusion prostate biopsy be used to better detect prostate cancer, particularly in patients with moderate/high suspicion lesions on MRI. PMID:26498362

  13. Optimizing prostate needle biopsy through 3D simulation

    NASA Astrophysics Data System (ADS)

    Zeng, Jianchao; Kaplan, Charles; Xuan, Jian Hua; Sesterhenn, Isabell A.; Lynch, John H.; Freedman, Matthew T.; Mun, Seong K.

    1998-06-01

    Prostate needle biopsy is used for the detection of prostate cancer. The protocol of needle biopsy that is currently routinely used in the clinical environment is the systematic sextant technique, which defines six symmetric locations on the prostate surface for needle insertion. However, this protocol has been developed based on the long-term observation and experience of urologists. Little quantitative or scientific evidence supports the use of this biopsy technique. In this research, we aim at developing a statistically optimized new prostate needle biopsy protocol to improve the quality of diagnosis of prostate cancer. This new protocol will be developed by using a three-dimensional (3-D) computer- based probability map of prostate cancer. For this purpose, we have developed a computer-based 3-D visualization and simulation system with prostate models constructed from the digitized prostate specimens, in which the process of prostate needle biopsy can be simulated automatically by the computer. In this paper, we first develop an interactive biopsy simulation mode in the system, and evaluate the performance of the automatic biopsy simulation with the sextant biopsy protocol by comparing the results by the urologist using the interactive simulation mode with respect to 53 prostate models. This is required to confirm that the automatic simulation is accurate and reliable enough for the simulation with respect to a large number of prostate models. Then we compare the performance of the existing protocols using the automatic biopsy simulation system with respect to 107 prostate models, which will statistically identify if one protocol is better than another. Since the estimation of tumor volume is extremely important in determining the significance of a tumor and in deciding appropriate treatment methods, we further investigate correlation between the tumor volume and the positive core volume with 89 prostate models. This is done in order to develop a method to

  14. Solitary fibrous tumour of the prostate identified on needle biopsy.

    PubMed

    Galosi, Andrea B; Mazzucchelli, Roberta; Scarpelli, Marina; Lopez-Beltran, Antonio; Cheng, Liang; Muzzonigro, Giovanni; Montironi, Rodolfo

    2009-09-01

    The clinical and radical prostatectomy features of a case of solitary fibrous tumour (SFT) of the prostate identified on needle biopsy are presented. The main differential diagnoses are discussed. SFTs involving the prostate are relatively uncommon, with only isolated cases reported in the literature. Owing to their relative rarity and lack of long-term follow-up, the clinical behaviour of prostatic SFTs is difficult to predict. Complete resection of the tumour is currently the single main prognostic factor.

  15. [Standards for the punch biopsy of the prostate].

    PubMed

    Seitz, M; Schlenker, B; Gratzke, C; Weidlich, P; Stief, C G; Reich, O

    2007-01-25

    If, within the framework of screening examinations for the early detection of cancer of the prostate, the patient wishes a PSA test, the physician should accommodate him, but only after providing comprehensive information about the possible consequences and complications. If a certain threshold value is exceeded, a punch biopsy of the prostate is recommended. This procedure must be performed in accordance with accepted standards to enable, within the diagnostic chain, the reliable detection of a carcinoma of the prostate PMID:17615715

  16. Mechanically assisted 3D ultrasound guided prostate biopsy system.

    PubMed

    Bax, Jeffrey; Cool, Derek; Gardi, Lori; Knight, Kerry; Smith, David; Montreuil, Jacques; Sherebrin, Shi; Romagnoli, Cesare; Fenster, Aaron

    2008-12-01

    There are currently limitations associated with the prostate biopsy procedure, which is the most commonly used method for a definitive diagnosis of prostate cancer. With the use of two-dimensional (2D) transrectal ultrasound (TRUS) for needle-guidance in this procedure, the physician has restricted anatomical reference points for guiding the needle to target sites. Further, any motion of the physician's hand during the procedure may cause the prostate to move or deform to a prohibitive extent. These variations make it difficult to establish a consistent reference frame for guiding a needle. We have developed a 3D navigation system for prostate biopsy, which addresses these shortcomings. This system is composed of a 3D US imaging subsystem and a passive mechanical arm to minimize prostate motion. To validate our prototype, a series of experiments were performed on prostate phantoms. The 3D scan of the string phantom produced minimal geometric distortions, and the geometric error of the 3D imaging subsystem was 0.37 mm. The accuracy of 3D prostate segmentation was determined by comparing the known volume in a certified phantom to a reconstructed volume generated by our system and was shown to estimate the volume with less then 5% error. Biopsy needle guidance accuracy tests in agar prostate phantoms showed that the mean error was 2.1 mm and the 3D location of the biopsy core was recorded with a mean error of 1.8 mm. In this paper, we describe the mechanical design and validation of the prototype system using an in vitro prostate phantom. Preliminary results from an ongoing clinical trial show that prostate motion is small with an in-plane displacement of less than 1 mm during the biopsy procedure.

  17. Accuracy validation for MRI-guided robotic prostate biopsy

    NASA Astrophysics Data System (ADS)

    Xu, Helen; Lasso, Andras; Vikal, Siddharth; Guion, Peter; Krieger, Axel; Kaushal, Aradhana; Whitcomb, Louis L.; Fichtinger, Gabor

    2010-02-01

    We report a quantitative evaluation of the clinical accuracy of a MRI-guided robotic prostate biopsy system that has been in use for over five years at the U.S. National Cancer Institute. A two-step rigid volume registration using mutual information between the pre and post needle insertion images was performed. Contour overlays of the prostate before and after registration were used to validate the registration. A total of 20 biopsies from 5 patients were evaluated. The maximum registration error was 2 mm. The mean biopsy target displacement, needle placement error, and biopsy error was 5.4 mm, 2.2 mm, and 5.1 mm respectively. The results show that the pre-planned biopsy target did dislocate during the procedure and therefore causing biopsy errors.

  18. Utilization trends and positive biopsy rates for prostate biopsies in the United States: 2005 to 2011.

    PubMed

    Kapoor, Deepak A; Bostwick, David G; Mendrinos, Savvas E; Anderson, Ann E; Olsson, Carl A

    2013-01-01

    This article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in > 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%-this was identical at both the NRL and UPL (P = .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P = .03). For the most recent 3-year period (2009-2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P = 0.08). Positive biopsy rate correlated strongly (P < .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009 to

  19. Utilization Trends and Positive Biopsy Rates for Prostate Biopsies in the United States: 2005 to 2011

    PubMed Central

    Kapoor, Deepak A; Bostwick, David G; Mendrinos, Savvas E; Anderson, Ann E; Olsson, Carl A

    2013-01-01

    This article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in > 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%-this was identical at both the NRL and UPL (P = .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P = .03). For the most recent 3-year period (2009–2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P = 0.08). Positive biopsy rate correlated strongly (P < .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009

  20. Elevated Prostate Health Index (phi) and Biopsy Reclassification During Active Surveillance of Prostate Cancer.

    PubMed

    Andreas, Darian; Tosoian, Jeffrey J; Landis, Patricia; Wolf, Sacha; Glavaris, Stephanie; Lotan, Tamara L; Schaeffer, Edward M; Sokoll, Lori J; Ross, Ashley E

    2016-07-01

    The Prostate Health Index (phi) has been FDA approved for decision-making regarding prostate biopsy. Phi has additionally been shown to positively correlate with tumor volume, extraprostatic disease and higher Gleason grade tumors. Here we describe a case in which an elevated phi encouraged biopsy of a gentleman undergoing active surveillance leading to reclassification of his disease as high risk prostate cancer. PMID:27335798

  1. Does length of prostate biopsy cores have an impact on diagnosis of prostate cancer?

    PubMed Central

    Ergün, Müslüm; İslamoğlu, Ekrem; Yalçınkaya, Soner; Tokgöz, Hüsnü; Savaş, Murat

    2016-01-01

    Objective To investigate whether core length is a significant biopsy parameter in the detection of prostate cancer. Material and methods We retrospectively analyzed pathology reports of the specimens of 188 patients diagnosed with prostate cancer who had undergone initial transrectal ultrasound (TRUS) guided prostate biopsy, and compared biopsy core lengths of the patients with, and without prostate cancer. The biopsy specimens of prostate cancer patients were divided into 3 groups according to core length, and the data obtained were compared (Group 1; total core length <10 mm, Group 2; total core length 10 mm–19 mm, and Group 3; total core length >20 mm). Biopsy core lengths of the patients diagnosed as prostate cancer, and benign prostatic hyperplasia were compared, and a certain cut-off value for core length with optimal diagnostic sensitivity and specificity for prostate cancer was calculated. Results Mean age, PSA and total length of cores were 65.08±7.41 years, 9.82±6.34 ng/mL and 11.2±0.2 mm, respectively. Assessment of biopsy core lengths showed that cores with cancer (n=993, median length 12.5 mm) were significantly longer than benign cores (n=1185, median length=11.3 mm) (p<0.001). Core length analysis yielded 12 mm cores have an optimal sensitivity (41.9%) and specificity (62%) for detection of cancer (odds ratio: 1.08). Conclusion Biopsy core length is one of the most important parameter that determines the quality of biopsy and detection of prostate cancer. A median sample length of 12 mm is ideal lower limit for cancer detection, and biopsy procedures which yield shorter biopsy cores should be repeated. PMID:27635285

  2. Greater Biopsy Core Number Is Associated With Improved Biochemical Control in Patients Treated With Permanent Prostate Brachytherapy

    SciTech Connect

    Bittner, Nathan; Wallner, Kent E.

    2010-11-15

    Purpose: Standard prostate biopsy schemes underestimate Gleason score in a significant percentage of cases. Extended biopsy improves diagnostic accuracy and provides more reliable prognostic information. In this study, we tested the hypothesis that greater biopsy core number should result in improved treatment outcome through better tailoring of therapy. Methods and Materials: From April 1995 to May 2006, 1,613 prostate cancer patients were treated with permanent brachytherapy. Patients were divided into five groups stratified by the number of prostate biopsy cores ({<=}6, 7-9, 10-12, 13-20, and >20 cores). Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) were evaluated as a function of core number. Results: The median patient age was 66 years, and the median preimplant prostate-specific antigen was 6.5 ng/mL. The overall 10-year bPFS, CSS, and OS were 95.6%, 98.3%, and 78.6%, respectively. When bPFS was analyzed as a function of core number, the 10-year bPFS for patients with >20, 13-20, 10-12, 7-9 and {<=}6 cores was 100%, 100%, 98.3%, 95.8%, and 93.0% (p < 0.001), respectively. When evaluated by treatment era (1995-2000 vs. 2001-2006), the number of biopsy cores remained a statistically significant predictor of bPFS. On multivariate analysis, the number of biopsy cores was predictive of bPFS but did not predict for CSS or OS. Conclusion: Greater biopsy core number was associated with a statistically significant improvement in bPFS. Comprehensive regional sampling of the prostate may enhance diagnostic accuracy compared to a standard biopsy scheme, resulting in better tailoring of therapy.

  3. Markers of Field Cancerization: Proposed Clinical Applications in Prostate Biopsies

    PubMed Central

    Trujillo, Kristina A.; Jones, Anna C.; Griffith, Jeffrey K.; Bisoffi, Marco

    2012-01-01

    Field cancerization denotes the occurrence of genetic, epigenetic, and biochemical aberrations in structurally intact cells in histologically normal tissues adjacent to cancerous lesions. This paper tabulates markers of prostate field cancerization known to date and discusses their potential clinical value in the analysis of prostate biopsies, including diagnosis, monitoring progression during active surveillance, and assessing efficacy of presurgical neoadjuvant and focal therapeutic interventions. PMID:22666601

  4. MRI-Guided Prostate Biopsy of Native and Recurrent Prostate Cancer.

    PubMed

    Woodrum, David A; Gorny, Krzysztof R; Greenwood, Bernadette; Mynderse, Lance A

    2016-09-01

    Prostate cancer is the most commonly diagnosed noncutaneous cancer and second-leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive, curative treatment of the whole gland with either radical prostatectomy or radiation therapy. However, many men are reluctant to take the definitive step due to potential morbidity associated with either therapy. A growing interest in active surveillance or focal therapy has emerged as realistic alternatives for many patients. With each of these management strategies, it is critical to accurately quantify and stage the cancer with improved biopsy targeting and more precise imaging with magnetic resonance imaging (MRI). Furthermore, having dependable prostate imaging allows for targeted biopsies to improve the yield of clinically significant prostate cancer and decrease detection of indolent prostate cancer. MRI-guided targeted biopsy techniques include cognitive MRI/transrectal ultrasound fusion biopsy, in-bore transrectal targeted biopsy using a calibrated guidance device, and in-bore direct MR-guided transperineal biopsy with a software-based transperineal grid template. Herein we present a contemporary review of MRI-guided targeted biopsy techniques for new and recurrent cancerous foci of the prostate. PMID:27582607

  5. Prostate contouring in MRI guided biopsy

    PubMed Central

    Vikal, Siddharth; Haker, Steven; Tempany, Clare; Fichtinger, Gabor

    2010-01-01

    With MRI possibly becoming a modality of choice for detection and staging of prostate cancer, fast and accurate outlining of the prostate is required in the volume of clinical interest. We present a semi-automatic algorithm that uses a priori knowledge of prostate shape to arrive at the final prostate contour. The contour of one slice is then used as initial estimate in the neighboring slices. Thus we propagate the contour in 3D through steps of refinement in each slice. The algorithm makes only minimum assumptions about the prostate shape. A statistical shape model of prostate contour in polar transform space is employed to narrow search space. Further, shape guidance is implicitly imposed by allowing only plausible edge orientations using template matching. The algorithm does not require region-homogeneity, discriminative edge force, or any particular edge profile. Likewise, it makes no assumption on the imaging coils and pulse sequences used and it is robust to the patient's pose (supine, prone, etc.). The contour method was validated using expert segmentation on clinical MRI data. We recorded a mean absolute distance of 2.0 ± 0.6 mm and dice similarity coefficient of 0.93 ± 0.3 in midsection. The algorithm takes about 1 second per slice. PMID:21132083

  6. Prostate contouring in MRI guided biopsy.

    PubMed

    Vikal, Siddharth; Haker, Steven; Tempany, Clare; Fichtinger, Gabor

    2009-03-27

    With MRI possibly becoming a modality of choice for detection and staging of prostate cancer, fast and accurate outlining of the prostate is required in the volume of clinical interest. We present a semi-automatic algorithm that uses a priori knowledge of prostate shape to arrive at the final prostate contour. The contour of one slice is then used as initial estimate in the neighboring slices. Thus we propagate the contour in 3D through steps of refinement in each slice. The algorithm makes only minimum assumptions about the prostate shape. A statistical shape model of prostate contour in polar transform space is employed to narrow search space. Further, shape guidance is implicitly imposed by allowing only plausible edge orientations using template matching. The algorithm does not require region-homogeneity, discriminative edge force, or any particular edge profile. Likewise, it makes no assumption on the imaging coils and pulse sequences used and it is robust to the patient's pose (supine, prone, etc.). The contour method was validated using expert segmentation on clinical MRI data. We recorded a mean absolute distance of 2.0 ± 0.6 mm and dice similarity coefficient of 0.93 ± 0.3 in midsection. The algorithm takes about 1 second per slice. PMID:21132083

  7. Evaluation of neutrophil-to-lymphocyte ratio prior to prostate biopsy to predict biopsy histology: Results of 1836 patients

    PubMed Central

    Gokce, Mehmet Ilker; Hamidi, Nurullah; Suer, Evren; Tangal, Semih; Huseynov, Adil; Ibiş, Arif

    2015-01-01

    Introduction: We evaluate the role of NLR prior to prostate biopsy to predict biopsy histology and Gleason score in patients with prostate cancer. Methods: In this retrospective study, we evaluated data of patients underwent prostate biopsy between May 2005 and March 2015. We collected the following data: age, prostate-specific antigen (PSA), biopsy histology, Gleason score (GS) in prostate cancer patients, neutrophil counts, and lymphocyte counts. Patients were grouped as benign prostatic hyperplasia (BPH), prostate cancer, and prostatitis. The Chi square test was used to compare categorical variables and analysis of variance (ANOVA) was applied for continuous variables. Results: Data of 1836 patients were investigated. The mean age, total PSA and neutrophil-lymphocyte ratio (NLR) of the population were 66.8 ± 8.17 years, 9.38 ± 4.7 ng/dL, and 3.11 ± 1.71, respectively. Patients were divided as follows: 625 in the group with BPH history, 600 in the prostatitis group, and 611 in the prostate cancer histology group. The mean NLR of the prostatitis group was higher compared to the prostate cancer and BPH groups (p = 0.0001). The mean NLR of the prostate cancer group was significantly higher compared to the BPH group (p = 0.002). The GS 8–10 group had a significantly higher mean NLR compared to GS 5–6 (3.64 vs. 2.54, p = 0.0001) and GS 7 (3.64 vs. 2.58, p = 0.0001) patients. Conclusions: NLR was found to differ with regard to histology of prostate biopsy and higher GS was associated with higher NLR in patients with prostate cancer. However prostatitis prevents the use of NLR in predicting prostate cancer before a prostate biopsy. Also, the retrospective nature and lack of multivariate analysis in this study somewhat limits the relevance of these results. PMID:26600880

  8. The global burden of major infectious complications following prostate biopsy.

    PubMed

    Bennett, H Y; Roberts, M J; Doi, S A R; Gardiner, R A

    2016-06-01

    We present a systematic review providing estimates of the overall and regional burden of infectious complications following prostate biopsy. A directly standardized prevalence estimate was used because it reflects the burden of disease more explicitly. Complications included sepsis, hospitalization, bacteraemia, bacteriuria, and acute urinary retention after biopsy. There were 165 articles, comprising 162 577 patients, included in the final analysis. Our findings demonstrate that transrectal biopsy was associated with a higher burden of hospitalization (1·1% vs. 0·9%) and sepsis (0·8% vs. 0·1%) compared to transperineal biopsy, while acute urinary retention was more prevalent after transperineal than transrectal biopsy (4·2% vs. 0·9%). The differences were statistically non-significant because of large heterogeneity across countries. We also demonstrate and discuss regional variations in complication rates, with Asian studies reporting higher rates of sepsis and hospitalization.

  9. The global burden of major infectious complications following prostate biopsy.

    PubMed

    Bennett, H Y; Roberts, M J; Doi, S A R; Gardiner, R A

    2016-06-01

    We present a systematic review providing estimates of the overall and regional burden of infectious complications following prostate biopsy. A directly standardized prevalence estimate was used because it reflects the burden of disease more explicitly. Complications included sepsis, hospitalization, bacteraemia, bacteriuria, and acute urinary retention after biopsy. There were 165 articles, comprising 162 577 patients, included in the final analysis. Our findings demonstrate that transrectal biopsy was associated with a higher burden of hospitalization (1·1% vs. 0·9%) and sepsis (0·8% vs. 0·1%) compared to transperineal biopsy, while acute urinary retention was more prevalent after transperineal than transrectal biopsy (4·2% vs. 0·9%). The differences were statistically non-significant because of large heterogeneity across countries. We also demonstrate and discuss regional variations in complication rates, with Asian studies reporting higher rates of sepsis and hospitalization. PMID:26645476

  10. Trans-rectal interventional MRI: initial prostate biopsy experience

    NASA Astrophysics Data System (ADS)

    Greenwood, Bernadette M.; Behluli, Meliha R.; Feller, John F.; May, Stuart T.; Princenthal, Robert; Winkel, Alex; Kaminsky, David B.

    2010-02-01

    Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate gland when evaluated along with T2-weighted images, diffusion-weighted images (DWI) and their corresponding apparent diffusion coefficient (ADC) maps can yield valuable information in patients with rising or elevated serum prostate-specific antigen (PSA) levels1. In some cases, patients present with multiple negative trans-rectal ultrasound (TRUS) biopsies, often placing the patient into a cycle of active surveillance. Recently, more patients are undergoing TRIM for targeted biopsy of suspicious findings with a cancer yield of ~59% compared to 15% for second TRUS biopsy2 to solve this diagnostic dilemma and plan treatment. Patients were imaged in two separate sessions on a 1.5T magnet using a cardiac phased array parallel imaging coil. Automated CAD software was used to identify areas of wash-out. If a suspicious finding was identified on all sequences it was followed by a second imaging session. Under MRI-guidance, cores were acquired from each target region3. In one case the microscopic diagnosis was prostatic intraepithelial neoplasia (PIN), in the other it was invasive adenocarcinoma. Patient 1 had two negative TRUS biopsies and a PSA level of 9ng/mL. Patient 2 had a PSA of 7.2ng/mL. He underwent TRUS biopsy which was negative for malignancy. He was able to go on to treatment for his prostate carcinoma (PCa)4. MRI may have an important role in a subset of patients with multiple negative TRUS biopsies and elevated or rising PSA.

  11. [Image-guided punch biopsy of the prostate].

    PubMed

    Seitz, M; Gratzke, C; Stief, C; Tilki, D

    2012-09-01

    The diagnnosis of prostate cancer is still being made on the basis of biopsy samples taken from the prostate. After the clinical introduction of transrectal sonography almost 30 years ago, this technique has undergone some innovations and changes in its methods of performance. Improvements in the transponder and ultrasound generator are not yet at an end. In the mean time supplementary methods to the B-mode imaging are available that enable improvements in the diagnosis. Apart from ultrasound-based procedure such as C-TRUS/ANNA, contrast medium-enhanced ultrasound (CEUS) and sonoelastography, MRI-based methods are now available to further improve the diagnosis of prostate cancer. It remains to be seen which method will establish itself in the future with the highest degree of diagnostic certainty and an appropriate cost-use relationship. From the urologist's point, however, diagnosis of and therapy for prostate cancer must remain in the domaine of urology. PMID:22990951

  12. Detection of preneoplasia in histologically normal prostate biopsies.

    PubMed

    Slater, M D; Delprado, W J; Murphy, C R; Barden, J A

    2001-01-01

    P2X immunolabeling of prostate detected preneoplastic changes in apparently normal tissue. Labeling occurred in two well-defined stages before the diagnostic histological markers of cancer were visible. As cancer progressed, the location of P2X expression changed from confinement within individual nuclei in the acini (stage 1) to a cytoplasmic punctate label in the acinal epithelium, with an associated removal of nuclear stain (stage 2). Finally, in advanced cases, where clear morphological evidence of cancer was apparent, the P2X label condensed exclusively on the apical epithelium (stage 3). BPH/normal tissue was entirely devoid of P2X label. Biopsy samples (77) were tested in three categories. One group (35) were diagnosed as normal benign prostatic hyperplasia (BPH) on the basis of haematoxylin and eosin (H&E) stain, although underlying disease was suspected. Of these, 14 (40%) were clearly normal and appeared entirely devoid of label, 13 (37%) exhibited the first stage of P2X receptor labeling and the remaining eight (23%) exhibited second stage labeling. The accompanying H&E-stained sections of all these cases had a normal appearance. Low grade cancer biopsy samples with Gleason scores G4-7 (25) all revealed widespread second stage receptor labeling in areas of both normal and cancerous morphology, while 17 high grade cancer biopsy samples (Gleason G8-10) all showed third stage labeling along with some residual second stage labeling. The features of each P2X labeling stage occupied the entire histological area affected, offering more opportunity to diagnose the tissue than was supplied by the more-localised diagnostic features identified by H&E-stain. Besides detecting cases of preneoplasia in biopsies with a normal H&E appearance, this technique was also able to rule out the presence of neoplasia in purely hyperplasic prostates by the absence of any P2X labeling.Prostate Cancer and Prostatic Diseases (2001) 4, 92-96 PMID:12497044

  13. Magnetic resonance spectroscopy-guided transperineal prostate biopsy and brachytherapy for recurrent prostate cancer.

    PubMed

    Barnes, Agnieszka Szot; Haker, Steven J; Mulkern, Robert V; So, Minna; D'Amico, Anthony V; Tempany, Clare M

    2005-12-01

    Brachytherapy targeted to the peripheral zone with magnetic resonance imaging (MRI) guidance is a prostate cancer treatment option with potentially fewer complications than other treatments. Follow-up MRI when failure is suspected is, however, difficult because of radiation-induced changes. Furthermore, MR spectroscopy (MRS) is compromised by susceptibility artifacts from radioactive seeds in the peripheral zone. We report a case in which combined MRI/MRS was useful for the detection of prostate cancer in the transitional zone in patients previously treated with MR-guided brachytherapy. We propose that MRI/MRS can help detect recurrent prostate cancer, guide prostate biopsy, and help manage salvage treatment decisions. PMID:16360468

  14. Magnetic Resonance Imaging-Guided Prostate Biopsy: Present and Future

    PubMed Central

    2015-01-01

    Systemic transrectal ultrasound-guided biopsy (TRUSBx) is the standard procedure for diagnosing prostate cancer (PCa), but reveals a limited accuracy for the detection of cancer. Currently, multiparametric MR imaging (mp-MRI) is increasingly regarded as a promising method to detect PCa with an excellent positive predictive value. The use of mp-MRI during a MRI-guided biopsy (MRGB) procedure improves the quality of a targeted biopsy. The aim of this article is to provide an overview about the MRGB technique for PCa detection, to review the accuracy and clinical indications of MRGB and discuss its current issues and further directions. A MRGB seems accurate and efficient for the detection of clinically significant PCa in men with previous negative TRUSBx. Moreover, it may decrease the detection of clinically insignificant cancers with fewer biopsy cores. PMID:25598677

  15. Inflammation and focal atrophy in prostate needle biopsy cores and association to prostatic adenocarcinoma.

    PubMed

    Benedetti, Ines; Bettin, Alfonso; Reyes, Niradiz

    2016-10-01

    The possible origin of proliferative inflammatory atrophy in the regenerative proliferation of prostate epithelial cells in response to injury caused by inflammation, and their relation to prostate adenocarcinoma have not been defined. Inflammation and focal atrophy are common pathological findings in prostate biopsies, currently not routinely included in surgical pathology reports. The objective of the study was to determine the correlation between inflammation and focal atrophy with prostate adenocarcinoma. Prostate needle biopsies from 203 patients with clinical parameters suspicious for malignancy were evaluated for the presence and extent of chronic inflammation, type and grade of focal atrophy, high-grade intraepithelial neoplasia, and adenocarcinoma. Relations among them and with age were also analyzed. χ(2) tests and binary logistic regression were used to estimate associations. Chronic inflammation was observed in 77.3% of the biopsies, significantly associated to adenocarcinoma (P = .031). Moderate/severe inflammation in at least 1 biopsy core increased the risk of prostate adenocarcinoma (odds ratio, 2.94; 95% confidence interval, 1.27-6.8), whereas glandular localization of inflammation decreased the risk. Focal atrophy was present in 72.9% of the biopsies, proliferative inflammatory atrophy was the most common type, and its grade was significantly associated to inflammation (P < .0001) and inflammation intensity (P = .003). An association between prostate adenocarcinoma and inflammation was found, with higher odds in presence of moderate/severe inflammation in at least 1 biopsy core. Increasing grades of proliferative inflammatory atrophy were associated to high levels of inflammation, supporting its previously proposed inflammatory nature. PMID:27649956

  16. Comparison of MR/Ultrasound Fusion–Guided Biopsy With Ultrasound-Guided Biopsy for the Diagnosis of Prostate Cancer

    PubMed Central

    Siddiqui, M. Minhaj; Rais-Bahrami, Soroush; Turkbey, Baris; George, Arvin K.; Rothwax, Jason; Shakir, Nabeel; Okoro, Chinonyerem; Raskolnikov, Dima; Parnes, Howard L.; Linehan, W. Marston; Merino, Maria J.; Simon, Richard M.; Choyke, Peter L.; Wood, Bradford J.; Pinto, Peter A.

    2015-01-01

    Importance Targeted magnetic resonance (MR)/ultrasound fusion prostate biopsy has been shown to detect prostate cancer. The implications of targeted biopsy alone vs standard extended-sextant biopsy or the 2 modalities combined are not well understood. Objective To assess targeted vs standard biopsy and the 2 approaches combined for the diagnosis of intermediate- to high-risk prostate cancer. Design, Setting, And Participants Prospective cohort study of 1003 men undergoing both targeted and standard biopsy concurrently from 2007 through 2014 at the National Cancer Institute in the United States. Patients were referred for elevated level of prostate-specific antigen (PSA) or abnormal digital rectal examination results, often with prior negative biopsy results. Risk categorization was compared among targeted and standard biopsy and, when available, whole-gland pathology after prostatectomy as the “gold standard.” Interventions Patients underwent multiparametric prostate magnetic resonance imaging to identify regions of prostate cancer suspicion followed by targeted MR/ultrasound fusion biopsy and concurrent standard biopsy. Main Outcomes And Measures The primary objective was to compare targeted and standard biopsy approaches for detection of high-risk prostate cancer (Gleason score ≥4 + 3); secondary end points focused on detection of low-risk prostate cancer (Gleason score 3 + 3 or low-volume 3 + 4) and the biopsy ability to predict whole-gland pathology at prostatectomy. Results Targeted MR/ultrasound fusion biopsy diagnosed 461 prostate cancer cases, and standard biopsy diagnosed 469 cases. There was exact agreement between targeted and standard biopsy in 690 men (69%) undergoing biopsy. Targeted biopsy diagnosed 30% more high-risk cancers vs standard biopsy (173 vs 122 cases, P < .001) and 17% fewer low-risk cancers (213 vs 258 cases, P < .001). When standard biopsy cores were combined with the targeted approach, an additional 103 cases (22%) of mostly low

  17. Anterior prostate biopsy at initial and repeat evaluation: is it useful to detect significant prostate cancer?

    PubMed Central

    Pepe, Pietro; Pennisi, Michele; Fraggetta, Filippo

    2015-01-01

    ABSTRACT Purpose: Detection rate for anterior prostate cancer (PCa) in men who underwent initial and repeat biopsy has been prospectively evaluated. Materials and Methods: From January 2013 to March 2014, 400 patients all of Caucasian origin (median age 63.5 years) underwent initial (285 cases) and repeat (115 cases) prostate biopsy; all the men had negative digital rectal examination and the indications to biopsy were: PSA values > 10 ng/mL, PSA between 4.1-10 or 2.6-4 ng/mL with free/total PSA≤25% and ≤20%, respectively. A median of 22 (initial biopsy) and 31 cores (repeat biopsy) were transperineally performed including 4 cores of the anterior zone (AZ) and 4 cores of the AZ plus 2 cores of the transition zone (TZ), respectively. Results: Median PSA was 7.9 ng/mL; overall, a PCa was found in 180 (45%) patients: in 135 (47.4%) and 45 (36%) of the men who underwent initial and repeat biopsy, respectively. An exclusive PCa of the anterior zone was found in the 8.9 (initial biopsy) vs 13.3% (repeat biopsy) of the men: a single microfocus of cancer was found in the 61.2% of the cases; moreover, in 7 out 18 AZ PCa the biopsy histology was predictive of significant cancer in 2 (28.5%) and 5 (71.5%) men who underwent initial and repeat biopsy, respectively. Conclusions: However AZ biopsies increased detection rate for PCa (10% of the cases), the majority of AZ PCa with histological findings predictive of clinically significant cancer were found at repeat biopsy (about 70% of the cases). PMID:26689509

  18. Tests on reliability of a prostate biopsy telerobotic system.

    PubMed

    Rovetta, A

    1999-01-01

    This paper deals with the development of a robotic (mechanical-electronic) system that operates in the field of surgery, with new sensors and equipment ("Biopsy Program"). The system permits a rapid analysis of the mechanical needle + needle-holder + mechanism system for penetration and aspiration for surgery, for prostate biopsies. These operations benefit from the use of a SR 8438 Sankyo Scara robot; they are also remote-controlled, i.e. via telerobotics. They require accurate positioning in known points of three-dimensional space with a high degree of precision. The safety of the surgical operations is guaranteed by the most complete observance of regulations under European Union Directives and Decrees 626 and 242 of Italian laws. The system proposed represents a big step for the application of industrial solutions, precisely for industrial companies in the medical and surgical field.

  19. Analysis of repeated 24-core saturation prostate biopsy: Inverse association between asymptomatic histological inflammation and prostate cancer detection

    PubMed Central

    Kato, Tomonori; Komiya, Akira; Morii, Akihiro; Iida, Hiroaki; Ito, Takatoshi; Fuse, Hideki

    2016-01-01

    Saturation prostate biopsy protocols have been developed to improve the prostate cancer (PCa) detection rate, particularly in the setting of repeat biopsies. The present study attempted to clarify the association between PCa detection and various risk factors in repeat saturation biopsies. A retrospective analysis was conducted on 78 Japanese patients for whom findings had caused suspicion of PCa despite previous negative prostate biopsies, and who consecutively underwent a 24-core transperineal repeat biopsy at Toyama University Hospital (Toyama, Japan). PCa was confirmed histologically in 16 of the 78 patients (20.5%). A univariate analysis revealed that the prostate-specific antigen (PSA) level at repeat biopsy was higher (P<0.01), the fPSA/tPSA ratio was lower (P=0.04), the total prostate volume was smaller (P=0.01) and the PSA density was higher (P<0.01) in PCa patients than in patients with benign prostatic disease (BPD). Histological inflammation was more frequently observed in BPD patients than in PCa patients (P<0.01). A multivariate analysis revealed that histological inflammation was the only independent predictor of the presence of a malignant lesion on repeat biopsy (odds ratio, 0.027; P=0.01). It must be considered that inflammation may cause a PSA increase in some patients with a negative initial biopsy, leading to unnecessary repeat biopsy. PMID:27446407

  20. Perineural invasion on prostate needle biopsy does not predict biochemical failure following brachytherapy for prostate cancer

    SciTech Connect

    Weight, Christopher J.; Ciezki, Jay P.; Reddy, Chandana A.; Zhou Ming; Klein, Eric A.

    2006-06-01

    Purpose: To determine if the presence of perineural invasion (PNI) predicts biochemical recurrence in patients who underwent low-dose-rate brachytherapy for the treatment of localized prostate cancer. Methods and Materials: A retrospective case control matching study was performed. The records of 651 patients treated with brachytherapy between 1996 and 2003 were reviewed. Sixty-three of these patients developed biochemical failure. These sixty-three patients were then matched in a one-to-one ratio to patients without biochemical failure, controlling for biopsy Gleason score, clinical stage, initial prostate-specific antigen, age, and the use of androgen deprivation. The pathology of the entire cohort was then reviewed for evidence of perineural invasion on initial prostate biopsy specimens. The biochemical relapse free survival rates for these two groups were compared. Results: Cases and controls were well matched, and there were no significant differences between the two groups in age, Gleason grade, clinical stage, initial prostate-specific antigen, and the use of androgen deprivation. PNI was found in 19 (17%) patients. There was no significant difference in the rates of PNI between cases and controls, 19.6% and 14.3% respectively (p 0.45). PNI did not correlate with biochemical relapse free survival (p 0.40). Conclusion: Perineural invasion is not a significant predictor of biochemical recurrence in patients undergoing brachytherapy for prostate cancer.

  1. MRI-Safe Robot for Endorectal Prostate Biopsy

    PubMed Central

    Stoianovici, Dan; Kim, Chunwoo; Srimathveeravalli, Govindarajan; Sebrecht, Peter; Petrisor, Doru; Coleman, Jonathan; Solomon, Stephen B.; Hricak, Hedvig

    2014-01-01

    This paper reports the development of an MRI-Safe robot for direct (interventional) MRI-guided endorectal prostate biopsy. The robot is constructed of nonmagnetic and electrically nonconductive materials, and is electricity free, using pneumatic actuation and optical sensors. Targeting biopsy lesions of MRI abnormality presents substantial clinical potential for the management of prostate cancer. The paper describes MRI-Safe requirements, presents the kinematic architecture, design and construction of the robot, and a comprehensive set of preclinical tests for MRI compatibility and needle targeting accuracy. The robot has a compact and simple 3 degree-of-freedom (DoF) structure, two for orienting a needle-guide and one to preset the depth of needle insertion. The actual insertion is performed manually through the guide and up to the preset depth. To reduce the complexity and size of the robot next to the patient, the depth setting DoF is remote. Experimental results show that the robot is safe to use in any MRI environment (MRI-Safe). Comprehensive MRI tests show that the presence and motion of the robot in the MRI scanner cause virtually no image deterioration or signal to noise ratio (SNR) change. Robot’s accuracy in bench test, CT-guided in-vitro, MRI-guided in-vitro and animal tests are 0.37mm, 1.10mm, 2.09mm, and 2.58mm respectively. These values are acceptable for clinical use. PMID:25378897

  2. Development of a 3D ultrasound-guided prostate biopsy system

    NASA Astrophysics Data System (ADS)

    Cool, Derek; Sherebrin, Shi; Izawa, Jonathan; Fenster, Aaron

    2007-03-01

    Biopsy of the prostate using ultrasound guidance is the clinical gold standard for diagnosis of prostate adenocarinoma. However, because early stage tumors are rarely visible under US, the procedure carries high false-negative rates and often patients require multiple biopsies before cancer is detected. To improve cancer detection, it is imperative that throughout the biopsy procedure, physicians know where they are within the prostate and where they have sampled during prior biopsies. The current biopsy procedure is limited to using only 2D ultrasound images to find and record target biopsy core sample sites. This information leaves ambiguity as the physician tries to interpret the 2D information and apply it to their 3D workspace. We have developed a 3D ultrasound-guided prostate biopsy system that provides 3D intra-biopsy information to physicians for needle guidance and biopsy location recording. The system is designed to conform to the workflow of the current prostate biopsy procedure, making it easier for clinical integration. In this paper, we describe the system design and validate its accuracy by performing an in vitro biopsy procedure on US/CT multi-modal patient-specific prostate phantoms. A clinical sextant biopsy was performed by a urologist on the phantoms and the 3D models of the prostates were generated with volume errors less than 4% and mean boundary errors of less than 1 mm. Using the 3D biopsy system, needles were guided to within 1.36 +/- 0.83 mm of 3D targets and the position of the biopsy sites were accurately localized to 1.06 +/- 0.89 mm for the two prostates.

  3. Effect of prostate volume on the peripheral nerve block anesthesia in the prostate biopsy

    PubMed Central

    Luan, Yang; Huang, Tian-bao; Gu, Xiao; Zhou, Guang-Chen; Lu, Sheng-Ming; Tao, Hua-Zhi; Liu, Bi-De; Ding, Xue-Fei

    2016-01-01

    Abstract Objective: The objective of this study was to evaluate the anesthetic efficacy of periprostatic nerve block (PNB) in transrectal ultrasound (TRUS)-guided biopsy on different prostate volume. Methods: A total of 568 patients received prostate biopsy in our hospital from May 2013 to September 2015 and were retrospectively studied. All patients were divided into local anesthesia group (LAG) and nerve block group (NBG). Then each group was subdivided into 4 subgroups (20–40, 40–60, 60–100, and >100 mL groups) according to different prostate volume range. Visual analogue scale (VAS) and visual numeric scale (VNS) were used to assess the patient's pain and quantify their satisfaction. The scores and complications were compared between the groups. Results: The age and serum prostate-specific antigen (PSA) level before biopsy had no significant differences at intergroup or intragroup level. The VAS scores were significantly lower in the NBG than those in the LAG in terms of prostate volume (1 (1–2) versus 2 (1–3), 2 (1–3) versus 2 (2–4), 2 (2–3) versus 3 (2–5), 4 (3–5) versus 5 (4–7), all P < 0.05). Conversely, the VNS scores were higher in the NBG (4 (3–4) versus 3.5 (3–4), 3 (3–4) versus 3 (3–3), 3 (2–4) versus 3 (2–3), 2 (2–2) versus 1 (1–2), all P < 0.05). Patients with smaller prostate volume undergoing PNB or local anesthesia experienced significantly lower pain and higher satisfaction scores than those with large prostate. Whether in PNB or local anesthesia group, patients with large prostate volume had more chance to have hematuria, hemospermia, urinary retention than smaller one except infection (P < 0.05). Those complications had no significant differences between LAG and NBG (P > 0.05). Conclusion: Compared with local anesthesia, ultrasound-guided PNB has superior analgesic effect and equal safety, but for patients with a large prostate volume, the analgesic effect is inefficient. PMID:27428215

  4. Serum testosterone as a biomarker for second prostatic biopsy in men with negative first biopsy for prostatic cancer and PSA>4ng/mL, or with PIN biopsy result

    PubMed Central

    Fiamegos, Alexandros; Varkarakis, John; Kontraros, Michael; Karagiannis, Andreas; Chrisofos, Michael; Barbalias, Dimitrios; Deliveliotis, Charalampos

    2016-01-01

    Abstract Introduction: Data from animal, clinical and prevention studies support the role of androgens in prostate cancer growth, proliferation and progression. Results of serum based epidemiologic studies in humans, however, have been inconclusive. The present study aims to define whether serum testosterone can be used as a predictor of a positive second biopsy in males considered for re-biopsy. Material and Methods: The study included 320 men who underwent a prostatic biopsy in our department from October 2011 until June 2012. Total testosterone, free testosterone, bioavailable testosterone and prostate pathology were evaluated in all cases. Patients undergoing a second biopsy were identified and biopsy results were statistically analyzed. Results: Forty men (12.5%) were assessed with a second biopsy. The diagnosis of the second biopsy was High Grade Intraepithelial Neoplasia in 14 patients (35%) and Prostate Cancer in 12 patients (30%). The comparison of prostatic volume, total testosterone, sex hormone binding globulin, free testosterone, bioavailable testosterone and albumin showed that patients with cancer of the prostate had significantly greater levels of free testosterone (p=0.043) and bioavailable T (p=0.049). Conclusion: In our study, higher free testosterone and bioavailable testosterone levels were associated with a cancer diagnosis at re-biopsy. Our results indicate a possible role for free and bioavailable testosterone in predicting the presence of prostate cancer in patients considered for re-biopsy. PMID:27532110

  5. The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey

    PubMed Central

    Bayar, Göksel; Horasanlı, Kaya; Acinikli, Hüseyin; Tanrıverdi, Orhan; Dalkılıç, Ayhan; Arısan, Serdar

    2016-01-01

    Objective To evaluate long-term outcomes of active surveillance (AS) applied in low-risk prostate cancer patients, and the impact of re-biopsy results on the prediction of progression. Material and methods In our clinic, patients who had undergone AS for low-risk localized prostate cancer between the years 2005–2013 were included in the study. Our AS criteria are Gleason score ≤6, prostate-specific antigen (PSA) level <10 ng/mL, number of positive cores <3, maximum cancer involvement ratio <50% each core. Immediate re-biopsy (within 3 months) was performed to 65 patients who accepted AS. Finally, 43 patients who met re-biopsy criteria were included in the study. Prostate biopsy specimens were harvested from 12 cores under the guidance of transrectal ultrasound (TRUS). Re-biopsy was performed within 3 months (1–12 weeks). In re-biopsy, a total of 20 core biopsies were performed including the far lateral (6 cores) and transition zone (2 cores) in addition to standard 12 core biopsy. Our follow-up protocol is PSA measurement and digital rectal examination (DRE) every 3 months within the first 2 years, than every 6 months. Control biopsies was performed one year later and once upon every 3 years to patients whose PSA levels and DREs were normal at follow-up visits. More than 2 tumor invaded cores or 50% tumor in one core, and Gleason score exceeding 6 points were accepted as indications for definitive treatment. Patients were divided into two groups by re-biopsy results and compared according to the time to progression. We have done multivariate regression analysis to predict prognosis by using data on age, PSA level, and detection of tumor in re-biopsy specimens. Results Patients’ median age was 61 years and PSA level was 5 (2.7–9) ng/mL. Tumor was detected in 22 (34%) patients at re-biopsy and they underwent definitive treatment. Additionally tumor was detected in 9 patients, but active surveillance was maintained because their pathologic results met active

  6. Direct MRI-guided biopsy of the prostate: use of post-biopsy needle track imaging to confirm targeting

    PubMed Central

    Nicholson, Alexander J.; Pettersson, David R.; Korngold, Elena K.; Foster, Bryan R.; Hung, Arthur Y.; Amling, Christopher L.; Coakley, Fergus V.

    2015-01-01

    Purpose To report the observation that in-plane post-biopsy T2-weighted MRI often demonstrates the needle track as a transient visible linear tissue distortion during direct MRI-guided biopsy. Materials and methods We retrospectively identified 11 prostatic lesions in 9 men that underwent direct MRI-guided biopsy and in which post-biopsy images were obtained in the plane of the biopsy needle. Results In 9 of 11 targets, a post-biopsy needle track was visible as a linear tissue distortion on in-plane T2-weighted images obtained at a mean interval of 6 min (range 3–15). In these nine cases, the needle track traversed the intended target, and the biopsy was positive for malignancy in six. Biopsy was positive in one of two cases where the needle track was not visible. In five targets, one or more delayed series were obtained after a mean interval of 21 min (range 8–33), showing the track was no longer visible (n = 3) or was of progressively decreased conspicuity (n = 2). Conclusion Accurate targeting during direct MRI-guided biopsy of the prostate can be confirmed by obtaining post-biopsy in-plane images, since the needle track is usually visible as a transient linear tissue distortion. PMID:25687631

  7. Multiparametric MRI in Biopsy Guidance for Prostate Cancer: Fusion-Guided

    PubMed Central

    Rothwax, Jason T.; George, Arvin K.; Wood, Bradford J.; Pinto, Peter A.

    2014-01-01

    Prostate cancer (PCa) is the most common solid-organ malignancy among American men and the second most deadly. Current guidelines recommend a 12-core systematic biopsy following the finding of an elevated serum prostate-specific antigen (PSA). However, this strategy fails to detect an unacceptably high percentage of clinically significant cancers, leading researchers to develop new, innovative methods to improve the effectiveness of prostate biopsies. Multiparametric-MRI (MP-MRI) has emerged as a promising instrument in identifying suspicious regions within the prostate that require special attention on subsequent biopsy. Fusion platforms, which incorporate the MP-MRI into the biopsy itself and provide active targets within real-time imaging, have shown encouraging results in improving the detection rate of significant cancer. Broader applications of this technology, including MRI-guided focal therapy for prostate cancer, are in early phase trials. PMID:25126559

  8. Multiparametric MRI guidance in first-time prostate biopsies: what is the real benefit?

    PubMed Central

    Acar, Ömer; Esen, Tarık; Çolakoğlu, Bülent; Vural, Metin; Onay, Aslıhan; Sağlıcan, Yeşim; Türkbey, Barış; Rozanes, İzzet

    2015-01-01

    PURPOSE With the increased recognition of the capabilities of prostate multiparametric (mp) magnetic resonance imaging (MRI), attempts are being made to incorporate MRI into routine prostate biopsies. In this study, we aimed to analyze the diagnostic yield via cognitive fusion, transrectal ultrasound (TRUS)-guided, and in-bore MRI-guided biopsies in biopsy-naive patients with positive findings for prostate cancer screening. METHODS Charts of 140 patients, who underwent transrectal prostate biopsy after the adaptation of mp-MRI into our routine clinical practice, were reviewed retrospectively. Patients with previous negative biopsies (n=24) and digital rectal examination findings suspicious for ≥cT3 prostate cancer (n=16) were excluded. T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging were included in mp-MRI. Cognitive fusion biopsies were performed after a review of mp-MRI data, whereas TRUS-guided biopsies were performed blinded to MRI information. In-bore biopsies were conducted by means of real-time targeting under MRI guidance. RESULTS Between January 2012 and February 2014, a total of 100 patients fulfilling the inclusion criteria underwent TRUS-guided (n=37), cognitive fusion (n=49), and in-bore (n=14) biopsies. Mean age, serum prostate specific antigen level, and prostate size did not differ significantly among the study groups. In TRUS-guided biopsy group, 51.3% were diagnosed with prostate cancer, while the same ratio was 55.1% and 71.4% in cognitive fusion and in-bore biopsy groups, respectively (P = 0.429). Clinically significant prostate cancer detection rate was 69.1%, 70.3%, and 90% in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively (P = 0.31). According to histopathologic variables in the prostatectomy specimen, significant prostate cancer was detected in 85.7%, 93.3%, and 100% of patients in TRUS-guided, cognitive fusion, and in-bore biopsy groups, respectively. CONCLUSION In the first

  9. Multiparametric MRI and targeted prostate biopsy: Improvements in cancer detection, localization, and risk assessment

    PubMed Central

    Bjurlin, Marc A.; Mendhiratta, Neil; Wysock, James S.

    2016-01-01

    Introduction Multiparametric-MRI (mp-MRI) is an evolving noninvasive imaging modality that increases the accurate localization of prostate cancer at the time of MRI targeted biopsy, thereby enhancing clinical risk assessment, and improving the ability to appropriately counsel patients regarding therapy. Material and methods We used MEDLINE/PubMed to conduct a comprehensive search of the English medical literature. Articles were reviewed, data was extracted, analyzed, and summarized. In this review, we discuss the mp-MRI prostate exam, its role in targeted prostate biopsy, along with clinical applications and outcomes of MRI targeted biopsies. Results Mp-MRI, consisting of T2-weighted imaging, diffusion-weighted imaging, dynamic contrast-enhanced imaging, and possibly MR spectroscopy, has demonstrated improved specificity in prostate cancer detection as compared to conventional T2-weighted images alone. An MRI suspicion score has been developed and is depicted using an institutional Likert or, more recently, a standardized reporting scale (PI-RADS). Techniques of MRI-targeted biopsy include in-gantry MRI guided biopsy, TRUS-guided visual estimation biopsy, and software co-registered MRI-US guided biopsy (MRI-US fusion). Among men with no previous biopsy, MRI-US fusion biopsy demonstrates up to a 20% increase in detection of clinically significant cancers compared to systematic biopsy while avoiding a significant portion of low risk disease. These data suggest a potential role in reducing over-detection and, ultimately, over-treatment. Among men with previous negative biopsy, 72–87% of cancers detected by MRI targeted biopsy are clinically significant. Among men with known low risk cancer, repeat biopsy by MR-targeting improves risk stratification in selecting men appropriate for active surveillance secondarily reducing the need for repetitive biopsy during surveillance. Conclusions Use of mp-MRI for targeting prostate biopsies has the potential to reduce the

  10. Optical coherence elastography (OCE) as a method for identifying benign and malignant prostate biopsies

    NASA Astrophysics Data System (ADS)

    Li, Chunhui; Guan, Guangying; Ling, Yuting; Lang, Stephen; Wang, Ruikang K.; Huang, Zhihong; Nabi, Ghulam

    2015-03-01

    Objectives. Prostate cancer is the most frequently diagnosed malignancy in men. Digital rectal examination (DRE) - a known clinical tool based on alteration in the mechanical properties of tissues due to cancer has traditionally been used for screening prostate cancer. Essentially, DRE estimates relative stiffness of cancerous and normal prostate tissue. Optical coherence elastography (OCE) are new optical imaging techniques capable of providing cross-sectional imaging of tissue microstructure as well as elastogram in vivo and in real time. In this preliminary study, OCE was used in the setting of the human prostate biopsies ex vivo, and the images acquired were compared with those obtained using standard histopathologic methods. Methods. 120 prostate biopsies were obtained by TRUS guided needle biopsy procedures from 9 patients with clinically suspected cancer of the prostate. The biopsies were approximately 0.8mm in diameter and 12mm in length, and prepared in Formalin solution. Quantitative assessment of biopsy samples using OCE was obtained in kilopascals (kPa) before histopathologic evaluation. The results obtained from OCE and standard histopathologic evaluation were compared provided the cross-validation. Sensitivity, specificity, and positive and negative predictive values were calculated for OCE (histopathology was a reference standard). Results. OCE could provide quantitative elasticity properties of prostate biopsies within benign prostate tissue, prostatic intraepithelial neoplasia, atypical hyperplasia and malignant prostate cancer. Data analysed showed that the sensitivity and specificity of OCE for PCa detection were 1 and 0.91, respectively. PCa had significantly higher stiffness values compared to benign tissues, with a trend of increasing in stiffness with increasing of malignancy. Conclusions. Using OCE, microscopic resolution elastogram is promising in diagnosis of human prostatic diseases. Further studies using this technique to improve the

  11. A Molecular Image-directed, 3D Ultrasound-guided Biopsy System for the Prostate

    PubMed Central

    Fei, Baowei; Schuster, David M.; Master, Viraj; Akbari, Hamed; Fenster, Aaron; Nieh, Peter

    2012-01-01

    Systematic transrectal ultrasound (TRUS)-guided biopsy is the standard method for a definitive diagnosis of prostate cancer. However, this biopsy approach uses two-dimensional (2D) ultrasound images to guide biopsy and can miss up to 30% of prostate cancers. We are developing a molecular image-directed, three-dimensional (3D) ultrasound image-guided biopsy system for improved detection of prostate cancer. The system consists of a 3D mechanical localization system and software workstation for image segmentation, registration, and biopsy planning. In order to plan biopsy in a 3D prostate, we developed an automatic segmentation method based wavelet transform. In order to incorporate PET/CT images into ultrasound-guided biopsy, we developed image registration methods to fuse TRUS and PET/CT images. The segmentation method was tested in ten patients with a DICE overlap ratio of 92.4% ± 1.1 %. The registration method has been tested in phantoms. The biopsy system was tested in prostate phantoms and 3D ultrasound images were acquired from two human patients. We are integrating the system for PET/CT directed, 3D ultrasound-guided, targeted biopsy in human patients. PMID:22708023

  12. High efficiency for prostate biopsy qualification with full-field OCT after training

    NASA Astrophysics Data System (ADS)

    Yang, C.; Ricco, R.; Sisk, A.; Duc, A.; Sibony, M.; Beuvon, F.; Dalimier, E.; Delongchamps, N. B.

    2016-02-01

    Full-field optical coherence tomography (FFOCT) offers a fast and non-destructive method of obtaining images of biological tissues at ultrahigh resolution, approaching traditional histological sections. In the context of prostate cancer diagnosis involving multiple biopsies, FFOCT could be used to validate the cores just after they are obtained in order to guide the number of biopsies to be performed. The aim of the study was to define and test a training protocol for efficient FFOCT prostate biopsy assessment. Three readers (a pathologist with previous experience with FFOCT, a pathologist new to FFOCT, and a urologist new to FFOCT) were trained to read FFOCT images of prostate biopsies on a set of 20 commented zooms (1 mm field of view) and 25 complete images. They were later tested on a set of 115 anonymized and randomized images of prostate biopsies. The results showed that an extra 30 images were necessary for more complete training as compared to prior studies. After training, pathologists obtained 100% sensitivity on high-grade cancer detection and 96% overall specificity; the urologist obtained 88% sensitivity on high-grade cancer and 89% overall specificity. Overall, the readers obtained a mean of 93% accuracy of qualifying malignancy on prostate biopsies. Moreover, the two pathologists showed a steeper learning curve than the urologist. This study demonstrates that a training protocol for such a new imaging modality may be implemented and yield very high efficiency for the pre-histologic detection of malignancy on prostate biopsies.

  13. Upgrading the Gleason Score in Extended Prostate Biopsy: Implications for Treatment Choice

    SciTech Connect

    Moreira Leite, Katia Ramos Camara-Lopes, Luiz H.A.; Dall'Oglio, Marcos F.; Cury, Jose; Antunes, Alberto A.; Sanudo, Adriana; Srougi, Miguel

    2009-02-01

    Purpose: To determine the incidence of overestimation of Gleason score (GS) in extended prostate biopsy, and consequently circumventing unnecessary aggressive treatment. Methods and Materials: This is a retrospective study of 464 patients who underwent prostate biopsy and radical prostatectomy between January 2001 and November 2007. The GS from biopsy and radical prostatectomy were compared. The incidence of overestimation of GS in biopsies and tumor volume were studied. Multivariate analysis was applied to find parameters that predict upgrading the GS in prostate biopsy. Results: The exact agreement of GS between prostate biopsy and radical prostatectomy occurred in 56.9% of cases. In 29.1% cases it was underestimated, and it was overestimated in 14%. One hundred and six (22.8%) patients received a diagnosis of high GS (8, 9, or 10) in a prostate biopsy. In 29.2% of cases, the definitive Gleason Score was 7 or lower. In cases in which GS was overestimated in the biopsy, tumors were significantly smaller. In multivariate analysis, the total percentage of tumor was the only independent factor in overestimation of GS. Tumors occupying less than 33% of cores had a 5.6-fold greater chance of being overestimated. Conclusion: In the extended biopsy era and after the International Society of Urological Pathology consensus on GS, almost one third of tumors considered to have high GS at the biopsy may be intermediate-risk cancers. In that condition, tumors are smaller in biopsy. This should be remembered by professionals involved with prostate cancer to avoid overtreatment and undesirable side effects.

  14. Confirmatory biopsy for the assessment of prostate cancer in men considering active surveillance: reference centre experience

    PubMed Central

    Bosco, Cecilia; Cozzi, Gabriele; Kinsella, Janette; Bianchi, Roberto; Acher, Peter; Challacombe, Benjamin; Popert, Rick; Brown, Christian; George, Gincy; Van Hemelrijck, Mieke; Cahill, Declan

    2016-01-01

    Objectives To evaluate how accurate a 12-core transrectal biopsy derived low-risk prostate cancer diagnosis is for an active surveillance programme by comparing the histological outcome with that from confirmatory transperineal sector biopsy. Subjects and methods The cohort included 166 men diagnosed with low volume Gleason score 3+3 prostate cancer on initial transrectal biopsy who also underwent a confirmatory biopsy. Both biopsy techniques were performed according to standard protocols and samples were taken for histopathology analysis. Subgroup analysis was performed according to disease severity at baseline to determine possible disease parameters of upgrading at confirmatory biopsy. Results After confirmatory biopsy, 34% demonstrated Gleason score upgrade, out of which 25% were Gleason score 3+4 and 8.5% primary Gleason pattern 4. Results remained consistent for the subgroup analysis and a weak positive association, but not statistically significant, between prostate specific antigen (PSA), age, and percentage of positive cores, and PCa upgrading at confirmatory biopsy was found. Conclusion In our single centre study, we found that one-third of patients had higher Gleason score at confirmatory biopsy. Furthermore 8.5% of these upgraders had a primary Gleason pattern 4. Our results together with previously published evidence highlight the need for the revision of current guidelines in prostate cancer diagnosis for the selection of men for active surveillance. PMID:27170833

  15. Prostate-specific Antigen Density Variation Rate as a Potential Guideline Parameter for Second Prostate Cancer Detection Biopsy

    PubMed Central

    Xie, Gan-Sheng; Lyv, Jin-Xing; Li, Gang; Yan, Chun-Yin; Hou, Jian-Quan; Pu, Jin-Xian; Ding, Xiang; Huang, Yu-Hua

    2016-01-01

    Background: The diagnostic value of current prostate-specific antigen (PSA) tests is challenged by the poor detection rate of prostate cancer (PCa) in repeat prostate biopsy. In this study, we proposed a novel PSA-related parameter named PSA density variation rate (PSADVR) and designed a clinical trial to evaluate its potential diagnostic value for detecting PCa on a second prostate biopsy. Methods: Data from 184 males who underwent second ultrasound-guided prostate biopsy 6 months after the first biopsy were included in the study. The subjects were divided into PCa and non-PCa groups according to the second biopsy pathological results. Prostate volume, PSA density (PSAD), free-total PSA ratio, and PSADVR were calculated according to corresponding formulas at the second biopsy. These parameters were compared using t-test or Mann-Whitney U-test between PCa and non-PCa groups, and receiver operating characteristic analysis were used to evaluate their predictability on PCa detection. Results: PCa was detected in 24 patients on the second biopsy. Mean values of PSA, PSAD, and PSADVR were greater in the PCa group than in the non-PCa group (8.39 μg/L vs. 7.16 μg/L, 0.20 vs. 0.16, 14.15% vs. −1.36%, respectively). PSADVR had the largest area under the curve, with 0.667 sensitivity and 0.824 specificity when the cutoff was 10%. The PCa detection rate was significantly greater in subjects with PSADVR >10% than PSADVR ≤10% (28.6% vs. 6.5%, P < 0.001). In addition, PSADVR was the only parameter in this study that showed a significant correlation with mid-to-high-risk PCa (r = 0.63, P = 0.03). Conclusions: Our results demonstrated that PSADVR improved the PCa detection rate on second biopsies, especially for mid-to-high-risk cancers requiring prompt treatment. PMID:27453228

  16. Safety of 12 core transrectal ultrasound guided prostate biopsy in patients on aspirin

    PubMed Central

    Vasudeva, Pawan; Kumar, Niraj; Kumar, Anup; Singh, Harbinder; Kumar, Gaurav

    2015-01-01

    ABSTRACT Objective: To prospectively assess safety outcome of TRUS guided prostate biopsy in patients taking low dose aspirin. Materials and methods: Consecutive patients, who were planned for 12 core TRUS guided prostate biopsy and satisfied eligibility criteria, were included in the study and divided into two Groups: Group A: patients on aspirin during biopsy, Group B: patients not on aspirin during biopsy, including patients in whom aspirin was stopped prior to the biopsy. Parameters included for statistical analysis were: age, serum prostate specific antigen (PSA), prostate volume, hemoglobin (Hb %), number of hematuria episodes, number of patient reporting hematuria, hematuria requiring intervention, number of patient reporting hematospermia and number of patient reporting rectal bleeding. Results: Of 681 eligible patients, Group A and B had 191 and 490 patients respectively. The mean age, prostate volume, serum PSA and pre-biopsy hemoglobin were similar in both Groups with no significant differences noted between them. None of the post-biopsy complications, including number of hematuria episodes (p=0.83), number of patients reporting hematuria (p=0.55), number of patients reporting hematospermia (p=0.36) and number of patients reporting rectal bleeding (p=0.65), were significantly different between Groups A and B respectively. None of the hemorrhagic complication in either group required intervention and were self limiting. Conclusion: Continuing low dose aspirin during TRUS guided prostate biopsy neither alters the minor bleeding episodes nor causes major bleeding complication. So, discontinuation of low dose aspirin prior to TRUS guided prostate biopsy is not required. PMID:26742966

  17. Optical biopsy of the prostate: can we TRUST (trans-rectal ultrasound-coupled spectral tomography)?

    NASA Astrophysics Data System (ADS)

    Piao, Daqing; Jiang, Zhen; Bartels, Kenneth E.; Holyoak, G. Reed; Ritchey, Jerry W.; Rock, Kendra; Ownby, Charlotte L.; Bunting, Charles F.; Slobodov, Gennady

    2011-03-01

    Needle-based core-biopsy to locate prostate cancer relies heavily upon trans-rectal ultrasound (TRUS) imaging guidance. Ultrasonographic findings of classic hypoechoic peripheral zone lesions have a low specificity of ~28%, a low positive predictive value of ~29%, and an overall accuracy of ~43%, in prostate cancer diagnosis. The prevalence of isoechoic or nearly invisible prostate cancers on ultrasonography ranges from 25 to 42%. As a result, TRUS is useful and convenient to direct the needle trajectory following a systematic biopsy sampling template rather than to target only the potentially malignant lesion for focal-biopsy. To address this deficiency in the first-line of prostate cancer imaging, a trans-rectal ultrasound-coupled spectral tomography (TRUST) approach is being developed to non-invasively resolve the likely optical signatures of prostate malignancy. The approach has evolved from using one NIR wavelength to two NIR bands, and recently to three bands of NIR spectrum information. The concept has been evaluated on one normal canine prostate and three dogs with implanted prostate tumor developed as a model. The initial results implementing TRUST on the canine prostate tumor model includes: (1) quantifying substantially increased total hemoglobin concentration over the time-course of imaging in a rapidly growing prostate tumor; (2) confirming hypoxia in a prostatic cystic lesion; and (3) imaging hypoxic changes of a necrotic prostate tumor. Despite these interesting results, intensive technologic development is necessary for translating the approach to benefiting clinical practice, wherein the ultimate utility is not possibly to eliminate needle-biopsy but to perform focal-biopsy that is only necessary to confirm the cancer, as well as to monitor and predict treatment responses.

  18. A PET/CT Directed, 3D Ultrasound-Guided Biopsy System for Prostate Cancer

    PubMed Central

    Master, Viraj; Nieh, Peter; Akbari, Hamed; Yang, Xiaofeng; Fenster, Aaron; Schuster, David

    2015-01-01

    Prostate cancer affects 1 in 6 men in the USA. Systematic transrectal ultrasound (TRUS)-guided biopsy is the standard method for a definitive diagnosis of prostate cancer. However, this “blind” biopsy approach can miss at least 20% of prostate cancers. In this study, we are developing a PET/CT directed, 3D ultrasound image-guided biopsy system for improved detection of prostate cancer. In order to plan biopsy in three dimensions, we developed an automatic segmentation method based wavelet transform for 3D TRUS images of the prostate. The segmentation was tested in five patients with a DICE overlap ratio of more than 91%. In order to incorporate PET/CT images into ultrasound-guided biopsy, we developed a nonrigid registration algorithm for TRUS and PET/CT images. The registration method has been tested in a prostate phantom with a target registration error (TRE) of less than 0.4 mm. The segmentation and registration methods are two key components of the multimodality molecular image-guided biopsy system. PMID:26866061

  19. 3-D statistical cancer atlas-based targeting of prostate biopsy using ultrasound image guidance

    NASA Astrophysics Data System (ADS)

    Narayanan, Ramkrishnan; Shen, Dinggang; Davatzikos, Christos A.; Crawford, E. David; Barqawi, Albaha; Werahera, Priya; Kumar, Dinesh; Suri, Jasjit S.

    2008-03-01

    Prostate cancer is a multifocal disease and lesions are not distributed uniformly within the gland. Several biopsy protocols concerning spatially specific targeting have been reported urology literature. Recently a statistical cancer atlas of the prostate was constructed providing voxelwise probabilities of cancers in the prostate. Additionally an optimized set of biopsy sites was computed with 94 - 96% detection accuracy was reported using only 6-7 needles. Here we discuss the warping of this atlas to prostate segmented side-fire ultrasound images of the patient. A shape model was used to speed up registration. The model was trained from over 38 expert segmented subjects off-line. This training yielded as few as 15-20 degrees of freedom that were optimized to warp the atlas surface to the patient's ultrasound image followed by elastic interpolation of the 3-D atlas. As a result the atlas is completely mapped to the patient's prostate anatomy along with optimal predetermined needle locations for biopsy. These do not preclude the use of additional biopsies if desired. A color overlay of the atlas is also displayed on the ultrasound image showing high cancer zones within the prostate. Finally current biopsy locations are saved in the atlas space and may be used to update the atlas based on the pathology report. In addition to the optimal atlas plan, previous biopsy locations and alternate plans can also be stored in the atlas space and warped to the patient with no additional time overhead.

  20. Mechanically assisted 3D prostate ultrasound imaging and biopsy needle-guidance system

    NASA Astrophysics Data System (ADS)

    Bax, Jeffrey; Williams, Jackie; Cool, Derek; Gardi, Lori; Montreuil, Jacques; Karnik, Vaishali; Sherebrin, Shi; Romagnoli, Cesare; Fenster, Aaron

    2010-02-01

    Prostate biopsy procedures are currently limited to using 2D transrectal ultrasound (TRUS) imaging to guide the biopsy needle. Being limited to 2D causes ambiguity in needle guidance and provides an insufficient record to allow guidance to the same suspicious locations or avoid regions that are negative during previous biopsy sessions. We have developed a mechanically assisted 3D ultrasound imaging and needle tracking system, which supports a commercially available TRUS probe and integrated needle guide for prostate biopsy. The mechanical device is fixed to a cart and the mechanical tracking linkage allows its joints to be manually manipulated while fully supporting the weight of the ultrasound probe. The computer interface is provided in order to track the needle trajectory and display its path on a corresponding 3D TRUS image, allowing the physician to aim the needle-guide at predefined targets within the prostate. The system has been designed for use with several end-fired transducers that can be rotated about the longitudinal axis of the probe in order to generate 3D image for 3D navigation. Using the system, 3D TRUS prostate images can be generated in approximately 10 seconds. The system reduces most of the user variability from conventional hand-held probes, which make them unsuitable for precision biopsy, while preserving some of the user familiarity and procedural workflow. In this paper, we describe the 3D TRUS guided biopsy system and report on the initial clinical use of this system for prostate biopsy.

  1. Evaluating The PCPT Risk Calculator in Ten International Biopsy Cohorts: Results from the Prostate Biopsy Collaborative Group

    PubMed Central

    Ankerst, Donna P.; Boeck, Andreas; Freedland, Stephen J.; Thompson, Ian M.; Cronin, Angel M.; Roobol, Monique J.; Hugosson, Jonas; Jones, J. Stephen; Kattan, Michael W.; Klein, Eric A.; Hamdy, Freddie; Neal, David; Donovan, Jenny; Parekh, Dipen J.; Klocker, Helmut; Horninger, Wolfgang; Benchikh, Amine; Salama, Gilles; Villers, Arnauld; Moreira, Daniel M.; Schröder, Fritz H.; Lilja, Hans; Vickers, Andrew J.

    2013-01-01

    Objectives To evaluate the discrimination, calibration and net benefit performance of the Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) across five European Randomized study of Screening for Prostate Cancer (ERSPC), 1 United Kingdom, 1 Austrian and 3 US biopsy cohorts. Methods PCPTRC risks were calculated for 25,733 biopsies using prostate-specific antigen (PSA), digital rectal examination, family history and history of prior biopsy, and single imputation for missing covariates. Predictions were evaluated using the areas underneath the receiver operating characteristic curves (AUC), discrimination slopes, chi-square tests of goodness of fit, and net benefit decision curves. Results AUCs of the PCPTRC ranged from a low of 56% in the ERSPC Goeteborg Rounds 2-6 cohort to a high of 72% in the ERSPC Goeteborg Round 1 cohort, and were statistically significantly higher than that of PSA in 6 out of the 10 cohorts. The PCPTRC was well-calibrated in the SABOR, Tyrol and Durham cohorts. There was limited to no net benefit to using the PCPTRC for biopsy referral compared to biopsying all or no men in all five ERSPC cohorts and benefit within a limited range of risk thresholds in all other cohorts. Conclusions External validation of the PCPTRC across ten cohorts revealed varying degree of success highly dependent on the cohort, most likely due to different criteria for and work-up before biopsy. Future validation studies of new calculators for prostate cancer should acknowledge the potential impact of the specific cohort studied when reporting successful versus failed validation. PMID:22210512

  2. Cancer detection rates of different prostate biopsy regimens in patients with renal failure.

    PubMed

    Hoşcan, Mustafa Burak; Özorak, Alper; Oksay, Taylan; Perk, Hakkı; Armağan, Abdullah; Soyupek, Sedat; Serel, Tekin Ahmet; Koşar, Alim

    2014-07-01

    We aimed to evaluate the cancer detection rates of 6-, 10-, 12-core biopsy regimens and the optimal biopsy protocol for prostate cancer diagnosis in patients with renal failure. A total of 122 consecutive patients with renal failure underwent biopsy with age-specific prostate-specific antigen (PSA) levels up to 20 ng/mL. The 12-core biopsy technique (sextant biopsy + lateral base, lateral mid-zone, lateral apex, bilaterally) performed to all patients. Pathology results were examined separately for each sextant, 10-core that exclude parasagittal mid-zones from 12-cores (10a), 10-core that exclude apex zones from 12-cores (10b) and 12-core biopsy regimens. Of 122 patients, 37 (30.3%) were positive for prostate cancer. The cancer detection rates for sextant, 10a, 10b and 12 cores were 17.2%, 29%, 23.7% and 30.7%, respectively. Biopsy techniques of 10a, 10b and 12 cores increased the cancer detection rates by 40%, 27.5% and 43.2% among the sextant technique, respectively. Biopsy techniques of 10a and 12 cores increased the cancer detection rates by 17.1% and 21.6% among 10b biopsy technique, respectively. There were no statistical differences between 12 core and 10a core about cancer detection rate. Adding lateral cores to sextant biopsy improves the cancer detection rates. In our study, 12-core biopsy technique increases the cancer detection rate by 5.4% among 10a core but that was not statistically different. On the other hand, 12-core biopsy technique includes all biopsy regimens. We therefore suggest 12-core biopsy or minimum 10-core strategy incorporating six peripheral biopsies with elevated age- specific PSA levels up to 20 ng/mL in patients with renal failure. PMID:24797801

  3. Cancer detection rates of different prostate biopsy regimens in patients with renal failure.

    PubMed

    Hoşcan, Mustafa Burak; Özorak, Alper; Oksay, Taylan; Perk, Hakkı; Armağan, Abdullah; Soyupek, Sedat; Serel, Tekin Ahmet; Koşar, Alim

    2014-07-01

    We aimed to evaluate the cancer detection rates of 6-, 10-, 12-core biopsy regimens and the optimal biopsy protocol for prostate cancer diagnosis in patients with renal failure. A total of 122 consecutive patients with renal failure underwent biopsy with age-specific prostate-specific antigen (PSA) levels up to 20 ng/mL. The 12-core biopsy technique (sextant biopsy + lateral base, lateral mid-zone, lateral apex, bilaterally) performed to all patients. Pathology results were examined separately for each sextant, 10-core that exclude parasagittal mid-zones from 12-cores (10a), 10-core that exclude apex zones from 12-cores (10b) and 12-core biopsy regimens. Of 122 patients, 37 (30.3%) were positive for prostate cancer. The cancer detection rates for sextant, 10a, 10b and 12 cores were 17.2%, 29%, 23.7% and 30.7%, respectively. Biopsy techniques of 10a, 10b and 12 cores increased the cancer detection rates by 40%, 27.5% and 43.2% among the sextant technique, respectively. Biopsy techniques of 10a and 12 cores increased the cancer detection rates by 17.1% and 21.6% among 10b biopsy technique, respectively. There were no statistical differences between 12 core and 10a core about cancer detection rate. Adding lateral cores to sextant biopsy improves the cancer detection rates. In our study, 12-core biopsy technique increases the cancer detection rate by 5.4% among 10a core but that was not statistically different. On the other hand, 12-core biopsy technique includes all biopsy regimens. We therefore suggest 12-core biopsy or minimum 10-core strategy incorporating six peripheral biopsies with elevated age- specific PSA levels up to 20 ng/mL in patients with renal failure.

  4. Realtime TRUS/MRI Fusion Targeted-Biopsy for Prostate Cancer: A Clinical Demonstration of Increased Positive Biopsy Rates

    NASA Astrophysics Data System (ADS)

    Kadoury, Samuel; Yan, Pingkun; Xu, Sheng; Glossop, Neil; Choyke, Peter; Turkbey, Baris; Pinto, Peter; Wood, Bradford J.; Kruecker, Jochen

    In this paper, a system for fusion of realtime transrectal ultrasound (TRUS) with pre-acquired 3D images of the prostate is presented with a clinical demonstration on a cohort of 101 patients with suspicion of prostate cancer. Electromagnetically tracked biopsy guides for endocavity ultrasound transducers were calibrated and used to fuse MRI-based suspicious lesion locations with ultrasound image coordinates. The prostate shape is segmented from MRI in a semi-automated fashion via a model-based approach, and intraoperative image registration is performed between MR and ultrasound image space to superimpose target fiducials markers on the ultrasound image. In order to align both modalities, a surface model is automatically extracted from 2D swept TRUS images using a partial active shape model, utilizing image features and prior statistics. An automatic prostate motion compensation algorithm can be triggered as needed. The results were used to display live TRUS images fused with spatially corresponding realtime multiplanar reconstructions (MPRs) of the MR image volume. In this study, all patients were scanned with 3T MRI and TRUS for biopsy. Clinical results show significant improvement of target visualization and of positive detection rates during TRUS-guided biopsies. It also demonstrates the feasibility of realtime MR/TRUS image fusion for out-of-gantry procedures.

  5. Prostate needle biopsy: what we do and what should be improved.

    PubMed

    Fraggetta, Filippo; Pepe, Pietro; Improta, Giuseppina; Aragona, Francesco; Colecchia, Maurizio

    2013-06-01

    Prostate cancer (PCa) is the cancer most frequently diagnosed in older men and the second most frequent for incidence of all tumors. With the widespread use of serum prostate-specific antigen (PSA), the detection rate as well as the incidence of localized tumors has been increasing, thus leading to a drop in PCa-related mortality. However, a corresponding estimated rate of overdiagnosis as high as 50% has been reported, and the adverse side effects related to unnecessary treatments make the overall benefit of PSA mass screening unclear. The lower PSA threshold and extended prostate biopsy protocols have led to a marked increase of small, low-grade tumors that will never threaten a patient's survival. Sextant biopsy technique, extended biopsy protocols (12-18 cores) and saturation prostate schemes are already familiar terms, together with quantitative histology in the pathology departments. This brief review will try to focus on what usually is done and what should be improved in prostate needle biopsy in order to answer many critical points such as the clinical implication of different modalities of prostate biopsy (transrectal, transperineal or even targeted), the use of quantitative histology and the importance of the new molecular findings in addition to conventional histological parameters in the era of the active surveillance protocols. PMID:24344499

  6. MRI-guided biopsies and minimally invasive therapy for prostate cancer

    PubMed Central

    Ghai, Sangeet; Trachtenberg, John

    2015-01-01

    Recent advances in multiparametric magnetic resonance imaging (mp-MRI) have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa). Its sensitivity in detecting clinically significant cancer and the ability to localize the tumor within the prostate gland has opened up discussion on targeted diagnosis and therapy in PCa. Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS) biopsy and improves the diagnosis of PCa. Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa. This review discusses the evidence and techniques for in-bore MRI-guided prostate biopsy and provides an update on the status of MRI-guided targeted focal therapy in PCa. PMID:26166964

  7. The comparison of the influence between two different bowel preparation methods on sepsis after prostate biopsies

    PubMed Central

    Yildirim, Mehmet Erol; Badem, Huseyin; Cavis, Mucahit; Karatas, Omer Faruk; Cimentepe, Ersin; Unal, Dogan

    2015-01-01

    Introduction Transrectal ultrasonography (TRUS) guided prostate needle biopsy has been performed to diagnose and stage prostate cancer for many years. There are many different bowel preparation protocols to diminish the infectious complications, but there is no standardized consensus among urologists. Therefore, we aimed to assess two different bowel preparation methods on the rate of infectious complications in patients who underwent TRUS–guided prostate biopsy. Material and methods A total of 387 cases of TRUS–guided prostate biopsy were included in this retrospective study. All patients received antibiotic prophylaxis with ciprofloxacin (500 mg) twice a day orally for 7 days starting on the day before the biopsy. The patients were divided into two groups according to the bowel preparation method used. Patients (Group 1, n = 164) only received self–administrated phosphate enema) on the morning of the prostate biopsy. Other patients (Group 2, n = 223) received sennasoid a–b laxatives the night before the prostate biopsy. Infectious complications were classified as sepsis, fever (greater than 38°C) without sepsis, and other clinical infections. Results Major complications developed in 14 cases (3.8%), including 3 cases (0.8%) of urinary retention, and 11 (3%) infectious complications, all of which were sepsis. There were 3 and 8 cases of urosepsis in Group 1 and Group 2, respectively. There were no statistically significant differences between both Groups regarding to the rates of urosepsis (p = 0.358). Conclusions Despite both methods of bowel preparation, sodium phosphate enema or sennasoid a–b calcium laxatives, before TRUS–guided prostate biopsy have similar effect on the rate of urosepsis, so both methods of bowel preparation can be safely used. PMID:25914845

  8. Intrarectal Lidocaine-Diltiazem-Meperidine Gel for Transrectal Ultrasound Guided Prostate Biopsy

    PubMed Central

    Imani, Farsad; Moghaddam, Yasaman; Shariat Moharari, Reza; Etezadi, Farhad; Khajavi, Mohammad Reza; Hosseini, Seyed Reza

    2015-01-01

    Background: TRUS-guided needle biopsy of the prostate gland is the current standard method used for diagnosis of prostate cancer. Pain control during this procedure is through the use of i.v. sedation or local anaesthetic (LA), depending on clinician preference. Objectives: The aim of this study was to evaluate the effectiveness of intrarectal lidocaine, lidocaine-diltiazem and lidocaine-meperidine-diltiazem gel for anesthetizing transrectal ultrasound guided prostate biopsy. Patients and Methods: In a randomized double-blind clinical trial, 100 consecutive patients were divided into three groups. The patients received one of the gels before transrectal ultrasound guided prostate needle biopsy: group A, intrarectal and perianal lidocaine, gel 1 g; group B, intrarectal lidocaine gel, 1 g, + perianal diltiazem, 1 g; group C, intrarectal lidocaine gel, 1 g, + meperidine, 25 mg, and perianal diltiazem, 1 g. Visual analog pain scale was used to estimate pain during probe insertion and biopsy. Heart rate and blood pressure during probe insertion and biopsy were recorded too. Results: The mean of visual analog pain scale was 4.5 in group A, 3.5 in group B, and 2.0 in group C during probe insertion (P value = 0.01). The mean of visual analog pain scale was 5.1 in group A, 3.5 group B, and 2.5 in group C during biopsy (P value = 0.001). The groups were comparable for patients' age, weight, serum prostate-specific antigen (PSA), and prostate size (P > 0.05). No side effects of meperidine and lidocaine including drowsiness, dizziness, tinnitus and light-headedness or requiring assistance for activity were noted. Conclusions: Lidocaine-meperidine-diltiazem gel provides significantly better pain control than lidocaine-diltiazem gel and lidocaine gel alone during transrectal ultrasound guided prostate biopsy and probe insertion. This mixture gel is safe, easy to administer and well accepted by patients. PMID:26161317

  9. What Is the Ideal Core Number for Ultrasound-Guided Prostate Biopsy?

    PubMed Central

    Tsuji, Fábio Hissachi; de Oliveira Lima, Flávio; Yamamoto, Hamilto Akihissa; de Jesus, Carlos Márcio Nóbrega

    2014-01-01

    Purpose We evaluated the utility of 10-, 12-, and 16-core prostate biopsies for detecting prostate cancer (PCa) and correlated the results with prostate-specific antigen (PSA) levels, prostate volumes, Gleason scores, and detection rates of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Materials and Methods A prospective controlled study was conducted in 354 consecutive patients with various indications for prostate biopsy. Sixteen-core biopsy specimens were obtained from 351 patients. The first 10-core biopsy specimens were obtained bilaterally from the base, middle third, apex, medial, and latero-lateral regions. Afterward, six additional punctures were performed bilaterally in the areas more lateral to the base, middle third, and apex regions, yielding a total of 16-core biopsy specimens. The detection rate of carcinoma in the initial 10-core specimens was compared with that in the 12- and 16-core specimens. Results No significant differences in the cancer detection rate were found between the three biopsy protocols. PCa was found in 102 patients (29.06%) using the 10-core protocol, in 99 patients (28.21%) using the 12-core protocol, and in 107 patients (30.48%) using the 16-core protocol (p=0.798). The 10-, 12-, and 16-core protocols were compared with stratified PSA levels, stratified prostate volumes, Gleason scores, and detection rates of HGPIN and ASAP; no significant differences were found. Conclusions Cancer positivity with the 10-core protocol was not significantly different from that with the 12- and 16-core protocols, which indicates that the 10-core protocol is acceptable for performing a first biopsy. PMID:25405014

  10. Identification of Threshold Prostate Specific Antigen Levels to Optimize the Detection of Clinically Significant Prostate Cancer by Magnetic Resonance Imaging/Ultrasound Fusion Guided Biopsy

    PubMed Central

    Shakir, Nabeel A.; George, Arvin K.; Siddiqui, M. Minhaj; Rothwax, Jason T.; Rais-Bahrami, Soroush; Stamatakis, Lambros; Su, Daniel; Okoro, Chinonyerem; Raskolnikov, Dima; Walton-Diaz, Annerleim; Simon, Richard; Turkbey, Baris; Choyke, Peter L.; Merino, Maria J.; Wood, Bradford J.; Pinto, Peter A.

    2015-01-01

    Purpose Prostate specific antigen sensitivity increases with lower threshold values but with a corresponding decrease in specificity. Magnetic resonance imaging/ultrasound targeted biopsy detects prostate cancer more efficiently and of higher grade than standard 12-core transrectal ultrasound biopsy but the optimal population for its use is not well defined. We evaluated the performance of magnetic resonance imaging/ultrasound targeted biopsy vs 12-core biopsy across a prostate specific antigen continuum. Materials and Methods We reviewed the records of all patients enrolled in a prospective trial who underwent 12-core transrectal ultrasound and magnetic resonance imaging/ultrasound targeted biopsies from August 2007 through February 2014. Patients were stratified by each of 4 prostate specific antigen cutoffs. The greatest Gleason score using either biopsy method was compared in and across groups as well as across the population prostate specific antigen range. Clinically significant prostate cancer was defined as Gleason 7 (4 + 3) or greater. Univariate and multivariate analyses were performed. Results A total of 1,003 targeted and 12-core transrectal ultrasound biopsies were performed, of which 564 diagnosed prostate cancer for a 56.2% detection rate. Targeted biopsy led to significantly more upgrading to clinically significant disease compared to 12-core biopsy. This trend increased more with increasing prostate specific antigen, specifically in patients with prostate specific antigen 4 to 10 and greater than 10 ng/ml. Prostate specific antigen 5.2 ng/ml or greater captured 90% of upgrading by targeted biopsy, corresponding to 64% of patients who underwent multiparametric magnetic resonance imaging and subsequent fusion biopsy. Conversely a greater proportion of clinically insignificant disease was detected by 12-core vs targeted biopsy overall. These differences persisted when controlling for potential confounders on multivariate analysis. Conclusions Prostate

  11. Effect on hemostasis of an absorbable hemostatic gelatin sponge after transrectal prostate needle biopsy

    PubMed Central

    Kobatake, Kohei; Mita, Koji; Kato, Masao

    2015-01-01

    Objectives To examine the usefulness of an absorbable hemostatic gelatin sponge for hemostasis after transrectal prostate needle biopsy. Subjects and Methods The subjects comprised 278 participants who underwent transrectal prostate needle biopsy. They were randomly allocated to the gelatin sponge insertion group (group A: 148 participants) and to the non-insertion group (group B: 130 participants). In group A, the gelatin sponge was inserted into the rectum immediately after biopsy. A biopsy-induced hemorrhage was defined as a case in which a subject complained of bleeding from the rectum, and excretion of blood clots was confirmed. A blood test was performed before and after biopsy, and a questionnaire survey was given after the biopsy. Results Significantly fewer participants in group A required hemostasis after biopsy compared to group B (3 (2.0%) vs. 11 (8.5%), P=0.029). The results of the blood tests and the responses from the questionnaire did not differ significantly between the two groups. In multivariate analysis, only “insertion of a gelatin sponge into the rectum” emerged as a significant predictor of hemostasis. Conclusion Insertion of a gelatin sponge into the rectum after transrectal prostate needle biopsy significantly increases hemostasis without increasing patient symptoms, such as pain and a sense of discomfort. PMID:26005977

  12. A biomedical engineering approach to mitigate the errors of prostate biopsy.

    PubMed

    Ahmed, Hashim Uddin; Emberton, Mark; Kepner, Gordon; Kepner, Jeremy

    2012-02-07

    The current protocol for detecting and ruling out prostate cancer involves serum PSA testing followed by sampling of the prostate using a transrectal ultrasonography (TRUS)-guided biopsy. Many specialists have discussed how PSA screening has contributed to underdetection of clinically significant prostate cancer, overdiagnosis of clinically insignificant disease and poor risk stratification; however, little consideration has been given to the role of TRUS-guided biopsy in these errors. The performance of TRUS-guided biopsy is constrained by the biomechanical attributes of the sampling strategy, resulting in suboptimal detection efficiency of each core. By using a biomedical engineering approach, a uniform grid sampling strategy could be used to improve the detection efficiency of prostate biopsy. Moreover, the calibration of the sampling can be adjusted by altering the distance between needle deployments. Our model shows that for any given number of needle trajectories, a uniform grid approach will be superior to a divergent, nonuniform strategy for the detection of clinically important disease. This is an important message that should result in a move away from divergent sampling to a uniform grid approach for prostate biopsy.

  13. [The Diagnostic Value of Pre-Biopsy Magnetic Resonance Imaging (MRI) for Detecting Prostate Cancer].

    PubMed

    Mori, Kohei; Miyoshi, Yasuhide; Yoneyama, Shuko; Ishida, Hiroaki; Hattori, Yusuke; Teranishi, Jun-ichi; Kondo, Keiichi; Noguchi, Kazumi

    2016-01-01

    We examined the value of pre-biopsy magnetic resonance imaging (MRI) for detecting prostate cancer. We analyzed 267 men with prostate-specific antigen (PSA) levels of 3-10 ng/ml who underwent systematic prostate needle biopsy. From April 2009 to March 2011, a total of 98 male patients underwent 16-core prostatic biopsies without pre-biopsy magnetic resonance imaging (MRI) (nonenforcement group). From April 2011 to March 2013, 169 men underwent pre-biopsy MRI [T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)] (enforcement group). When MRI findings indicated cancer in the latter group, in addition to the systematic 16-core biopsy one or two targeted biopsies were performed. Patients without suspicious MRI findings underwent only systematic 16-core biopsy. Cancer detection rates in the nonenforcement and enforcement groups were 42.9% (48/92) and 46. 2% (78/169), respectively. The difference did not reach significance (p=0.612). Although the cancer detection rates were 39.4% (41/104) in the MRI-negative group and 56. 9% (37/65) in the MRI-positive group (p=0.039), the sensitivity and specificity for cancer detection by MRI were relatively low: 47.4% and 69.2%, respectively. By receiver-operating curve analysis, the area under the curve for cancer detection by MRI was only 0.583. There were two study limitations. First, the patient sample size was small. Second, it is unclear whether an adequate sample of the suspicious lesion was obtained by biopsy. We thus demonstrated that it might be improper to base a diagnosis solely on pre-biopsy MRI (T2WI and DWI) findings in men with serum PSA levels of 3-10 ng/ml.

  14. Can Confirmatory Biopsy be Omitted in Prostate Cancer Active Surveillance Patients with Favorable Diagnostic Features?

    PubMed Central

    Satasivam, Prassannah; Poon, Bing Ying; Ehdaie, Behfar; Vickers, Andrew J.; Eastham, James A.

    2016-01-01

    Purpose We evaluated whether initial diagnostic parameters could predict the confirmatory biopsy result in patients initiating active surveillance for prostate cancer, to determine whether some men at low risk of reclassification could be spared unnecessary biopsy. Materials and Methods The cohort included 392 men with Gleason 6 prostate cancer on initial biopsy undergoing confirmatory biopsy. We used univariate and multivariable logistic regression to assess if high-grade cancer (Gleason ≥ 7) on confirmatory biopsy could be predicted from initial diagnostic parameters (prostate-specific antigen density, magnetic resonance imaging result, percent positive cores, percent cancer in positive cores, and total tumor length). Results Median age was 62 years (IQR 56–66) and 47% of patients were found to have a dominant or focal lesion on magnetic resonance imaging. Of the 392 patients, 44 (11%) were found to have high-grade cancer on confirmatory biopsy, among whom 39 had 3+4, 1 had 4+3, 3 had Gleason 8, and 1 patient had Gleason 9 disease. All predictors were significantly associated with high-grade cancer at confirmatory biopsy on univariate analysis. However, in the multivariable model only prostate-specific antigen density and total tumor length were significantly associated (AUC of 0.85). Using this model to select patients for confirmatory biopsy would generally provide a higher net benefit than performing confirmatory biopsy in all patients, across a wide range of threshold probabilities. Conclusion If externally validated, a model based on initial diagnostic criteria could be used to avoid confirmatory biopsy in many patients initiating active surveillance. PMID:26192258

  15. The presence of prostate cancer at biopsy is predicted by a number of genetic variants.

    PubMed

    Kashyap, Aniruddh; Kluźniak, Wojciech; Wokołorczyk, Dominika; Gołąb, Adam; Sikorski, Andrzej; Słojewski, Marcin; Gliniewicz, Bartłomiej; Świtała, Jerzy; Borkowski, Tomasz; Borkowski, Andrzej; Antczak, Andrzej; Wojnar, Łukasz; Przybyła, Jacek; Sosnowski, Marek; Małkiewicz, Bartosz; Zdrojowy, Romuald; Sikorska-Radek, Paulina; Matych, Józef; Wilkosz, Jacek; Różański, Waldemar; Kiś, Jacek; Bar, Krzysztof; Bryniarski, Piotr; Paradysz, Andrzej; Jersak, Konrad; Niemirowicz, Jerzy; Słupski, Piotr; Jarzemski, Piotr; Skrzypczyk, Michał; Dobruch, Jakub; Domagała, Paweł; Piotrowski, Krzysztof; Jakubowska, Anna; Gronwald, Jacek; Huzarski, Tomasz; Byrski, Tomasz; Dębniak, Tadeusz; Górski, Bohdan; Masojć, Bartłomiej; van de Wetering, Thierry; Menkiszak, Janusz; Akbari, Mohammad R; Lubiński, Jan; Narod, Steven A; Cybulski, Cezary

    2014-03-01

    Several single nucleotide polymorphisms (SNPs) have been associated with an elevated risk of prostate cancer risk. It is not established if they are useful in predicting the presence of prostate cancer at biopsy or if they can be used to define a low-risk group of men. In this study, 4,548 men underwent a prostate biopsy because of an elevated prostate specific antigen (PSA; ≥4 ng/mL) or an abnormal digital rectal examination (DRE). All men were genotyped for 11 selected SNPs. The effect of each SNP, alone and in combination, on prostate cancer prevalence was studied. Of 4,548 men: 1,834 (40.3%) were found to have cancer. A positive association with prostate cancer was seen for 5 of 11 SNPs studied (rs1800629, rs1859962, rs1447295, rs4430796, rs11228565). The cancer detection rate rose with the number of SNP risk alleles from 29% for men with no variant to 63% for men who carried seven or more risk alleles (OR = 4.2; p = 0.002). The SNP data did not improve the predictive power of clinical factors (age, PSA and DRE) for detecting prostate cancer (AUC: 0.726 vs. 0.735; p = 0.4). We were unable to define a group of men with a sufficiently low prevalence of prostate cancer that a biopsy might have been avoided. In conclusion, our data do not support the routine use of SNP polymorphisms as an adjunct test to be used on the context of prostate biopsy for Polish men with an abnormal screening test.

  16. Deformable registration for integration of MRI/MRSI information in TRUS-guided prostate biopsy

    NASA Astrophysics Data System (ADS)

    Shao, Wei; Wu, Ruoyun; Thng, Choon Hua; Ling, Keck Voon; Ho, Henry Sun Sien; Cheng, Christopher Wai Sam; Ng, Wan Sing

    2005-04-01

    Prostate cancer has been ranked as the second leading cause of cancer death in men. The existence of cancer in prostate is usually examined by a biopsy procedure under the transrectal ultrasound (TRUS) guidance. Development of a prostate biopsy robotics can alleviate urologists' labor and guarantee accuracy. However, it is usually impossible to identify cancer region in the noisy ultrasound images, thus leading to a random biopsy protocol for prostate. It is being recognized that Magnetic Resonance Imaging (MRI) and Magnetic Resonance Spectroscopy Imaging (MRSI) techniques are potential to diagnose cancer distribution in prostate. So navigating the biopsy needle towards those cancer-suspected sites could improve the cancer detection rate and reduce the possibility of false negative diagnosis results. As the prostate usually deforms under the different rectal filling of probes and change of patient postures, a deformable registration scheme is implemented for the integration of the pre-operative MRI/MRSI information with the intra-operative TRUS images. A framework including a global rigid alignment and a sequent non-rigid transformation was described in this paper to match the cross-modal prostate surfaces and thereafter their volumes. For validation, an elastic prostate phantom that simulated the human condition was built up, with fiducial markers implanted inside the phantom prostate as the "ground truth". It shows that our method can achieve at least 30% improvement in accuracy compared with an affine transformation. Preliminary study was also conducted on patient data but with visual assessments presented only due to the current lack of "ground truth".

  17. Correlation of HOXD3 promoter hypermethylation with clinical and pathologic features in screening prostate biopsies

    PubMed Central

    Chen, Leonard N; Rubin, Rachel S; Othepa, Eugide; Cer, Caroline; Yun, Elizabeth; Agarwal, Raghunath P; Collins, Brian T; McGeagh, Kevin; Pahira, John; Bandi, Guarav; Kowalczyk, Keith; Kumar, Deepak; Dritschilo, Anatoly; Collins, Sean P; Bostwick, David G; Lynch, John H; Suy, Simeng

    2014-01-01

    BACKGROUND Molecular markers that can discriminate indolent cancers from aggressive ones may improve the management of prostate cancer and minimize unnecessary treatment. Aberrant DNA methylation is a common epigenetic event in cancers and HOXD3 promoter hypermethylation (H3PH) has been found in prostate cancer. Our objective was to evaluate the relationship between H3PH and clinicopathologic features in screening prostate biopsies. METHODS Ninety-two patients who underwent a prostate biopsy at our institution between October 2011 and May 2012 were included in this study. The core with the greatest percentage of the highest grade disease was analyzed for H3PH by methylation-specific PCR. Correlational analysis was used to analyze the relationship between H3PH and various clinical parameters. Chi-square analysis was used to compare H3PH status between benign and malignant disease. RESULTS Of the 80 biopsies with HOXD3 methylation status assessable, 66 sets were confirmed to have cancer. In the 14 biopsies with benign disease there was minimal H3PH with the mean percentage of methylation reference (PMR) of 0.7%. In contrast, the HOXD3 promoter was hypermethylated in 16.7% of all cancers and in 50% of high risk tumors with an average PMR of 4.3% (P = 0.008). H3PH was significantly correlated with age (P = 0.013), Gleason score (P = 0.031) and the maximum involvement of the biopsy core (P = 0.035). CONCLUSIONS H3PH is associated with clinicopathologic features. The data indicate that H3PH is more common in older higher risk patients. More research is needed to determine the role of this marker in optimizing management strategies in men with newly diagnosed prostate cancer. Prostate 74:714–721, 2014. © 2014 The Authors. The Prostate published by Wiley Periodicals, Inc. PMID:24847526

  18. Effect of hypertension on bacteria composition of prostate biopsy in patients with benign prostatic hyperplasia and prostate cancer in PSA grey-zone

    PubMed Central

    NI, XIAOFENG; MENG, HONGZHOU; ZHOU, FENG; YU, HAINING; XIANG, JIANJIAN; SHEN, SHENGRONG

    2016-01-01

    Diagnostic prostate cancer (PC) is difficult to diagnose by prostate biopsy, even in patients with markedly elevated PSA levels. Therefore, we aimed to identify a new, better technique to detect PC in a more consistent manner. A variety of steps were employed to validate this proposed method, including DNA extraction, polymerase chain reaction (PCR) amplification, denaturing gradient gel electrophoresis (DGGE) and DGGE band sequencing. Four transperineal prostate biopsy specimens were obtained from male patients. The patients were under the age of 65 and PSA levels were 4–10 ng/ml. We also investigated the bacteria composition of transperineal prostate biopsy in patients with benign prostatic hyperplasia (BPH) and PC by PCR-DGGE profiling. Sequences from selected bands 2 and 4 both matched with Sphingomonas, which is present in lower amounts in PC without hypertension as compared to PC with hypertension, while there were no particular differences in the BPH group. Specific bacteria from the prostate biopsy tissues provide further confidence in PC diagnosis based on a PCR approach as a diagnostic tool, while hypertension was found to be a disturbing factor that can affect the diagnosis of BPH and PC in grey-zone. PMID:27284421

  19. Probability modeling of the number of positive cores in a prostate cancer biopsy session, with applications.

    PubMed

    Serfling, Robert; Ogola, Gerald

    2016-02-10

    Among men, prostate cancer (CaP) is the most common newly diagnosed cancer and the second leading cause of death from cancer. A major issue of very large scale is avoiding both over-treatment and under-treatment of CaP cases. The central challenge is deciding clinical significance or insignificance when the CaP biopsy results are positive but only marginally so. A related concern is deciding how to increase the number of biopsy cores for larger prostates. As a foundation for improved choice of number of cores and improved interpretation of biopsy results, we develop a probability model for the number of positive cores found in a biopsy, given the total number of cores, the volumes of the tumor nodules, and - very importantly - the prostate volume. Also, three applications are carried out: guidelines for the number of cores as a function of prostate volume, decision rules for insignificant versus significant CaP using number of positive cores, and, using prior distributions on total tumor size, Bayesian posterior probabilities for insignificant CaP and posterior median CaP. The model-based results have generality of application, take prostate volume into account, and provide attractive tradeoffs of specificity versus sensitivity. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Transurethral biopsy of the prostatic urethra is associated with final apical margin status at radical cystoprostatectomy

    PubMed Central

    von Rundstedt, Friedrich-Carl; Mata, Douglas A; Shen, Steven; Li, Yi; Godoy, Guilherme; Lerner, Seth P

    2015-01-01

    Purpose Biopsy of the prostatic urethra is an integral part of clinical staging in patients prior to radical cystoprostatectomy (RC) and urinary diversion. We examined whether preoperative transurethral resection (TUR) biopsy was associated with final apical urethral margin status and hypothesized that a negative biopsy could replace intraoperative frozen section for decision making regarding the feasibility of orthotopic neobladder reconstruction. Methods TUR biopsy, frozen section, urethrectomy, and final apical urethral margin pathologic data were extracted from the charts of men who had undergone RC at the Houston Methodist Hospital between 1987 and 2013. TUR biopsies were performed at five and seven o’clock adjacent to the verumontanum. A positive biopsy was defined as the presence of in situ or invasive urothelial carcinoma. Clinical and perioperative variables were analyzed using descriptive and inferential statistics. Results We reviewed the medical records of 272 men. Preoperative TUR biopsies of the prostatic urethra were negative in 74% (200/272) and positive in 26% (72/272) of men. The overall incidence of apical urethral margin positivity on final pathology was 2.2% (six of 272). Four men underwent primary or secondary urethrectomy. TUR biopsy negative and positive predictive values for apical urethral margin positivity were 99.5% (95% confidence interval (CI): 97.2 to 99.9) and 6.9% (95% CI: 2.3 to 15.5), respectively. Conclusions The incidence of a positive apical urethral margin was low in patients undergoing RC. A negative preoperative TUR biopsy of the prostatic urethra was reliably associated with a negative final margin, obviating the need for intraoperative frozen section. Furthermore, a positive biopsy was not reliably associated with final margin status. These data will aid in the counseling of patients regarding the feasibility of neobladder reconstruction.

  1. The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey

    PubMed Central

    Bayar, Göksel; Horasanlı, Kaya; Acinikli, Hüseyin; Tanrıverdi, Orhan; Dalkılıç, Ayhan; Arısan, Serdar

    2016-01-01

    Objective To evaluate long-term outcomes of active surveillance (AS) applied in low-risk prostate cancer patients, and the impact of re-biopsy results on the prediction of progression. Material and methods In our clinic, patients who had undergone AS for low-risk localized prostate cancer between the years 2005–2013 were included in the study. Our AS criteria are Gleason score ≤6, prostate-specific antigen (PSA) level <10 ng/mL, number of positive cores <3, maximum cancer involvement ratio <50% each core. Immediate re-biopsy (within 3 months) was performed to 65 patients who accepted AS. Finally, 43 patients who met re-biopsy criteria were included in the study. Prostate biopsy specimens were harvested from 12 cores under the guidance of transrectal ultrasound (TRUS). Re-biopsy was performed within 3 months (1–12 weeks). In re-biopsy, a total of 20 core biopsies were performed including the far lateral (6 cores) and transition zone (2 cores) in addition to standard 12 core biopsy. Our follow-up protocol is PSA measurement and digital rectal examination (DRE) every 3 months within the first 2 years, than every 6 months. Control biopsies was performed one year later and once upon every 3 years to patients whose PSA levels and DREs were normal at follow-up visits. More than 2 tumor invaded cores or 50% tumor in one core, and Gleason score exceeding 6 points were accepted as indications for definitive treatment. Patients were divided into two groups by re-biopsy results and compared according to the time to progression. We have done multivariate regression analysis to predict prognosis by using data on age, PSA level, and detection of tumor in re-biopsy specimens. Results Patients’ median age was 61 years and PSA level was 5 (2.7–9) ng/mL. Tumor was detected in 22 (34%) patients at re-biopsy and they underwent definitive treatment. Additionally tumor was detected in 9 patients, but active surveillance was maintained because their pathologic results met active

  2. How does prostate biopsy guidance error impact pathologic cancer risk assessment?

    NASA Astrophysics Data System (ADS)

    Martin, Peter R.; Gaed, Mena; Gómez, José A.; Moussa, Madeleine; Gibson, Eli; Cool, Derek W.; Chin, Joseph L.; Pautler, Stephen; Fenster, Aaron; Ward, Aaron D.

    2016-03-01

    Magnetic resonance imaging (MRI)-targeted, 3D transrectal ultrasound (TRUS)-guided "fusion" prostate biopsy aims to reduce the 21-47% false negative rate of clinical 2D TRUS-guided sextant biopsy, but still has a substantial false negative rate. This could be improved via biopsy needle target optimization, accounting for uncertainties due to guidance system errors, image registration errors, and irregular tumor shapes. As an initial step toward the broader goal of optimized prostate biopsy targeting, in this study we elucidated the impact of biopsy needle delivery error on the probability of obtaining a tumor sample, and on the core involvement. These are both important parameters to patient risk stratification and the decision for active surveillance vs. definitive therapy. We addressed these questions for cancer of all grades, and separately for high grade (>= Gleason 4+3) cancer. We used expert-contoured gold-standard prostatectomy histology to simulate targeted biopsies using an isotropic Gaussian needle delivery error from 1 to 6 mm, and investigated the amount of cancer obtained in each biopsy core as determined by histology. Needle delivery error resulted in variability in core involvement that could influence treatment decisions; the presence or absence of cancer in 1/3 or more of each needle core can be attributed to a needle delivery error of 4 mm. However, our data showed that by making multiple biopsy attempts at selected tumor foci, we may increase the probability of correctly characterizing the extent and grade of the cancer.

  3. Effectiveness of stress management in patients undergoing transrectal ultrasound-guided biopsy of the prostate

    PubMed Central

    Chiu, Li-Pin; Tung, Heng-Hsin; Lin, Kuan-Chia; Lai, Yu-Wei; Chiu, Yi-Chun; Chen, Saint Shiou-Sheng; Chiu, Allen W

    2016-01-01

    Background To assess the utilization of stress management in relieving anxiety and pain among patients who undergo transrectal ultrasound (TRUS)-guided biopsy of the prostate. Methods Eighty-two patients admitted to a community hospital for a TRUS biopsy of the prostate participated in this case-controlled study. They were divided into an experimental group that was provided with stress management and a control group that received only routine nursing care. Stress management included music therapy and one-on-one simulation education. Before and after the TRUS biopsy, the patients’ state-anxiety inventory score, pain visual analogue scale (VAS), respiratory rate, heart rate, and blood pressure were obtained. Results There were no differences in baseline and disease characteristics between the two groups. The VAS in both groups increased after the TRUS biopsy, but the difference in pre- and postbiopsy VAS scores was significantly lower in the experimental group (P=0.03). Patients in both groups experienced mild anxiety before and after the biopsy, but those in the experimental group displayed a significantly greater decrease in postbiopsy state-anxiety inventory score compared to the control group (P=0.02). Conclusion Stress management can alleviate anxiety and pain in patients who received a TRUS biopsy of the prostate under local anesthesia. PMID:26929606

  4. The results of transperineal versus transrectal prostate biopsy: a systematic review and meta-analysis

    PubMed Central

    Shen, Peng-Fei; Zhu, Yu-Chun; Wei, Wu-Ran; Li, Yong-Zhong; Yang, Jie; Li, Yu-Tao; Li, Ding-Ming; Wang, Jia; Zeng, Hao

    2012-01-01

    This systematic review was performed to compare the efficacy and complications of transperineal (TP) vs. transrectal (TR) prostate biopsy. A systematic research of PUBMED, EMBASE and the Cochrane Library was performed to identify all clinical controlled trials on prostate cancer (PCa) detection rate and complications achieved by TP and TR biopsies. Prostate biopsies included sextant, extensive and saturation biopsy procedures. All patients were assigned to a TR group and a TP group. Subgroup analysis was performed according to prostate-specific antigen (PSA) levels and digital rectal examination (DRE) findings. The Cochrane Collaboration's RevMan 5.1 software was used for the meta-analysis. A total of seven trials, including three randomized controlled trials (RCTs) and four case–control studies (CCS), met our inclusion criteria. There was no significant difference in the cancer detection rate between the sextant TR and TP groups (risk difference (RD), −0.02; 95% confidence interval (CI), −0.08–0.03; P=0.34). Meta-analysis for RCTs combined with CCS showed that there was no difference in the cancer detection rate between the extensive TR and TP group (RD, −0.01; 95% CI, −0.05–0.04; P=0.81). There was no significant difference in PCa detection rate between the saturation TR and TP approaches (31.4% vs. 25.7%, respectively; P=0.3). There were also no significant differences in cancer detection between the TR and TP groups in each subgroup. Although the data on complications were not pooled for the meta-analysis, no significant difference was found when comparing TR and TP studies. TR and TP biopsies were equivalent in terms of efficiency and related complications. TP prostate biopsy should be an available and alternative procedure for use by urologists. PMID:22101942

  5. Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy

    PubMed Central

    Cormio, Luigi; Lucarelli, Giuseppe; Selvaggio, Oscar; Di Fino, Giuseppe; Mancini, Vito; Massenio, Paolo; Troiano, Francesco; Sanguedolce, Francesca; Bufo, Pantaleo; Carrieri, Giuseppe

    2016-01-01

    Abstract The purpose of this study was to investigate the relationship between bladder outlet obstruction (BOO) and the risk of being diagnosed with prostate cancer (PCa). Study population consisted of 2673 patients scheduled for the first prostate biopsy (PBx). All patients underwent uroflowmetry before PBx; those with a peak flow rate (PFR) <10 mL/s were considered to have BOO. The incidence of PCa was 41.3% (1104/2673) in the overall population and 34.1% (659/1905) in patients with serum prostate-specific antigen (PSA) ≤ 10 ng/mL. Univariate and multivariate logistic regression analyses showed that patients with BOO had a significantly (P < 0.0001) lower risk than those without BOO of being diagnosed with PCa (33.1% vs 66.9% in the overall population; 30% vs 70% in patients with PSA ≤ 10 ng/mL). As the presence of BOO was significantly correlated to a large prostate volume, another independent predictor of PBx outcome, we tested whether these parameters could be used to identify, in the subset of patients with PSA≤10 ng/mL, those who could potentially be spared from a PBx. If we would have not biopsied patients with BOO and prostate volume ≥60 mL, 14.5% of biopsies could have been avoided while missing only 6% of tumors. Only 10% of the tumors that would have been missed were high-risk cancers. In conclusion, in men undergoing PBx, the absence of BOO, as determined by a PFR ≥10 mL/s, is an independent risk factor for PCa. Our study provides ground for this simple, noninvasive, objective parameter being used, alone or in combination with prostate volume, in the decision-making process of men potentially facing a PBx. PMID:26886598

  6. Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy.

    PubMed

    Cormio, Luigi; Lucarelli, Giuseppe; Selvaggio, Oscar; Di Fino, Giuseppe; Mancini, Vito; Massenio, Paolo; Troiano, Francesco; Sanguedolce, Francesca; Bufo, Pantaleo; Carrieri, Giuseppe

    2016-02-01

    The purpose of this study was to investigate the relationship between bladder outlet obstruction (BOO) and the risk of being diagnosed with prostate cancer (PCa).Study population consisted of 2673 patients scheduled for the first prostate biopsy (PBx). All patients underwent uroflowmetry before PBx; those with a peak flow rate (PFR) <10 mL/s were considered to have BOO.The incidence of PCa was 41.3% (1104/2673) in the overall population and 34.1% (659/1905) in patients with serum prostate-specific antigen (PSA) ≤ 10 ng/mL. Univariate and multivariate logistic regression analyses showed that patients with BOO had a significantly (P < 0.0001) lower risk than those without BOO of being diagnosed with PCa (33.1% vs 66.9% in the overall population; 30% vs 70% in patients with PSA ≤ 10 ng/mL). As the presence of BOO was significantly correlated to a large prostate volume, another independent predictor of PBx outcome, we tested whether these parameters could be used to identify, in the subset of patients with PSA≤10 ng/mL, those who could potentially be spared from a PBx. If we would have not biopsied patients with BOO and prostate volume ≥60 mL, 14.5% of biopsies could have been avoided while missing only 6% of tumors. Only 10% of the tumors that would have been missed were high-risk cancers.In conclusion, in men undergoing PBx, the absence of BOO, as determined by a PFR ≥10 mL/s, is an independent risk factor for PCa. Our study provides ground for this simple, noninvasive, objective parameter being used, alone or in combination with prostate volume, in the decision-making process of men potentially facing a PBx.

  7. Rare complication after a transrectal ultrasound guided prostate biopsy: a giant retroperitoneal hematoma.

    PubMed

    Chiancone, Francesco; Mirone, Vincenzo; Fedelini, Maurizio; Meccariello, Clemente; Pucci, Luigi; Carrino, Maurizio; Fedelini, Paolo

    2016-05-24

    Common complications related to transrectal ultrasound (TRUS) guided prostatic needle biopsy are hematuria, hematospermia, and hematochezia. To the best of our knowledge, we report the second case of a very large hematoma extending from the pelvis into the retroperitoneal space in literature.A 66-year-old man with a serum prostate-specific antigen (PSA) of 5.4 ng/ml was admitted to our department for a TRUS-guided prostatic needle biopsy. Laboratory values on the day before biopsy, including coagulation studies, were all normal. The patients did not take any anticoagulant drugs. No immediate complications were encountered. Nevertheless, 7 hours after the biopsy, the patient reached our emergency department with severe diffuse abdominal pain, hypotension, tachycardia, and confusional state. He underwent an ultrasonography and then a computed tomography (CT) scan that showed "a blood collection in the pelvis that extending to the lower pole of left kidney associated with a focus of active contrast extravasation, indicating active ongoing prostate bleeding." Consequently, he underwent a diagnostic angiography that showed no more contrast extravasation, without the need of embolization. Management of hematoma has been conservative and hematoma was completely reabsorbed 4 months later.

  8. Outbreak of Achromobacter xylosoxidans and Ochrobactrum anthropi Infections after Prostate Biopsies, France, 2014.

    PubMed

    Haviari, Skerdi; Cassier, Pierre; Dananché, Cédric; Hulin, Monique; Dauwalder, Olivier; Rouvière, Olivier; Bertrand, Xavier; Perraud, Michel; Bénet, Thomas; Vanhems, Philippe

    2016-08-01

    We report an outbreak of healthcare-associated prostatitis involving rare environmental pathogens in immunocompetent patients undergoing transrectal prostate biopsies at Hôpital Édouard Herriot (Lyon, France) during August 13-October 10, 2014. Despite a fluoroquinolone-based prophylaxis, 5 patients were infected with Achromobacter xylosoxidans and 3 with Ochrobactrum anthropi, which has not been reported as pathogenic in nonimmunocompromised persons. All patients recovered fully. Analysis of the outbreak included case investigation, case-control study, biopsy procedure review, microbiologic testing of environmental and clinical samples, and retrospective review of hospital records for 4 years before the outbreak. The cases resulted from asepsis errors during preparation of materials for the biopsies. A low-level outbreak involving environmental bacteria was likely present for years, masked by antimicrobial drug prophylaxis and a low number of cases. Healthcare personnel should promptly report unusual pathogens in immunocompetent patients to infection control units, and guidelines should explicitly mention asepsis during materials preparation.

  9. Multi-parametric MRI-pathologic correlation of prostate cancer using tracked biopsies

    NASA Astrophysics Data System (ADS)

    Xu, Sheng; Turkbey, Baris; Kruecker, Jochen; Yan, Pingkun; Locklin, Julia; Pinto, Peter; Choyke, Peter; Wood, Bradford

    2010-02-01

    MRI is currently the most promising imaging modality for prostate cancer diagnosis due to its high resolution and multiparametric nature. However, currently there is no standard for integration of diagnostic information from different MRI sequences. We propose a method to increase the diagnostic accuracy of MRI by correlating biopsy specimens with four MRI sequences including T2 weighted MRI, Diffusion Weight Imaging, Dynamic Contrast Enhanced MRI and MRI spectroscopy. This method uses device tracking and image fusion to determine the specimen's position on MRI images. The proposed method is unbiased and cost effective. It does not substantially interfere with the standard biopsy workflow, allowing it to be easily accepted by physicians. A study of 41 patients was carried out to validate the approach. The performance of all four MRI sequences in various combinations is reported. Guidelines are given for multi-parametric imaging and tracked biopsy of prostate cancer.

  10. Comparison between ciprofloxacin and trimethoprim-sulfamethoxazole in antibiotic prophylaxis for transrectal prostate biopsy

    PubMed Central

    Atılgan, Doğan; Gençten, Yusuf; Kölükçü, Engin; Kılıç, Şahin; Uluocak, Nihat; Parlaktaş, Bekir Süha; Erdemir, Fikret

    2015-01-01

    Objective: The aim of this study was to compare the efficacies of oral ciprofloxacin administration and oral trimethoprim-sulfamethoxazole (TMP-SMX) regimens in preventing infectious complications following transrectal ultrasound guided biopsy of the prostate. Material and methods: Between 2011–2013, the medical records of 391 (mean age 64.62±7.64 years; range 40 to 87 years) patients who underwent transrectal prostate biopsies, due to suspicion of prostate cancer were retrospectively reviewed. While 500 mg ciprofloxacin was given orally twice daily starting one day before the procedure, continued for 3 days in the first 174 patients (group 1); was given orally twice daily starting one day before the procedure, continued for 3 days in the remaining 217 patients (group 2) for prophylaxis. Urine samples were obtained for urine culture before the procedure. The two groups were compared with respect to findings of urine cultures performed before and after the procedure and complications. Results: In the ciprofloxacin and groups, any positive urine culture before the procedure was not observed. Complications occured in 93 patients (37 in group 1 and 56 in group 2), after the procedure. Twenty-two (5.6%) (11 in group 1 and 11 in group 2). patients were admitted to our clinic because of high fever occurring after biopsy. Nine ciprofloxacin-treated (5.2%) and 16 TMP-SMX-treated (7.4%) patients had severe dysuria after the procedure. Twenty-one ciprofloxacin recipients (12.1%) and 40 TMP-SMX recipients (18.4%) had macroscopic hematuria. In the ciprofloxacin and TMP-SMX groups, the incidences of new culture positivity were 4% (n=7) and 2.8% (n=6) after the procedure, respectively. All of the isolated bacteria was Escherichia coli. While 11 patients were hospitalized due to signs of complicated urinary tract infections, and 2 patients were treated as outpatients. Rectal bleeding that did not require any intervention was observed in a patient 8 hours after biopsy. SIRS

  11. Determination of Optimum Formalin Fixation Duration for Prostate Needle Biopsies for Immunohistochemistry and Quantum Dot FISH Analysis.

    PubMed

    Sathyanarayana, Ubaradka G; Birch, Chandler; Nagle, Raymond B; Tomlins, Scott A; Palanisamy, Nallasivam; Zhang, Wenjun; Hubbard, Antony; Brunhoeber, Patrick; Wang, Yixin; Tang, Lei

    2015-01-01

    Prostate biopsy is the key clinical specimen for disease diagnosis. However, various conditions used during biopsy processing for histologic analysis may affect the performance of diagnostic tests, such as hematoxylin and eosin (H&E) staining, immunohistochemistry (IHC), or in situ hybridization (ISH). One such condition that may affect diagnostic test performance is fixation duration in 10% neutral buffered formalin (NBF). For example, prostate needle biopsies are often <1 mm in diameter and thus overfixed. It is important to understand the impact of tissue fixation duration on diagnostic test performance to enable optimized assay procedures. This study was designed to study the effect of 10% NBF fixation duration of prostate needle biopsy on multiplexed quantum dot (QD) ISH assay of ERG and PTEN, 2 genes commonly altered in prostate cancer. The samples were also evaluated for H&E staining and ERG and PTEN IHC. H&E staining and ERG and PTEN IHC were acceptable for all the durations of fixation tested. For QD ISH, we observed good signals with biopsy samples fixed from 4 to 120 hours. Biopsy specimens fixed between 8 and 72 hours gave the best signal as scored by the study pathologist. In a separate cohort of 18 routinely processed prostate biopsy cores, all cores were stained successfully with the QD ISH assay, and results were 100% concordant to ERG and PTEN IHC. We conclude that 8 to 72 hours duration of fixation for prostate needle biopsies in 10% NBF results in optimal QD ISH assay performance.

  12. Serial transperineal sector prostate biopsies: impact on long-term erectile dysfunction.

    PubMed

    Chong, James Jy; Van Hemelrijck, Mieke; Cahill, Declan; Kinsella, Janette

    2016-01-01

    We wanted to determine whether serial transperineal sector prostate biopsies have a long-term effect on erectile dysfunction (ED). A total of 64 men with prostate cancer entered our active surveillance (AS) programme after a transrectal prostate biopsy as well as a confirmatory initial transperineal sector prostate biopsy (TPSBx). A repeat TPSBx was performed 24 months later as part of our active surveillance protocol. The International Index of Erectile Function-5 (IIEF-5) questionnaire assessed ED at baseline prior to each TPSBx, and at one, three, and six months after first and second TPSBx. There was a significant short-term deterioration in erectile function on mean IIEF-5 score between baseline (19.5), when compared to one month (10.5) (P <0.001) and three months (18.7) (P = 0.001) following first TPSBx. This resolved at six month follow-up (19.6) (P = 0.681). Following second TPSBx, there was a deterioration in erectile function between baseline (16.6), compared to one month (7.3), three months (13.8), and six months (15.9) (P <0.05) following second TPSBx. Initial TPSBx caused significant short-term ED, which resolved by six months. Serial TPSBx appears to have an adverse impact on erectile function in men monitored on AS, increasing the risk of long-term ED. This risk should be highlighted and discussed during the consent process. PMID:27350788

  13. Toward 3D-guided prostate biopsy target optimization: an estimation of tumor sampling probabilities

    NASA Astrophysics Data System (ADS)

    Martin, Peter R.; Cool, Derek W.; Romagnoli, Cesare; Fenster, Aaron; Ward, Aaron D.

    2014-03-01

    Magnetic resonance imaging (MRI)-targeted, 3D transrectal ultrasound (TRUS)-guided "fusion" prostate biopsy aims to reduce the ~23% false negative rate of clinical 2D TRUS-guided sextant biopsy. Although it has been reported to double the positive yield, MRI-targeted biopsy still yields false negatives. Therefore, we propose optimization of biopsy targeting to meet the clinician's desired tumor sampling probability, optimizing needle targets within each tumor and accounting for uncertainties due to guidance system errors, image registration errors, and irregular tumor shapes. We obtained multiparametric MRI and 3D TRUS images from 49 patients. A radiologist and radiology resident contoured 81 suspicious regions, yielding 3D surfaces that were registered to 3D TRUS. We estimated the probability, P, of obtaining a tumor sample with a single biopsy. Given an RMS needle delivery error of 3.5 mm for a contemporary fusion biopsy system, P >= 95% for 21 out of 81 tumors when the point of optimal sampling probability was targeted. Therefore, more than one biopsy core must be taken from 74% of the tumors to achieve P >= 95% for a biopsy system with an error of 3.5 mm. Our experiments indicated that the effect of error along the needle axis on the percentage of core involvement (and thus the measured tumor burden) was mitigated by the 18 mm core length.

  14. Significant impact of transperineal template biopsy of the prostate at a single tertiary institution

    PubMed Central

    Huang, Sean; Reeves, Fairleigh; Preece, Jessica; Satasivam, Prassannah; Royce, Peter; Grummet, Jeremy P.

    2015-01-01

    Objective: The objective was to review the impact of transperineal biopsy (TPB) at our institution by assessing rates of cancer detection/grading, treatment outcomes and complications. Patients and Methods: A retrospective review of TPBs between 2009 and 2013 was performed. Variables included reason for TPB, age, prostate-specific antigen, previous histology, TPB histology, and management outcomes. Results: In total, 110 patients underwent 111 TPBs at our institution. On average, 22 cores were taken from each procedure. Disease-upgrade occurred in 37.5% of active surveillance patients, 35% of patients with previous negative transrectal ultrasound, and 58.8% in patients undergoing TPB for other reasons. Of these patients, anterior and/or transition zones were involved in 66%, 79%, and 80%, respectively. Involvement in anterior and/or transition zones only occurred in 40%, 37%, and 10%, respectively. About 77% of patients with disease-upgrading underwent treatment with curative intent. Complications included a 6.3% rate of acute urinary retention and 2.7% of clot retention, with no episodes of urosepsis. Conclusions: Transperineal biopsy at our institution showed a high rate of disease-upgrading, with a large proportion involving anterior and transition zones. A significant amount of patients went on to receive curative treatment. TPB is a valuable diagnostic procedure with minimal risk of developing urosepsis. We believe TBP should be offered as an option for all repeat prostate biopsies and considered as an option for initial prostate biopsy. PMID:26692659

  15. Hematoma in Retzius' space following US-guided prostate biopsy: evidence of the diagnostic accuracy using transrectal end-fire probe in the anterior prostate gland.

    PubMed

    Dell'atti, Lucio

    2014-03-01

    We report a rare case of hematoma in Retzius' space in a 62-year-old man who underwent transrectal prostate biopsy using an endocavitary, end-fire, convex probe. Clinical symptoms resolved spontaneously after catheter placement and appropriate antibiotic therapy. Transrectal ultrasound 1 month later showed partial resolution of the hematoma. Based on the analysis of this unusual complication, we demonstrate the effectiveness of transrectal biopsy as compared to transperineal biopsy in detecting cancer of the anterior prostate. We have also analyzed the various factors that may be the reason why core biopsy harvested in this "hidden" area may be inadequate.

  16. Cell type specific gene expression analysis of prostate needle biopsies resolves tumor tissue heterogeneity.

    PubMed

    Krönig, Malte; Walter, Max; Drendel, Vanessa; Werner, Martin; Jilg, Cordula A; Richter, Andreas S; Backofen, Rolf; McGarry, David; Follo, Marie; Schultze-Seemann, Wolfgang; Schüle, Roland

    2015-01-20

    A lack of cell surface markers for the specific identification, isolation and subsequent analysis of living prostate tumor cells hampers progress in the field. Specific characterization of tumor cells and their microenvironment in a multi-parameter molecular assay could significantly improve prognostic accuracy for the heterogeneous prostate tumor tissue. Novel functionalized gold-nano particles allow fluorescence-based detection of absolute mRNA expression levels in living cells by fluorescent activated flow cytometry (FACS). We use of this technique to separate prostate tumor and benign cells in human prostate needle biopsies based on the expression levels of the tumor marker alpha-methylacyl-CoA racemase (AMACR). We combined RNA and protein detection of living cells by FACS to gate for epithelial cell adhesion molecule (EPCAM) positive tumor and benign cells, EPCAM/CD45 double negative mesenchymal cells and CD45 positive infiltrating lymphocytes. EPCAM positive epithelial cells were further sub-gated into AMACR high and low expressing cells. Two hundred cells from each population and several biopsies from the same patient were analyzed using a multiplexed gene expression profile to generate a cell type resolved profile of the specimen. This technique provides the basis for the clinical evaluation of cell type resolved gene expression profiles as pre-therapeutic prognostic markers for prostate cancer.

  17. Cell type specific gene expression analysis of prostate needle biopsies resolves tumor tissue heterogeneity

    PubMed Central

    Krönig, Malte; Walter, Max; Drendel, Vanessa; Werner, Martin; Jilg, Cordula A.; Richter, Andreas S.; Backofen, Rolf; McGarry, David; Follo, Marie; Schultze-Seemann, Wolfgang; Schüle, Roland

    2015-01-01

    A lack of cell surface markers for the specific identification, isolation and subsequent analysis of living prostate tumor cells hampers progress in the field. Specific characterization of tumor cells and their microenvironment in a multi-parameter molecular assay could significantly improve prognostic accuracy for the heterogeneous prostate tumor tissue. Novel functionalized gold-nano particles allow fluorescence-based detection of absolute mRNA expression levels in living cells by fluorescent activated flow cytometry (FACS). We use of this technique to separate prostate tumor and benign cells in human prostate needle biopsies based on the expression levels of the tumor marker alpha-methylacyl-CoA racemase (AMACR). We combined RNA and protein detection of living cells by FACS to gate for epithelial cell adhesion molecule (EPCAM) positive tumor and benign cells, EPCAM/CD45 double negative mesenchymal cells and CD45 positive infiltrating lymphocytes. EPCAM positive epithelial cells were further sub-gated into AMACR high and low expressing cells. Two hundred cells from each population and several biopsies from the same patient were analyzed using a multiplexed gene expression profile to generate a cell type resolved profile of the specimen. This technique provides the basis for the clinical evaluation of cell type resolved gene expression profiles as pre-therapeutic prognostic markers for prostate cancer. PMID:25514598

  18. The detection and upgrade rates of prostate adenocarcinoma following transperineal template-guided prostate biopsy – a tertiary referral centre experience

    PubMed Central

    Telford, Robert; Viney, Richard; Patel, Prashant

    2016-01-01

    Introduction We aim to present transperineal template-guided prostate biopsy (template biopsy) outcomes at a tertiary referral centre. Furthermore, to identify the detection rate of prostate cancer in those with a previous negative transrectal ultrasound guided prostate biopsy and the upgrade rate of those on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma. Material and methods We conducted a prospective study of 200 consecutive men who underwent template biopsy over a 22-month period in a tertiary referral centre, using a standard 24 region template prostate biopsy technique. Indications and histology results, as well as complications, were recorded. Results Median age was 67 years and median PSA was 10 ng/mL. Overall detection rate was 47%. 39.5% of cases with previous negative transrectal biopsies were found to have prostate adenocarcinoma. 47.5% of cases on active surveillance for Gleason 3 + 3 = 6 prostate adenocarcinoma were upgraded. The most frequent complication was acute urinary retention at a rate of 12.5%, however, the use of a single prophylactic dose of tamsulosin was found to be beneficial, with 13 cases needed to treat to prevent one episode. Conclusions Template biopsies are safe and efficacious with an overall detection rate of 47% in the present series. Due to the high detection rate, one must consider template biopsy following one negative transrectal biopsy where there is persistent clinical suspicion. Furthermore, those considering active surveillance for Gleason 3 + 3 = 6 disease should be offered template biopsy to confirm the grade of their disease. PMID:27123325

  19. Stratification of the aggressiveness of prostate cancer using pre-biopsy multiparametric MRI (mpMRI).

    PubMed

    Dwivedi, Durgesh Kumar; Kumar, Rajeev; Bora, Girdhar S; Thulkar, Sanjay; Sharma, Sanjay; Gupta, Siddhartha Datta; Jagannathan, Naranamangalam R

    2016-03-01

    Risk stratification, based on the Gleason score (GS) of a prostate biopsy, is an important decision-making tool in prostate cancer management. As low-grade disease may not need active intervention, the ability to identify aggressive cancers on imaging could limit the need for prostate biopsies. We assessed the ability of multiparametric MRI (mpMRI) in pre-biopsy risk stratification of men with prostate cancer. One hundred and twenty men suspected to have prostate cancer underwent mpMRI (diffusion MRI and MR spectroscopic imaging) prior to biopsy. Twenty-six had cancer and were stratified into three groups based on GS: low grade (GS ≤ 6), intermediate grade (GS = 7) and high grade (GS ≥ 8). A total of 910 regions of interest (ROIs) from the peripheral zone (PZ, range 25-45) were analyzed from these 26 patients. The metabolite ratio [citrate/(choline + creatine)] and apparent diffusion coefficient (ADC) of voxels were calculated for the PZ regions corresponding to the biopsy cores and compared with histology. The median metabolite ratios for low-grade, intermediate-grade and high-grade cancer were 0.29 (range: 0.16, 0.61), 0.17 (range: 0.13, 0.32) and 0.13 (range: 0.05, 0.23), respectively (p = 0.004). The corresponding mean ADCs (×10(-3) mm(2) /s) for low-grade, intermediate-grade and high-grade cancer were 0.99 ± 0.08, 0.86 ± 0.11 and 0.69 ± 0.12, respectively (p < 0.0001). The combined ADC and metabolite ratio model showed strong discriminatory ability to differentiate subjects with GS ≤ 6 from subjects with GS ≥ 7 with an area under the curve of 94%. These data indicate that pre-biopsy mpMRI may stratify PCa aggressiveness noninvasively. As the recent literature data suggest that men with GS ≤ 6 cancer may not need radical therapy, our data may help limit the need for biopsy and allow informed decision making for clinical intervention. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Multiple cores of high grade prostatic intraepithelial neoplasia and any core of atypia on first biopsy are significant predictor for cancer detection at a repeat biopsy

    PubMed Central

    Kim, Tae Sun; Ko, Kwang Jin; Shin, Seung Jea; Ryoo, Hyun Soo; Song, Wan; Sung, Hyun Hwan; Han, Deok Hyun; Jeong, Byong Chang; Seo, Seong Il; Jeon, Seong Soo; Lee, Kyu Sung; Lee, Sung Won; Lee, Hyun Moo; Choi, Han Yong

    2015-01-01

    Purpose To investigate the differences in the cancer detection rate and pathological findings on a second prostate biopsy according to benign diagnosis, high-grade prostatic intraepithelial neoplasia (HGPIN), and atypical small acinar proliferation (ASAP) on first biopsy. Materials and Methods We retrospectively reviewed the records of 1,323 patients who underwent a second prostate biopsy between March 1995 and November 2012. We divided the patients into three groups according to the pathologic findings on the first biopsy (benign diagnosis, HGPIN, and ASAP). We compared the cancer detection rate and Gleason scores on second biopsy and the unfavorable disease rate after radical prostatectomy among the three groups. Results A total of 214 patients (16.2%) were diagnosed with prostate cancer on a second biopsy. The rate of cancer detection was 14.6% in the benign diagnosis group, 22.1% in the HGPIN group, and 32.1% in the ASAP group, respectively (p<0.001). When patients were divided into subgroups according to the number of positive cores, the rate of cancer detection was 16.7%, 30.5%, 31.0%, and 36.4% in patients with a single core of HGPIN, more than one core of HGPIN, a single core of ASAP, and more than one core of ASAP, respectively. There were no significant differences in Gleason scores on second biopsy (p=0.324) or in the unfavorable disease rate after radical prostatectomy among the three groups (benign diagnosis vs. HGPIN, p=0.857, and benign diagnosis vs. ASAP, p=0.957, respectively). Conclusions Patients with multiple cores of HGPIN or any core number of ASAP on a first biopsy had a significantly higher cancer detection rate on a second biopsy. Repeat biopsy should be considered and not be delayed in those patients. PMID:26682019

  1. Variability in diagnostic opinion among pathologists for single small atypical foci in prostate biopsies.

    PubMed

    Van der Kwast, Theodorus H; Evans, Andrew; Lockwood, Gina; Tkachuk, Doug; Bostwick, David G; Epstein, Jonathan I; Humphrey, Peter A; Montironi, Rodolfo; Van Leenders, Geert J L H; Pihl, Carl-Gustaf; Neetens, Ingrid; Kujala, Paula M; Laurila, Marita; Mazerolles, Catharine; Bubendorf, Lukas; Finelli, Antonio; Watson, Kemp; Srigley, John

    2010-02-01

    Pathologists are increasingly exposed to prostate biopsies with small atypical foci, requiring differentiation between adenocarcinoma, atypical small acinar proliferation suspicious for malignancy, and a benign diagnosis. We studied the level of agreement for such atypical foci among experts in urologic pathology and all-round reference pathologists of the European Randomized Screening study of Prostate Cancer (ERSPC). For this purpose, we retrieved 20 prostate biopsies with small (most <1 mm) atypical foci. Hematoxylin and eosin-stained slides, including 10 immunostained slides were digitalized for virtual microscopy. The lesional area was not marked. Five experts and 7 ERSPC pathologists examined the cases. Multirater kappa statistics was applied to determine agreement and significant differences between experts and ERSPC pathologists. The kappa value of experts (0.39; confidence interval, 0.29-0.49) was significantly higher than that of ERSPC pathologists (0.21; confidence interval, 0.14-0.27). Full (100%) agreement was reached by the 5 experts for 7 of 20 biopsies. Experts and ERSPC pathologists rendered diagnoses ranging from benign to adenocarcinoma on the same biopsy in 5 and 9 biopsies, respectively. Most of these lesions comprised between 2 and 5 atypical glands. The experts diagnosed adenocarcinoma (49%) more often than the ERSPC pathologists (32%) (P<0.001). As agreement was particularly poor for foci comprising <6 glands, we would encourage pathologists to obtain intercollegial consultation of a specialized pathologist for these lesions before a carcinoma diagnosis, whereas clinicians may consider to perform staging biopsies before engaging on deferred or definite therapy. PMID:20061936

  2. Pathologic findings in patients with targeted magnetic resonance imaging-guided prostate needle core biopsies

    PubMed Central

    Geller, Rachel L; Nour, Sherif G; Osunkoya, Adeboye O

    2015-01-01

    In contrast to the routine (non-targeted) sampling approach of transrectal ultrasound guided biopsies (TRUS-GB), targeted magnetic resonance imaging-guided biopsies (TMRI-GB) target regions of the prostate suspicious for prostate cancer (PCa), based on findings on multiparametric MRI. We sought to examine the pathologic findings identified on TMRI-GB, due to the fact that there are limited studies on this in the Pathology literature. A search was made through our Urologic Pathology files for prostate needle core biopsies that were obtained via TMRI-GB. Forty-six patients were identified. Mean patient (PT) age was 62 years (range: 50-78 years). Twenty one of 46 PTs (46%) had a history of PCa, 10/46 PTs (22%) had a history of negative TRUS-GB and rising PSA, and the remaining 15/46 PTs (32%) had never undergone biopsy. Cancer detection rate on TMRI-GB was 57% for PTs with a prior diagnosis of PCa, 50% for PTs with a history of benign biopsy, and 67% who were biopsy naïve. An average of 3.16 cores were sampled from malignant lesions and an average of 2.74 were sampled from benign lesions (P=0.02). TMRI-GB has a higher cancer detection rate than TRUS-GB. TMRI-GB may have a critical role as a tool for active surveillance, tumor mapping, and primary detection of PCa, which will likely evolve as the ability to identify malignant lesions improve. The roles of pathologists and radiologists in the validation of this procedure will continue to be even more vital in the future. PMID:26617689

  3. Non-rigid MRI-TRUS registration in targeted prostate biopsy

    NASA Astrophysics Data System (ADS)

    Marami, Bahram; Sirouspour, Shahin; Ghoul, Suha; Emami Abarghouei, Shadi; Sun, Yue; Fenster, Aaron

    2015-03-01

    A non-rigid registration method is presented for the alignment of pre-procedural magnetic resonance (MR) images with delineated suspicious regions to intra-procedural 3D transrectal ultrasound (TRUS) images in TRUS-guided prostate biopsy. In the first step, 3D MR and TRUS images are aligned rigidly using six pairs of manually identified approximate matching points on the boundary of the prostate. Then, two image volumes are non-rigidly registered using a finite element method (FEM)-based linear elastic deformation model. A vector of observation prediction errors at some points of interest within the prostate volume is computed using an intensity-based similarity metric called the modality independent neighborhood descriptor (MIND). The error vector is employed in a classical state estimation framework to estimate prostate deformation between MR and TRUS images. The points of interests are identified using speeded-up robust features (SURF) that are scale and rotation-invariant descriptors in MR images. The proposed registration method on 10 sets of prostate MR and TRUS images yielded a target registration error of 1.99+/-0.83 mm, and 1.97+/-0.87 mm in the peripheral zone (PZ) and whole gland (WG), respectively, using 68 manually-identified fiducial points. The Dice similarity coefficient (DSC) was 87.9+/-2.9, 82.3+/-4.8, 93.0+/-1.7, and 84.2+/-6.2 percent for the WG, apex, mid-gland and base of the prostate, respectively. Moreover, the mean absolute distances (MAD) between the WG surfaces in the TRUS and registered MR images was 1.6+/-0.3 mm. Registration results indicate effectiveness of the proposed method in improving the targeting accuracy in the TRUS-guided prostate biopsy.

  4. Reducing Infectious Complications Following Transrectal Ultrasound-guided Prostate Biopsy: A Systematic Review

    PubMed Central

    Walker, Jordon T.; Singla, Nirmish; Roehrborn, Claus G.

    2016-01-01

    A rise in antimicrobial resistant uropathogens has generated a global increase in infections following transrectal ultrasound-guided prostate biopsy (TRUS-Bx). We performed a systematic search of Ovid MEDLINE® and PubMed to comprehensively review strategies to mitigate infections. Of 1664 articles retrieved, 62 were included. The data suggest that augmented prophylaxis and povidone-iodine bowel preparation warrant consideration in regions with high rates of antimicrobial resistance. Transperineal biopsy may be a safer, equally effective alternative to TRUS-Bx in select cases. Recent international travel appears to increase patients’ risk for experiencing infections. These findings can aid clinicians in minimizing post-TRUS-Bx infectious complications. PMID:27601966

  5. Reducing Infectious Complications Following Transrectal Ultrasound-guided Prostate Biopsy: A Systematic Review

    PubMed Central

    Walker, Jordon T.; Singla, Nirmish; Roehrborn, Claus G.

    2016-01-01

    A rise in antimicrobial resistant uropathogens has generated a global increase in infections following transrectal ultrasound-guided prostate biopsy (TRUS-Bx). We performed a systematic search of Ovid MEDLINE® and PubMed to comprehensively review strategies to mitigate infections. Of 1664 articles retrieved, 62 were included. The data suggest that augmented prophylaxis and povidone-iodine bowel preparation warrant consideration in regions with high rates of antimicrobial resistance. Transperineal biopsy may be a safer, equally effective alternative to TRUS-Bx in select cases. Recent international travel appears to increase patients’ risk for experiencing infections. These findings can aid clinicians in minimizing post-TRUS-Bx infectious complications.

  6. Reducing Infectious Complications Following Transrectal Ultrasound-guided Prostate Biopsy: A Systematic Review.

    PubMed

    Walker, Jordon T; Singla, Nirmish; Roehrborn, Claus G

    2016-01-01

    A rise in antimicrobial resistant uropathogens has generated a global increase in infections following transrectal ultrasound-guided prostate biopsy (TRUS-Bx). We performed a systematic search of Ovid MEDLINE® and PubMed to comprehensively review strategies to mitigate infections. Of 1664 articles retrieved, 62 were included. The data suggest that augmented prophylaxis and povidone-iodine bowel preparation warrant consideration in regions with high rates of antimicrobial resistance. Transperineal biopsy may be a safer, equally effective alternative to TRUS-Bx in select cases. Recent international travel appears to increase patients' risk for experiencing infections. These findings can aid clinicians in minimizing post-TRUS-Bx infectious complications. PMID:27601966

  7. Target detection: magnetic resonance imaging-ultrasound fusion-guided prostate biopsy.

    PubMed

    Sonn, Geoffrey A; Margolis, Daniel J; Marks, Leonard S

    2014-08-01

    Recent advances in multiparametric magnetic resonance imaging (MRI) have enabled image-guided detection of prostate cancer. Fusion of MRI with real-time ultrasound (US) allows the information from MRI to be used to direct biopsy needles under US guidance in an office-based procedure. Fusion can be performed either cognitively or electronically, using a fusion device. Fusion devices allow superimposition (coregistration) of stored MRI images on real-time US images; areas of suspicion found on MRI can then serve as targets during US-guided biopsy. Currently available fusion devices use a variety of technologies to perform coregistration: robotic tracking via a mechanical arm with built-in encoders (Artemis/Eigen, BioJet/Geoscan); electromagnetic tracking (UroNav/Philips-Invivo, Hi-RVS/Hitachi); or tracking with a 3D US probe (Urostation/Koelis). Targeted fusion biopsy has been shown to identify more clinically significant cancers and fewer insignificant cancers than conventional biopsy. Fusion biopsy appears to be a major advancement over conventional biopsy because it allows (1) direct targeting of suspicious areas not seen on US and (2) follow-up biopsy of specific cancerous sites in men undergoing active surveillance. PMID:24239473

  8. Target detection: Magnetic resonance imaging-ultrasound fusion–guided prostate biopsy

    PubMed Central

    Sonn, Geoffrey A.; Margolis, Daniel J.; Marks, Leonard S.

    2014-01-01

    Recent advances in multiparametric magnetic resonance imaging (MRI) have enabled image-guided detection of prostate cancer. Fusion of MRI with real-time ultrasound (US) allows the information from MRI to be used to direct biopsy needles under US guidance in an office-based procedure. Fusion can be performed either cognitively or electronically, using a fusion device. Fusion devices allow superimposition (coregistration) of stored MRI images on real-time US images; areas of suspicion found on MRI can then serve as targets during US-guided biopsy. Currently available fusion devices use a variety of technologies to perform coregistration: robotic tracking via a mechanical arm with built-in encoders (Artemis/Eigen, BioJet/Geoscan); electromagnetic tracking (UroNav/Philips-Invivo, Hi-RVS/Hitachi); or tracking with a 3D US probe (Urostation/Koelis). Targeted fusion biopsy has been shown to identify more clinically significant cancers and fewer insignificant cancers than conventional biopsy. Fusion biopsy appears to be a major advancement over conventional biopsy because it allows (1) direct targeting of suspicious areas not seen on US and (2) follow-up biopsy of specific cancerous sites in men undergoing active surveillance. PMID:24239473

  9. Radiofrequency identification specimen tracking in anatomical pathology: pilot study of 1067 consecutive prostate biopsies.

    PubMed

    Bostwick, David G

    2013-10-01

    Improved methods such as radiofrequency identification (RFID) are needed to optimize specimen tracking in anatomical pathology. We undertook a study of RFID in an effort to optimize specimen tracking and patient identification, including the following: (1) creation of workflow process maps, (2) evaluation of existing RFID hardware technologies, (3) creation of Web-based software to support the RFID-enabled workflow, and (4) assessment of the impact with a series of prostate biopsies. We identified multiple steps in the workflow process in which RFID enhanced specimen tracking. Multiple product choices were found that could withstand the harsh heat and chemical environments encountered in pathology processing, and software that was compatible with our laboratory information system was designed in-house. A total of 1067 prostate biopsies were received, and 78.3% were successfully processed with the RFID system. Radiofrequency identification allowed dynamic specimen tracking throughout the workflow process in anatomical pathology. PMID:23796559

  10. A four-kallikrein panel for the prediction of repeat prostate biopsy: data from the European Randomized Study of Prostate Cancer Screening in Rotterdam, Netherlands

    PubMed Central

    Gupta, A; Roobol, M J; Savage, C J; Peltola, M; Pettersson, K; Scardino, P T; Vickers, A J; Schröder, F H; Lilja, H

    2010-01-01

    Background: Most men with elevated levels of prostate-specific antigen (PSA) do not have prostate cancer, leading to a large number of unnecessary biopsies. A statistical model based on a panel of four kallikreins has been shown to predict the outcome of a first prostate biopsy. In this study, we apply the model to an independent data set of men with previous negative biopsy but persistently elevated PSA. Methods: The study cohort consisted of 925 men with a previous negative prostate biopsy and elevated PSA (⩾3 ng ml−1), with 110 prostate cancers detected (12%). A previously published statistical model was applied, with recalibration to reflect the lower positive biopsy rates on rebiopsy. Results: The full-kallikrein panel had higher discriminative accuracy than PSA and DRE alone, with area under the curve (AUC) improving from 0.58 (95% confidence interval (CI): 0.52, 0.64) to 0.68 (95% CI: 0.62, 0.74), P<0.001, and high-grade cancer (Gleason ⩾7) at biopsy with AUC improving from 0.76 (95% CI: 0.64, 0.89) to 0.87 (95% CI: 0.81, 0.94), P=0.003). Application of the panel to 1000 men with persistently elevated PSA after initial negative biopsy, at a 15% risk threshold would reduce the number of biopsies by 712; would miss (or delay) the diagnosis of 53 cancers, of which only 3 would be Gleason 7 and the rest Gleason 6 or less. Conclusions: Our data constitute an external validation of a previously published model. The four-kallikrein panel predicts the result of repeat prostate biopsy in men with elevated PSA while dramatically decreasing unnecessary biopsies. PMID:20664589

  11. Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

    PubMed Central

    Shahait, Mohammed; Degheili, Jad; El-Merhi, Fadi; Tamim, Hani; Nasr, Rami

    2016-01-01

    ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS) guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03), and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02). Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy. PMID:27136468

  12. Relationship Between Perineural Invasion in Prostate Needle Biopsy Specimens and Pathologic Staging After Radical Prostatectomy

    PubMed Central

    Niroomand, Hassan; Nowroozi, Mohammadreza; Ayati, Mohsen; Jamshidian, Hassan; Arbab, Amir; Momeni, Seyed Ali; Ghadian, Alireza; Ghorbani, Hamidreza

    2016-01-01

    Background Prostate cancer is the second most common malignancy among men worldwide and the sixth cause of cancer-related death. Some authors have reported a relationship between perineural invasion (PNI), Gleason score, and the invasion of peripheral organs during prostatectomy. However, it is not yet clear whether pathological evidence of PNI is necessary for risk stratification in selecting treatment type. Objectives The clinical and pathological stages of prostate cancer are compared in patients under radical prostatectomy and in patients without perineural invasion. Patients and Methods This cross-sectional study was conducted using a sample of 109 patients who attended a tertiary health care center from 2008 to 2013. The selection criteria were PNI in prostate biopsy with Gleason scores less than six, seven, and eight to ten. The participants were enrolled in a census manner, and they underwent clinical staging. After radical prostatectomy, the rates of pathological staging were compared. The under-staging and over-staging rates among those with and without perineural invasion in biopsy samples were compared. Results The concordance between Gleason scores according to biopsy and pathology was 36.7% (40 subjects). The concordance rate was 46.4% and 33.3% among those with and without PNI, respectively. The concordance rates were significantly varied in different subclasses of Gleason scores in patients without PNI (P = 0.003); the highest concordance rate was a Gleason score of 7 (63.6%) and the lowest was a Gleason score of eight to ten (25%). However, there were no significant differences in patients with PNI (P > 0.05). Conclusions Although the presence of PNI in prostate biopsy is accompanied by higher surgical stages, PNI is not an appropriate independent factor in risk stratification. PMID:27635390

  13. Transrectal-ultrasound prostatic biopsy preparation: rectal enema vs. mechanical bowel preparation

    PubMed Central

    Lombardo, Riccardo; Presicce, Fabrizio; Bellangino, Mariangela; Agro, Enrico Finazzi; Gambrosier, Matteo Bonetto; Trucchi, Alberto; Petta, Stefano; Tubaro, Andrea

    2015-01-01

    Introduction Transrectal prostate biopsy (TRUSbx) is the standard for the diagnosis of prostate cancer. Different bowel preparations are used for patients undergoing TRUSbx. The aim of our study was to compare two different bowel preparations for TRUSbx. Material and methods From May 2012 and onwards, a selected group of men undergoing TRUS 12-core prostate biopsy were enrolled into a prospective database. Patients were randomized 1:1 to receive a rectal enema (Group A) the night before the procedure or polyethylene glycol 34.8 grams/4 liters of water the day before the procedure (Group B). A VAS scale to evaluate the patients’ discomfort according to the two preparations was collected. The same antibiotic prophylaxis was performed in both groups. All complications were prospectively recorded and graded according to the Clavien Classification System (CCS). Results A total of 198 patients were consecutively enrolled. Mean age was 67.5 ±7.9 years, mean body mass index (BMI) was 27.1 ±4.2 Kg/m2, mean PSA value was 9.3 ±12.6 ng/ml and the mean prostatic volume was 60.6 ±29 ml. 97 patients were enrolled in Group A and 101 in Group B. Overall post-biopsy morbidity rate was 60%. No significant differences for low-grade and high-grade complications was observed between the two groups. Patients receiving the rectal enema presented with a significantly lower VAS score (3.1 ±1.1 vs. 5.9 ±1.7; p = 0.02). Conclusions Our study confirmed that a rectal enema should be considered as the standard bowel preparation in patients undergoing a TRUS biopsy; it is as effective as PEG and associated with less discomfort. PMID:26251750

  14. A fully actuated robotic assistant for MRI-guided prostate biopsy and brachytherapy

    NASA Astrophysics Data System (ADS)

    Li, Gang; Su, Hao; Shang, Weijian; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Fischer, Gregory S.

    2013-03-01

    Intra-operative medical imaging enables incorporation of human experience and intelligence in a controlled, closed-loop fashion. Magnetic resonance imaging (MRI) is an ideal modality for surgical guidance of diagnostic and therapeutic procedures, with its ability to perform high resolution, real-time, high soft tissue contrast imaging without ionizing radiation. However, for most current image-guided approaches only static pre-operative images are accessible for guidance, which are unable to provide updated information during a surgical procedure. The high magnetic field, electrical interference, and limited access of closed-bore MRI render great challenges to developing robotic systems that can perform inside a diagnostic high-field MRI while obtaining interactively updated MR images. To overcome these limitations, we are developing a piezoelectrically actuated robotic assistant for actuated percutaneous prostate interventions under real-time MRI guidance. Utilizing a modular design, the system enables coherent and straight forward workflow for various percutaneous interventions, including prostate biopsy sampling and brachytherapy seed placement, using various needle driver configurations. The unified workflow compromises: 1) system hardware and software initialization, 2) fiducial frame registration, 3) target selection and motion planning, 4) moving to the target and performing the intervention (e.g. taking a biopsy sample) under live imaging, and 5) visualization and verification. Phantom experiments of prostate biopsy and brachytherapy were executed under MRI-guidance to evaluate the feasibility of the workflow. The robot successfully performed fully actuated biopsy sampling and delivery of simulated brachytherapy seeds under live MR imaging, as well as precise delivery of a prostate brachytherapy seed distribution with an RMS accuracy of 0.98mm.

  15. Electrical property-based biopsy for prostate cancer detection and assessment

    NASA Astrophysics Data System (ADS)

    Halter, Ryan J.; Mishra, Vaishali; Bouayad, Hamza; Manwaring, Preston; Heaney, John; Schned, Alan

    2011-03-01

    Prostate cancer diagnosis is based solely on biopsy-based findings. Unfortunately, routine biopsy protocols only sample ~0.95% of the entire gland limiting the technique's sensitivity to cancer detection. Previous studies have demonstrated significant electrical property differences between malignant and benign prostate tissues due to their dissimilar morphological architectures. We have taken the important step of translating these findings to the clinic by integrating an electrical property sensor into the tip of a standard biopsy needle. This novel device allows clinicians to simultaneously extract a tissue core and assess the electrical properties around the needle tip in real-time. The expected volume of tissue sensed with this device was estimated using finite-element method (FEM) based simulations to model the potential fields and current distributions. Prototype devices have been constructed and evaluated in a series of saline baths in order to validate the FEM-based findings. Simulations suggest that the electrical property sensor is able to interrogate a tissue volume of ~62.1 mm3 and experimental results demonstrated a volume of sensitivity of ~68.7 mm3. This coupled device is being used to assess the increased sensitivity and specificity to cancer detection when electrical properties are sensed in concert with tissue core extraction in a series of 50 ex vivo prostates. Typical 12-core prostate biopsy protocols extract a total tissue volume of 228 mm3 for histological assessment. Employing this electrical property sensor to gauge electrical properties at both the beginning and end of the needle trajectory will provide pathological assessment of an additional 1648 mm3 of tissue.

  16. Prostate cancer detection using multiparametric 3 – tesla MRI and fusion biopsy: preliminary results

    PubMed Central

    Mussi, Thais Caldara; Garcia, Rodrigo Gobbo; de Queiroz, Marcos Roberto Gomes; Lemos, Gustavo Caserta; Baroni, Ronaldo Hueb

    2016-01-01

    ABSTRACT Objective: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) biopsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clinically significant tumors according to histological criteria. Materials and Methods: A total of 189 consecutive US/MRI fusion biopsies were performed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria. Results: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively. There was a statistically significant difference in terms of biopsy results between different levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different levels of suspicion on mpMRI (p-value <0.05 in both analyzes). Conclusion: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI. PMID:27532112

  17. Is effective a prior multiparametric magnetic resonance scan in patients candidates to prostate biopsy? CAT Study.

    PubMed

    Ramos Rodríguez, J R; Molinero Pérez, M; Herrera Imbroda, B; Domínguez Pinos, M D

    2016-01-01

    We carried out a critically appraised topic (CAT)-type study to determine whether the relevant scientific evidence supports the recommendation of doing a multiparametric magnetic resonance imaging study of the prostate in all patients who are candidates for prostate biopsy with the aim of improving the detection of clinically significant prostate cancer and stratifying patients to receive active surveillance or treatment. After a formal literature search and an analysis of the two most relevant articles it found, we reached the conclusion that, despite promising results that point to the potential usefulness of this approach, there is still not enough clear scientific evidence to endorse it categorically. Before this approach can be endorsed, we need evidence from well-designed prospective randomized trials using widely agreed upon criteria and including large numbers of patients at multiple centers.

  18. Biopsy

    MedlinePlus

    Tissue sampling ... biopsy is called a percutaneous biopsy. It removes tissue using a needle attached to a hollow tube ... The needle is passed several times through the tissue being examined. The doctor uses the needle to ...

  19. Evaluation of T2-weighted and dynamic contrast-enhanced MRI in localizing prostate cancer before repeat biopsy.

    PubMed

    Cheikh, Alexandre Ben; Girouin, Nicolas; Colombel, Marc; Maréchal, Jean-Marie; Gelet, Albert; Bissery, Alvine; Rabilloud, Muriel; Lyonnet, Denis; Rouvière, Olivier

    2009-03-01

    We assessed the accuracy of T2-weighted (T2w) and dynamic contrast-enhanced (DCE) 1.5-T magnetic resonance imaging (MRI) in localizing prostate cancer before transrectal ultrasound-guided repeat biopsy. Ninety-three patients with abnormal PSA level and negative prostate biopsy underwent T2w and DCE prostate MRI using pelvic coil before repeat biopsy. T2w and DCE images were interpreted using visual criteria only. MR results were correlated with repeat biopsy findings in ten prostate sectors. Repeat biopsy found prostate cancer in 23 patients (24.7%) and 44 sectors (6.6%). At per patient analysis, the sensitivity, specificity, positive and negative predictive values were 47.8%, 44.3%, 20.4% and 79.5% for T2w imaging and 82.6%, 20%, 24.4% and 93.3% for DCE imaging. When all suspicious areas (on T2w or DCE imaging) were taken into account, a sensitivity of 82.6% and a negative predictive value of 100% could be achieved. At per sector analysis, DCE imaging was significantly less specific (83.5% vs. 89.7%, p < 0.002) than T2w imaging; it was more sensitive (52.4% vs. 32.1%), but the difference was hardly significant (p = 0.09). T2w and DCE MRI using pelvic coil and visual diagnostic criteria can guide prostate repeat biopsy, with a good sensitivity and NPV.

  20. Comparison between Ultrasound Guided Transperineal and Transrectal Prostate Biopsy: A Prospective, Randomized, and Controlled Trial

    PubMed Central

    Guo, Le-Hang; Wu, Rong; Xu, Hui-Xiong; Xu, Jun-Mei; Wu, Jian; Wang, Shuai; Bo, Xiao-Wan; Liu, Bo-Ji

    2015-01-01

    This prospective study of comparing transperineal prostate biopsy (TPBx) with transrectal prostate biopsy (TRBx) was aimed to provide evidence for clinicians to select the appropriate biopsy approach under different conditions. TPBx (n = 173) and TRBx (n = 166) were performed randomly for 339 patients who were suspicious of prostate cancer (PCa). The cancer detection rate (CDR), complication rate, visual analogue scale (VAS) score, most painful procedure, number of repeated biopsy and additional anesthesia, and operating time (starting from lying down on the operating table to getting up) were recorded. The results showed that TPBx and TRBx were equivalent in CDR (35.3% vs. 31.9%) and minor complication rate (44.9% vs. 41.0%) (both P > 0.05). The major complication rate was lower in TPBx than in TRBx (0.6% vs. 4.3%, P < 0.05). TPBx was more time-consuming (17.51 ± 3.33 min vs. 14.73 ± 3.25 min) and painful (VAS score: 4.0 vs. 2.0); and it had higher rates of repeated biopsy (3.2% vs. 1.1%) and additional anesthesia (15.0% vs. 1.2%) (all P < 0.05). In summary, both TPBx and TRBx are effective to detect PCa. The major complication rate for TRBx is higher, whereas TPBx procedure is more complex and painful. PMID:26526558

  1. Magnetic resonance imaging - ultrasound fusion targeted biopsy outperforms standard approaches in detecting prostate cancer: A meta-analysis

    PubMed Central

    Jiang, Xuping; Zhang, Jiayi; Tang, Jingyuan; Xu, Zhen; Zhang, Wei; Zhang, Qing; Guo, Hongqian; Zhou, Weimin

    2016-01-01

    The aim of the present study was to determine whether magnetic resonance imaging - ultrasound (MRI-US) fusion prostate biopsy is superior to systematic biopsy for making a definitive diagnosis of prostate cancer. The two strategies were also compared regarding their ability to detect clinically significant and insignificant prostate cancer. A literature search was conducted through the PubMed, EMBASE and China National Knowledge Infrastructure databases using appropriate search terms. A total of 3,415 cases from 21 studies were included in the present meta-analysis. Data were expressed as relative risk (RR) and 95% confidence interval. The results revealed that MRI-US fusion biopsy achieved a higher rate of overall prostate cancer detection compared with systematic biopsy (RR=1.09; P=0.047). Moreover, MRI-US fusion biopsy detected more clinically significant cancers compared with systematic biopsy (RR=1.22; P<0.01). It is therefore recommended that multi-parametric MRI-US is performed in men suspected of having prostate cancer to optimize the detection of clinically significant disease, while reducing the burden of biopsies. PMID:27446568

  2. Targeted Prostate Biopsy: Lessons Learned Midst the Evolution of a Disruptive Technology.

    PubMed

    Nassiri, Nima; Natarajan, Shyam; Margolis, Daniel J; Marks, Leonard S

    2015-09-01

    Lessons learned during a 6-year experience with more than 1200 patients undergoing targeted prostate biopsy via MRI/ultrasound fusion are reported: (1) the procedure is safe and efficient, requiring some 15-20 minutes in an office setting; (2) MRI is best performed by a radiologist with specialized training, using a transabdominal multiparametric approach and preferably a 3T magnet; (3) grade of MRI suspicion is the most powerful predictor of biopsy results, eg, Grade 5 usually represents cancer; (4) some potentially important cancers (15%-30%) are MRI-invisible; (5) Targeted biopsies provide >80% concordance with whole-organ pathology. Early enthusiasm notwithstanding, cost-effectiveness is yet to be resolved, and the technologies remain in evolution. PMID:26166671

  3. TARGETED PROSTATE BIOPSY: LESSONS LEARNED MIDST THE EVOLUTION OF A DISRUPTIVE TECHNOLOGY

    PubMed Central

    Nassiri, Nima; Natarajan, Shyam; Margolis, Daniel J.; Marks, Leonard S.

    2015-01-01

    Lessons learned during a 6-year experience with more than 1200 patients undergoing targeted prostate biopsy via MRI/US fusion are reported: (1) The procedure is safe and efficient, requiring some 15–20 minutes in an office setting; (2) MRI is best performed by a radiologist with specialized training, employing a trans-abdominal multi-parametric approach and preferably a 3T magnet; (3) Grade of MRI suspicion is the most powerful predictor of biopsy results, e.g., Grade 5 usually represents cancer; (4) Some potentially-important cancers (15%–30%) are MRI-invisible; (5) Targeted biopsies provide >80% concordance with whole-organ pathology. Early enthusiasm notwithstanding, cost-effectiveness is yet to be resolved, and the technologies remain in evolution. PMID:26166671

  4. Ten-core versus 16-core transrectal ultrasonography guided prostate biopsy for detection of prostatic carcinoma: a prospective comparative study in Indian population

    PubMed Central

    Prakash, V. Surya; Mohan, G. Chandra; Krishnaiah, S. Venkata; Vijaykumar, V.; Babu, G. Ramesh; Reddy, G. Vijaya Bhaskar; Mahaboob, V. S.

    2013-01-01

    Purpose: To compare the cancer detection rate in patients with raised serum prostate-specific antigen (PSA) or abnormal digital rectal examination (DRE) results between the 10-core and the 16-core biopsy techniques in an Indian population. Methods: Between November 2010 and November 2012, 95 men aged >50 years who presented to the Urology Department with lower urinary tract symptoms, elevated serum PSA, and/or abnormal DRE findings underwent transrectal ultrasonography (TRUS)-guided prostate biopsy. A total of 53 patients underwent 10-core biopsy and 42 patients underwent 16-core biopsy. Results: Of the 53 men in the 10-core group, 8 had cancer, whereas in the 16-core biopsy group, 23 of 42 men had cancer. Detection of prostate cancer was significantly higher in patients who underwent 16-core biopsy than in those who underwent 10-core biopsy (P<0.001). Among the 95 men, 44 men had abnormal DRE findings (46.3%), of whom 23 showed cancer (52.27%). Of 51 men with normal DRE findings and elevated PSA, 8 men had malignancy with a cancer detection rate of 15.68%. Among 20 men with PSA between 4.1 and 10 ng/mL, 2 (10%) had cancer. In 31 men with PSA between 10.1 and 20 ng/mL, 3 cancers (9.67%) were detected, and in 44 men with PSA >20 ng/mL, 26 cancers were detected (59.09%). Conclusions: The cancer detection rate with 16-core TRUS-guided biopsy is significantly higher than that with 10-core biopsy (54.76% vs. 15.09%, P<0.001). In patients with both normal and abnormal DRE findings, 16-core biopsy has a better detection rate than the 10-core biopsy protocol. With increasing PSA, there is a high rate of detection of prostate cancer in both 10-core and 16-core biopsy patients. PMID:24392441

  5. In vivo testing of laser optoacoustic system for image-guided biopsy of prostate

    NASA Astrophysics Data System (ADS)

    Oraevsky, Alexander; Ermilov, Sergey; Mehta, Ketan; Miller, Tom; Bell, Brent; Orihuela, Eduardo; Motamedi, Massoud

    2006-02-01

    We have developed and used a laser optoacoustic imaging system with transrectal probe (LOIS-P) for detection of mechanical lesions in canine prostates in vivo. LOIS images have been acquired with a 128-channel transrectal probe and a 32-channel data acquisition system. Optoacoustic images showed a strong contrast enhancement for a blood containing lesion, when compared with ultrasound images. Our studies demonstrated that sufficient optoacoustic contrast exists between blood containing lesion and prostate tissue, although the lesion has been undetectable with ultrasound. The imaging results have been compared with visual examination of surgically excised prostates. Although axial resolution of the wide-band transducers employed in the transrectal probe provides good axial resolution of 0.5 mm, the convex arc geometry of the this array of transducers provides lateral resolution degrading with depth in tissue. A two step algorithm has been developed to improve the lateral resolution of deeply located objects. This algorithm employs optoacoustic image reconstruction based on radial back-projection to determine location and shape of the target object, then a procedure, we call Maximum Angular Amplitude Probability (MAAP), to determine true brightness of the object and simultaneously remove arc-shaped artifacts associated with radial back-projection. A laser optoacoustic imaging system (LOIS-P) with transrectal probe operating in backward detection mode empowered with the new image reconstruction algorithm seems promising as a modality for detection of prostate cancer and guiding prostate biopsy.

  6. Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation

    PubMed Central

    Cool, Derek W.; Romagnoli, Cesare; Izawa, Jonathan I.; Chin, Joseph; Gardi, Lori; Tessier, David; Mercado, Ashley; Mandel, Jonathan; Ward, Aaron D.; Fenster, Aaron

    2016-01-01

    Introduction: This study evaluates the clinical benefit of magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy over systematic biopsy between first-time and repeat prostate biopsy patients with prior atypical small acinar proliferation (ASAP). Materials: 100 patients were enrolled in a single-centre prospective cohort study: 50 for first biopsy, 50 for repeat biopsy with prior ASAP. Multiparameteric magnetic resonance imaging (MP-MRI) and standard 12-core ultrasound biopsy (Std-Bx) were performed on all patients. Targeted biopsy using MRI-TRUS fusion (Fn-Bx) was performed f suspicious lesions were identified on the pre-biopsy MP-MRI. Classification of clinically significant disease was assessed independently for the Std-Bx vs. Fn-Bx cores to compare the two approaches. Results: Adenocarcinoma was detected in 49/100 patients (26 first biopsy, 23 ASAP biopsy), with 25 having significant disease (17 first, 8 ASAP). Fn-Bx demonstrated significantly higher per-core cancer detection rates, cancer involvement, and Gleason scores for first-time and ASAP patients. However, Fn-Bx was significantly more likely to detect significant cancer missed on Std-Bx for ASAP patients than first-time biopsy patients. The addition of Fn-Bx to Std-Bx for ASAP patients had a 166.7% relative risk reduction for missing Gleason ≥ 3 + 4 disease (number needed to image with MP-MRI=10 patients) compared to 6.3% for first biopsy (number to image=50 patients). Negative predictive value of MP-MRI for negative biopsy was 79% for first-time and 100% for ASAP patients, with median followup of 32.1 ± 15.5 months. Conclusions: MR-TRUS Fn-Bx has a greater clinical impact for repeat biopsy patients with prior ASAP than biopsy-naïve patients by detecting more significant cancers that are missed on Std-Bx. PMID:27800057

  7. NOTE: Adaptation of a 3D prostate cancer atlas for transrectal ultrasound guided target-specific biopsy

    NASA Astrophysics Data System (ADS)

    Narayanan, R.; Werahera, P. N.; Barqawi, A.; Crawford, E. D.; Shinohara, K.; Simoneau, A. R.; Suri, J. S.

    2008-10-01

    Due to lack of imaging modalities to identify prostate cancer in vivo, current TRUS guided prostate biopsies are taken randomly. Consequently, many important cancers are missed during initial biopsies. The purpose of this study was to determine the potential clinical utility of a high-speed registration algorithm for a 3D prostate cancer atlas. This 3D prostate cancer atlas provides voxel-level likelihood of cancer and optimized biopsy locations on a template space (Zhan et al 2007). The atlas was constructed from 158 expert annotated, 3D reconstructed radical prostatectomy specimens outlined for cancers (Shen et al 2004). For successful clinical implementation, the prostate atlas needs to be registered to each patient's TRUS image with high registration accuracy in a time-efficient manner. This is implemented in a two-step procedure, the segmentation of the prostate gland from a patient's TRUS image followed by the registration of the prostate atlas. We have developed a fast registration algorithm suitable for clinical applications of this prostate cancer atlas. The registration algorithm was implemented on a graphical processing unit (GPU) to meet the critical processing speed requirements for atlas guided biopsy. A color overlay of the atlas superposed on the TRUS image was presented to help pick statistically likely regions known to harbor cancer. We validated our fast registration algorithm using computer simulations of two optimized 7- and 12-core biopsy protocols to maximize the overall detection rate. Using a GPU, patient's TRUS image segmentation and atlas registration took less than 12 s. The prostate cancer atlas guided 7- and 12-core biopsy protocols had cancer detection rates of 84.81% and 89.87% respectively when validated on the same set of data. Whereas the sextant biopsy approach without the utility of 3D cancer atlas detected only 70.5% of the cancers using the same histology data. We estimate 10-20% increase in prostate cancer detection rates

  8. Testing for the recurrent HOXB13 G84E germline mutation in men with clinical indications for prostate biopsy

    PubMed Central

    Schroeck, Florian R.; Zuhlke, Kimberly A.; Siddiqui, Javed; Siddiqui, Rabia; Cooney, Kathleen A.; Wei, John T.

    2014-01-01

    Purpose The G84E variant of HOXB13 was recently found to be associated with a significantly increased risk of prostate cancer in a case control study. We estimated the prevalence of this mutation in a clinical population of men at risk for prostate cancer scheduled to undergo prostate biopsy. Materials and Methods We prospectively collected clinical information and DNA samples from men undergoing diagnostic prostate biopsy between June 2005 and October 2011. We genotyped samples for HOXB13 G84E using the MassARRAY system. We determined the prevalence of the G84E variant in the overall cohort, among patients with positive family history (FH), and among men age 55 years or younger. Results 1175 subjects underwent biopsy, of which 948 had a DNA sample for analysis. Four patients had the G84E variant detected [prevalence 0.42%, 95% confidence interval (CI) 0.12% - 1.12%], of which three had prostate cancer on biopsy. None of 301 patients with a positive FH (prevalence 0.00%, 95% CI 0.00% – 1.52%) and one of 226 subjects age 55 years or younger tested positive (prevalence 0.44%, 95% CI 0.01% – 2.44%). Conclusion The HOXB13 G84E variant is rare in this cohort, even in those with a positive family history. Our findings question the utility of testing for this variant among unselected men presenting for a diagnostic prostate biopsy. PMID:23036981

  9. EVALUATING THE PROSTATE CANCER PREVENTION TRIAL HIGH GRADE PROSTATE CANCER RISK CALCULATOR IN TEN INTERNATIONAL BIOSY COHORTS: RESULTS FROM THE PROSTATE BIOPSY COLLABORATIVE GROUP

    PubMed Central

    Ankerst, Donna P.; Boeck, Andreas; Freedland, Stephen J.; Jones, J. Stephen; Cronin, Angel M.; Roobol, Monique J.; Hugosson, Jonas; Kattan, Michael W.; Klein, Eric A.; Hamdy, Freddie; Neal, David; Donovan, Jenny; Parekh, Dipen J.; Klocker, Helmut; Horninger, Wolfgang; Benchikh, Amine; Salama, Gilles; Villers, Arnauld; Moreira, Daniel M.; Schröder, Fritz H.; Lilja, Hans; Vickers, Andrew J.; Thompson, Ian M.

    2013-01-01

    OBJECTIVES To assess the applicability of the Prostate Cancer Prevention Trial High Grade (Gleason grade ≥ 7) Risk Calculator (PCPTHG) in ten international cohorts, representing a range of populations. METHODS 25,512 biopsies from 10 cohorts (6 European, 1 UK, and 3 US) were included; 4 implemented 6-core biopsies and the remaining had 10- or higher schemes; 8 were screening cohorts and 2 were clinical. PCPTHG risks were calculated using prostate-specific antigen (PSA), digital rectal examination, age, African origin and history of prior biopsy and evaluated in terms of calibration plots, areas underneath the receiver operating characteristic curve (AUC), and net benefit curves. RESULTS The median AUC of the PCPTHG for high grade disease detection in the 10- and higher-core cohorts was 73.5% (range 63.9% to 76.7%) compared to a median of 78.1 (range = 72.0 to 87.6) among the four 6-core cohorts. Only the 10-core Cleveland Clinic cohort showed clear evidence of under-prediction by the PCPTHG, and this was restricted to risk ranges less than 15%. The PCPTHG demonstrated higher clinical net benefit in higher- compared to six-core biopsy cohorts, and among the former, there were no notable differences observed between clinical and screening cohorts, nor between European and US cohorts. CONCLUSIONS The PCPTHG requires minimal patient information and can be applied across a range of populations. PCPTHG risk thresholds ranging from 5 to 20%, depending on patient risk averseness, are recommended for clinical prostate biopsy decision-making. PMID:22527674

  10. Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies

    PubMed Central

    Yilmaz, Ömer; Kurul, Özgür; Ates, Ferhat; Soydan, Hasan; Aktas, Zeki

    2016-01-01

    ABSTRACT Introduction: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. Materials and Methods: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level(>4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume, biopsy results and PSA levels were recorded. Results: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. Conclusion: Nodule is the most important finding in DRE for cancer detection. Only an asymmetric prostate itself does not mean malignity. PMID:27564280

  11. Solitary fibrous tumor on needle biopsy and transurethral resection of the prostate: a clinicopathologic study of 13 cases.

    PubMed

    Herawi, Mehsati; Epstein, Jonathan I

    2007-06-01

    One of the least commonly encountered spindle cell tumors seen on prostatic needle biopsy or transurethral resection (TUR) of the prostate is solitary fibrous tumor (SFT). We studied 13 cases of SFTs identified on either prostate needle biopsy (n=9) or TUR of the prostate (n=4). Mean patient age at diagnosis was 63 years (range: 46 to 75 y; median: 65 y). Twelve men presented with urinary tract symptoms and 1 patient was biopsied during work-up of bone metastases. Ten cases were SFTs originating in the prostate, 2 cases arose between the prostate and rectum extending into the prostate (n=2), and 1 case was a pelvic mass without infiltration of the prostate. In 9 cases, a complete tumor resection was attempted by cystoprostatectomy (n=2), radical prostatectomy (n=4), pelvic exenteration (n=2), or pelvic tumor resection (n=1). Enucleation (n=1) and TUR (n=1) were performed in 2 other cases. Tumor sizes ranged from 8.5 to 15 cm in 7 radically resected cases. Mitotic rates were 3 to 5 per 10 high power fields in 5 cases, with the remaining cases having either rare (n=4) or no mitoses (n=4). Seven cases demonstrated areas of necrosis. Based on a combination of increased cellularity, mitotic activity, necrosis, nuclear pleomorphism, and infiltrativeness, 4 prostatic SFTs were malignant, 4 were benign, and 2 were borderline. Of the 3 non-prostatic SFTs, 1 was malignant and 2 were borderline. All tumors but 1 were immunoreactive for CD34 (n=12). Material for additional immunohistochemistry was available for the majority of cases with positive stains for Bcl-2 (11/11), CD99 (7/10), beta-catenin (5/10), and c-kit (0/11). Three SFTs demonstrated >or=10% p53 immunoreactivity including 1 tumor with 50% positivity; and 3 cases had Ki-67 rates of >or=20%. Although all SFTs were initially clinically considered to be of prostatic origin, some of the cases arose in the pelvis with secondary involvement of the prostate. Approximately 50% of prostatic SFTs were malignant. Even in the

  12. Transrectal Ultrasound Guided Biopsy of the Prostate: Is the Information Accessible, Usable, Reliable and Readable?

    PubMed Central

    Redmond, Ciaran E.; Nason, Gregory J.; Kelly, Michael E.; McMahon, Colm; Cantwell, Colin P.; Quinlan, David M.

    2015-01-01

    Background/Aims To evaluate the accessibility, usability, reliability and readability of Internet information regarding transrectal ultrasound (TRUS) guided biopsy of the prostate. Materials and Methods The terms “prostate biopsy”, “TRUS biopsy” and “transrectal ultrasound guided biopsy of the prostate” were separately entered into the each of the top 5 most accessed Internet search engines. Websites were evaluated for accessibility, usability and reliability using the LIDA tool – a validated tool for the assessment of health related websites. Website readability was assessed using the Flesch Reading Ease Score and the Flesch Kincaid Grade Level. Results Following the application of exclusion criteria, 82 unique websites were analyzed. There was a significant difference in scores depending on authorship categories (p ≤ 0.001), with health related charity websites scoring highest (mean 122.29 ± 13.98) and non-academic affiliated institution websites scoring lowest (mean 87 ± 19.76). The presence of advertisements on a website was associated with a lower mean overall LIDA tool score (p = 0.024). Only a single website adhered to the National Institutes for Health recommendations on readability. Conclusions This study demonstrates variability in the quality of information available to Internet users regarding TRUS biopsies. Collaboration of website design and clinical acumen are necessary to develop appropriate websites for patient benefit. PMID:26195961

  13. Outbreak of Achromobacter xylosoxidans and Ochrobactrum anthropi Infections after Prostate Biopsies, France, 2014

    PubMed Central

    Cassier, Pierre; Dananché, Cédric; Hulin, Monique; Dauwalder, Olivier; Rouvière, Olivier; Bertrand, Xavier; Perraud, Michel; Bénet, Thomas; Vanhems, Philippe

    2016-01-01

    We report an outbreak of healthcare-associated prostatitis involving rare environmental pathogens in immunocompetent patients undergoing transrectal prostate biopsies at Hôpital Édouard Herriot (Lyon, France) during August 13–October 10, 2014. Despite a fluoroquinolone-based prophylaxis, 5 patients were infected with Achromobacter xylosoxidans and 3 with Ochrobactrum anthropi, which has not been reported as pathogenic in nonimmunocompromised persons. All patients recovered fully. Analysis of the outbreak included case investigation, case–control study, biopsy procedure review, microbiologic testing of environmental and clinical samples, and retrospective review of hospital records for 4 years before the outbreak. The cases resulted from asepsis errors during preparation of materials for the biopsies. A low-level outbreak involving environmental bacteria was likely present for years, masked by antimicrobial drug prophylaxis and a low number of cases. Healthcare personnel should promptly report unusual pathogens in immunocompetent patients to infection control units, and guidelines should explicitly mention asepsis during materials preparation. PMID:27434277

  14. Improving prostate cancer detection in veterans through the development of a clinical decision rule for prostate biopsy

    PubMed Central

    2013-01-01

    Background We sought to improve prostate cancer (PC) detection through developing a prostate biopsy clinical decision rule (PBCDR), based on an elevated PSA and laboratory biomarkers. This decision rule could be used after initial PC screening, providing the patient and clinician information to consider prior to biopsy. Methods This case–control study evaluated men from the Tampa, Florida, James A. Haley (JH) Veteran’s Administration (VA) (N = 1,378), from January 1, 1998, through April 15, 2005. To assess the PBCDR we did all of the following: 1) Identified biomarkers that are related to PC and have the capability of improving the efficiency of PC screening; 2) Developed statistical models to determine which can best predict the probability of PC; 3) Compared each potential model to PSA alone using Receiver Operator Characteristic (ROC) curves, to evaluate for improved overall effectiveness in PC detection and reduction in (negative) biopsies; and 4) Evaluated dose–response relationships between specified lab biomarkers (surrogates for extra-prostatic disease development) and PC progression. Results The following biomarkers were related to PC: hemoglobin (HGB) (OR = 1.42 95% CI 1.27, 1.59); red blood cell (RBC) count (OR = 2.52 95% CI 1.67, 3.78); PSA (OR = 1.04 95% CI 1.03, 1.05); and, creatinine (OR = 1.55 95% CI 1.12, 2.15). Comparing all PC stages versus non-cancerous conditions, the ROC curve area under the curve (AUC) enlarged (increasing the probability of correctly classifying PC): PSA (alone) 0.59 (95% CI 0.55, 0.61); PBCDR model 0.68 (95% CI 0.65, 0.71), and the positive predictive value (PPV) increased: PSA 44.7%; PBCDR model 61.8%. Comparing PC (stages II, III, IV) vs. other, the ROC AUC increased: PSA (alone) 0.63 (95% CI 0.58, 0.66); PBCDR model 0.72 (95% CI 0.68, 0.75), and the PPV increased: 20.6% (PSA); PBCDR model 55.3%. Conclusions These results suggest evaluating certain common biomarkers in conjunction with PSA may improve PC prediction

  15. HYALURONIC ACID AND HYAL-1 EXPRESSION IN PROSTATE BIOPSY SPECIMENS: PREDICTORS OF BIOCHEMICAL RECURRENCE

    PubMed Central

    Gomez, Christopher S; Gomez, Pablo; Knapp, Judith; Jorda, Merce; Soloway, Mark S.; Lokeshwar, Vinata B.

    2010-01-01

    Purpose Molecular markers could aid PSA, biopsy Gleason sum and clinical stage in providing accurate information about prostate cancer (CaP) progression. HYAL-1 hyaluronidase and hyaluronic acid (HA) staining in prostatectomy specimens predicts biochemical recurrence. We examined whether HA and HYAL-1 staining in biopsy specimens predicts biochemical recurrence and correlates with the staining in matched prostatectomy specimens. Materials and Methods Biopsy and prostatectomy specimens were obtained from patients with clinically localized CaP (n = 61; mean follow-up = 103.1 months) from multiple centers; Gr. 1: patients with biochemical recurrence (n = 23); Gr. 2: patients without recurrence (n = 38). A biotinylated HA-binding protein and an anti-HYAL-1 antibody were used for HA and HYAL-1 staining. The staining was graded between 0 – 300 depending upon staining intensity and the area. Results HYAL-1 and HA were expressed in tumor cells and stroma, respectively. In biopsy specimens, HYAL-1 and HA expression was higher in Gr.1 (203.9 and 182.1) when compared to Gr. 2 (48.8 and 87.0; P < 0.0001). In univariate analysis, HA, HYAL-1, biopsy Gleason and PSA significantly predicted biochemical recurrence (P < 0.001). In multivariate analysis only HYAL-1 staining was an independent predictor of recurrence (P < 0.001; accuracy: 81.8%). In prostatectomy specimens only HYAL-1 staining correlated with the staining in biopsy specimens (Spearman ρ= 0.72; P = 0.0002), and predicted biochemical recurrence. Conclusion This is the first report that demonstrates that in biopsy specimens HYAL-1 staining is an independent predictor of biochemical recurrence and may be useful in selecting treatment. PMID:19683287

  16. DNA Ploidy Measured on Archived Pretreatment Biopsy Material May Correlate With Prostate-Specific Antigen Recurrence After Prostate Brachytherapy

    SciTech Connect

    Keyes, Mira; MacAulay, Calum; Hayes, Malcolm; Korbelik, Jagoda; Morris, W. James; Palcic, Branko

    2013-08-01

    Purpose: To explore whether DNA ploidy of prostate cancer cells determined from archived transrectal ultrasound-guided biopsy specimens correlates with disease-free survival. Methods and Materials: Forty-seven failures and 47 controls were selected from 1006 consecutive low- and intermediate-risk patients treated with prostate {sup 125}I brachytherapy (July 1998-October 2003). Median follow-up was 7.5 years. Ten-year actuarial disease-free survival was 94.1%. Controls were matched using age, initial prostate-specific antigen level, clinical stage, Gleason score, use of hormone therapy, and follow-up (all P nonsignificant). Seventy-eight specimens were successfully processed; 27 control and 20 failure specimens contained more than 100 tumor cells were used for the final analysis. The Feulgen-Thionin stained cytology samples from archived paraffin blocks were used to determine the DNA ploidy of each tumor by measuring integrated optical densities. Results: The samples were divided into diploid and aneuploid tumors. Aneuploid tumors were found in 16 of 20 of the failures (80%) and 8 of 27 controls (30%). Diploid DNA patients had a significantly lower rate of disease recurrence (P=.0086) (hazard ratio [HR] 0.256). On multivariable analysis, patients with aneuploid tumors had a higher prostate-specific antigen failure rate (HR 5.13). Additionally, those with “excellent” dosimetry (V100 >90%; D90 >144 Gy) had a significantly lower recurrence rate (HR 0.25). All patients with aneuploid tumors and dosimetry classified as “nonexcellent” (V100 <90%; D90 <144 Gy) (5 of 5) had disease recurrence, compared with 40% of patients with aneuploid tumors and “excellent” dosimetry (8 of 15). In contrast, dosimetry did not affect the outcome for diploid patients. Conclusions: Using core biopsy material from archived paraffin blocks, DNA ploidy correctly classified the majority of failures and nonfailures in this study. The results suggest that DNA ploidy can be used as a

  17. Febrile Infection in Post-Prostate Biopsy: Results of a Ten-Year Single-Institution Study in South Taiwan

    PubMed Central

    Tsai, Yuh-Shyan; Chen, Chia-Hong; Jou, Yeong-Chin; Yang, Wen-Horng; Chang, Chien-Chen

    2014-01-01

    Abstract Background: Post-biopsy infection is one of the major concerns of urologists and patients for prostate biopsy. Many efforts have been made to reduce the infection rate. We conducted a study at a single institution with the goal of describing the bacteriology and incidence trends of febrile infections following trans-rectal ultrasound (TRUS)-guided biopsy of the prostate. Materials and Methods: From January 1998 to December 2002 (Period 1 of the study), January 2003 to August 2005 (Period 2), September 2005 to October 2007 (Period 3), and November 2007 to December 2009 (Period 4), 1,406 patients underwent prostate biopsy at our hospital. All biopsies were conducted under TRUS guidance without preparation by enemas. Several steps were taken to reduce infectious complications following biopsy, including a shift to levofloxacin prophylaxis starting from Period 3 of our study and thorough instructions in post-biopsy self-care starting from the beginning of Period 4. The incidence and bacteriology of urinary tract infection (UTI) following the prostate biopsies were reviewed from chart records. Results: Twenty-eight of 514 (5.4%), 13 of 276 (4.7%) nine of 274 (3.2%), and three of 342 (0.9%) patients had post-biopsy febrile infections during the four periods of the study, respectively. Fifteen of 28 (53.5%), four of 13 (30.8%), five of nine (55.6%), and zero of three patients, respectively, had positive cultures of blood, urine, or both during the four study periods. Escherichia coli was the pathogen isolated most commonly and ampicillin- and fluoroquinolone-resistant strains of this organism were identified at a high frequency. The times to onset of fever after biopsy in the four study periods were 1.5±1.3 d, 3.7±2.7 d, 2.2±1.6 d, and 2.5±0.9 d, respectively. Conclusions: Ampicillin- and fluoroquinolone-resistant strains of E. coli were the uropathogenic bacteria identified most commonly after prostate biopsy at our hospital. The incidence of UTI

  18. MRI-guided core needle biopsy of the prostate: acceptance and side effects

    PubMed Central

    Egbers, Nina; Schwenke, Carsten; Maxeiner, Andreas; Teichgräber, Ulf; Franiel, Tobias

    2015-01-01

    PURPOSE We aimed to study side effects, complications, and patient acceptance of magnetic resonance imaging-guided real-time biopsy (MRI-GB) of the prostate. METHODS Fifty-four men (49–78 years) with elevated prostate-specific antigen after at least one negative systematic transrectal ultrasound-guided biopsy (TRUS-GB) were included in a prospective clinical study. Suspicious areas on images were selectively sampled by obtaining a median of four specimens (range, 1–9 specimens) using MRI-GB. In TRUS-GB, a median of 10 specimens (range, 6–14 specimens) were obtained. Telephone interviews were conducted one week after outpatient MRI-GB, asking patients about pain and side effects (hematuria, hemospermia, rectal bleeding, fever, and chills) of the two biopsy procedures and which of the two procedures they preferred. Multinomial regression analysis and Fisher’s exact test was used to test for differences. RESULTS MRI-GB was preferred by 65% (35/54), and 82% (44/54) would undergo MRI-GB again. Pain intensity (P = 0.005) and bleeding duration (P = 0.004) were significantly lower for MRI-GB compared with TRUS-GB. Hematuria was less common after MRI-GB compared with TRUS-GB (P = 0.006). A high correlation was given between bleeding intensity and bleeding duration for TRUS-GB (r=0.77) and pain intensity and pain duration for MRI-GB (r=0.65). Although hemospermia, rectal hemorrhage, fever, and chills were less common in MRI, they showed no statistically significant difference. CONCLUSION MRI-GB of the prostate seems to have fewer side effects and less pain intensity than TRUS-GB and was preferred by the majority of patients. PMID:25858525

  19. 3D non-rigid surface-based MR-TRUS registration for image-guided prostate biopsy

    NASA Astrophysics Data System (ADS)

    Sun, Yue; Qiu, Wu; Romagnoli, Cesare; Fenster, Aaron

    2014-03-01

    Two dimensional (2D) transrectal ultrasound (TRUS) guided prostate biopsy is the standard approach for definitive diagnosis of prostate cancer (PCa). However, due to the lack of image contrast of prostate tumors needed to clearly visualize early-stage PCa, prostate biopsy often results in false negatives, requiring repeat biopsies. Magnetic Resonance Imaging (MRI) has been considered to be a promising imaging modality for noninvasive identification of PCa, since it can provide a high sensitivity and specificity for the detection of early stage PCa. Our main objective is to develop and validate a registration method of 3D MR-TRUS images, allowing generation of volumetric 3D maps of targets identified in 3D MR images to be biopsied using 3D TRUS images. Our registration method first makes use of an initial rigid registration of 3D MR images to 3D TRUS images using 6 manually placed approximately corresponding landmarks in each image. Following the manual initialization, two prostate surfaces are segmented from 3D MR and TRUS images and then non-rigidly registered using a thin-plate spline (TPS) algorithm. The registration accuracy was evaluated using 4 patient images by measuring target registration error (TRE) of manually identified corresponding intrinsic fiducials (calcifications and/or cysts) in the prostates. Experimental results show that the proposed method yielded an overall mean TRE of 2.05 mm, which is favorably comparable to a clinical requirement for an error of less than 2.5 mm.

  20. High-resolution rapid diagnostic imaging of whole prostate biopsies using video-rate fluorescence structured illumination microscopy

    PubMed Central

    Wang, Mei; Kimbrell, Hillary Z.; Sholl, Andrew B.; Tulman, David B.; Elfer, Katherine N.; Schlichenmeyer, Tyler C.; Lee, Benjamin R.; Lacey, Michelle; Brown, J. Quincy

    2015-01-01

    Rapid assessment of prostate core biopsy pathology at the point-of-procedure could provide benefit in a variety of clinical situations. Even with advanced trans-rectal ultrasound guidance and saturation biopsy protocols, prostate cancer can be missed in up to half of all initial biopsy procedures. In addition, collection of tumor specimens for downstream histological, molecular, and genetic analysis is hindered by low tumor yield due to inability to identify prostate cancer grossly. However, current point-of-procedure pathology protocols such as frozen section analysis (FSA) are destructive, and too time- and labor-intensive to be practical or economical. Ex vivo microscopy of the excised specimens, stained with fast-acting fluorescent histology dyes, could be an attractive non-destructive alternative to FSA. In this work, we report the first demonstration of video-rate structured illumination microscopy (VR-SIM) for rapid high-resolution diagnostic imaging of prostate biopsies in realistic point-of-procedure timeframes. Large mosaic images of prostate biopsies stained with acridine orange are rendered in seconds, and contain excellent contrast and detail, exhibiting close correlation with corresponding H&E histology. A clinically-relevant review of VR-SIM images of 34 unfixed and uncut prostate core biopsies by two independent pathologists resulted in an area under the ROC curve (AUC) of 0.82–0.88, with a sensitivity ranging from 63–88% and a specificity ranging from 78–89%. When biopsies contained more than 5% tumor content, the sensitivity improved to 75–92%. The image quality, speed, minimal complexity, and ease of use of VR-SIM could prove to be features in favor of adoption as an alternative to destructive pathology at the point-of-procedure. PMID:26282168

  1. Association between number of prostate biopsies and patient-reported functional outcomes after radical prostatectomy: implications for active surveillance protocols

    PubMed Central

    Anderson, Christopher B.; Tin, Amy L.; Sjoberg, Daniel D.; Mulhall, John P.; Sandhu, Jaspreet; Laudone, Vincent P.; Eastham, James A.; Scardino, Peter T.; Ehdaie, Behfar

    2016-01-01

    Purpose Men with prostate cancer who progress on active surveillance (AS) are subject to multiple prostate biopsies prior to radical prostatectomy (RP). Our objective was to evaluate whether the number of preoperative prostate biopsies affects functional outcomes after RP. Materials and methods We identified men treated with RP at our institution between 2008 and 2011. At 6 and 12 months post-operatively, patients completed questionnaires assessing erectile and urinary function. Men with preoperative incontinence or erectile dysfunction or who did not complete the questionnaire were excluded. Primary outcomes were urinary and erectile function at 12 months postoperatively. We used logistic regression to estimate the impact of number of prostate biopsies on functional outcomes after adjusting for demographic and clinical factors. Results We identified 2,712 men treated with RP between 2008 and 2011. Most men (80%) had 1 preoperative prostate biopsy, 16% had 2, and 4% had at least 3. On adjusted analysis, erectile function at 12 months was not significantly different for men with 2 (OR 1.25; 95% CI 0.90, 1.75) or 3 or more (OR 1.52; 95% CI 0.84, 2.78) biopsies, compared to those with 1. Similarly, urinary function at 12 months was not significantly different for men with 2 (0.84, 95% CI 0.64, 1.10) or 3 or more (0.99, 95% CI 0.60, 1.61) biopsies compared to those with 1. Conclusions We did not find evidence that more preoperative prostate biopsies adversely affected erectile or urinary function at 12 months following RP. PMID:26118438

  2. Percentage of Positive Biopsy Cores: A Better Risk Stratification Model for Prostate Cancer?

    SciTech Connect

    Huang Jiayi; Vicini, Frank A.; Williams, Scott G.; Ye Hong; McGrath, Samuel; Ghilezan, Mihai; Krauss, Daniel; Martinez, Alvaro A.; Kestin, Larry L.

    2012-07-15

    Purpose: To assess the prognostic value of the percentage of positive biopsy cores (PPC) and perineural invasion in predicting the clinical outcomes after radiotherapy (RT) for prostate cancer and to explore the possibilities to improve on existing risk-stratification models. Methods and Materials: Between 1993 and 2004, 1,056 patients with clinical Stage T1c-T3N0M0 prostate cancer, who had four or more biopsy cores sampled and complete biopsy core data available, were treated with external beam RT, with or without a high-dose-rate brachytherapy boost at William Beaumont Hospital. The median follow-up was 7.6 years. Multivariate Cox regression analysis was performed with PPC, Gleason score, pretreatment prostate-specific antigen, T stage, PNI, radiation dose, androgen deprivation, age, prostate-specific antigen frequency, and follow-up duration. A new risk stratification (PPC classification) was empirically devised to incorporate PPC and replace the T stage. Results: On multivariate Cox regression analysis, the PPC was an independent predictor of distant metastasis, cause-specific survival, and overall survival (all p < .05). A PPC >50% was associated with significantly greater distant metastasis (hazard ratio, 4.01; 95% confidence interval, 1.86-8.61), and its independent predictive value remained significant with or without androgen deprivation therapy (all p < .05). In contrast, PNI and T stage were only predictive for locoregional recurrence. Combining the PPC ({<=}50% vs. >50%) with National Comprehensive Cancer Network risk stratification demonstrated added prognostic value of distant metastasis for the intermediate-risk (hazard ratio, 5.44; 95% confidence interval, 1.78-16.6) and high-risk (hazard ratio, 4.39; 95% confidence interval, 1.70-11.3) groups, regardless of the use of androgen deprivation and high-dose RT (all p < .05). The proposed PPC classification appears to provide improved stratification of the clinical outcomes relative to the National

  3. Advantages of caudal block over intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy

    PubMed Central

    Wang, Na; Fu, Yaowen; Ma, Haichun; Wang, Jinguo; Gao, Yang

    2016-01-01

    Objective: To compare caudal block with intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy. Methods: One hundred and ninety patients scheduled for transrectal ultrasound guided prostate biopsy were randomized equally into Group-A who received caudal block (20 ml 1.2% lidocaine) and Group-B who received intrarectal local anesthesia (0.3% oxybuprocaine cream) plus periprostatic nerve block (10 ml 1% lidocaine plus 0.5% ropivacaine) before biopsy. During and after the procedure, the patients rated the level of pain/discomfort at various time points. Complications during the whole study period and the patient overall satisfaction were also evaluated. Results: More pain and discomfort was detected during periprostatic nerve block than during caudal block. Pain and discomfort was significantly lower during prostate biopsy and during the manipulation of the probe in the rectum in Group-A than in Group-B. No significant differences were detected in the pain intensity after biopsy and side effects between the two groups. Conclusions: Caudal block provides better anesthesia than periprostatic nerve block plus intrarectal local anesthesia for TRUS guided prostate biopsy without an increase of side effects. PMID:27648052

  4. [PCA3 AND TMPRSS2:ERG GENES EXPRESSION IN BIOPSIES OF BENIGN PROSTATE HYPERPLASIA, INTRAEPITHELIAL NEOPLASIA, AND PROSTATE CANCER].

    PubMed

    Mikhaylenko, D S; Perepechin, D V; Grigoryeva, M V; Zhinzhilo, T A; Safronova, N Yu; Efremov, G D; Sivkov, A V

    2015-01-01

    Morphological analysis of the biopsies for prostate cancer (PCa) often is a difficult task due to heterogeneity and multifocality of tumors. At the same time, a lot of data exist about the potential molecular genetic markers of PCa. The aim of our study is to determine of PCA3 and TMPRSS2:ERG genes expression in benign hyperplasia (BPH), low and high grade intraepithelial neoplasia (PIN), PCa for revealing of diagnostic value of those genes expression in benign and precancerous changes in prostate. Total RNA was isolated from 53 biopsies, reverse transcription was performed, gene expression was determined by real time PCR (RT-PCR) then deltaCt index was determined as Ct(PCA3)--Ct(KLK3). Average deltaCt and its SD in BPH were 8.28 ± 3.13, low PIN--8.56 ± 2.64, high PIN--8.98 ±1.69, PCa--1.08 ± 2.36. We have demonstarted that deltaCt did not differ in patients with BPH, low and high grade PIN, whereas significantly increased in PCa relative to any of the three groups listed above (p < 0.0001). Expression of TMPRSS2:ERG was absent in BPH, PIN, but it was detected in 40% (4/10) of PCa cases. ROC-analysis showed that the AUC (area under ROC-curve with 95% CI, p < 0.0001) was 0.98 ± 0.02 in the analysis of a combination of overexpression of PCA3 and TMPRSS2:ERG. Thus, the expression analysis of the PCA3 and chimeric oncogene TMPRSS2:ERG in biopsy cannot be used for differential diagnosis of BPH, low and high grade PIN. However, overexpression of PCA3 and expression of TMPRSS2:ERG are characteristic in PCa. Expression analysis of these genes by the proposed RT-PCR modification at the threshold level deltaCt 3,22 has diagnostic accuracy 90% to detect PCa in biopsy specimens. PMID:26859937

  5. Efficacy of prophylactic antimicrobial regimens in preventing infectious complications after transrectal biopsy of the prostate.

    PubMed

    Melekos, M D

    1990-01-01

    In a prospective study on 81 patients undergoing transrectal needle biopsy of the prostate, the efficacy of prophylaxis in preventing postbiopsy infectious complications was determined. The patients were divided randomly into four groups, and a comparison of the rate of postbiopsy complications in each group was made. In 11 and 17% of the patients in Group A (n = 18) who received povidone-iodine enema alone, bacteriuria and bacteraemia, respectively, occurred. When parenteral piperacillin alone in Group B (n = 22) was administered, the rates of the same complications were 9 and 14%, respectively, while both rates were as low as 4% in Group C (n = 25) when piperacillin in combination with povidone-iodine enema was given. On the other hand, in 31 and 37.5% of the patients in Group D (n = 16), who served as controls, bacteriuria and bacteraemia developed. The study has thus shown that parenteral piperacillin in combination with povidone-iodine enema significantly reduces the incidence of infectious complications associated with transrectal prostatic biopsy.

  6. Predictive values of vascular endothelial growth factor and microvessel-density levels in initial biopsy for prostate cancer.

    PubMed

    Kervancioglu, Enis; Kosan, Murat; Erinanc, Hilal; Gonulalan, Umut; Oguzulgen, Ahmet Ibrahim; Coskun, Esra Zeynep; Ozkardes, Hakan

    2016-02-01

    Angiogenesis is an important factor in the development and progression of prostate cancer (PCA). We aimed to investigate the values of vascular-endothelial-growth-factor (VEGF) expression level and microvessel density (MVD) in the prediction of PCA diagnosis at repeated prostate biopsy (re-PBx). We retrospectively evaluated 167 patients with re-PBx according to elevated prostate-specific antigen levels, suspicious digital rectal examination, and the presence of premalignant lesions. Patients with PCA on re-PBx were included in the cancer group (n = 17). Patients with benign prostatic hyperplasia or normal tissues on re-PBx were included in the control group (n = 21). The groups were compared according to the expression level of VEGF and MVD in initial prostate biopsy. There was no statistically significant difference between groups according to age and serum prostate-specific-antigen values. The mean VEGF scores of the cancer and control groups were 232.64 ± 11.14 and 183.09 ± 14.56, respectively (p < 0.05). The mean MVD of the biopsy samples in the cancer and control groups were 246.47 ± 17.59 n/mm(2) and 197.33 ± 16.26 n/mm(2), respectively (p < 0.05). The cutoff values of VEGF scores and MVD were set as 200 and 215, respectively, for PCA detection in our study. Our results showed that the expression level of VEGF and MVD significantly increased in the initial prostate-biopsy samples of patients with PCA diagnosed with re-PBx. The evaluation of VEGF expression level and MVD might have an important value in the prediction of PCA at re-PBx. The expression level of VEGF and MVD should be kept in mind as PCA-related histopathological changes that indicate the increased angiogenesis in prostatic tissue.

  7. Can the Free/Total PSA Ratio Predict the Gleason Score Before Prostate Biopsy?

    PubMed Central

    Ceylan, Cavit; Gazel, Eymen; Keleş, İbrahim; Doluoğlu, Ömer; Yığman, Metin

    2016-01-01

    Objectives To determine whether there is a correlation between high Gleason score and free/total (f/t) prostate specific antigen (PSA) in patients newly diagnosed with prostate carcinoma. Materials and Methods The study included 272 prostate biopsy patients whose total PSA value ranged from 4–10 ng/ml. The patients were divided into 2 groups according to the f/t PSA ratio: Group 1 ≤ 15% and Group 2 > 15%. Furthermore, the groups were also compared to each other in terms of mild (≤ 6), moderate (= 7), and high (≥ 8) Gleason score. Results Group 1 consisted of 135 (49.6%) patients and Group 2 consisted of 137 (50.4%) patients. While 27 (20%) patients had a high Gleason score in Group 1, only 10 (7.3%) patients had a high Gleason score in Group 2 (p = 0.008). Using Spearman's correlation test, we found that the f/t PSA ratios were observed to decrease significantly in all patients with increased Gleason scores (p = 0.002, r = −0.185). Conclusion According to our study, there is a relationship between higher Gleason score and decreased f/t PSA ratio. Therefore, f/t PSA can be an indicator for predicting the Gleason score. PMID:26989367

  8. High-Throughput Prostate Cancer Gland Detection, Segmentation, and Classification from Digitized Needle Core Biopsies

    NASA Astrophysics Data System (ADS)

    Xu, Jun; Sparks, Rachel; Janowczyk, Andrew; Tomaszewski, John E.; Feldman, Michael D.; Madabhushi, Anant

    We present a high-throughput computer-aided system for the segmentation and classification of glands in high resolution digitized images of needle core biopsy samples of the prostate. It will allow for rapid and accurate identification of suspicious regions on these samples. The system includes the following three modules: 1) a hierarchical frequency weighted mean shift normalized cut (HNCut) for initial detection of glands; 2) a geodesic active contour (GAC) model for gland segmentation; and 3) a diffeomorphic based similarity (DBS) feature extraction for classification of glands as benign or cancerous. HNCut is a minimally supervised color based detection scheme that combines the frequency weighted mean shift and normalized cuts algorithms to detect the lumen region of candidate glands. A GAC model, initialized using the results of HNCut, uses a color gradient based edge detection function for accurate gland segmentation. Lastly, DBS features are a set of morphometric features derived from the nonlinear dimensionality reduction of a dissimilarity metric between shape models. The system integrates these modules to enable the rapid detection, segmentation, and classification of glands on prostate biopsy images. Across 23 H & E stained prostate studies of whole-slides, 105 regions of interests (ROIs) were selected for the evaluation of segmentation and classification. The segmentation results were evaluated on 10 ROIs and compared to manual segmentation in terms of mean distance (2.6 ±0.2 pixels), overlap (62±0.07%), sensitivity (85±0.01%), specificity (94±0.003%) and positive predictive value (68±0.08%). Over 105 ROIs, the classification accuracy for glands automatically segmented was (82.5 ±9.10%) while the accuracy for glands manually segmented was (82.89 ±3.97%); no statistically significant differences were identified between the classification results.

  9. Multiparametric Magnetic Resonance Imaging and Image-Guided Biopsy to Detect Seminal Vesicle Invasion by Prostate Cancer

    PubMed Central

    Raskolnikov, Dima; George, Arvin K.; Rais-Bahrami, Soroush; Turkbey, Baris; Shakir, Nabeel A.; Okoro, Chinonyerem; Rothwax, Jason T.; Walton-Diaz, Annerleim; Siddiqui, M. Minhaj; Su, Daniel; Stamatakis, Lambros; Merino, Maria J.; Wood, Bradford J.; Choyke, Peter L.

    2014-01-01

    Abstract Objectives: To evaluate the correlation between multiparametric prostate MRI (MP-MRI) suspicion for seminal vesicle invasion (SVI) by prostate cancer (PCa) and pathology on MRI/ultrasound (US) fusion-guided biopsy. Patients and Methods: From March 2007 to June 2013, 822 patients underwent MP-MRI at 3 Tesla and MRI/US fusion-guided biopsy. Of these, 25 patients underwent targeted biopsy of the seminal vesicles (SVs). In six patients, bilateral SVI was suspected, resulting in 31 samples. MP-MRI findings that triggered these SV biopsies were scored as low, moderate, or high suspicion for SVI based on the degree of involvement on MRI. Correlative prostate biopsy and radical prostatectomy (RP) pathology were reviewed by a single genitourinary pathologist. Results: At the time of MP-MRI, the median age was 64 years with a median prostate-specific antigen of 10.74 ng/mL. Of the 31 SV lesions identified, MP-MRI suspicion scores of low, moderate, and high were assigned to 3, 19, and 9 lesions, respectively. MRI/US fusion-guided biopsy detected SVI in 20/31 (65%) of cases. For the four patients who underwent RP after a preoperative assessment of SVI, biopsy pathology and RP pathology were concordant in all cases. Conclusions: As this technology becomes more available, MP-MRI and MRI/US fusion-guided biopsy may play a role in the preoperative staging for PCa. Future work will determine if improved preoperative staging leads to better surgical outcomes. PMID:25010361

  10. Prostate volume and biopsy tumor length are significant predictors for classical and redefined insignificant cancer on prostatectomy specimens in Japanese men with favorable pathologic features on biopsy

    PubMed Central

    2014-01-01

    Background Gleason pattern 3 less often has molecular abnormalities and often behaves indolent. It is controversial whether low grade small foci of prostate cancer (PCa) on biopsy could avoid immediate treatment or not, because substantial cases harbor unfavorable pathologic results on prostatectomy specimens. This study was designed to identify clinical predictors for classical and redefined insignificant cancer on prostatectomy specimens in Japanese men with favorable pathologic features on biopsy. Methods Retrospective review of 1040 PCa Japanese patients underwent radical prostatectomy between 2006 and 2013. Of those, 170 patients (16.3%) met the inclusion criteria of clinical stage ≤ cT2a, Gleason score (GS) ≤ 6, up to two positive biopsies, and no more than 50% of cancer involvement in any core. The associations between preoperative data and unfavorable pathologic results of prostatectomy specimens, and oncological outcome were analyzed. The definition of insignificant cancer consisted of pathologic stage ≤ pT2, GS ≤ 6, and an index tumor volume < 0.5 mL (classical) or 1.3 mL (redefined). Results Pathologic stage ≥ pT3, upgraded GS, index tumor volume ≥ 0.5 mL, and ≥ 1.3 mL were detected in 25 (14.7%), 77 (45.3%), 83 (48.8%), and 53 patients (31.2%), respectively. Less than half of cases had classical (41.2%) and redefined (47.6%) insignificant cancer. The 5-year recurrence-free survival was 86.8%, and the insignificant cancers essentially did not relapse regardless of the surgical margin status. MRI-estimated prostate volume, tumor length on biopsy, prostate-specific antigen density (PSAD), and findings of magnetic resonance imaging were associated with the presence of classical and redefined insignificant cancer. Large prostate volume and short tumor length on biopsy remained as independent predictors in multivariate analysis. Conclusions Favorable features of biopsy often are followed by adverse pathologic

  11. Detection and characterisation of biopsy tissue using quantitative optical coherence elastography (OCE) in men with suspected prostate cancer.

    PubMed

    Li, Chunhui; Guan, Guangying; Ling, Yuting; Hsu, Ying-Ting; Song, Shaozhen; Huang, Jeffrey T-J; Lang, Stephen; Wang, Ruikang K; Huang, Zhihong; Nabi, Ghulam

    2015-02-01

    We present first quantitative three-dimensional (3D) data sets recorded using optical coherence elastography (OCE) for the diagnosis and detection of prostate cancer (PCa). 120 transrectal ultrasound guided prostate biopsy specimens from 10 men suspected with prostate cancer were imaged using OCE. 3D quantitative mechanical assessment of biopsy specimens obtained in kilopascals (kPa) at an interval of 40 µm was compared with histopathology. Sensitivity, specificity, and positive and negative predictive values were calculated for OCE in comparison to histopathology. The results show OCE imaging could reliably differentiate between benign prostate tissue, acinar atypical hyperplasia, prostatic intraepithelial neoplasia and malignant PCa. The sensitivity and specificity of OCE for the detection of prostate cancer was 0.98 and 0.91 with AUC > 0.99. Quantitative 3D OCE based on the assessment of mechanical properties of tissues can reliably differentiate prostate tissue specimen in an ex-vivo setting. This is a promising imaging modality for characterising different grades of cancers.

  12. Predicting Prostate Biopsy Results Using a Panel of Plasma and Urine Biomarkers Combined in a Scoring System

    PubMed Central

    Albitar, Maher; Ma, Wanlong; Lund, Lars; Albitar, Ferras; Diep, Kevin; Fritsche, Herbert A.; Shore, Neal

    2016-01-01

    Background: Determining the need for prostate biopsy is frequently difficult and more objective criteria are needed to predict the presence of high grade prostate cancer (PCa). To reduce the rate of unnecessary biopsies, we explored the potential of using biomarkers in urine and plasma to develop a scoring system to predict prostate biopsy results and the presence of high grade PCa. Methods: Urine and plasma specimens were collected from 319 patients recommended for prostate biopsies. We measured the gene expression levels of UAP1, PDLIM5, IMPDH2, HSPD1, PCA3, PSA, TMPRSS2, ERG, GAPDH, B2M, AR, and PTEN in plasma and urine. Patient age, serum prostate-specific antigen (sPSA) level, and biomarkers data were used to develop two independent algorithms, one for predicting the presence of PCa and the other for predicting high-grade PCa (Gleason score [GS] ≥7). Results: Using training and validation data sets, a model for predicting the outcome of PCa biopsy was developed with an area under receiver operating characteristic curve (AUROC) of 0.87. The positive and negative predictive values (PPV and NPV) were 87% and 63%, respectively. We then developed a second algorithm to identify patients with high-grade PCa (GS ≥7). This algorithm's AUROC was 0.80, and had a PPV and NPV of 56% and 77%, respectively. Patients who demonstrated concordant results using both algorithms showed a sensitivity of 84% and specificity of 93% for predicting high-grade aggressive PCa. Thus, the use of both algorithms resulted in a PPV of 90% and NPV of 89% for predicting high-grade PCa with toleration of some low-grade PCa (GS <7) being detected. Conclusions: This model of a biomarker panel with algorithmic interpretation can be used as a “liquid biopsy” to reduce the need for unnecessary tissue biopsies, and help to guide appropriate treatment decisions. PMID:26918043

  13. Comparative Effectiveness of Targeted Prostate Biopsy Using MRI-US Fusion Software and Visual Targeting: a Prospective Study

    PubMed Central

    Lee, Daniel J.; Recabal, Pedro; Sjoberg, Daniel D.; Thong, Alan; Lee, Justin K.; Eastham, James A.; Scardino, Peter T.; Vargas, Hebert Alberto; Coleman, Jonathan; Ehdaie, Behfar

    2016-01-01

    Purpose To compare diagnostic outcomes between 2 different techniques for targeting regions-of-interest on prostate multiparametric Magnetic resonance imaging (mpMRI); MRI-ultrasound fusion (MR-F) and visually targeted (VT) biopsy. Materials and Methods Patients presenting for prostate biopsy with regions-of-interest on mpMRI underwent MRI-targeted biopsy. For each region-of-interest two VT cores were obtained, followed by 2 cores using an MR-F device. Our primary endpoint was the difference in the detection of high-grade (Gleason ≥7) and any-grade cancer between VT and MR-F, investigated using McNemar’s method. Secondary endpoints were the difference in detection rate by biopsy location using a logistic regression model, and difference in median cancer length using Wilcoxon sign-rank test. Results We identified 396 regions-of-interest in 286 men. The difference in high-grade cancer detection between MR-F biopsy and VT biopsy was −1.4% (95% CI −6.4% to 3.6%; p=0.6); for any-grade cancer the difference was 3.5% (95% CI −1.9% to 8.9%; p=0.2). Median cancer length detected by MR-F and VT were 5.5mm vs. 5.8mm, respectively (p=0.8). MR-F biopsy detected 15% more cancers in the transition zone (p=0.046), and VT biopsy detected 11% more high-grade cancer at the prostate base (p=0.005). Only 52% of all high-grade cancers were detected by both techniques. Conclusions We found no evidence of a significant difference in the detection of high-grade or any-grade cancer between VT and MR-F biopsy. However, the performance of each technique varied in specific biopsy locations, and the outcomes of both techniques were complementary. Combining VT biopsy and MR-F biopsy may optimize prostate cancer detection. PMID:27038768

  14. The proportion of prostate biopsy tissue with Gleason pattern 4 or 5 predicts for biochemical and clinical outcome after radiotherapy for prostate cancer

    SciTech Connect

    D'Ambrosio, David J.; Hanlon, Alexandra L.; Al-Saleem, Tahseen; Feigenberg, Steven J.; Horwitz, Eric M.; Uzzo, Robert G.; Pollack, Alan; Buyyounouski, Mark K. . E-mail: mark.buyyounouski@fccc.edu

    2007-03-15

    Purpose: To investigate the prognostic utility of the proportion of prostate biopsy tissue containing Gleason pattern 4 or 5 (GP4/5) after definitive radiotherapy (RT) for prostate cancer. Methods and Materials: A total of 568 patients with T1c-3 Nx/0 prostate cancer who received three-dimensional conformal RT alone between May 1989 and August 2001 were studied. There were 161 men with Gleason score 7-10 disease. The GP4/5 was defined as the percentage of biopsy tissue containing Gleason pattern 4 or 5. A Cox proportional hazards model was used for univariate and multivariate analyses (MVA) for biochemical failure (BF) (American Society of Therapeutic Radiology and Oncology definition) and distant metastasis (DM). A recursive partitioning analysis was done using the results of the MVA to identify a cutpoint for GP4/5. Results: The median follow-up was 46 (range, 13-114) months and median RT dose was 76 (range, 65-82) Gy. On MVA, increasing initial prostate-specific antigen (p = 0.0248) decreasing RT dose (continuous, p = 0.0022), T stage (T1/2 vs. T3) (p = 0.0136) and GP4/5 (continuous, p < 0.0001) were significant predictors of BF in a model also containing GS. GP4/5 was the only significant predictor of DM in the same model (p < 0.0001). Conclusion: The GP4/5 in prostate biopsy specimens is a predictor of BF and DM after RT independent of Gleason score. This parameter should be reported by the pathologist when reviewing prostatic biopsy specimens.

  15. 3T MR Guided in bore transperineal prostate biopsy: A Comparison of robotic and manual needle-guidance templates

    PubMed Central

    Tilak, Gaurie; Tuncali, Kemal; Song, Sang-Eun; Tokuda, Junichi; Olubiyi, Olutayo; Fennessy, Fiona; Fedorov, Andriy; Penzkofer, Tobias; Tempany, Clare; Hata, Nobuhiko

    2014-01-01

    Purpose To demonstrate the utility of a robotic needle-guidance template device as compared to a manual template for in-bore 3T transperineal MR-guided prostate biopsy. Materials and Methods This two-arm mixed retrospective-prospective study included 99 cases of targeted transperineal prostate biopsies. The biopsy needles were aimed at suspicious foci noted on multiparametric 3T MRI using manual template (historical control) as compared with a robotic template. The following data was obtained: the accuracy of average and closest needle placement to the focus, histologic yield, percentage of cancer volume in positive core samples, complication rate, and time to complete the procedure. Results 56 cases were performed using the manual template, and 43 cases were performed using the robotic template. The mean accuracy of the best needle placement attempt was higher in the robotic group (2.39 mm) than the manual group (3.71 mm, p<0.027). The mean core procedure time was shorter in the robotic (90.82min) than the manual group (100.63min, p<0.030). Percentage of cancer volume in positive core samples was higher in robotic group (p<0.001). Cancer yields and complication rates were not statistically different between the two sub-groups (p = 0.557 and p=0.172 respectively). Conclusion The robotic needle-guidance template helps accurate placement of biopsy needles in MRI-guided core biopsy of prostate cancer. PMID:25263213

  16. Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

    PubMed Central

    Serrao, Eva M.; Barrett, Tristan; Wadhwa, Karan; Parashar, Deepak; Frey, Julia; Koo, Brendan C.; Warren, Anne Y.; Doble, Andrew; Kastner, Christof; Gallagher, Ferdia A.

    2015-01-01

    Introduction: We characterized false negative prostate magnetic resonance imaging (MRI) reporting by using histology derived from MRI-transrectal ultrasound (TRUS)-guided transperineal (MTTP) fusion biopsies. Methods: In total, 148 consecutive patients were retrospectively reviewed. Men underwent multiparametric MRI (mpMRI), reported by a consultant/attending radiologist in line with European Society of Urogenital Radiology (ESUR) standards. MTTP biopsy of the lesions was performed according to the Ginsburg recommendations. Cases with an MRI-histology mismatch were identified and underwent a second read by an experienced radiologist. A third review was performed with direct histology comparison to determine a true miss from an MRI-occult cancer. Statistical analysis was performed with McNemar’s test. Results: False negative lesions were identified in 29 MRI examinations (19.6%), with a total of 46 lesions. Most false negative lesions (21/46) were located in the anterior sectors of the prostate. The second read led to a significant decrease of false-negative lesions with 7/29 further studies identified as positive on a patient-by-patient basis (24.1% of studies, p = 0.016) and 11/46 lesions (23.9%; p = 0.001). Of these, 30 lesions following the first read and 23 lesions after the second read were considered significant cancer according to the University College London criteria. However, on direct comparison with histology, most lesions were MRI occult. Conclusion: We demonstrate that MRI can fail to detect clinically relevant lesions. Improved results were achieved with a second read but despite this, a number of lesions remain MRI-occult. Further advances in imaging are required to reduce false negative results. PMID:26788234

  17. Imaging and pathology findings after an initial negative MRI-US fusion-guided and 12-core extended sextant prostate biopsy session

    PubMed Central

    Hong, Cheng William; Walton-Diaz, Annerleim; Rais-Bahrami, Soroush; Hoang, Anthony N.; Türkbey, Barış; Stamatakis, Lambros; Xu, Sheng; Amalou, Hayet; Minhaj Siddiqui, M.; Nix, Jeffrey W.; Vourganti, Srinivas; Merino, Maria J.; Choyke, Peter L.; Wood, Bradford J.; Pinto, Peter A.

    2014-01-01

    PURPOSE A magnetic resonance imaging-ultrasonography (MRI-US) fusion-guided prostate biopsy increases detection rates compared to an extended sextant biopsy. The imaging characteristics and pathology outcomes of subsequent biopsies in patients with initially negative MRI-US fusion biopsies are described in this study. MATERIALS AND METHODS We reviewed 855 biopsy sessions of 751 patients (June 2007 to March 2013). The fusion biopsy consisted of two cores per lesion identified on multiparametric MRI (mpMRI) and a 12-core extended sextant transrectal US (TRUS) biopsy. Inclusion criteria were at least two fusion biopsy sessions, with a negative first biopsy and mpMRI before each. RESULTS The detection rate on the initial fusion biopsy was 55.3%; 336 patients had negative findings. Forty-one patients had follow-up fusion biopsies, but only 34 of these were preceded by a repeat mpMRI. The median interval between biopsies was 15 months. Fourteen patients (41%) were positive for cancer on the repeat MRI-US fusion biopsy. Age, prostate-specific antigen (PSA), prostate volume, PSA density, digital rectal exam findings, lesion diameter, and changes on imaging were comparable between patients with negative and positive rebiopsies. Of the patients with positive rebiopsies, 79% had a positive TRUS biopsy before referral (P = 0.004). Ten patients had Gleason 3+3 disease, three had 3+4 disease, and one had 4+4 disease. CONCLUSION In patients with a negative MRI-US fusion prostate biopsy and indications for repeat biopsy, the detection rate of the follow-up sessions was lower than the initial detection rate. Of the prostate cancers subsequently found, 93% were low grade (≤3+4). In this low risk group of patients, increasing the follow-up time interval should be considered in the appropriate clinical setting. PMID:24509182

  18. Chronic Inflammation in Prostate Biopsy Cores is an Independent Factor that Lowers the Risk of Prostate Cancer Detection and is Inversely Associated with the Number of Positive Cores in Patients Elected to a First Biopsy

    PubMed Central

    Porcaro, Antonio B.; Novella, Giovanni; Mattevi, Daniele; Bizzotto, Leonardo; Cacciamani, Giovanni; Luyk, Nicolò De; Tamanini, Irene; Cerruto, Maria A.; Brunelli, Matteo; Artibani, Walter

    2016-01-01

    Objectives To investigate associations of chronic inflammatory infiltrate (CII) with prostate cancer (PCa) risk and the number of positive cores in patients elected to a first set of biopsies. Materials and Methods Excluding criteria were as follows: active surveillance, prostate specific antigen (PSA) ≥ 30 ng/l, re-biopsies, incidental PCa, less than 14 cores, metastases, or 5-alpha reductase inhibitors. The cohort study was classified as negative (control group) and positive cores between 1 and 2 or > 2. Results The cohort included 421 cases who did not meet the exclusion criteria. PCa was detected in 192 cases (45.6%) of which the number of positive cores was between 1 and 2 in 77 (40.1%) cases. The median PSA was 6.05 ng/ml (range 0.3-29 ng/ml). Linear regression models showed that CII was an independent predictor inversely associated with the risk of PCa. Multinomial logistic regression models showed that CII was an independent factor that was inversely associated with PCa risk in cases with positive cores between 1 and 2 (OR = 0.338; p = 0.004) or more than 2 (OR = 0.076; p < 0.0001) when compared to the control group. Conclusion In a cohort of men undergoing the first biopsy set after prostate assessment, the presence of CII in the biopsy core was an independent factor inversely associated with PCa risk as well as with the number of positive biopsy cores (tumor extension). Clinically, the detection of CII in negative biopsy cores might reduce the risk of PCa in repeat biopsies as well as the probability of detecting multiple positive cores. PMID:27390581

  19. Fluid biopsy in patients with metastatic prostate, pancreatic and breast cancers

    NASA Astrophysics Data System (ADS)

    Marrinucci, Dena; Bethel, Kelly; Kolatkar, Anand; Luttgen, Madelyn S.; Malchiodi, Michael; Baehring, Franziska; Voigt, Katharina; Lazar, Daniel; Nieva, Jorge; Bazhenova, Lyudmila; Ko, Andrew H.; Korn, W. Michael; Schram, Ethan; Coward, Michael; Yang, Xing; Metzner, Thomas; Lamy, Rachelle; Honnatti, Meghana; Yoshioka, Craig; Kunken, Joshua; Petrova, Yelena; Sok, Devin; Nelson, David; Kuhn, Peter

    2012-02-01

    Hematologic spread of carcinoma results in incurable metastasis; yet, the basic characteristics and travel mechanisms of cancer cells in the bloodstream are unknown. We have established a fluid phase biopsy approach that identifies circulating tumor cells (CTCs) without using surface protein-based enrichment and presents them in sufficiently high definition (HD) to satisfy diagnostic pathology image quality requirements. This 'HD-CTC' assay finds >5 HD-CTCs mL-1 of blood in 80% of patients with metastatic prostate cancer (n = 20), in 70% of patients with metastatic breast cancer (n = 30), in 50% of patients with metastatic pancreatic cancer (n = 18), and in 0% of normal controls (n = 15). Additionally, it finds HD-CTC clusters ranging from 2 HD-CTCs to greater than 30 HD-CTCs in the majority of these cancer patients. This initial validation of an enrichment-free assay demonstrates our ability to identify significant numbers of HD-CTCs in a majority of patients with prostate, breast and pancreatic cancers.

  20. Are complications of transrectal ultrasound-guided biopsies of the prostate gland increasing?

    PubMed

    Dodds, Peter R; Boucher, Jonathan D; Shield, Dennis E; Bernie, Jonathan E; Batter, Stephen J; Serels, Scott R; Dodds, Jon H

    2011-09-01

    Although transrectal ultrasound-guided biopsies (TRUSB) of the prostate gland are generally considered to be low-risk procedures, a study from Canada reported that there had been a significant increase in the percentage of hospital admissions following TRUSBs between 1996 and 2005 (1.0% to 4.1%). The authors speculated that the increase may be secondary to the emergence of antibiotic-resistant enteric bacteria or the result of an increasing number of cores taken with each TRUSB. In a chart review, we retrospectively evaluated complications from 2,080 consecutive TRUSBs performed by one urology group in Connecticut between January 2003 and August 2010. We identified seven patients (0.34%) who were admitted to an acute-care hospital for infectious complications and three patients (0.14%) who were admitted for bleeding. The risk of serious infections and bleeding did not significantly rise during the study period despite a significant increase in the mean number of biopsy cores taken.

  1. mp-MRI Prostate Characterised PIRADS 3 Lesions are Associated with a Low Risk of Clinically Significant Prostate Cancer - A Retrospective Review of 92 Biopsied PIRADS 3 Lesions

    PubMed Central

    Liddell, Heath; Jyoti, Rajeev; Haxhimolla, Hodo Z.

    2015-01-01

    Objective To determine whether prostate image reporting and data system (PIRADS) 3 lesions as assessed by a 3T multiparametric magnetic resonance imaging (MRI) represent clinically significant prostate cancer. Method A retrospective review was performed on a series of consecutive patients who underwent MRI guided biopsy of the prostate for clinical suspicion of prostate cancer between January 2013 and March 2014. Demographic, clinical, MRI and biopsy data were reviewed and compared. The same 3T MRI without the use of an endo-rectal coil was employed to assess each patient, obtaining high resolution T2 weighted images, diffusion weighted imaging and dynamic contrast enhancement. The MRI data was sent to Dynacad software for analysis. A single experienced radiologist reported all the studies from this series using a modified PIRADS scoring system. Subsequently, all the lesions marked PIRADS 3 or above were targeted with 18G core biopsy using DynaTrim in-gantry MRI guidance system. Needle position targeting the lesion was recorded prior to each biopsy. All core biopsy samples were sent to one of two pathology laboratories where they were processed and reported as per the International Society of Urological Pathology protocols. Results One hundred and eighteen patients comprising a total of 215 lesions were reviewed. Amongst this cohort, 92 PIRADS 3 lesions were identified and biopsied. The mean age of patients in this cohort was 62.6 years. Median prostate specific antigen (PSA) was 6.5 ng/ml and median prostate size was 78.4 ml. Eightysix (93.5%) of biopsied PIRADS 3 lesions were benign and 6 (6.5%) lesions were found to be malignant. Of these 6 malignant lesions, 4 (66%) were Gleason score 6 (3 + 3) and 2 (33%) were Gleason score 7 (3 + 4). Of the 86 non-malignant lesions, 1 (1.2%) represented high-grade prostate intraepithelial neoplasia and 2 (2.4%) represented atypical small acinar proliferation. PIRADS 3 lesions within the peripheral zone were more likely to be

  2. Robotic system for MRI-guided prostate biopsy: feasibility of teleoperated needle insertion and ex vivo phantom study

    PubMed Central

    Seifabadi, Reza; Song, Sang-Eun; Krieger, Axel; Cho, Nathan Bongjoon; Tokuda, Junichi; Fichtinger, Gabor; Iordachita, Iulian

    2012-01-01

    Purpose Magnetic Resonance Imaging (MRI) combined with robotic assistance has the potential to improve on clinical outcomes of biopsy and local treatment of prostate cancer. Methods We report the workspace optimization and phantom evaluation of a five Degree of Freedom (DOF) parallel pneumatically actuated modular robot for MRI-guided prostate biopsy. To shorten procedure time and consequently increase patient comfort and system accuracy, a prototype of a MRI-compatible master–slave needle driver module using piezo motors was also added to the base robot. Results Variable size workspace was achieved using appropriate link length, compared with the previous design. The 5-DOF targeting accuracy demonstrated an average error of 2.5mm (STD=1.37mm) in a realistic phantom inside a 3T magnet with a bevel-tip 18G needle. The average position tracking error of the master–slave needle driver was always below 0.1mm. Conclusion Phantom experiments showed sufficient accuracy for manual prostate biopsy. Also, the implementation of teleoperated needle insertion was feasible and accurate. These two together suggest the feasibility of accurate fully actuated needle placement into prostate while keeping the clinician supervision over the task. PMID:21698389

  3. Visually Estimated MRI Targeted Prostate Biopsy Could Improve the Detection of Significant Prostate Cancer in Patients with a PSA Level <10 ng/mL

    PubMed Central

    Lee, Dong Hoon; Nam, Jong Kil; Park, Sung Woo; Lee, Seung Soo; Han, Ji-Yeon; Lee, Sang Don; Lee, Joon Woo

    2016-01-01

    Purpose To compare prostate cancer detection rates between 12 cores transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and visually estimated multiparametric magnetic resonance imaging (mp-MRI)-targeted prostate biopsy (MRI-visual-Bx) for patients with prostate specific antigen (PSA) level less than 10 ng/mL. Materials and Methods In total, 76 patients with PSA levels below 10 ng/mL underwent 3.0 Tesla mp-MRI and TRUS-Bx prospectively in 2014. In patients with abnormal lesions on mp-MRI, we performed additional MRI-visual-Bx. We compared pathologic results, including the rate of clinically significant prostate cancer cores (cancer length greater than 5 mm and/or any Gleason grade greater than 3 in the biopsy core). Results The mean PSA was 6.43 ng/mL. In total, 48 of 76 (63.2%) patients had abnormal lesions on mp-MRI, and 116 targeted biopsy cores, an average of 2.42 per patient, were taken. The overall detection rates of prostate cancer using TRUS-Bx and MRI-visual-Bx were 26/76 (34.2%) and 23/48 (47.9%), respectively. In comparing the pathologic results of TRUS-Bx and MRI-visual-Bx cores, the positive rates were 8.4% (77 of 912 cores) and 46.6% (54 of 116 cores), respectively (p<0.001). Mean cancer core lengths and mean cancer core percentages were 3.2 mm and 24.5%, respectively, in TRUS-Bx and 6.3 mm and 45.4% in MRI-visual-Bx (p<0.001). In addition, Gleason score ≥7 was noted more frequently using MRI-visual-Bx (p=0.028). The detection rate of clinically significant prostate cancer was 27/77 (35.1%) and 40/54 (74.1%) for TRUS-Bx and MRI-visual-Bx, respectively (p<0.001). Conclusion MRI-visual-Bx showed better performance in the detection of clinically significant prostate cancer, compared to TRUS-Bx among patients with a PSA level less than 10 ng/mL. PMID:26996553

  4. 2D-3D rigid registration to compensate for prostate motion during 3D TRUS-guided biopsy

    NASA Astrophysics Data System (ADS)

    De Silva, Tharindu; Fenster, Aaron; Bax, Jeffrey; Gardi, Lori; Romagnoli, Cesare; Samarabandu, Jagath; Ward, Aaron D.

    2012-02-01

    Prostate biopsy is the clinical standard for prostate cancer diagnosis. To improve the accuracy of targeting suspicious locations, systems have been developed that can plan and record biopsy locations in a 3D TRUS image acquired at the beginning of the procedure. Some systems are designed for maximum compatibility with existing ultrasound equipment and are thus designed around the use of a conventional 2D TRUS probe, using controlled axial rotation of this probe to acquire a 3D TRUS reference image at the start of the biopsy procedure. Prostate motion during the biopsy procedure causes misalignments between the prostate in the live 2D TRUS images and the pre-acquired 3D TRUS image. We present an image-based rigid registration technique that aligns live 2D TRUS images, acquired immediately prior to biopsy needle insertion, with the pre-acquired 3D TRUS image to compensate for this motion. Our method was validated using 33 manually identified intrinsic fiducials in eight subjects and the target registration error was found to be 1.89 mm. We analysed the suitability of two image similarity metrics (normalized cross correlation and mutual information) for this task by plotting these metrics as a function of varying parameters in the six degree-of-freedom transformation space, with the ground truth plane obtained from registration as the starting point for the parameter exploration. We observed a generally convex behaviour of the similarity metrics. This encourages their use for this registration problem, and could assist in the design of a tool for the detection of misalignment, which could trigger the execution of a non-real-time registration, when needed during the procedure.

  5. The Practicality of Targeted Prostate Biopsy Procedures on the Dominant Side of the Tumor Determined by Magnetic Resonance Imaging in Elderly Patients with High Serum Levels of Prostate-Specific Antigen

    PubMed Central

    Huh, Jung Sik; Kim, Bong Soo; Kim, Young Joo; Kim, Sung Dae

    2015-01-01

    Purpose To examine the possibility of reducing the number of cores per prostate biopsy in elderly patients with high levels of prostate-specific antigen (PSA) without significantly lowering the detection rate of prostate cancer. Materials and Methods Two hundreds sixteen men with PSA levels >20 ng/mL who underwent prostate biopsies from May 2009 to April 2013 were retrospectively reviewed. With the help of magnetic resonance imaging (MRI), the laterality of the dominant tumor burden in patients was determined. The results of targeted biopsies were compared with those of conventional biopsy procedures. Results The mean age and PSA level were 79.5 years and 81.3 ng/mL, respectively, and the overall diagnostic rate of sextant biopsies was 81.9% (177/216). MRI was able to show the tumor burden in 189 of the 216 patients. The detection rate of transrectal ultrasonography (TRUS)-guided targeted biopsies was 87.3% (165/189). Detection rates were comparable with conventional biopsies (81.9% [177/216]) (p=0.23). Of the 177 men in whom the results of the sextant biopsy were positive, 12 men (6.8%) with PSA levels <29 ng/mL did not have any cancer cells according to targeted biopsies. However, all other patients were diagnosed with prostate cancer using the abovementioned techniques. Conclusions We believe that TRUS-guided targeted biopsies of the prostate in elderly men with high PSA levels could reduce the number of unnecessary cores per biopsy. However, a risk of detection loss remains. Therefore, we recommend that at least a sextant biopsy should be performed, even in elderly patients, in order to detect prostate cancer. PMID:26770939

  6. PSA velocity does not aid the detection of prostate cancer in men with a prior negative biopsy: data from the European Randomized Study of Prostate Cancer Screening in Göteborg, Sweden and Rotterdam, Netherlands

    PubMed Central

    Vickers, Andrew J.; Wolters, Tineke; Savage, Caroline J.; Cronin, Angel M.; O’Brien, M. Frank; Roobol, Monique J.; Aus, Gunnar; Scardino, Peter T.; Hugosson, Jonas; Schröder, Fritz H.; Lilja, Hans

    2012-01-01

    Purpose Prostate specific antigen (PSA) velocity has been proposed as a marker to aid detection of prostate cancer. We sought to determine whether PSA velocity could predict the results of repeat biopsy in men with persistently elevated PSA after initial negative biopsy. Materials and Methods We identified 1,837 men who participated in the Göteborg or Rotterdam section of the European Randomized Screening study of Prostate Cancer (ERSPC), and who had one or more subsequent prostate biopsies after an initial negative finding. We evaluated whether PSA velocity improved predictive accuracy beyond that of PSA alone. Results There were a total of 2579 repeat biopsies, of which 363 (14%) were positive for prostate cancer, and 44 (1.7%) were high grade (Gleason score ≥7). Although PSA velocity was statistically associated with cancer risk (p<0.001), it had very low predictive accuracy (area-under-the-curve [AUC] of 0.55). There was some evidence that PSA velocity improved AUC compared to PSA for high grade cancer. However, the small increase in risk associated with high PSA velocity – from 1.7 % to 2.8% as velocity increased from 0 to 1 ng / ml / year - is of questionable clinical relevance. Conclusions Men with a prior negative biopsy have a lower risk for prostate cancer at subsequent biopsies, with high grade disease particularly rare. We found little evidence to support the use of PSA velocity to aid decisions about repeat biopsy for prostate cancer. PMID:20643434

  7. Quantification of prostate deformation due to needle insertion during TRUS-guided biopsy: comparison of hand-held and mechanically stabilized systems

    NASA Astrophysics Data System (ADS)

    De Silva, Tharindu; Bax, Jeffrey; Fenster, Aaron; Samarabandu, Jagath; Ward, Aaron D.

    2011-03-01

    Prostate biopsy is the clinical standard for the definitive diagnosis of prostate cancer. To overcome the limitations of 2D TRUS-guided biopsy systems when targeting pre-planned locations, systems have been developed with 3D guidance to improve the accuracy of cancer detection. Prostate deformation due to needle insertion and biopsy gun firing is a potential source of error that can cause target misalignments during biopsies. We use non-rigid registration of 2D TRUS images to quantify the deformation during the needle insertion and the biopsy gun firing procedure, and compare this effect in biopsies performed using a handheld TRUS probe with those performed using a mechanically assisted 3D TRUS guided biopsy system. Although the mechanically assisted biopsy system had a mean deformation approximately 0.2 mm greater than that of the handheld approach, it yielded a lower relative increase of deformation near the needle axis during the needle insertion stage and greater deformational stability of the prostate during the biopsy gun firing stage. We also analyzed the axial and lateral components of the tissue motion; our results indicated that the motion is weakly biased in the direction orthogonal to the needle, which is less than ideal from a targeting standpoint given the long, narrow cylindrical shape of the biopsy core.

  8. Optimizing MRI-targeted fusion prostate biopsy: the effect of systematic error and anisotropy on tumor sampling

    NASA Astrophysics Data System (ADS)

    Martin, Peter R.; Cool, Derek W.; Romagnoli, Cesare; Fenster, Aaron; Ward, Aaron D.

    2015-03-01

    Magnetic resonance imaging (MRI)-targeted, 3D transrectal ultrasound (TRUS)-guided "fusion" prostate biopsy aims to reduce the 21-47% false negative rate of clinical 2D TRUS-guided sextant biopsy. Although it has been reported to double the positive yield, MRI-targeted biopsy still has a substantial false negative rate. Therefore, we propose optimization of biopsy targeting to meet the clinician's desired tumor sampling probability, optimizing needle targets within each tumor and accounting for uncertainties due to guidance system errors, image registration errors, and irregular tumor shapes. As a step toward this optimization, we obtained multiparametric MRI (mpMRI) and 3D TRUS images from 49 patients. A radiologist and radiology resident contoured 81 suspicious regions, yielding 3D surfaces that were registered to 3D TRUS. We estimated the probability, P, of obtaining a tumor sample with a single biopsy, and investigated the effects of systematic errors and anisotropy on P. Our experiments indicated that a biopsy system's lateral and elevational errors have a much greater effect on sampling probabilities, relative to its axial error. We have also determined that for a system with RMS error of 3.5 mm, tumors of volume 1.9 cm3 and smaller may require more than one biopsy core to ensure 95% probability of a sample with 50% core involvement, and tumors 1.0 cm3 and smaller may require more than two cores.

  9. Comparison of two different doses of lidocaine on the pain sensation during transrectal ultrasound-guided prostate biopsy

    PubMed Central

    Ateş, Ferhat; Dursun, Furkan; Malkoç, Ercan; Yılmaz, Ömer; Soydan, Hasan; Şen, Hüseyin; Başal, Şeref; Zekey, Fatih; Karademir, Kenan

    2016-01-01

    Objective To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. Material and methods A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients’ pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. Results The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). Conclusion According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.

  10. Comparison of two different doses of lidocaine on the pain sensation during transrectal ultrasound-guided prostate biopsy

    PubMed Central

    Ateş, Ferhat; Dursun, Furkan; Malkoç, Ercan; Yılmaz, Ömer; Soydan, Hasan; Şen, Hüseyin; Başal, Şeref; Zekey, Fatih; Karademir, Kenan

    2016-01-01

    Objective To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. Material and methods A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients’ pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. Results The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). Conclusion According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding. PMID:27635288

  11. A shape-based statistical method to retrieve 2D TRUS-MR slice correspondence for prostate biopsy

    NASA Astrophysics Data System (ADS)

    Mitra, Jhimli; Srikantha, Abhilash; Sidibé, Désiré; Martí, Robert; Oliver, Arnau; Lladó, Xavier; Ghose, Soumya; Vilanova, Joan C.; Comet, Josep; Meriaudeau, Fabrice

    2012-02-01

    This paper presents a method based on shape-context and statistical measures to match interventional 2D Trans Rectal Ultrasound (TRUS) slice during prostate biopsy to a 2D Magnetic Resonance (MR) slice of a pre-acquired prostate volume. Accurate biopsy tissue sampling requires translation of the MR slice information on the TRUS guided biopsy slice. However, this translation or fusion requires the knowledge of the spatial position of the TRUS slice and this is only possible with the use of an electro-magnetic (EM) tracker attached to the TRUS probe. Since, the use of EM tracker is not common in clinical practice and 3D TRUS is not used during biopsy, we propose to perform an analysis based on shape and information theory to reach close enough to the actual MR slice as validated by experts. The Bhattacharyya distance is used to find point correspondences between shape-context representations of the prostate contours. Thereafter, Chi-square distance is used to find out those MR slices where the prostates closely match with that of the TRUS slice. Normalized Mutual Information (NMI) values of the TRUS slice with each of the axial MR slices are computed after rigid alignment and consecutively a strategic elimination based on a set of rules between the Chi-square distances and the NMI leads to the required MR slice. We validated our method for TRUS axial slices of 15 patients, of which 11 results matched at least one experts validation and the remaining 4 are at most one slice away from the expert validations.

  12. The national burden of infections after prostate biopsy in England and Wales: a wake-up call for better prevention.

    PubMed

    Batura, Deepak; Gopal Rao, Guduru

    2013-02-01

    Transrectal ultrasound-guided needle biopsies (TGBs) are the mainstay of prostate cancer diagnosis. An average of 72,500 TGBs were performed in England and Wales in 2008. Current guidelines recommend fluoroquinolone prophylaxis for TGBs. However, emerging fluoroquinolone resistance has led to increased frequency and morbidity due to post-TGB infections. Following TGB, 2.15%-3.6% of patients are readmitted with infective complications. We estimate readmissions result in 25,745-37,062 bed days at an annual cost of £ 7.7-11.1 million in England and Wales. Clearly, an increase in post-TGB infections with resistant organisms has a profound clinical and economic impact. We suggest alternative approaches to prophylaxis to reduce post-TGB infections. These include prophylaxis based on local antibiotic resistance surveillance and targeted prophylaxis based on antibiograms of coliforms detected in pre-biopsy rectal swabs. Other strategies include selective prostate-specific antigen (PSA) screening and the use of biomarkers like prostate cancer antigen 3 (PCA3) to reduce the number of TGBs. Furthermore, transperineal biopsy has been shown to be associated with fewer infections.

  13. A prostate cancer computer-aided diagnosis system using multimodal magnetic resonance imaging and targeted biopsy labels

    NASA Astrophysics Data System (ADS)

    Liu, Peter; Wang, Shijun; Turkbey, Baris; Grant, Kinzya; Pinto, Peter; Choyke, Peter; Wood, Bradford J.; Summers, Ronald M.

    2013-02-01

    We propose a new method for prostate cancer classification based on supervised statistical learning methods by integrating T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI images with targeted prostate biopsy results. In the first step of the method, all three imaging modalities are registered based on the image coordinates encoded in the DICOM images. In the second step, local statistical features are extracted in each imaging modality to capture intensity, shape, and texture information at every biopsy target. Finally, using support vector machines, supervised learning is conducted with the biopsy results to train a classification system that predicts the pathology of suspicious cancer lesions. The algorithm was tested with a dataset of 54 patients that underwent 164 targeted biopsies (58 positive, 106 negative). The proposed tri-modal MRI algorithm shows significant improvement over a similar approach that utilizes only T2-weighted MRI images (p= 0.048). The areas under the ROC curve for these methods were 0.82 (95% CI: [0.71, 0.93]) and 0.73 (95% CI: [0.55, 0.84]), respectively.

  14. Workflow assessment of 3T MRI-guided transperineal targeted prostate biopsy using a robotic needle guidance

    NASA Astrophysics Data System (ADS)

    Song, Sang-Eun; Tuncali, Kemal; Tokuda, Junichi; Fedorov, Andriy; Penzkofer, Tobias; Fennessy, Fiona; Tempany, Clare; Yoshimitsu, Kitaro; Magill, John; Hata, Nobuhiko

    2014-03-01

    Magnetic resonance imaging (MRI) guided transperineal targeted prostate biopsy has become a valuable instrument for detection of prostate cancer in patients with continuing suspicion for aggressive cancer after transrectal ultrasound guided (TRUS) guided biopsy. The MRI-guided procedures are performed using mechanical targeting devices or templates, which suffer from limitations of spatial sampling resolution and/or manual in-bore adjustments. To overcome these limitations, we developed and clinically deployed an MRI-compatible piezoceramic-motor actuated needle guidance device, Smart Template, which allows automated needle guidance with high targeting resolution for use in a wide closed-bore 3-Tesla MRI scanner. One of the main limitations of the MRI-guided procedure is the lengthy procedure time compared to conventional TRUS-guided procedures. In order to optimize the procedure, we assessed workflow of 30 MRI-guided biopsy procedures using the Smart Template with focus on procedure time. An average of 3.4 (range: 2~6) targets were preprocedurally selected per procedure and 2.2 ± 0.8 biopsies were performed for each target with an average insertion attempt of 1.9 ± 0.7 per biopsy. The average technical preparation time was 14 ± 7 min and the in-MRI patient preparation time was 42 ± 7 min. After 21 ± 7 min of initial imaging, 64 ± 12 min of biopsy was performed yielding an average of 10 ± 2 min per tissue sample. The total procedure time occupying the MRI suite was 138 ± 16 min. No noticeable tendency in the length of any time segment was observed over the 30 clinical cases.

  15. The Prostate Health Index adds predictive value to multi-parametric MRI in detecting significant prostate cancers in a repeat biopsy population

    PubMed Central

    Gnanapragasam, V. J.; Burling, K.; George, A.; Stearn, S.; Warren, A.; Barrett, T.; Koo, B.; Gallagher, F. A.; Doble, A.; Kastner, C.; Parker, R. A.

    2016-01-01

    Both multi-parametric MRI (mpMRI) and the Prostate Health Index (PHI) have shown promise in predicting a positive biopsy in men with suspected prostate cancer. Here we investigated the value of combining both tests in men requiring a repeat biopsy. PHI scores were measured in men undergoing re-biopsy with an mpMRI image-guided transperineal approach (n = 279, 94 with negative mpMRIs). The PHI was assessed for ability to add value to mpMRI in predicting all or only significant cancers (Gleason ≥7). In this study adding PHI to mpMRI improved overall and significant cancer prediction (AUC 0.71 and 0.75) compared to mpMRI + PSA alone (AUC 0.64 and 0.69 respectively). At a threshold of ≥35, PHI + mpMRI demonstrated a NPV of 0.97 for excluding significant tumours. In mpMRI negative men, the PHI again improved prediction of significant cancers; AUC 0.76 vs 0.63 (mpMRI + PSA). Using a PHI≥35, only 1/21 significant cancers was missed and 31/73 (42%) men potentially spared a re-biopsy (NPV of 0.97, sensitivity 0.95). Decision curve analysis demonstrated clinically relevant utility of the PHI across threshold probabilities of 5–30%. In summary, the PHI adds predictive performance to image-guided detection of clinically significant cancers and has particular value in determining re-biopsy need in men with a negative mpMRI. PMID:27748407

  16. Identification of isolated and early prostatic adenocarcinoma in radical prostatectomy specimens with correlation to biopsy cores: clinical and pathogenetic significance.

    PubMed

    Mai, Kien T; Landry, Denise C; Yazdi, Hossein M; Stinson, William A; Perkins, D Garth; Morash, Christopher

    2002-01-01

    Prostatic adenocarcinoma (PAC) is a multifocal disease. In this study, we identified isolated and small foci of PAC (ISPAC) in radical prostatectomy specimens, described the histopathologic features, investigated their zonal distribution in the prostate and their relationship with large tumor nodules, and correlated the findings with those of preceding biopsy cores. One hundred and thirty radical prostatectomy specimens performed for PAC or for urothelial carcinoma of the urinary bladder with incidental PAC were reviewed for identification of ISPAC. Prostates were serially sectioned in the horizontal plane and submitted in toto for microscopic examination. ISPAC were defined as foci of PAC measuring less than 3 mm in maximum diameter. There were 461 ISPAC identified in 114 cases. They were distributed in the transitional zone (TZ) (18 foci), the apex (73 foci), the anterior horn of the non-TZ (NTZ) (118 foci), the base (8 foci), and the remaining NTZ (244 foci). ISPAC usually consisted of groups of small acini with a GS ranging from 2 to 7 (3 + 4). GSs of ISPAC consisted of single grade or two consecutive grades equal to or lower than those of the main PAC. ISPAC were more often located in close proximity to large tumor nodules. The number of ISPAC increased with the tumor volume up to 3 cm3, then decreased as the PAC became more extensive (p value = 0.02, statistically significant). Prostates with NTZ PAC <1.5 cm3 and TZ PAC or prostates containing 4 or more than 4 ISPAC tended to be frequently associated with small foci of PAC in biopsy cores In this study, we identified ISPAC that likely represent foci of PAC in early development and account for the multicentricity and heterogeneity of PAC. ISPAC in the NTZ were common and may account for small foci of PAC or atypia in biopsy cores. Although these small foci of PAC or atypia in biopsy cores without accompanying higher GS PAC were often associated with significant PAC, they may also occasionally represent

  17. The value of magnetic resonance imaging and ultrasonography (MRI/US)-fusion biopsy platforms in prostate cancer detection: a systematic review.

    PubMed

    Gayet, Maudy; van der Aa, Anouk; Beerlage, Harrie P; Schrier, Bart Ph; Mulders, Peter F A; Wijkstra, Hessel

    2016-03-01

    Despite limitations considering the presence, staging and aggressiveness of prostate cancer, ultrasonography (US)-guided systematic biopsies (SBs) are still the 'gold standard' for the diagnosis of prostate cancer. Recently, promising results have been published for targeted prostate biopsies (TBs) using magnetic resonance imaging (MRI) and ultrasonography (MRI/US)-fusion platforms. Different platforms are USA Food and Drug Administration registered and have, mostly subjective, strengths and weaknesses. To our knowledge, no systematic review exists that objectively compares prostate cancer detection rates between the different platforms available. To assess the value of the different MRI/US-fusion platforms in prostate cancer detection, we compared platform-guided TB with SB, and other ways of MRI TB (cognitive fusion or in-bore MR fusion). We performed a systematic review of well-designed prospective randomised and non-randomised trials in the English language published between 1 January 2004 and 17 February 2015, using PubMed, Embase and Cochrane Library databases. Search terms included: 'prostate cancer', 'MR/ultrasound(US) fusion' and 'targeted biopsies'. Extraction of articles was performed by two authors (M.G. and A.A.) and were evaluated by the other authors. Randomised and non-randomised prospective clinical trials comparing TB using MRI/US-fusion platforms and SB, or other ways of TB (cognitive fusion or MR in-bore fusion) were included. In all, 11 of 1865 studies met the inclusion criteria, involving seven different fusion platforms and 2626 patients: 1119 biopsy naïve, 1433 with prior negative biopsy, 50 not mentioned (either biopsy naïve or with prior negative biopsy) and 24 on active surveillance (who were disregarded). The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of included articles. No clear advantage of MRI/US fusion-guided TBs was seen for cancer detection rates (CDRs) of all prostate

  18. Prostate extracellular vesicles in patient plasma as a liquid biopsy platform for prostate cancer using nanoscale flow cytometry

    PubMed Central

    Al-Zahrani, Ali A.; Pardhan, Siddika; Brett, Sabine I.; Guo, Qiu Q.; Yang, Jun; Wolf, Philipp; Power, Nicholas E.; Durfee, Paul N.; MacMillan, Connor D.; Townson, Jason L.; Brinker, Jeffrey C.; Fleshner, Neil E.; Izawa, Jonathan I.; Chambers, Ann F.; Chin, Joseph L.; Leong, Hon S.

    2016-01-01

    Background Extracellular vesicles released by prostate cancer present in seminal fluid, urine, and blood may represent a non-invasive means to identify and prioritize patients with intermediate risk and high risk of prostate cancer. We hypothesize that enumeration of circulating prostate microparticles (PMPs), a type of extracellular vesicle (EV), can identify patients with Gleason Score≥4+4 prostate cancer (PCa) in a manner independent of PSA. Patients and Methods Plasmas from healthy volunteers, benign prostatic hyperplasia patients, and PCa patients with various Gleason score patterns were analyzed for PMPs. We used nanoscale flow cytometry to enumerate PMPs which were defined as submicron events (100-1000nm) immunoreactive to anti-PSMA mAb when compared to isotype control labeled samples. Levels of PMPs (counts/μL of plasma) were also compared to CellSearch CTC Subclasses in various PCa metastatic disease subtypes (treatment naïve, castration resistant prostate cancer) and in serially collected plasma sets from patients undergoing radical prostatectomy. Results PMP levels in plasma as enumerated by nanoscale flow cytometry are effective in distinguishing PCa patients with Gleason Score≥8 disease, a high-risk prognostic factor, from patients with Gleason Score≤7 PCa, which carries an intermediate risk of PCa recurrence. PMP levels were independent of PSA and significantly decreased after surgical resection of the prostate, demonstrating its prognostic potential for clinical follow-up. CTC subclasses did not decrease after prostatectomy and were not effective in distinguishing localized PCa patients from metastatic PCa patients. Conclusions PMP enumeration was able to identify patients with Gleason Score ≥8 PCa but not patients with Gleason Score 4+3 PCa, but offers greater confidence than CTC counts in identifying patients with metastatic prostate cancer. CTC Subclass analysis was also not effective for post-prostatectomy follow up and for

  19. Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

    PubMed Central

    Casey, Rowan G; Galvin, David J; Manecksha, Rustom P; Varadaraj, Haradikar; McDermott, TED; Grainger, Ronald; Lynch, Thomas H

    2012-01-01

    Purpose Historically, it was thought that hemorrhagic complications were increased with transrectal ultrasound-guided prostate biopsies (TRUS biopsy) of patients receiving anticoagulation/antiplatelet therapy. However, the current literature supports the continuation of anticoagulation/antiplatelet therapy without additional morbidity. We assessed our experience regarding the continuation of anticoagulation/antiplatelet therapy during TRUS biopsy. Materials and Methods A total of 91 and 98 patients were included in the anticoagulation/antiplatelet (group I) and control (group II) groups, respectively. Group I subgroups consisted of patients on monotherapy or dual therapy of aspirin, warfarin, clopidogrel, or low molecular weight heparin. The TRUS biopsy technique was standardized to 12 cores from the peripheral zones. Patients completed a questionnaire over the 7 days following TRUS biopsy. The questionnaire was designed to assess the presence of hematuria, rectal bleeding, and hematospermia. Development of rectal pain, fever, and emergency hospital admissions following TRUS biopsy were also recorded. Results The patients' mean age was 65 years (range, 52 to 74 years) and 63.5 years (range, 54 to 74 years) in groups I and II, respectively. The overall incidence of hematuria was 46% in group I compared with 63% in group II (p=0.018). The incidence of hematospermia was 6% and 10% in groups I and II, respectively. The incidence of rectal bleeding was similar in group I (40%) and group II (39%). Statistical analysis was conducted by using Fisher exact test. Conclusions There were fewer hematuria episodes in anticoagulation/antiplatelet patients. This study suggests that it is not necessary to discontinue anticoagulation/antiplatelet treatment before TRUS biopsy. PMID:22536465

  20. Impact of the US Preventive Services Task Force Grade D Recommendation: Assessment of Evaluations for Elevated Prostate-specific Antigen and Prostate Biopsies in a Large Urology Group Practice Following Statement Revision

    PubMed Central

    McGinley, Kathleen F; McMahon, Gregory C; Brown, Gordon A

    2015-01-01

    On October 7, 2011, the United States Preventive Services Task Force (USPSTF) released their evidence statement and grade D recommendation against prostate-specific antigen (PSA)-based prostate cancer screening. Using a time series design, we assessed the effect of this recommendation upon evaluations for elevated PSA levels and prostate biopsies in our large urology group practice. We found that, despite a 24.1% increase in total visits, the 32 urologists in our practice completed 16.4% fewer evaluations for elevated PSA levels (317 fewer evaluations per month; P = .017) and 21.4% fewer prostate biopsies (42 fewer biopsies per month; P = .001) in the 2 years following the USPSTF grade D recommendation. PMID:26543432

  1. Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis

    PubMed Central

    Yan, Pu; Wang, Xiao-yan; Huang, Wei; Zhang, Yong

    2016-01-01

    Background A meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA), periprostatic nerve block (PPNB), and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and methods A literature review was performed to identify all published randomized controlled trials (RCTs) about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB) vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale. Results A total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: −0.22, 95% CI: −0.45 to 0, P=0.06). PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: −1.32, 95% CI: −1.68 to −0.95, P<0.00001), placebo injection (WMD: −2.62, 95% CI: −3.16 to −2.07, P<0.00001), or IRLA (WMD: −1.31, 95% CI: −1.40 to −1.22, P<0.00001). PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: −0.45, 95% CI: −0.62 to −0.28, P<0.00001). PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: −0.73, 95% CI: −0.92 to −0.55, P<0.00001). There were no severe reported general or local complications related to local anesthesia. Conclusion This meta-analysis indicates that a combination of PPNB and IRLA/IPNB is effective and safe in alleviating the pain during TRUS-guided prostate biopsy. Further high-quality RCTs are needed

  2. Targeted proteomics identifies liquid-biopsy signatures for extracapsular prostate cancer

    PubMed Central

    Kim, Yunee; Jeon, Jouhyun; Mejia, Salvador; Yao, Cindy Q; Ignatchenko, Vladimir; Nyalwidhe, Julius O; Gramolini, Anthony O; Lance, Raymond S; Troyer, Dean A; Drake, Richard R; Boutros, Paul C; Semmes, O. John; Kislinger, Thomas

    2016-01-01

    Biomarkers are rapidly gaining importance in personalized medicine. Although numerous molecular signatures have been developed over the past decade, there is a lack of overlap and many biomarkers fail to validate in independent patient cohorts and hence are not useful for clinical application. For these reasons, identification of novel and robust biomarkers remains a formidable challenge. We combine targeted proteomics with computational biology to discover robust proteomic signatures for prostate cancer. Quantitative proteomics conducted in expressed prostatic secretions from men with extraprostatic and organ-confined prostate cancers identified 133 differentially expressed proteins. Using synthetic peptides, we evaluate them by targeted proteomics in a 74-patient cohort of expressed prostatic secretions in urine. We quantify a panel of 34 candidates in an independent 207-patient cohort. We apply machine-learning approaches to develop clinical predictive models for prostate cancer diagnosis and prognosis. Our results demonstrate that computationally guided proteomics can discover highly accurate non-invasive biomarkers. PMID:27350604

  3. Comparison of Biochemical Relapse-Free Survival Between Primary Gleason Score 3 and Primary Gleason Score 4 for Biopsy Gleason Score 7 Prostate Cancer

    SciTech Connect

    Burdick, Michael J. Reddy, Chandana A.; Ulchaker, James; Angermeier, Kenneth; Altman, Andrew; Chehade, Nabil; Mahadevan, Arul; Kupelian, Patrick A.; Klein, Eric A.; Ciezki, Jay P.

    2009-04-01

    Purpose: To determine whether the primary grade (PG) of biopsy Gleason score (GS) 7 prostate cancer (CaP) was predictive for biochemical relapse-free survival (bRFS). Most of the present data regarding the PG of GS7 CaP refer to surgical specimens. Our goal was to determine whether the biopsy GS used at the time of medical decision making predicted for the biochemical outcome. Methods and Materials: We reviewed the data from 705 patients with biopsy GS7 CaP, from a prospectively maintained database, who had been treated at our institution between September 1996 and March 2005 with radical prostatectomy (n = 310), external beam radiotherapy (n = 268), or prostate radioactive seed implantation (n = 127). The bRFS rates were estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used for univariate and multivariate analyses examining these factors in relation to bRFS: PG of biopsy GS, initial prostate-specific antigen level, clinical T stage, use of androgen deprivation, risk group (high or intermediate), and treatment modality. Results: The 5-year bRFS rate was 78% and 71% (p = 0.0108) for biopsy GS7 PG3 CaP and biopsy GS7 PG4 CaP, respectively. Comparing PG3 and PG4 within treatment modalities, only prostate implantation patients had a significant difference in the 5-year bRFS rate, 88% vs. 76%, respectively (p = 0.0231). On multivariate analysis, the PG of biopsy GS remained an independent predictor of bRFS, with PG3 having better bRFS than PG4 (relative risk, 0.655; 95% confidence interval, 0.472-0.909; p = 0.0113). Conclusion: Biopsy GS7 PG4 CaP carries a worse bRFS than biopsy GS7 PG3 CaP.

  4. New variants at 10q26 and 15q21 are associated with aggressive prostate cancer in a genome-wide association study from a prostate biopsy screening cohort

    PubMed Central

    Zhang, William; Siminovitch, Katherine; Shlien, Adam; Kattan, Michael W.; Klotz, Laurence H.; Trachtenberg, John; Lu, Yan; Zhang, Jinyi; Yu, Changhong; Toi, Ants; Loblaw, D. Andrew; Venkateswaran, Vasundara; Stanimirovic, Aleksandra; Sugar, Linda; Malkin, David; Narod, Steven A.

    2011-01-01

    Purpose: To identify and examine polymorphisms of genes associated with aggressive and clinical significant forms of prostate cancer among a screening cohort.     Experimental Design: We conducted a genome-wide association study among patients with aggressive forms of prostate cancer and biopsy-proven normal controls ascertained from a prostate cancer screening program. We then examined significant associations of specific polymorphisms among a prostate cancer screened cohort to examine their predictive ability in detecting prostate cancer. Results: We found significant associations between aggressive prostate cancer and five single nucleotide polymorphisms (SNPs) in the 10q26 (rs10788165, rs10749408, and rs10788165, p value for association 1.3 × 10−10 to 3.2 × 10−11) and 15q21 (rs4775302 and rs1994198, p values for association 3.1 × 10−8 to 8.2 × 10−9) regions. Results of a replication study done in 3439 patients undergoing a prostate biopsy, revealed certain combinations of these SNPs to be significantly associated not only with prostate cancer but with aggressive forms of prostate cancer using an established classification criterion for prostate cancer progression (odds ratios for intermediate to high-risk disease 1.8–3.0, p value 0.003–0.001). These SNP combinations were also important clinical predictors for prostate cancer detection based on nomogram analysis that assesses prostate cancer risk. Conclusions: Five SNPs were found to be associated with aggressive forms of prostate cancer. We demonstrated potential clinical applications of these associations. PMID:22130093

  5. A Comparative Performance Analysis of Total PSA, Percentage Free PSA, PSA Velocity, and PSA Density versus the Detection of Primary Circulating Prostate Cells in Predicting Initial Prostate Biopsy Findings in Chilean Men

    PubMed Central

    Murray, Nigel P.; Reyes, Eduardo; Orellana, Nelson; Fuentealba, Cynthia; Dueñas, Ricardo

    2014-01-01

    Introduction. PSA parameters have been used in an attempt to improve the diagnostic yield of prostate screening tests; the detection of primary malignant circulating prostate cells (CPCs) may improve the diagnostic yield of screening and therefore avoid unnecessary biopsies. Patients and Methods. Prospective study of all men undergoing initial prostate biopsy due to an elevated total serum PSA. Free percent PSA, PSA velocity, and PSA density were determined. Primary CPCs were detected using standard immunocytochemistry. A positive test for CPCs was defined as one cell PSA (+) P504S (+) in an 8 ml blood sample. Positive predictive and negative predictive values, specificity, and sensitivity were calculated for each test as well as the number of biopsies avoided and cancers missed. Results. 303 men participated in the study of whom 113/303 (37.3%) men had prostate cancer. Of the three PSA based parameters, free percent PSA was superior, sensitivity 70.8%, and specificity 67.4%. Primary CPCs detection had a sensitivity of 88.5% and a specificity of 88.4% avoiding 181 (59.7%) biopsies, detecting 93/95 (98%) of clinically significant cancers, and missing 13 (11.5%) low grade, small volume tumors. Conclusions. The use of primary CPCs as a sequential test could decrease the number of initial prostate biopsies missing those cancers which are treated by active observation. PMID:25101294

  6. Nomograms for predicting Gleason upgrading in a contemporary Chinese cohort receiving radical prostatectomy after extended prostate biopsy: development and internal validation.

    PubMed

    He, Biming; Chen, Rui; Gao, Xu; Ren, Shancheng; Yang, Bo; Hou, Jianguo; Wang, Linhui; Yang, Qing; Zhou, Tie; Zhao, Lin; Xu, Chuanliang; Sun, Yinghao

    2016-03-29

    The current strategy for the histological assessment of prostate cancer (PCa) is mainly based on the Gleason score (GS). However, 30-40% of patients who undergo radical prostatectomy (RP) are misclassified at biopsy pathologically. Thus, we developed and validated nomograms for the prediction of Gleason score upgrading (GSU) in patients who underwent radical prostatectomy after extended prostate biopsy in a Chinese population. This retrospective study included a total of 411 patients who underwent radical prostatectomy at our institute after having prostate biopsies between 2011 and 2015. The final pathologic GS was upgraded in 151 (36.74%) of the cases in all patients and 92 (60.13%) cases in men with GS=6. In multivariate analyses, the primary biopsy GS, secondary biopsy GS and obesity were predictive of GSU in the patient cohort assessed. In patients with GS=6, the significant predictors of GSU included the body mass index (BMI), prostate-specific antigen density(PSAD) and percentage of positive cores. The area under the curve (AUC) of the prediction models was 0.753 for the entire patient population and 0.727 for the patients with GS=6. Both nomograms were well calibrated, and decision curve analysis demonstrated a high net benefit across a wide range of threshold probabilities. This study may be relevant for improved risk assessment and clinical decision-making in PCa patients. PMID:26943768

  7. Factors Associated with Adherence to an End-of-study Biopsy: Lessons from the Prostate Cancer Prevention Trial (SWOG-Coordinated Intergroup Study S9217)

    PubMed Central

    Gritz, Ellen R.; Arnold, Kathryn B.; Moinpour, Carol M.; Burton-Chase, Allison M.; Tangen, Catherine M.; Probstfield, Jeffrey F.; See, William A.; Lieber, Michael M.; Caggiano, Vincent; Moody-Thomas, Sarah; Szczepanek, Connie; Ryan, Anne; Carlin, Susie; Hill, Shannon; Goodman, Phyllis J.; Padberg, Rose Mary; Minasian, Lori M.; Meyskens, Frank L.; Thompson, Ian M.

    2014-01-01

    Background The Prostate Cancer Prevention Trial (PCPT) was a 7-year randomized, double-blind, placebo-controlled trial of the efficacy of finasteride for the prevention of prostate cancer with a primary outcome of histologically-determined prevalence of prostate cancer at the end of 7 years. Methods A systematic modeling process using logistic regression identified factors available at year 6 that are associated with end-of-study (EOS) biopsy adherence at year 7, stratified by whether participants were ever prompted for a prostate biopsy by year 6. Final models were evaluated for discrimination. At year 6, 13,590 men were available for analysis. Results Participants were more likely to have the EOS biopsy if they were adherent to study visit schedules and procedures and/or were in good health (p<.01). Participants at larger sites and/or sites that received retention and adherence grants were also more likely to have the EOS biopsy (p<.05). Conclusions Our results show good adherence to study requirements one year prior to the EOS biopsy was associated with greater odds that a participant would comply with the invasive EOS requirement. Impact Monitoring adherence behaviors may identify participants at risk of non-adherence to more demanding study end points. Such information could help frame adherence intervention strategies in future trials. PMID:25028457

  8. 3D non-rigid registration using surface and local salient features for transrectal ultrasound image-guided prostate biopsy

    NASA Astrophysics Data System (ADS)

    Yang, Xiaofeng; Akbari, Hamed; Halig, Luma; Fei, Baowei

    2011-03-01

    We present a 3D non-rigid registration algorithm for the potential use in combining PET/CT and transrectal ultrasound (TRUS) images for targeted prostate biopsy. Our registration is a hybrid approach that simultaneously optimizes the similarities from point-based registration and volume matching methods. The 3D registration is obtained by minimizing the distances of corresponding points at the surface and within the prostate and by maximizing the overlap ratio of the bladder neck on both images. The hybrid approach not only capture deformation at the prostate surface and internal landmarks but also the deformation at the bladder neck regions. The registration uses a soft assignment and deterministic annealing process. The correspondences are iteratively established in a fuzzy-to-deterministic approach. B-splines are used to generate a smooth non-rigid spatial transformation. In this study, we tested our registration with pre- and postbiopsy TRUS images of the same patients. Registration accuracy is evaluated using manual defined anatomic landmarks, i.e. calcification. The root-mean-squared (RMS) of the difference image between the reference and floating images was decreased by 62.6+/-9.1% after registration. The mean target registration error (TRE) was 0.88+/-0.16 mm, i.e. less than 3 voxels with a voxel size of 0.38×0.38×0.38 mm3 for all five patients. The experimental results demonstrate the robustness and accuracy of the 3D non-rigid registration algorithm.

  9. Droplet Digital PCR Based Androgen Receptor Variant 7 (AR-V7) Detection from Prostate Cancer Patient Blood Biopsies

    PubMed Central

    Ma, Yafeng; Luk, Alison; Young, Francis P.; Lynch, David; Chua, Wei; Balakrishnar, Bavanthi; de Souza, Paul; Becker, Therese M.

    2016-01-01

    Androgen receptor splice variant V7 (AR-V7) was recently identified as a valuable predictive biomarker in metastatic castrate-resistant prostate cancer. Here, we report a new, sensitive and accurate screen for AR-V7 mRNA expression directly from circulating tumor cells (CTCs): We combined EpCAM-based immunomagnetic CTC isolation using the IsoFlux microfluidic platform with droplet digital polymerase chain reaction (ddPCR) to analyze total AR and AR-V7 expression from prostate cancer patients CTCs. We demonstrate that AR-V7 is reliably detectable in enriched CTC samples with as little as five CTCs, even considering tumor heterogeneity, and confirm detection of AR-V7 in CTC samples from advanced prostate cancer (PCa) patients with AR-V7 detection limited to castrate resistant disease status in our sample set. Sensitive molecular analyses of circulating tumor cells (CTCs) or circulating tumor nucleic acids present exciting strategies to detect biomarkers, such as AR-V7 from non-invasive blood samples, so-called blood biopsies. PMID:27527157

  10. Droplet Digital PCR Based Androgen Receptor Variant 7 (AR-V7) Detection from Prostate Cancer Patient Blood Biopsies.

    PubMed

    Ma, Yafeng; Luk, Alison; Young, Francis P; Lynch, David; Chua, Wei; Balakrishnar, Bavanthi; de Souza, Paul; Becker, Therese M

    2016-08-04

    Androgen receptor splice variant V7 (AR-V7) was recently identified as a valuable predictive biomarker in metastatic castrate-resistant prostate cancer. Here, we report a new, sensitive and accurate screen for AR-V7 mRNA expression directly from circulating tumor cells (CTCs): We combined EpCAM-based immunomagnetic CTC isolation using the IsoFlux microfluidic platform with droplet digital polymerase chain reaction (ddPCR) to analyze total AR and AR-V7 expression from prostate cancer patients CTCs. We demonstrate that AR-V7 is reliably detectable in enriched CTC samples with as little as five CTCs, even considering tumor heterogeneity, and confirm detection of AR-V7 in CTC samples from advanced prostate cancer (PCa) patients with AR-V7 detection limited to castrate resistant disease status in our sample set. Sensitive molecular analyses of circulating tumor cells (CTCs) or circulating tumor nucleic acids present exciting strategies to detect biomarkers, such as AR-V7 from non-invasive blood samples, so-called blood biopsies.

  11. The role of imaging based prostate biopsy morphology in a data fusion paradigm for transducing prognostic predictions

    NASA Astrophysics Data System (ADS)

    Khan, Faisal M.; Kulikowski, Casimir A.

    2016-03-01

    A major focus area for precision medicine is in managing the treatment of newly diagnosed prostate cancer patients. For patients with a positive biopsy, clinicians aim to develop an individualized treatment plan based on a mechanistic understanding of the disease factors unique to each patient. Recently, there has been a movement towards a multi-modal view of the cancer through the fusion of quantitative information from multiple sources, imaging and otherwise. Simultaneously, there have been significant advances in machine learning methods for medical prognostics which integrate a multitude of predictive factors to develop an individualized risk assessment and prognosis for patients. An emerging area of research is in semi-supervised approaches which transduce the appropriate survival time for censored patients. In this work, we apply a novel semi-supervised approach for support vector regression to predict the prognosis for newly diagnosed prostate cancer patients. We integrate clinical characteristics of a patient's disease with imaging derived metrics for biomarker expression as well as glandular and nuclear morphology. In particular, our goal was to explore the performance of nuclear and glandular architecture within the transduction algorithm and assess their predictive power when compared with the Gleason score manually assigned by a pathologist. Our analysis in a multi-institutional cohort of 1027 patients indicates that not only do glandular and morphometric characteristics improve the predictive power of the semi-supervised transduction algorithm; they perform better when the pathological Gleason is absent. This work represents one of the first assessments of quantitative prostate biopsy architecture versus the Gleason grade in the context of a data fusion paradigm which leverages a semi-supervised approach for risk prognosis.

  12. THE IMPORTANCE OF LOCAL CONTROL IN EARLY STAGE PROSTATE CANCER: OUTCOMES OF PATIENTS WITH A POSITIVE POST-RADIOTHERAPY BIOPSY TREATED ON RTOG 9408

    PubMed Central

    Krauss, Daniel J.; Hu, Chen; Bahary, Jean-Paul; Souhami, Luis; Gore, Elizabeth M.; Chafe, Susan Maria Jacinta; Leibenhaut, Mark H.; Narayan, Samir; Torres-Roca, Javier; Michalski, Jeff; Zeitzer, Kenneth L.; Donavanik, Viroon; Sandler, Howard; McGowan, David G.; Jones, Christopher U.; Shipley, William U.

    2015-01-01

    Purpose To assess the association of positive post-radiotherapy (RT) biopsy with subsequent clinical outcomes in men with localized prostate cancer. Methods RTOG 94-08 analyzed 1979 men with stage T1b-T2b, PSA ≤ 20 prostate cancer testing whether 4 months of total androgen suppression (TAS) added to RT improved survival over RT alone. Patients randomized to TAS received flutamide with leutenizing hormone releasing hormone (LHRH) agonist. Per protocol, patients without evidence of clinical recurrence or initiation of additional endocrine therapy underwent repeat prostate biopsy 2 years following RT completion. Statistical analysis was performed to evaluate the impact of positive post-RT biopsies on clinical outcomes. Results 831 patients underwent post-RT biopsy, 398 treated with RT alone and 433 RT + TAS. Patients with positive post-RT biopsies had higher rates of biochemical failure (BCF) [HR=1.7; 95% CI 1.3–2.1] and distant metastasis (DM) [HR=2.4; 95% CI 1.3–4.4] as well as inferior disease specific survival (DSS) [HR=3.8; 95% CI 1.9–7.5]. Positive biopsy remained predictive of such outcomes after correction for potential confounders such as Gleason score, tumor stage, and TAS administration. Prior TAS did not prevent elevated risk of adverse outcome in the setting of post-RT positive biopsy. Patients with Gleason score ≥ 7 with a positive biopsy additionally had inferior overall survival compared to those with a negative biopsy [HR=1.56; 95% CI 1.04–2.35]. Conclusions Positive post-RT biopsy is associated with increased rates of DM and inferior DSS in patients treated with definitive RT and was associated with inferior OS for patients with high-grade tumors. PMID:26104939

  13. Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) significantly improve prostate cancer detection at initial biopsy in a total PSA range of 2-10 ng/ml.

    PubMed

    Ferro, Matteo; Bruzzese, Dario; Perdonà, Sisto; Marino, Ada; Mazzarella, Claudia; Perruolo, Giuseppe; D'Esposito, Vittoria; Cosimato, Vincenzo; Buonerba, Carlo; Di Lorenzo, Giuseppe; Musi, Gennaro; De Cobelli, Ottavio; Chun, Felix K; Terracciano, Daniela

    2013-01-01

    Many efforts to reduce prostate specific antigen (PSA) overdiagnosis and overtreatment have been made. To this aim, Prostate Health Index (Phi) and Prostate Cancer Antigen 3 (PCA3) have been proposed as new more specific biomarkers. We evaluated the ability of phi and PCA3 to identify prostate cancer (PCa) at initial prostate biopsy in men with total PSA range of 2-10 ng/ml. The performance of phi and PCA3 were evaluated in 300 patients undergoing first prostate biopsy. ROC curve analyses tested the accuracy (AUC) of phi and PCA3 in predicting PCa. Decision curve analyses (DCA) were used to compare the clinical benefit of the two biomarkers. We found that the AUC value of phi (0.77) was comparable to those of %p2PSA (0.76) and PCA3 (0.73) with no significant differences in pairwise comparison (%p2PSA vs phi p = 0.673, %p2PSA vs. PCA3 p = 0.417 and phi vs. PCA3 p = 0.247). These three biomarkers significantly outperformed fPSA (AUC = 0.60), % fPSA (AUC = 0.62) and p2PSA (AUC = 0.63). At DCA, phi and PCA3 exhibited a very close net benefit profile until the threshold probability of 25%, then phi index showed higher net benefit than PCA3. Multivariable analysis showed that the addition of phi and PCA3 to the base multivariable model (age, PSA, %fPSA, DRE, prostate volume) increased predictive accuracy, whereas no model improved single biomarker performance. Finally we showed that subjects with active surveillance (AS) compatible cancer had significantly lower phi and PCA3 values (p<0.001 and p = 0.01, respectively). In conclusion, both phi and PCA3 comparably increase the accuracy in predicting the presence of PCa in total PSA range 2-10 ng/ml at initial biopsy, outperforming currently used %fPSA.

  14. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes

    SciTech Connect

    Stone, Nelson N.; Stock, Richard G.; Cesaretti, Jamie A.; Unger, Pam

    2010-02-01

    Purpose: To determine factors that influence local control and systemic relapse in patients undergoing permanent prostate brachytherapy (PPB). Methods and Materials: A total of 584 patients receiving PPB alone or PPB with external beam radiation therapy (19.5%) agreed to undergo prostate biopsy (PB) at 2 years postimplantion and yearly if results were positive or if the prostate-specific antigen (PSA) level increased. Short-term hormone therapy was used with 280 (47.9%) patients. Radiation doses were converted to biologically effective doses (BED) (using alpha/beta = 2). Comparisons were made by chi-square analysis and linear regression. Survival was determined by the Kaplan-Meier method. Results: The median PSA concentration was 7.1 ng/ml, and the median follow-up period was 7.1 years. PB results were positive for 48/584 (8.2%) patients. Positive biopsy results by BED group were as follows: 22/121 (18.2%) patients received a BED of <=150 Gy; 15/244 (6.1%) patients received >150 to 200 Gy; and 6/193 (3.1%; p < 0.001) patients received >200 Gy. Significant associations of positive PB results by risk group were low-risk group BED (p = 0.019), intermediate-risk group hormone therapy (p = 0.011) and BED (p = 0.040), and high-risk group BED (p = 0.004). Biochemical freedom from failure rate at 7 years was 82.7%. Biochemical freedom from failure rate by PB result was 84.7% for negative results vs. 59.2% for positive results (p < 0.001). Cox regression analysis revealed significant associations with BED (p = 0.038) and PB results (p = 0.002) in low-risk patients, with BED (p = 0.003) in intermediate-risk patients, and with Gleason score (p = 0.006), PSA level (p < 0.001), and PB result (p = 0.038) in high-risk patients. Fifty-three (9.1%) patients died, of which eight deaths were due to prostate cancer. Cause-specific survival was 99.2% for negative PB results vs. 87.6% for positive PB results (p < 0.001). Conclusions: Higher radiation doses are required to achieve local

  15. The prevalence of urinary tract infection, or urosepsis following transrectal ultrasound-guided prostate biopsy in a subset of the Saudi population and patterns of susceptibility to flouroquinolones

    PubMed Central

    AlKhateeb, Sultan S.; AlShammari, Nayf A.; AlZughaibi, Mohand A.; Ghazwani, Yahya G.; Alrabeeah, Khalid A.; Albqami, Nasser M.

    2016-01-01

    Objectives: To study the prevalence of urinary tract infections (UTI), or sepsis secondary to trans-rectal ultrasound-guided (TRUS) biopsy of the prostate, the pathogens involved, and patterns of antibiotic resistance in a cohort of patients. Methods: This is a descriptive study of a consecutive cohort of patients who underwent elective TRUS biopsy at King Abdulaziz Medical City Riyadh, Saudi Arabia between January 2012 and December 2014. All patients who underwent the TRUS guided prostate biopsy were prescribed the standard prophylactic antibiotics. Variables included were patients’ demographics, type of antibiotic prophylaxis, results of biopsy, the rate of UTI, and urosepsis with the type of pathogen(s) involved and its/their antimicrobial sensitivity. Results: Simple descriptive statistics were used in a total of 139 consecutive patients. Urosepsis requiring hospital admission was encountered in 7 (5%) patients and uncomplicated UTI was observed in 4 (2.8%). The most common pathogens were Escherichia coli (90.1%) and Klebsiella pneumoniae (9.1%). Resistance to the routinely used prophylaxis (ciprofloxacin) was observed in 10 of these patients (90.9%). Conclusion: This showed an increase in the rate of infectious complications after TRUS prostate biopsy. Ciprofloxacin resistance was found in 90.9% of patients with no sepsis. PMID:27464862

  16. Magnetic resonance imaging-targeted, 3D transrectal ultrasound-guided fusion biopsy for prostate cancer: Quantifying the impact of needle delivery error on diagnosis

    SciTech Connect

    Martin, Peter R.; Cool, Derek W.; Romagnoli, Cesare; Fenster, Aaron; Ward, Aaron D.

    2014-07-15

    Purpose: Magnetic resonance imaging (MRI)-targeted, 3D transrectal ultrasound (TRUS)-guided “fusion” prostate biopsy intends to reduce the ∼23% false negative rate of clinical two-dimensional TRUS-guided sextant biopsy. Although it has been reported to double the positive yield, MRI-targeted biopsies continue to yield false negatives. Therefore, the authors propose to investigate how biopsy system needle delivery error affects the probability of sampling each tumor, by accounting for uncertainties due to guidance system error, image registration error, and irregular tumor shapes. Methods: T2-weighted, dynamic contrast-enhanced T1-weighted, and diffusion-weighted prostate MRI and 3D TRUS images were obtained from 49 patients. A radiologist and radiology resident contoured 81 suspicious regions, yielding 3D tumor surfaces that were registered to the 3D TRUS images using an iterative closest point prostate surface-based method to yield 3D binary images of the suspicious regions in the TRUS context. The probabilityP of obtaining a sample of tumor tissue in one biopsy core was calculated by integrating a 3D Gaussian distribution over each suspicious region domain. Next, the authors performed an exhaustive search to determine the maximum root mean squared error (RMSE, in mm) of a biopsy system that gives P ≥ 95% for each tumor sample, and then repeated this procedure for equal-volume spheres corresponding to each tumor sample. Finally, the authors investigated the effect of probe-axis-direction error on measured tumor burden by studying the relationship between the error and estimated percentage of core involvement. Results: Given a 3.5 mm RMSE for contemporary fusion biopsy systems,P ≥ 95% for 21 out of 81 tumors. The authors determined that for a biopsy system with 3.5 mm RMSE, one cannot expect to sample tumors of approximately 1 cm{sup 3} or smaller with 95% probability with only one biopsy core. The predicted maximum RMSE giving P ≥ 95% for each

  17. Development and Preliminary Evaluation of a Motorized Needle Guide Template for MRI-guided Targeted Prostate Biopsy

    PubMed Central

    Song, Sang-Eun; Tokuda, Junichi; Tuncali, Kemal; Tempany, Clare; Zhang, Elizabeth; Hata, Nobuhiko

    2013-01-01

    To overcome the problems of limited needle insertion accuracy and human error in the use of a conventional needle guide template in MRI-guided prostate intervention, we developed a motorized MRI-compatible needle guide template that resembles a TRUS-guided prostate template. The motorized template allows automated, gapless needle guidance in a 3T MRI scanner with minimal changes in the current clinical procedure. To evaluate the impact of the motorized template on MRI, signal-to-noise ratio and distortion were measured under various system configurations. A maximum of 44% signal-to-noise ratio decrease was found when the ultrasonic motors were running, and a maximum of 0.4% image distortion was observed due to the presence of the motorized template. To measure needle insertion accuracy, we performed four sets of five random target needle insertions mimicking four biopsy procedures, which resulted in an average in-plane targeting error of 0.94 mm with a standard deviation of 0.34 mm. The evaluation studies indicated that the presence and operation of the motorized template in the MRI bore creates insignificant image degradation, and provides submillimeter targeting accuracy. The automated needle guide that is directly controlled by navigation software eliminates human error so that the safety of the procedure can be improved. PMID:23335658

  18. Importance of Local Control in Early-Stage Prostate Cancer: Outcomes of Patients With Positive Post-Radiation Therapy Biopsy Results Treated in RTOG 9408

    SciTech Connect

    Krauss, Daniel J.; Hu, Chen; Bahary, Jean-Paul; Souhami, Luis; Gore, Elizabeth M.; Chafe, Susan Maria Jacinta; Leibenhaut, Mark H.; Narayan, Samir; Torres-Roca, Javier; Michalski, Jeff; Zeitzer, Kenneth L.; Donavanik, Viroon; Sandler, Howard; McGowan, David G.; Jones, Christopher U.; Shipley, William U.

    2015-07-15

    Purpose: The purpose of this study was to assess the association between positive post-radiation therapy (RT) biopsy results and subsequent clinical outcomes in males with localized prostate cancer. Methods and Materials: Radiation Therapy Oncology Group study 94-08 analyzed 1979 males with prostate cancer, stage T1b-T2b and prostate-specific antigen concentrations of ≤20 ng/dL, to investigate whether 4 months of total androgen suppression (TAS) added to RT improved survival compared to RT alone. Patients randomized to receive TAS received flutamide with luteinizing hormone releasing hormone (LHRH) agonist. According to protocol, patients without evidence of clinical recurrence or initiation of additional endocrine therapy underwent repeat prostate biopsy 2 years after RT completion. Statistical analysis was performed to evaluate the impact of positive post-RT biopsy results on clinical outcomes. Results: A total of 831 patients underwent post-RT biopsy, 398 were treated with RT alone and 433 with RT plus TAS. Patients with positive post-RT biopsy results had higher rates of biochemical failure (hazard ratio [HR] = 1.7; 95% confidence interval [CI] = 1.3-2.1) and distant metastasis (HR = 2.4; 95% CI = 1.3-4.4) and inferior disease-specific survival (HR = 3.8; 95% CI = 1.9-7.5). Positive biopsy results remained predictive of such outcomes after correction for potential confounders such as Gleason score, tumor stage, and TAS administration. Prior TAS therapy did not prevent elevated risk of adverse outcome in the setting of post-RT positive biopsy results. Patients with Gleason score ≥7 with a positive biopsy result additionally had inferior overall survival compared to those with a negative biopsy result (HR = 1.56; 95% CI = 1.04-2.35). Conclusions: Positive post-RT biopsy is associated with increased rates of distant metastases and inferior disease-specific survival in patients treated with definitive RT and was associated with inferior overall

  19. Comparison of Multiparametric MRI Scoring Systems and the Impact on Cancer Detection in Patients Undergoing MR US Fusion Guided Prostate Biopsies

    PubMed Central

    Rastinehad, Ardeshir R.; Waingankar, Nikhil; Turkbey, Baris; Yaskiv, Oksana; Sonstegard, Anna M.; Fakhoury, Mathew; Olsson, Carl A.; Siegel, David N.; Choyke, Peter L.; Ben-Levi, Eran; Villani, Robert

    2015-01-01

    Introduction Multiple scoring systems have been proposed for prostate MRI reporting. We sought to review the clinical impact of the new Prostate Imaging Reporting and Data System v2 (PI-RADS) and compare those results to our proposed Simplified Qualitative System (SQS) score with respect to detection of prostate cancers and clinically significant prostate cancers. Methods All patients who underwent multiparametric prostate MRI (mpMRI) had their images interpreted using PI-RADS v1 and SQS score. PI-RADS v2 was calculated from prospectively collected data points. Patients with positive mpMRIs were then referred by their urologists for enrollment in an IRB-approved prospective phase III trial of mpMRI-Ultrasound (MR/TRUS) fusion biopsy of suspicious lesions. Standard 12-core biopsy was performed at the same setting. Clinical data were collected prospectively. Results 1060 patients were imaged using mpMRI at our institution during the study period. 341 participants were then referred to the trial. 312 participants underwent MR/TRUS fusion biopsy of 452 lesions and were included in the analysis. 202 participants had biopsy-proven cancer (64.7%) and 206 (45.6%) lesions were positive for cancer. Distribution of cancer detected at each score produced a Gaussian distribution for SQS while PI-RADS demonstrates a negatively skewed curve with 82.1% of cases being scored as a 4 or 5. Patient-level data demonstrated AUC of 0.702 (95% CI 0.65 to 0.73) for PI-RADS and 0.762 (95% CI 0.72 to 0.81) for SQS (p< 0.0001) with respect to the detection of prostate cancer. The analysis for clinically significant prostate cancer at a per lesion level resulted in an AUC of 0.725 (95% CI 0.69 to 0.76) and 0.829 (95% CI 0.79 to 0.87) for the PI-RADS and SQS score, respectively (p< 0.0001). Conclusions mpMRI is a useful tool in the workup of patients at risk for prostate cancer, and serves as a platform to guide further evaluation with MR/TRUS fusion biopsy. SQS score provided a more normal

  20. Biopsy Quantitative Patohistology and Seral Values of Prostate Specific Antigen-Alpha (1) Antichymotrypsine Complex in Prediction of Adverse Pathology Findings after Radical Prostatectomy.

    PubMed

    Tomasković, Igor; Milicić, Valerija; Tomić, Miroslav; Ruzić, Boris; Ulamec, Monika

    2015-09-01

    In this prospective study we examined the utility of parameters obtained on prostate needle biopsy and prostate specific antigen-alpha(1)-antichymotripsine complex (PSA-ACT) to predict adverse pathologic findings after radical prostatectomy. 45 consecutive patients assigned for radical prostatectomy due to clinically localized prostate cancer were included in the study. Prostate biopsy parameters such as number of positive cores, the greatest percentage of tumor in the positive cores, Gleason score, perineural invasion, unilaterality or bilaterality of the tumor were recorded. PSA-ACT was determined using sandwich immunoassay chemiluminiscent method (Bayer, Tarrytown, New York). We analyzed relationship of preoperative PSA, PSA-ACTand quantitative biopsy parameters with final pathology after prostatectomy. Adverse findings were considered when extracapsular extension of cancer (pT3) was noted. Postoperatively, 29 (64.4%) patients were diagnosed with pT2 disease and 16 (35.6%) with pT3 disease. There was a significant difference in localized vs. locally advanced disease in number of positive biopsy cores (p<0.001), greatest percentage of tumor in the core (p=0.008), localization of the tumor (p=0.003) and perineural invasion (p=0.004). Logistic regression was used to develop a model on the multivariate level. It included number of positive cores and PSA-ACT and was significant on our cohort with the reliability of 82.22%. The combination of PSA-ACT and a large scale of biopsy parameters could be used in prediction of adverse pathologic findings after radical prostatectomy. Clinical decisions and patients counselling could be influenced by these predictors but further confirmation on a larger population is necessary. PMID:26898067

  1. [Analysis of influential factors for prostate biopsy and establishment of logistic regression model for 
prostate cancer].

    PubMed

    Li, Yonglin; Tang, Zhengyan; Qi, Lin; Chen, Zhi; Li, Dongjie; Zeng, Mingqiang; Xue, Ruizhi; Peng, Chuan

    2015-06-01

    目的:建立前列腺癌logistic回归预测模型,为决策前列腺穿刺提供更充分的指征。方法:回顾性分析117例行前列腺穿刺活组织检查术的病例资料,按照病例收集的时间先后顺序分为两组,前2/3(78例)分入建模组,后1/3(39例)分入验证组,建立logistic回归预测模型,并通过受试者工作特征(receiver operating characteristic,ROC)曲线下面积来评估该模型的预测价值。结果:直肠指诊(digital rectal examination ,DRE)、经直肠超声(transrectal ultrasound,TRUS)、MRI、前列腺特异性抗原密度(prostate-specific antigen density,PSAD)以及前列腺特异性抗原游离比值(free PSA/total PSA,fPSA/tPSA)是前列腺穿刺的影响因素(P<0.01)。根据各影响因素的回归系数值,建立前列腺癌logistic回归预测模型:logit P=−2.362+2.561×DRE+1.747×TRUS+2.901×MRI+1.126×PSAD−2.569×fPSA/tPSA。ROC曲线下面积为0.907,当P的临界值取值0.12时,其敏感度、特异度分别为81.80%,89.30%。结论:利用logistic回归分析建立预测模型可以为前列腺穿刺提供更充分的指征。当该模型预测概率P>0.12时建议行前列腺穿刺活组织检查。.

  2. Can a Gleason 6 or Less Microfocus of Prostate Cancer in One Biopsy and Prostate-Specific Antigen Level <10 ng/mL Be Defined as the Archetype of Low-Risk Prostate Disease?

    PubMed

    Taverna, Gianluigi; Benecchi, Luigi; Grizzi, Fabio; Seveso, Mauro; Giusti, Guido; Piccinelli, Alessandro; Benetti, Alessio; Colombo, Piergiuseppe; Minuti, Francesco; Graziotti, Pierpaolo

    2012-01-01

    Prostate cancer (PC) remains a cause of death worldwide. Here we investigate whether a single microfocus of PC at the biopsy (graded as Gleason 6 or less, ≤5% occupancy) and the PSA <10 ng/mL can define the archetype of low-risk prostate disease. 4500 consecutive patients were enrolled. Among them, 134 patients with a single micro-focus of PC were followed up, and the parameters influencing the biochemical relapse (BR) were analysed. Out of 134 patients, 94 had clinically significant disease, specifically in 74.26% of the patients with PSA <10 ng/mL. Positive surgical margins and the extracapsular invasion were found in 29.1% and 51.4% patients, respectively. BR was observed in 29.6% of the patients. Cox regression evidenced a correlation between the BR and Gleason grade at the retropubic radical prostatectomy (RRP), capsular invasion, and the presence of positive surgical margins. Multivariate regression analysis showed a statistically significant correlation between the presence of surgical margins at the RRP and BR. Considering a single micro-focus of PC at the biopsy and PSA serum level <10 ng/mL, clinically significant disease was found in 74.26% patients and only positive surgical margins are useful for predicting the BR.

  3. Percentage of Cancer Volume in Biopsy Cores Is Prognostic for Prostate Cancer Death and Overall Survival in Patients Treated With Dose-Escalated External Beam Radiotherapy

    SciTech Connect

    Vance, Sean M.; Stenmark, Matthew H.; Blas, Kevin; Halverson, Schulyer; Hamstra, Daniel A.; Feng, Felix Y.

    2012-07-01

    Purpose: To investigate the prognostic utility of the percentage of cancer volume (PCV) in needle biopsy specimens for prostate cancer patients treated with dose-escalated external beam radiotherapy. Methods and Materials: The outcomes were analyzed for 599 men treated for localized prostate cancer with external beam radiotherapy to a minimal planning target volume dose of 75 Gy (range, 75-79.2). We assessed the effect of PCV and the pretreatment and treatment-related factors on the freedom from biochemical failure, freedom from metastasis, cause-specific survival, and overall survival. Results: The median number of biopsy cores was 7 (interquartile range, 6-12), median PCV was 10% (interquartile range, 2.5-25%), and median follow-up was 62 months. The PCV correlated with the National Comprehensive Cancer Network risk group and individual risk features, including T stage, prostate-specific antigen level, Gleason score, and percentage of positive biopsy cores. On log-rank analysis, the PCV stratified by quartile was prognostic for all endpoints, including overall survival. In addition, the PCV was a stronger prognostic factor than the percentage of positive biopsy cores when the two metrics were analyzed together. On multivariate analysis, the PCV predicted a worse outcome for all endpoints, including freedom from biochemical failure, (hazard ratio, 1.9; p = .0035), freedom from metastasis (hazard ratio, 1.7, p = .09), cause-specific survival (hazard ratio, 3.9, p = .014), and overall survival (hazard ratio, 1.8, p = .02). Conclusions: For patients treated with dose-escalated external beam radiotherapy, the volume of cancer in the biopsy specimen adds prognostic value for clinically relevant endpoints, particularly in intermediate- and high-risk patients. Although the PCV determination is more arduous than the percentage of positive biopsy cores, it provides superior risk stratification.

  4. Risk of Pathologic Upgrading or Locally Advanced Disease in Early Prostate Cancer Patients Based on Biopsy Gleason Score and PSA: A Population-Based Study of Modern Patients

    SciTech Connect

    Caster, Joseph M.; Falchook, Aaron D.; Hendrix, Laura H.; Chen, Ronald C.

    2015-06-01

    Purpose: Radiation oncologists rely on available clinical information (biopsy Gleason score and prostate-specific antigen [PSA]) to determine the optimal treatment regimen for each prostate cancer patient. Existing published nomograms correlating clinical to pathologic extent of disease were based on patients treated in the 1980s and 1990s at select academic institutions. We used the Surveillance, Epidemiology, and End Results (SEER) database to examine pathologic outcomes (Gleason score and cancer stage) in early prostate cancer patients based on biopsy Gleason score and PSA concentration. Methods and Materials: This analysis included 25,858 patients whose cancer was diagnosed between 2010 and 2011, with biopsy Gleason scores of 6 to 7 and clinical stage T1 to T2 disease, who underwent radical prostatectomy. In subgroups based on biopsy Gleason score and PSA level, we report the proportion of patients with pathologically advanced disease (positive surgical margin or pT3-T4 disease) or whose Gleason score was upgraded. Logistic regression was used to examine factors associated with pathologic outcomes. Results: For patients with biopsy Gleason score 6 cancers, 84% of those with PSA <10 ng/mL had surgical T2 disease with negative margins; this decreased to 61% in patients with PSA of 20 to 29.9 ng/mL. Gleason score upgrading was seen in 43% (PSA: <10 ng/mL) to 61% (PSA: 20-29.9 ng/mL) of biopsy Gleason 6 patients. Patients with biopsy Gleason 7 cancers had a one-third (Gleason 3 + 4; PSA: <10 ng/mL) to two-thirds (Gleason 4 + 3; PSA: 20-29.9 ng/mL) probability of having pathologically advanced disease. Gleason score upgrading was seen in 11% to 19% of patients with biopsy Gleason 4 + 3 cancers. Multivariable analysis showed that higher PSA and older age were associated with Gleason score upgrading and pathologically advanced disease. Conclusions: This is the first population-based study to examine pathologic extent of disease and pathologic Gleason score

  5. Automated high-throughput assessment of prostate biopsy tissue using infrared spectroscopic chemical imaging

    NASA Astrophysics Data System (ADS)

    Bassan, Paul; Sachdeva, Ashwin; Shanks, Jonathan H.; Brown, Mick D.; Clarke, Noel W.; Gardner, Peter

    2014-03-01

    Fourier transform infrared (FT-IR) chemical imaging has been demonstrated as a promising technique to complement histopathological assessment of biomedical tissue samples. Current histopathology practice involves preparing thin tissue sections and staining them using hematoxylin and eosin (H&E) after which a histopathologist manually assess the tissue architecture under a visible microscope. Studies have shown that there is disagreement between operators viewing the same tissue suggesting that a complementary technique for verification could improve the robustness of the evaluation, and improve patient care. FT-IR chemical imaging allows the spatial distribution of chemistry to be rapidly imaged at a high (diffraction-limited) spatial resolution where each pixel represents an area of 5.5 × 5.5 μm2 and contains a full infrared spectrum providing a chemical fingerprint which studies have shown contains the diagnostic potential to discriminate between different cell-types, and even the benign or malignant state of prostatic epithelial cells. We report a label-free (i.e. no chemical de-waxing, or staining) method of imaging large pieces of prostate tissue (typically 1 cm × 2 cm) in tens of minutes (at a rate of 0.704 × 0.704 mm2 every 14.5 s) yielding images containing millions of spectra. Due to refractive index matching between sample and surrounding paraffin, minimal signal processing is required to recover spectra with their natural profile as opposed to harsh baseline correction methods, paving the way for future quantitative analysis of biochemical signatures. The quality of the spectral information is demonstrated by building and testing an automated cell-type classifier based upon spectral features.

  6. A comparison of isolated circulating tumor cells and tissue biopsies using whole-genome sequencing in prostate cancer.

    PubMed

    Jiang, Runze; Lu, Yi-Tsung; Ho, Hao; Li, Bo; Chen, Jie-Fu; Lin, Millicent; Li, Fuqiang; Wu, Kui; Wu, Hanjie; Lichterman, Jake; Wan, Haolei; Lu, Chia-Lun; OuYang, William; Ni, Ming; Wang, Linlin; Li, Guibo; Lee, Tom; Zhang, Xiuqing; Yang, Jonathan; Rettig, Matthew; Chung, Leland W K; Yang, Huanming; Li, Ker-Chau; Hou, Yong; Tseng, Hsian-Rong; Hou, Shuang; Xu, Xun; Wang, Jun; Posadas, Edwin M

    2015-12-29

    Previous studies have demonstrated focal but limited molecular similarities between circulating tumor cells (CTCs) and biopsies using isolated genetic assays. We hypothesized that molecular similarity between CTCs and tissue exists at the single cell level when characterized by whole genome sequencing (WGS). By combining the NanoVelcro CTC Chip with laser capture microdissection (LCM), we developed a platform for single-CTC WGS. We performed this procedure on CTCs and tissue samples from a patient with advanced prostate cancer who had serial biopsies over the course of his clinical history. We achieved 30X depth and ≥ 95% coverage. Twenty-nine percent of the somatic single nucleotide variations (SSNVs) identified were founder mutations that were also identified in CTCs. In addition, 86% of the clonal mutations identified in CTCs could be traced back to either the primary or metastatic tumors. In this patient, we identified structural variations (SVs) including an intrachromosomal rearrangement in chr3 and an interchromosomal rearrangement between chr13 and chr15. These rearrangements were shared between tumor tissues and CTCs. At the same time, highly heterogeneous short structural variants were discovered in PTEN, RB1, and BRCA2 in all tumor and CTC samples. Using high-quality WGS on single-CTCs, we identified the shared genomic alterations between CTCs and tumor tissues. This approach yielded insight into the heterogeneity of the mutational landscape of SSNVs and SVs. It may be possible to use this approach to study heterogeneity and characterize the biological evolution of a cancer during the course of its natural history. PMID:26575023

  7. A comparison of isolated circulating tumor cells and tissue biopsies using whole-genome sequencing in prostate cancer.

    PubMed

    Jiang, Runze; Lu, Yi-Tsung; Ho, Hao; Li, Bo; Chen, Jie-Fu; Lin, Millicent; Li, Fuqiang; Wu, Kui; Wu, Hanjie; Lichterman, Jake; Wan, Haolei; Lu, Chia-Lun; OuYang, William; Ni, Ming; Wang, Linlin; Li, Guibo; Lee, Tom; Zhang, Xiuqing; Yang, Jonathan; Rettig, Matthew; Chung, Leland W K; Yang, Huanming; Li, Ker-Chau; Hou, Yong; Tseng, Hsian-Rong; Hou, Shuang; Xu, Xun; Wang, Jun; Posadas, Edwin M

    2015-12-29

    Previous studies have demonstrated focal but limited molecular similarities between circulating tumor cells (CTCs) and biopsies using isolated genetic assays. We hypothesized that molecular similarity between CTCs and tissue exists at the single cell level when characterized by whole genome sequencing (WGS). By combining the NanoVelcro CTC Chip with laser capture microdissection (LCM), we developed a platform for single-CTC WGS. We performed this procedure on CTCs and tissue samples from a patient with advanced prostate cancer who had serial biopsies over the course of his clinical history. We achieved 30X depth and ≥ 95% coverage. Twenty-nine percent of the somatic single nucleotide variations (SSNVs) identified were founder mutations that were also identified in CTCs. In addition, 86% of the clonal mutations identified in CTCs could be traced back to either the primary or metastatic tumors. In this patient, we identified structural variations (SVs) including an intrachromosomal rearrangement in chr3 and an interchromosomal rearrangement between chr13 and chr15. These rearrangements were shared between tumor tissues and CTCs. At the same time, highly heterogeneous short structural variants were discovered in PTEN, RB1, and BRCA2 in all tumor and CTC samples. Using high-quality WGS on single-CTCs, we identified the shared genomic alterations between CTCs and tumor tissues. This approach yielded insight into the heterogeneity of the mutational landscape of SSNVs and SVs. It may be possible to use this approach to study heterogeneity and characterize the biological evolution of a cancer during the course of its natural history.

  8. Erectile dysfunction in 1050 men following extended (18 cores) vs saturation (28 cores) vs saturation plus MRI-targeted prostate biopsy (32 cores).

    PubMed

    Pepe, P; Pennisi, M

    2016-01-01

    Erectile dysfunction (ED) following transperineal prostate biopsy (TPB) was prospectively evaluated. From January 2011 to January 2014, 1050 patients were submitted to TPB: 18 core (extended TPB) in 610 cases, 28 core (saturation TPB) in 360 cases and 32 core (saturation plus magnetic resonance imaging (MRI) targeted TPB) in 210 cases. The indications for biopsy were increasing prostate-specific antigen (PSA) or PSA>10 ng ml(-1). All patients were prospectively evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5) at time zero and at 1, 3 and 6 months from TPB. Prostate cancer was diagnosed in 385/1050 (36.6%) patients; 560 men (350 vs 110 vs 100) having benign histology and normal sexual activity also completed the study. Overall, IEEF-5 score at time zero and at 1, 3 and 6 months did not significantly worsen (P>0.05); in detail, at 1 month from biopsy 15 extended TPB (4.2%) vs 7 saturation TPB (6.4%) vs 7 saturation plus MRI targeted TPB (7%) men referred mild ED that disappeared after 3 months. Irrespective of method (18 vs 28 vs 32 core) TPB did not significantly worsen erectile function at 3-6 months from the procedure. PMID:26289906

  9. Erectile dysfunction in 1050 men following extended (18 cores) vs saturation (28 cores) vs saturation plus MRI-targeted prostate biopsy (32 cores).

    PubMed

    Pepe, P; Pennisi, M

    2016-01-01

    Erectile dysfunction (ED) following transperineal prostate biopsy (TPB) was prospectively evaluated. From January 2011 to January 2014, 1050 patients were submitted to TPB: 18 core (extended TPB) in 610 cases, 28 core (saturation TPB) in 360 cases and 32 core (saturation plus magnetic resonance imaging (MRI) targeted TPB) in 210 cases. The indications for biopsy were increasing prostate-specific antigen (PSA) or PSA>10 ng ml(-1). All patients were prospectively evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5) at time zero and at 1, 3 and 6 months from TPB. Prostate cancer was diagnosed in 385/1050 (36.6%) patients; 560 men (350 vs 110 vs 100) having benign histology and normal sexual activity also completed the study. Overall, IEEF-5 score at time zero and at 1, 3 and 6 months did not significantly worsen (P>0.05); in detail, at 1 month from biopsy 15 extended TPB (4.2%) vs 7 saturation TPB (6.4%) vs 7 saturation plus MRI targeted TPB (7%) men referred mild ED that disappeared after 3 months. Irrespective of method (18 vs 28 vs 32 core) TPB did not significantly worsen erectile function at 3-6 months from the procedure.

  10. The role of targeted prophylactic antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in reducing infection rates: a systematic review.

    PubMed

    Cussans, Amelia; Somani, Bhaskar K; Basarab, Adriana; Dudderidge, Timothy J

    2016-05-01

    To compare the incidence of infective complications after transrectal ultrasonography (TRUS)-guided biopsy with either empirical fluoroquinolone or culture-based targeted antimicrobial prophylaxis, and the prevalence of fluoroquinolone resistance (FQ-R) in men undergoing prostate biopsy. A systematic review of the literature was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included studies of patients undergoing TRUS-guided biopsy that compared infective outcomes of those who received targeted antimicrobial therapy based on the results of pre-procedural rectal swab cultures, with those receiving empiric fluoroquinolone antimicrobial prophylaxis. The prevalence of FQ-R was recorded as a secondary outcome measure. Studies with no control group were excluded. From 125 studies screened, nine studies (4 571 patients) met the inclusion criteria. All studies were of cohort design, and included a combination of retrospective and prospective data. Six studies included were undertaken in North America. The remaining studies were undertaken in Spain, Turkey and Columbia. Within these studies, 2 484 (54.3%) patients received empirical fluoroquinolone prophylaxis, whilst 2 087 (45.7%) patients had pre-biopsy rectal swabs and targeted antibiotics. The mean FQ-R was 22.8%. Post-biopsy infection and sepsis rates were significantly higher in groups given empirical prophylaxis (4.55% and 2.21%) compared with groups receiving targeted antibiotics (0.72% and 0.48%). Based on these results 27 men would need to receive targeted antibiotics to prevent one infective complication. Our systematic review suggests that targeted prophylactic antimicrobial therapy before TRUS-guided prostate biopsy is associated with lower rates of sepsis. We therefore recommend changing current pathways to adopt this measure. PMID:26709240

  11. Performance of a Single Assay for Both Type III and Type VI TMPRSS2:ERG Fusions in Noninvasive Prediction of Prostate Biopsy Outcome

    PubMed Central

    Clark, Jarrod P.; Munson, Kristofer W.; Gu, Jessie W.; Lamparska-Kupsik, Katarzyna; Chan, Kevin G.; Yoshida, Jeffrey S.; Kawachi, Mark H.; Crocitto, Laura E.; Wilson, Timothy G.; Feng, Ziding; Smith, Steven S.

    2010-01-01

    BACKGROUND TMPRSS2:ERG fusions are promising prostate cancer biomarkers. Because they can occur in multiple forms in a single cancer specimen, we developed a quantitative PCR test that detects both type III and type VI TMPRSS2:ERG fusions. The assay is quantified from a standard curve determined with a plasmid-cloned type III TMPRSS2:ERG fusion target. METHODS We collected expressed prostatic secretion (EPS) under an institutional review board–approved, blinded, prospective study from 74 patients undergoing transrectal ultrasound-guided biopsy for prostate cancer. We compared the characteristic performance of the test for type III and type VI TMPRSS2:ERG fusions in predicting biopsy outcome and distinguishing between high and low Gleason scores with similar tests for the expression of PCA3 and DNA methylation levels of the APC, RARB, RASSF1, and GSTP1 genes. We used logistic regression to analyze the effects of multiple biomarkers in linear combinations. RESULTS Each test provided a significant improvement in characteristic performance over baseline digital rectal examination (DRE) plus serum prostate-specific antigen (PSA); however, the test for type III and type VI TMPRSS2:ERG fusions yielded the best performance in predicting biopsy outcome [area under the curve (AUC) 0.823, 95% CI 0.728–0.919, P < 0.001] and Gleason grade >7 (AUC 0.844, 95% CI 0.740–0.948, P < 0.001). CONCLUSIONS Although each test appears to have diagnostic value, PSA plus DRE plus type III and type VI TMPRSS2:ERG provided the best diagnostic performance in EPS specimens. PMID:18948370

  12. Prognostic Importance of Gleason 7 Disease Among Patients Treated With External Beam Radiation Therapy for Prostate Cancer: Results of a Detailed Biopsy Core Analysis

    SciTech Connect

    Spratt, Daniel E.; Zumsteg, Zach; Ghadjar, Pirus; Pangasa, Misha; Pei, Xin; Fine, Samson W.; Yamada, Yoshiya; Kollmeier, Marisa; Zelefsky, Michael J.

    2013-04-01

    Purpose: To analyze the effect of primary Gleason (pG) grade among a large cohort of Gleason 7 prostate cancer patients treated with external beam radiation therapy (EBRT). Methods and Materials: From May 1989 to January 2011, 1190 Gleason 7 patients with localized prostate cancer were treated with EBRT at a single institution. Of these patients, 613 had a Gleason 7 with a minimum of a sextant biopsy with nonfragmented cores and full biopsy core details available, including number of cores of cancer involved, percentage individual core involvement, location of disease, bilaterality, and presence of perineural invasion. Median follow-up was 6 years (range, 1-16 years). The prognostic implication for the following outcomes was analyzed: biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific mortality (PCSM). Results: The 8-year bRFS rate for pG3 versus pG4 was 77.6% versus 61.3% (P<.0001), DMFS was 96.8% versus 84.3% (P<.0001), and PCSM was 3.7% versus 8.1% (P=.002). On multivariate analysis, pG4 predicted for significantly worse outcome in all parameters. Location of disease (apex, base, mid-gland), perineural involvement, maximum individual core involvement, and the number of Gleason 3+3, 3+4, or 4+3 cores did not predict for distant metastases. Conclusions: Primary Gleason grade 4 independently predicts for worse bRFS, DMFS, and PCSM among Gleason 7 patients. Using complete core information can allow clinicians to utilize pG grade as a prognostic factor, despite not having the full pathologic details from a prostatectomy specimen. Future staging and risk grouping should investigate the incorporation of primary Gleason grade when complete biopsy core information is used.

  13. Magnetic Resonance Imaging/Transrectal Ultrasonography Fusion Prostate Biopsy Significantly Outperforms Systematic 12–Core Biopsy for Prediction of Total Magnetic Resonance Imaging Tumor Volume in Active Surveillance Patients

    PubMed Central

    Okoro, Chinonyerem; George, Arvin K.; Siddiqui, M. Minhaj; Rais–Bahrami, Soroush; Walton–Diaz, Annerleim; Shakir, Nabeel A.; Rothwax, Jason T.; Raskolnikov, Dima; Stamatakis, Lambros; Su, Daniel; Turkbey, Baris; Choyke, Peter L.; Merino, Maria J.; Parnes, Howard L.; Wood, Bradford J.

    2015-01-01

    Abstract Objective: To correlate the highest percentage core involvement (HPCI) and corresponding tumor length (CTL) on systematic 12-core biopsy (SBx) and targeted magnetic resonance imaging/transrectal ultrasonography (MRI/TRUS) fusion biopsy (TBx), with total MRI prostate cancer (PCa) tumor volume (TV). Patients and Methods: Fifty patients meeting criteria for active surveillance (AS) based on outside SBx, who underwent 3.0T multiparametric prostate MRI (MP–MRI), followed by SBx and TBx during the same session at our institution were examined. PCa TVs were calculated using MP-MRI and then correlated using bivariate analysis with the HPCI and CTL for SBx and TBx. Results: For TBx, HPCI and CTL showed a positive correlation (R2=0.31, P<0.0001 and R2=0.37, P<0.0001, respectively) with total MRI PCa TV, whereas for SBx, these parameters showed a poor correlation (R2=0.00006, P=0.96 and R2=0.0004, P=0.89, respectively). For detection of patients with clinically significant MRI derived tumor burden greater than 500 mm3, SBx was 25% sensitive, 90.9% specific (falsely elevated because of missed tumors and extremely low sensitivity), and 54% accurate in comparison with TBx, which was 53.6% sensitive, 86.4% specific, and 68% accurate. Conclusions: HPCI and CTL on TBx positively correlates with total MRI PCa TV, whereas there was no correlation seen with SBx. TBx is superior to SBx for detecting tumor burden greater than 500 mm3. When using biopsy positive MRI derived TVs, TBx better reflects overall disease burden, improving risk stratification among candidates for active surveillance. PMID:25897467

  14. Dose Escalation to the Dominant Intraprostatic Lesion Defined by Sextant Biopsy in a Permanent Prostate I-125 Implant: A Prospective Comparative Toxicity Analysis

    SciTech Connect

    Gaudet, Marc; Vigneault, Eric; Aubin, Sylviane; Varfalvy, Nicolas; Harel, Francois; Beaulieu, L.; Martin, Andre-Guy

    2010-05-01

    Purpose: Using real-time intraoperative inverse-planned permanent seed prostate implant (RTIOP/PSI), multiple core biopsy maps, and three-dimensional ultrasound guidance, we planned a boost volume (BV) within the prostate to which hyperdosage was delivered selectively. The aim of this study was to investigate the potential negative effects of such a procedure. Methods and Materials: Patients treated with RTIOP/PSI for localized prostate cancer with topographic biopsy results received an intraprostatic boost (boost group [BG]). They were compared with patients treated with a standard plan (reference group [RG]). Plans were generated using a simulated annealing inverse planning algorithm. Prospectively recorded urinary, rectal, and sexual toxicities and dosimetric parameters were compared between groups. Results: The study included 120 patients treated with boost technique who were compared with 70 patients treated with a standard plan. Boost technique did not significantly change the number of seeds (55.1/RG vs. 53.6/BG). The intraoperative prostate V150 was slightly higher in BG (75.2/RG vs. 77.2/BG, p = 0.039). Urethra V100, urethra D90, and rectal D50 were significantly lower in the BG. No significant differences were seen in acute or late urinary, rectal, or sexual toxicities. Conclusions: Because there were no differences between the groups in acute and late toxicities, we believe that BV can be planned and delivered to the dominant intraprostatic lesion without increasing toxicity. It is too soon to say whether a boost technique will ultimately increase local control.

  15. Fluoroquinolone-Resistant Escherichia coli Infections After Transrectal Biopsy of the Prostate in the Veterans Affairs Healthcare System

    PubMed Central

    Saade, Elie A.; Suwantarat, Nuntra; Zabarsky, Trina F.; Wilson, Brigid; Donskey, Curtis J.

    2016-01-01

    Background Recent reports suggest that infections due to fluoroquinolone-resistant Escherichia coli (E. coli) are an increasingly common complication of transrectal biopsy of the prostate (TBP) in the United States. A better understanding of the magnitude and scope of these infections is needed to guide prevention efforts. Our objective is to determine whether the incidence of infections due to fluoroquinolone-resistant E. coli after TBP has increased nationwide in the Veterans Affairs Health Care System and to identify risk factors for infection. Methods We performed a retrospective, observational cohort study and a nested case-control study within the US Deparment of Veterans Affairs Healthcare System. The primary outcomes were the incidence of urinary tract infection (UTI) and bacteremia with E. coli and with fluoroquinolone- resistant E. coli strains within 30 days after TBP. Secondary endpoints focused on the correlation between fluoroquinolone-resistance in all urinary E. coli isolates and post-TBP infection and risk factors for infection due to fluoroquinolone-resistant E. coli infection. Results 245 618 patients undergoing 302 168 TBP procedures from 2000 through 2013 were included in the cohort study, and 59 469 patients undergoing TBP from 2011 through 2013 were included in the nested case-control study. Between 2000 and 2013, there was a 5-fold increase in the incidence of E. coli UTI (0.18%–0.93%) and a 4-fold increase in the incidence of E. coli bacteremia (0.04%–0.18%) after TBP that was attributable to an increase in the incidence of fluoroquinolone- resistant E. coli UTI (0.03%–0.75%) and bacteremia (0.01%–0.14%). The increasing incidence of fluoroquinolone-resistant E. coli infections after TBP occurred in parallel with increasing rates of fluoroquinolone-resistance in all urinary E. coli isolates. By multivariable logistic regression analysis, independent risk factors for fluoroquinolone-resistant E. coli UTI after TBP included diabetes

  16. Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection.

    PubMed

    Raman, Jay D; Lehman, Kathleen K; Dewan, Kalyan; Kirimanjeswara, Girish

    2015-09-21

    Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB. All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml of a 10% solution of commercially available povidone iodine is mixed with 5 ml of 1% lidocaine jelly to create slurry. A 4 cmx4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2-3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p=0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

  17. In prostate cancer needle biopsies, detections of PTEN loss by fluorescence in situ hybridization (FISH) and by immunohistochemistry (IHC) are concordant and show consistent association with upgrading.

    PubMed

    Picanço-Albuquerque, C G; Morais, C L; Carvalho, F L F; Peskoe, S B; Hicks, J L; Ludkovski, O; Vidotto, T; Fedor, H; Humphreys, E; Han, M; Platz, E A; De Marzo, A M; Berman, D M; Lotan, T L; Squire, J A

    2016-05-01

    The prognostic value of phosphatase and tensin homolog (PTEN) loss in prostate cancer has primarily been evaluated by either fluorescence in situ hybridization (FISH) or immunohistochemistry (IHC). Previously, we found that PTEN loss by IHC was associated with increased risk of upgrading from biopsy (Gleason 3 + 3) to prostatectomy (Gleason 7+). Now, using an evaluable subset of 111 patients with adjacent biopsy sections, we analyzed the association between PTEN deletion in cancer and the odds of upgrading by a highly sensitive and specific four-color FISH assay. We also compared the concordance of PTEN loss by IHC and PTEN deletion by FISH. PTEN deletion was found in 27 % (12/45) of upgraded cases compared with 11 % (7/66) of controls (P = 0.03). Cancers with PTEN deletions were more likely to be upgraded than those without deletions (adjusting for age odds ratio = 3.40, 95 % confidence interval 1.14-10.11). With respect to concordance, of 93 biopsies with PTEN protein detected by IHC, 89 (96 %) had no PTEN deletion by FISH, and of 18 biopsies without PTEN protein by IHC, 15 had homozygous or hemizygous PTEN deletion by FISH. Only 4 biopsies of the 93 (4 %) with PTEN protein intact had PTEN deletion by FISH. When the regions of uncertainty in these biopsies were systematically studied by FISH, intra-tumoral variation of PTEN deletion was found, which could account for variation in immunoreactivity. Thus, FISH provides a different approach to determining PTEN loss when IHC is uncertain. Both FISH and IHC are concordant, showing consistent positive associations between PTEN loss and upgrading.

  18. Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection.

    PubMed

    Raman, Jay D; Lehman, Kathleen K; Dewan, Kalyan; Kirimanjeswara, Girish

    2015-01-01

    Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB. All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml of a 10% solution of commercially available povidone iodine is mixed with 5 ml of 1% lidocaine jelly to create slurry. A 4 cmx4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2-3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p=0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies. PMID:26436913

  19. Prostate cancer.

    PubMed

    Castillejos-Molina, Ricardo Alonso; Gabilondo-Navarro, Fernando Bernardo

    2016-04-01

    Prostate cancer is the most frequent tumor found in men worldwide and in Mexico in particular. Age and family history are the main risk factors. The diagnosis is made by prostate biopsy in patients with abnormalities detected in their prostate-specific antigen (PSA) levels or digital rectal exam (DRE). This article reviews screening and diagnostic methods as well as treatment options for patients diagnosed with prostate cancer. PMID:27557386

  20. Pretreatment biopsy analysis of DAB2IP identifies subpopulation of high-risk prostate cancer patients with worse survival following radiation therapy.

    PubMed

    Jacobs, Corbin; Tumati, Vasu; Kapur, Payal; Yan, Jingsheng; Xie, Xian-Jin; Hannan, Raquibul; Hsieh, Jer-Tsong; Kim, Dong Wook Nathan; Saha, Debabrata

    2015-12-01

    Decreased expression of tumor suppressor DAB2IP is linked to aggressive cancer and radiation resistance in several malignancies, but clinical survival data is largely unknown. We hypothesized that pretreatment DAB2IP reduction would predict worse prostate cancer-specific survival (PCSS). Immunohistochemistry of pretreatment biopsies was scored by an expert genitourinary pathologist. Other endpoints analyzed include freedom from biochemical failure (FFBF), castration resistance-free survival (CRFS), and distant metastasis-free survival (DMFS). Seventy-nine patients with NCCN-defined high-risk prostate cancer treated with radiotherapy from 2005 to 2012 at our institution were evaluated. Twenty-eight percent (22/79) of pretreatment biopsies revealed DAB2IP-reduction. The median follow up times were 4.8 years and 5.3 years for patients in the DAB2IP-reduced group and DAB2IP-retained group, respectively. Patients with reduced DAB2IP demonstrated worse outcome compared to patients retaining DAB2IP, including FFBF (4-year: 34 vs. 92%; P < 0.0001), CRFS (4-year: 58 vs. 96%; P = 0.0039), DMFS (4-year: 58 vs. 100%; P = 0.0006), and PCSS (5-year: 83 vs. 100%; P = 0.0102). Univariate analysis showed T stage, N stage, and Gleason score were statistically significant variables. Pretreatment tumor DAB2IP status remained significant in multivariable analyses. This study suggests that about one-fourth of men with high-risk prostate cancer have decreased tumor expression of DAB2IP. This subpopulation with reduced DAB2IP has a suboptimal response and worse malignancy-specific survival following radiation therapy and androgen deprivation. DAB2IP loss may be a genetic explanation for the observed differences in aggressive tumor characteristics and radiation resistance. Further study into improving treatment response and survival in this subpopulation is warranted.

  1. Incorporating Known Genetic Variants Does Not Improve the Accuracy of PSA Testing to Identify High Risk Prostate Cancer on Biopsy

    PubMed Central

    Gilbert, Rebecca; Martin, Richard M.; Evans, David M.; Tilling, Kate; Davey Smith, George; Kemp, John P.; Lane, J. Athene; Hamdy, Freddie C.; Neal, David E.; Donovan, Jenny L.; Metcalfe, Chris

    2015-01-01

    Introduction Prostate-specific antigen (PSA) testing is a widely accepted screening method for prostate cancer, but with low specificity at thresholds giving good sensitivity. Previous research identified four single nucleotide polymorphisms (SNPs) principally associated with circulating PSA levels rather than with prostate cancer risk (TERT rs2736098, FGFR2 rs10788160, TBX3 rs11067228, KLK3 rs17632542). Removing the genetic contribution to PSA levels may improve the ability of the remaining biologically-determined variation in PSA to discriminate between high and low risk of progression within men with identified prostate cancer. We investigate whether incorporating information on the PSA-SNPs improves the discrimination achieved by a single PSA threshold in men with raised PSA levels. Materials and Methods Men with PSA between 3-10ng/mL and histologically-confirmed prostate cancer were categorised as high or low risk of progression (Low risk: Gleason score≤6 and stage T1-T2a; High risk: Gleason score 7–10 or stage T2C). We used the combined genetic effect of the four PSA-SNPs to calculate a genetically corrected PSA risk score. We calculated the Area under the Curve (AUC) to determine how well genetically corrected PSA risk scores distinguished men at high risk of progression from low risk men. Results The analysis includes 868 men with prostate cancer (Low risk: 684 (78.8%); High risk: 184 (21.2%)). Receiver operating characteristic (ROC) curves indicate that including the 4 PSA-SNPs does not improve the performance of measured PSA as a screening tool for high/low risk prostate cancer (measured PSA level AU C = 59.5% (95% CI: 54.7,64.2) vs additionally including information from the 4 PSA-SNPs AUC = 59.8% (95% CI: 55.2,64.5) (p-value = 0.40)). Conclusion We demonstrate that genetically correcting PSA for the combined genetic effect of four PSA-SNPs, did not improve discrimination between high and low risk prostate cancer in men with raised PSA levels (3-10ng

  2. Eosinophilic prostatitis and prostatic specific antigen.

    PubMed

    Liu, S; Miller, P D; Holmes, S A; Christmas, T J; Kirby, R S

    1992-01-01

    Eosinophilic prostatitis is a rare form of abacterial prostatitis with uncertain aetiology. Its clinical presentation, like other types of abacterial prostatitis, commonly mimics carcinoma of the prostate. Transrectal ultrasound may be helpful in the diagnosis of prostatitis but histological confirmation is necessary. Prostatic specific antigen has been widely used in the diagnosis and follow-up of patients with prostatic carcinoma. High levels of this antigen (greater than 30 micrograms/l) have been claimed to be highly specific for prostate cancer, although lesser elevations may also occur in patients with large benign prostate glands and in bacterial prostatitis. We report 3 patients with histologically proven eosinophilic prostatitis and high levels of prostatic specific antigen. This diagnosis may closely mimic carcinoma of the prostate and must be excluded by histological examination of biopsy material before treatment for presumed prostate carcinoma is initiated.

  3. Radical Prostatectomy Findings in White Hispanic/Latino Men With NCCN Very Low-risk Prostate Cancer Detected by Template Biopsy

    PubMed Central

    Kryvenko, Oleksandr N.; Lyapichev, Kirill; Chinea, Felix M.; Prakash, Nachiketh Soodana; Pollack, Alan; Gonzalgo, Mark L.; Punnen, Sanoj; Jorda, Merce

    2016-01-01

    Radical prostatectomy (RP) outcomes have been studied in White and Black non-Hispanic men qualifying for Epstein active surveillance criteria (EASC). Herein, we first analyzed such outcomes in White Hispanic men. We studied 70 men with nonpalpable Gleason score 3+3 = 6 (Grade Group [GG] 1) prostate cancer (PCa) with ≤2 positive cores on biopsy who underwent RP. In 18 men, prostate-specific antigen (PSA) density (PSAD) was >0.15 ng/mL/g. Three of these had insignificant and 15 had significant PCa. The remaining 52 men qualified for EASC. One patient had no PCa identified at RP. Nineteen (37%) had significant PCa defined by volume (n = 7), grade (n = 7), and volume and grade (n = 5). Nine cases were 3+4 = 7 (GG 2) (5/9 [56%] with pattern 4 <5%), 2 were 3+5 = 8 (GG 4), and 1 was 4+5 = 9 (GG 5). Patients with significant PCa more commonly had anterior dominant disease (11/19, 58%) versus patients with insignificant cancer (7/33, 21%) (P = 0.01). In 12 cases with higher grade at RP, the dominant tumor nodule was anterior in 6 (50%) and posterior in 6 (median volumes: 1.1 vs. 0.17 cm3, respectively; P = 0.01). PSA correlated poorly with tumor volume (r = 0.28, P = 0.049). Gland weight significantly correlated with PSA (r = 0.54, P < 0.001). While PSAD and PSA mass density correlated with tumor volume, only PSA mass density distinguished cases with significant disease (median, 0.008 vs. 0.012 μg/g; P = 0.03). In summary, a PSAD threshold of 0.15 works well in predicting significant tumor volume in Hispanic men. EASC appear to perform better in White Hispanic men than previously reported outcomes for Black non-Hispanic and worse than in White non-Hispanic men. Significant disease is often Gleason score 3+3 = 6 (GG 1) PCa >0.5 cm3. Significant PCa is either a larger-volume anterior disease that may be detected by multi-parametric magnetic resonance imaging-targeted biopsy or anterior sampling of the prostate or higher-grade smaller-volume posterior disease that in most

  4. Predicting Prostate Biopsy Outcomes: A Preliminary Investigation on Screening with Ultrahigh B-Value Diffusion-Weighted Imaging as an Innovative Diagnostic Biomarker

    PubMed Central

    Zhang, Kun; Shen, Yanguang; Zhang, Xu; Ma, Lu; Wang, Haiyi; An, Ningyu; Guo, Aitao; Ye, Huiyi

    2016-01-01

    Background Routine screening of prostate specific antigen (PSA) is no longer recommended because of a high rate of over-diagnosis of prostate cancer (PCa). Objective To evaluate the efficacy of diffusion-weighted magnetic resonance imaging (DW-MRI) for PCa detection, and to explore the clinical utility of ultrahigh b-value DW-MRI in predicting prostate biopsy outcomes. Methodology 73 male patients were selected for the study. They underwent 3T MRI using T2WI conventional DW-MRI with b-value 1000 s/mm2, and ultrahigh b-value DW-MRI with b-values of 2000 s/mm2 and 3000 s/mm2. Two radiologists evaluated individual prostate gland images on a 5-point rating scale using PI-RADS, for the purpose of region-specific comparisons among modalities. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios (LR) were investigated for each MRI modality. The area under the receiver operating characteristic (ROC) curve (AUC) was also calculated. Results Results showed the improved diagnostic value of ultrahigh b-value DWI-MRI for detection of PCa when compared to other b values and conventional MRI protocols. Sensitivity values for 3000 s/mm2 in both peripheral zone (PZ) and transition zone (TZ) were significantly higher than those observed with conventional DW-MRI—Specificity values for 3000 s/mm2 in the TZ were significantly higher than other b-value images, whereas specificity values using 3000 s/mm2 in the PZ were not significantly higher than 2000 s/mm2 images. PPV and NPV between 3000 s/mm2 and the other three modalities were significantly higher for both PZ and TZ images. The PLRs and NLRs of b-value 3000 s/mm2 DW-MRI in the PZ and TZ were also recorded. ROC analysis showed greater AUCs for the b value 3000 s/mm2 DWI than for the other three modalities. Conclusions DW-MRI with a b-value of 3000 s/mm2 was found to be the most accurate and reliable MRI modality for PCa tumor detection and localization

  5. Baseline prevalence of antimicrobial resistance and subsequent infection following prostate biopsy using empirical or altered prophylaxis: A bias-adjusted meta-analysis.

    PubMed

    Roberts, Matthew J; Williamson, Deborah A; Hadway, Paul; Doi, Suhail A R; Gardiner, Robert A; Paterson, David L

    2014-04-01

    Transrectal ultrasound-guided prostate biopsy (TRUSPB) is a commonly performed urological procedure. Recent studies suggest that pre-biopsy screening for fluoroquinolone-resistant (FQ-R) pathogens may be useful in reducing post-biopsy infections. We sought to determine the baseline prevalence of fluoroquinolone (FQ) resistance in rectal flora and to investigate the relationship between pre-biopsy carriage of FQ-R pathogens and the risk of post-TRUSPB infection. Electronic databases were searched for related literature. Studies were assessed for methodological quality and comparable outcomes prior to meta-analysis (using quality- and random-effects models). Nine studies, representing 2541 patients, were included. The prevalence of FQ resistance was higher (20.4%, 95% CI 18.2-22.6%) in rectal cultures obtained following FQ-based prophylaxis compared with those obtained before (12.8%, 95% CI 10.7-15.0%). Overall infection rates in patients using empirical prophylaxis were higher (3.3%, 95% CI 2.6-4.2%) than in those using altered (targeted/protocol) regimens (0.3%, 95% CI 0-0.9%). Higher infection rates were seen in men with FQ-R rectal cultures (7.1%, 95% CI 4.0-10.5%) than in those with FQ-sensitive (FQ-S) rectal cultures (1.1%, 95% CI 0.5-1.8%). For every 14 men with FQ-R rectal cultures, one additional infection was observed compared with men with FQ-S rectal cultures. Prior FQ use and prior genitourinary infection were significant risk factors for FQ-R colonisation. FQ resistance in rectal flora is a significant predictor of post-TRUSPB infection and may require re-assessment of empirical antimicrobial prophylaxis methods. Altered prophylaxis based on rectal culturing prior to TRUSPB may reduce morbidity and potentially provide economic benefits to health services.

  6. Validation of an RNA cell cycle progression score for predicting death from prostate cancer in a conservatively managed needle biopsy cohort

    PubMed Central

    Cuzick, J; Stone, S; Fisher, G; Yang, Z H; North, B V; Berney, D M; Beltran, L; Greenberg, D; Møller, H; Reid, J E; Gutin, A; Lanchbury, J S; Brawer, M; Scardino, P

    2015-01-01

    Background: The natural history of prostate cancer is highly variable and difficult to predict accurately. Better markers are needed to guide management and avoid unnecessary treatment. In this study, we validate the prognostic value of a cell cycle progression score (CCP score) independently and in a prespecified linear combination with standard clinical variables, that is, a clinical-cell-cycle-risk (CCR) score. Methods: Paraffin sections from 761 men with clinically localized prostate cancer diagnosed by needle biopsy and managed conservatively in the United Kingdom, mostly between 2000 and 2003. The primary end point was prostate cancer death. Clinical variables consisted of centrally reviewed Gleason score, baseline PSA level, age, clinical stage, and extent of disease; these were combined into a single predefined risk assessment (CAPRA) score. Full data were available for 585 men who formed a fully independent validation cohort. Results: In univariate analysis, the CCP score hazard ratio was 2.08 (95% CI (1.76, 2.46), P<10−13) for one unit change of the score. In multivariate analysis including CAPRA, the CCP score hazard ratio was 1.76 (95% CI (1.44, 2.14), P<10−6). The predefined CCR score was highly predictive, hazard ratio 2.17 (95% CI (1.83, 2.57), χ2=89.0, P<10−20) and captured virtually all available prognostic information. Conclusions: The CCP score provides significant pretreatment prognostic information that cannot be provided by clinical variables and is useful for determining which patients can be safely managed conservatively, avoiding radical treatment. PMID:26103570

  7. The efficiency of a sedative or analgesic supplement to periprostatic nerve blockage for pain control during transrectal ultrasound-guided prostate biopsy – a prospective, randomized, controlled, double blind study

    PubMed Central

    Ozok, Hakki U.; Ates, Mevlut A.; Karakoyunlu, Nihat; Topaloglu, Hikmet; Ersoy, Hamit

    2010-01-01

    Introduction The aim was to examine the effect of a sedative or analgesic supplement to periprostatic nerve blockage (PNB) on pain reduction during probe insertion and needle penetration in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. We also investigated the effects of this procedure on the positive response rate in re-biopsy. Material and methods One hundred TRUS-guided prostate biopsy patients due to prostate-specific antigen (PSA) levels higher than 2.5 ng/ml and/or abnormal rectal examination findings were evaluated. Group 1 (PNB) was given periprostatic lidocaine injection before the procedure. Group 2 (analgesic) was given tramadol and PNB. Group 3 (sedative) was given midazolam and PNB. Group 4 (control) was not given any anaesthesia or analgesics. Pain scores were assessed during probe insertion and needle penetration by a visual analogue scale. Results During probe insertion, the mean pain score of the sedative group was lower than that of the control, analgesic and PNB groups (p < 0.001, p = 0.009, and p < 0.001, respectively). During needle penetration, the mean pain score of the control group was higher than that of the other groups (p < 0.001). The rate of positive response to re-biopsy was found to be 56% in the control group and between 92% and 100% in the other three groups (p < 0.001). Conclusion According to our results, it can be concluded that midazolam, given supplementary to PNB, contributes as an effective and safe alternative for pain control during both probe insertion and penetration of the biopsy needle into the prostate capsule; however, tramadol supplement does not provide any additional contributions. PMID:22419940

  8. The Percent of Positive Biopsy Cores Improves Prediction of Prostate Cancer-Specific Death in Patients Treated With Dose-Escalated Radiotherapy

    SciTech Connect

    Qian Yushen; Feng, Felix Y.; Halverson, Schuyler; Blas, Kevin; Sandler, Howard M.; Hamstra, Daniel A.

    2011-11-01

    Purpose: To examine the prognostic utility of the percentage of positive cores (PPC) at the time of prostate biopsy for patients treated with dose-escalated external beam radiation therapy. Methods and Materials: We performed a retrospective analysis of patients treated at University of Michigan Medical Center to at least 75 Gy. Patients were stratified according to PPC by quartile, and freedom from biochemical failure (nadir + 2 ng/mL), freedom from metastasis (FFM), cause-specific survival (CSS), and overall survival (OS) were assessed by log-rank test. Receiver operator characteristic (ROC) curve analysis was used to determine the optimal cut point for PPC stratification. Finally, Cox proportional hazards multivariate regression was used to assess the impact of PPC on clinical outcome when adjusting for National Comprehensive Cancer Network (NCCN) risk group and androgen deprivation therapy. Results: PPC information was available for 651 patients. Increasing-risk features including T stage, prostate-specific antigen, Gleason score, and NCCN risk group were all directly correlated with increasing PPC. On log-rank evaluation, all clinical endpoints, except for OS, were associated with PPC by quartile, with worse clinical outcomes as PPC increased, with the greatest impact seen in the highest quartile (>66.7% of cores positive). ROC curve analysis confirmed that a cut point using two-thirds positive cores was most closely associated with CSS (p = 0.002; area under ROC curve, 0.71). On univariate analysis, stratifying patients according to PPC less than or equal to 66.7% vs. PPC greater than 66.7% was prognostic for freedom from biochemical failure (p = 0.0001), FFM (p = 0.0002), and CSS (p = 0.0003) and marginally prognostic for OS (p = 0.055). On multivariate analysis, after adjustment for NCCN risk group and androgen deprivation therapy use, PPC greater than 66.7% increased the risk for biochemical failure (p = 0.0001; hazard ratio [HR], 2.1 [95% confidence

  9. Kidney biopsy

    MedlinePlus

    Renal biopsy; Biopsy - kidney ... Barisoni L, Arend LJ, Thomas DB. Introduction to renal biopsy. In: Zhou M, Mari-Galluzzi C, eds. ... Saunders; 2015:chap 7. Topham PS, Chen Y. Renal biopsy. In: Johnson RJ, Feehally J, Floege J, ...

  10. Gum biopsy

    MedlinePlus

    Biopsy - gingiva (gums) ... used to close the opening created for the biopsy. ... to eat for a few hours before the biopsy. ... Risks for this procedure include: Bleeding from the biopsy site Infection of the gums Soreness

  11. The incidence and risk factors of resistant E. coli infections after prostate biopsy under fluoroquinolone prophylaxis: a single-centre experience with 2215 patients.

    PubMed

    Kandemir, Özlem; Bozlu, Murat; Efesoy, Ozan; Güntekin, Onur; Tek, Mesut; Akbay, Erdem

    2016-08-01

    We evaluated the incidence and risk factors of resistant Escherichia coli infections after the prostate biopsy under flouroquinolone prophylaxis. From January 2003 to December 2012, we retrospectively evaluated the records of 2215 patients. The risk factors were described for infective complications and resistant E. coli in positive cultures was calculated. Of 2215 patients, 153 had positive urine cultures, such as 129 (84·3%) E. coli, 8 (5·2%) Enterococcus spp., 6 (3·9%) Enterobacter spp., 5 (3·2%) Pseudomonas spp., 3 (1·9%) MRCNS, and 2 (1·3%) Klebsiella spp. Of the positive urine cultures which yielded E. coli, 99 (76·7%) were evaluated for fluoroquinolone resistance. Of those, 83 (83·8%) were fluoroquinolone-resistant and composed of 51 (61·4%) extended-spectrum beta-lactamase (ESBL)-positive. Fluoroquinolone-resistant E. coli ratios were 73·4 and 95·9% before 2008 and after 2008, respectively (P = 0·002). The most sensitive antibiotics for fluoroquinolone-resistant E. coli strains were imipenem (100%), amikacin (84%) and cefoperazone (83%). The use of quinolones in the last 6 months and a history of hospitalization in the last 30 days were found to be significant risk factors. We found that resistant E. coli strains might be a common microorganism in patients with this kind of complication. The risk factors for development of infection with these resistant strains were history of the use of fluoroquinolones and hospitalization.

  12. The incidence and risk factors of resistant E. coli infections after prostate biopsy under fluoroquinolone prophylaxis: a single-centre experience with 2215 patients.

    PubMed

    Kandemir, Özlem; Bozlu, Murat; Efesoy, Ozan; Güntekin, Onur; Tek, Mesut; Akbay, Erdem

    2016-08-01

    We evaluated the incidence and risk factors of resistant Escherichia coli infections after the prostate biopsy under flouroquinolone prophylaxis. From January 2003 to December 2012, we retrospectively evaluated the records of 2215 patients. The risk factors were described for infective complications and resistant E. coli in positive cultures was calculated. Of 2215 patients, 153 had positive urine cultures, such as 129 (84·3%) E. coli, 8 (5·2%) Enterococcus spp., 6 (3·9%) Enterobacter spp., 5 (3·2%) Pseudomonas spp., 3 (1·9%) MRCNS, and 2 (1·3%) Klebsiella spp. Of the positive urine cultures which yielded E. coli, 99 (76·7%) were evaluated for fluoroquinolone resistance. Of those, 83 (83·8%) were fluoroquinolone-resistant and composed of 51 (61·4%) extended-spectrum beta-lactamase (ESBL)-positive. Fluoroquinolone-resistant E. coli ratios were 73·4 and 95·9% before 2008 and after 2008, respectively (P = 0·002). The most sensitive antibiotics for fluoroquinolone-resistant E. coli strains were imipenem (100%), amikacin (84%) and cefoperazone (83%). The use of quinolones in the last 6 months and a history of hospitalization in the last 30 days were found to be significant risk factors. We found that resistant E. coli strains might be a common microorganism in patients with this kind of complication. The risk factors for development of infection with these resistant strains were history of the use of fluoroquinolones and hospitalization. PMID:25630553

  13. Evaluation of PCA3 and multiparametric MRI’s: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL

    PubMed Central

    Okcelik, Sezgin; Soydan, Hasan; Ates, Ferhat; Berber, Ufuk; Saygin, Hasan; Sönmez, Güner; Karademir, Kenan

    2016-01-01

    ABSTRACT Objective To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). Materials and Methods PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. Results 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. Conclusion Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI. PMID:27286106

  14. Discontinuous foci of cancer in a single core of prostatic biopsy: when it occurs and performance of quantification methods in a private-practice setting.

    PubMed

    Schultz, Luciana; Maluf, Carlos E; da Silva, Rogério C; Falashi, Rodrigo de H; da Costa, Matheus V; Schultz, Maria Ines O

    2013-12-01

    In addition to clinical data, prostatic biopsy (Bx) reports orient urologists in outlining the patient's treatment options. Discontinuous involvement of a core by multiple foci of cancer is not infrequent; however, there is currently no consensus as to which method of quantification should be the standard. We applied 2 distinct approaches to quantify the length of cancer foci in the Bx and compared the results to prostatectomy (RP) parameters. All patients with matched Bx and RP treated by the same medical team between 2006 and 2010 were consecutively included in the study. Tumor extent in the Bx was estimated by multiple approaches, and the length was measured in millimeters. The subset of cases with discontinuous foci of cancer in a single core was initially reported by adding each foci and ignoring the benign intervening prostatic tissue, which was designated as additive quantification (AQ). Upon slide review, these foci were reassessed as a single focus and measured by linear quantification (LQ). RPs were partially embedded according to the International Society of Urological Pathology recommendations, and the percentage of tumor was evaluated with graphic precision. Mean percentage of the tumor in RP (%RP) and in the Bx were arbitrarily classified as limited (<6%) and nonlimited (≥6%). Bx parameters were then correlated with %RP and margin status. All methods of quantification of the tumor in the Bx obtained excellent correlation with %RP. LQ and AQ diverged in 14/38 patients, with a mean total length of cancer of 5.8 mm more than the length obtained by LQ in the same population, accurately upgrading 6/14 cases to nonlimited. This subset (LQ>AQ) was more often seen in Bx with significantly more positive cores (P=0.003) of predominantly Gleason score 7 and associated with positive surgical margins in RP (P=0.034) independent of %RP (21% vs. 19% in the margin-negative cases). However, in the subset of Bx in which the tumor infiltration was continuous (AQ

  15. Diagnosis of "Poorly Formed Glands" Gleason Pattern 4 Prostatic Adenocarcinoma on Needle Biopsy: An Interobserver Reproducibility Study Among Urologic Pathologists With Recommendations.

    PubMed

    Zhou, Ming; Li, Jianbo; Cheng, Liang; Egevad, Lars; Deng, Fang-Ming; Kunju, Lakshmi Priya; Magi-Galluzzi, Cristina; Melamed, Jonathan; Mehra, Rohit; Mendrinos, Savvas; Osunkoya, Adeboye O; Paner, Gladell; Shen, Steve S; Tsuzuki, Toyonori; Trpkov, Kiril; Tian, Wei; Yang, Ximing; Shah, Rajal B

    2015-10-01

    Accurate recognition of Gleason pattern (GP) 4 prostate carcinoma (PCa) on needle biopsy is critical for patient management and prognostication. "Poorly formed glands" are the most common GP4 subpattern. We studied the diagnostic reproducibility and the quantitative threshold of grading GP4 "poorly formed glands" and the criteria to distinguish them from tangentially sectioned GP3 glands. Seventeen urologic pathologists were first queried for the definition of "poorly formed glands" using cases representing a spectrum of PCa glandular differentiation. Cancer glands with no or rare lumens, elongated compressed glands, and elongated nests were considered "poorly formed glands" by consensus. Participants then graded a second set of 23 PCa cases that potentially contained "poorly formed glands" with a fair interobserver agreement (κ = 0.34). The consensus diagnoses, defined as agreement by > 70% participants, were then correlated with the quantitative (≤ 5, 6 to 10, >10) and topographic features of poorly formed glands (clustered, immediately adjacent to, and intermixed with other well-formed PCa glands) in each case. Poorly formed glands immediately adjacent to other well-formed glands regardless of their number and small foci of ≤ 5 poorly formed glands regardless of their location were not graded as GP4. In contrast, large foci of >10 poorly formed glands that were not immediately adjacent to well-formed glands were graded as GP4. Grading "poorly formed glands" is challenging. Some morphologic features are, however, reproducible for and against a GP4 diagnosis. This study represents an important step in standardization of grading of "poorly formed glands" based on quantitative and topographic morphologic features.

  16. Liver biopsy

    MedlinePlus

    Biopsy - liver; Percutaneous biopsy ... the biopsy needle to be inserted into the liver. This is often done by using ultrasound. The ... the chance of damage to the lung or liver. The needle is removed quickly. Pressure will be ...

  17. Biopsy - polyps

    MedlinePlus

    Polyp biopsy ... are treated is the colon. How a polyp biopsy is done depends on the location: Colonoscopy or flexible sigmoidoscopy explores the large bowel Colposcopy-directed biopsy examines the vagina and cervix Esophagogastroduodenoscopy (EGD) or ...

  18. Impact of Comorbidity, Race, and Marital Status in Men Referred for Prostate Biopsy with PSA >20 ng/mL: A Pilot Study in High-Risk Patients.

    PubMed

    Klaassen, Zachary; Muller, Roberto; Li, Qiang; Tatem, Alexander J; King, Sherita A; Freedland, Stephen J; Madi, Rabii; Terris, Martha K; Moses, Kelvin A

    2014-01-01

    Objective. To assess the impact of comorbidity, race, and marital status on overall survival (OS) among men presenting for prostate biopsy with PSA >20 ng/mL. Methods. Data were reviewed from 2000 to 2012 and 78 patients were included in the cohort. We analyzed predictors of OS using a Cox proportional hazards model and the association between Charlson Comorbidity Index (CCI) score and PCa diagnosis or high-grade cancer using logistic regression and multinomial regression models, respectively. Results. The median age of patients was 62.5 (IQR 57-73) years. Median CCI was 3 (IQR 2-4), 69% of patients were African American men, 56% of patients were married, and 85% of patients had a positive biopsy. CCI (HR 1.52, 95% CI 1.19, 1.94), PSA (HR 1.62, 95% CI 1.09, 2.42), and Gleason sum (HR 2.04, 95% CI 1.17, 3.56) were associated with OS. CCI was associated with Gleason sum 7 (OR 4.06, 95% CI 1.04, 15.89) and Gleason sum 8-10 (OR 4.52, 95% CI 1.16, 17.54) PCa. Conclusions. CCI is an independent predictor of high-grade disease and worse OS among men with PCa. Race and marital status were not significantly associated with survival in this cohort. Patient comorbidity is an important component of determining the optimal approach to management of prostate cancer.

  19. Kidney Biopsy

    MedlinePlus

    ... right diagnosis. [ Top ] What should a person do days before a kidney biopsy? Days before the procedure, ... Top ] What can a person expect on the day of the kidney biopsy? A person should arrive ...

  20. Tongue biopsy

    MedlinePlus

    Biopsy - tongue ... A tongue biopsy can be done using a needle. You will get numbing medicine at the place where the ... provider will gently stick the needle into the tongue and remove a tiny piece of tissue. Some ...

  1. Improvement of diagnostic agreement among pathologists in resolving an "atypical glands suspicious for cancer" diagnosis in prostate biopsies using a novel "Disease-Focused Diagnostic Review" quality improvement process.

    PubMed

    Shah, Rajal B; Leandro, Gioacchino; Romerocaces, Gloria; Bentley, James; Yoon, Jiyoon; Mendrinos, Savvas; Tadros, Yousef; Tian, Wei; Lash, Richard

    2016-10-01

    One of the major goals of an anatomic pathology laboratory quality program is to minimize unwarranted diagnostic variability and equivocal reporting. This study evaluated the utility of Miraca Life Sciences' "Disease-Focused Diagnostic Review" (DFDR) quality program in improving interobserver diagnostic reproducibility associated with classification of "atypical glands suspicious for adenocarcinoma" (ATYP) in prostate biopsies. Seventy-one selected prostate biopsies with a focus of ATYP were reviewed by 8 pathologists. Participants were blinded to the original diagnosis and were first asked to classify the ATYP as benign, atypical, or limited adenocarcinoma. DFDR comprised a "theoretical consensus" (in which pathologists first reached consensus on the morphological features they considered relevant for the diagnosis of limited prostatic adenocarcinoma), a didactic review including relevant literature, and "practical consensus" (pathologists performed joint microscopic sessions, reconciling each other's observations and positions evaluating a separate unique slide set). Participants were finally asked to reclassify the original 71 ATYP cases based on knowledge gleaned from DFDR. Pre- and post-DFDR interobserver reproducibility of overall diagnostic agreement was assessed. Interobserver reproducibility measured by Fleiss κ values of pre- and post-DFDR was 0.36 and 0.59, respectively (P=.006). Post-DFDR, there were significant improvement for "100% concordance" (P=.011) and reduction for "no consensus" (P=.0004) categories. Despite a lower pre-DFDR reproducibility for non-uropathology fellowship-trained (n=3, κ=0.38) versus uropathology fellowship-trained (n=5, κ=0.43) pathologists, both groups achieved similarly high post-DFDR κ levels (κ=0.58 and 0.56, respectively). DFDR represents an effective tool to formally achieve diagnostic consensus and reduce variability associated with critical diagnoses in an anatomic pathology practice.

  2. Liver Biopsy

    MedlinePlus

    ... PDF, 341 KB)​​​​. Alternate Language URL Español Liver Biopsy Page Content On this page: What is a ... to Remember Clinical Trials What is a liver biopsy? A liver biopsy is a procedure that involves ...

  3. Prostate cancer staging

    MedlinePlus

    ... test. A faster increase could show a more aggressive tumor. A prostate biopsy is done in your ... suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that ...

  4. Prostatic Stromal Hyperplasia with Atypia

    PubMed Central

    Hutchinson, Ryan C.; Wu, Kevin J.; Cheville, John C.; Thiel, David D.

    2013-01-01

    Prostatic stromal hyperplasia with atypia (PSHA) is a rare histologic finding diagnosed incidentally on prostate biopsies, transurethral resection specimens, and radical prostatectomy specimens. PSHA has a bizarre histologic appearance and these lesions often raise concern for sarcoma; however, their clinical course is indolent and does not include extraprostatic progression. We discuss a case of PHSA discovered on prostate biopsy performed for an abnormal digital rectal examination and review the literature on this rare pathologic finding. PMID:23781384

  5. Prostatic stromal hyperplasia with atypia.

    PubMed

    Hutchinson, Ryan C; Wu, Kevin J; Cheville, John C; Thiel, David D

    2013-01-01

    Prostatic stromal hyperplasia with atypia (PSHA) is a rare histologic finding diagnosed incidentally on prostate biopsies, transurethral resection specimens, and radical prostatectomy specimens. PSHA has a bizarre histologic appearance and these lesions often raise concern for sarcoma; however, their clinical course is indolent and does not include extraprostatic progression. We discuss a case of PHSA discovered on prostate biopsy performed for an abnormal digital rectal examination and review the literature on this rare pathologic finding. PMID:23781384

  6. Utility of Gleason pattern 4 morphologies detected on transrectal ultrasound (TRUS)-guided biopsies for prediction of upgrading or upstaging in Gleason score 3 + 4 = 7 prostate cancer.

    PubMed

    Flood, Trevor A; Schieda, Nicola; Keefe, Daniel T; Breau, Rodney H; Morash, Chris; Hogan, Kevin; Belanger, Eric C; Mai, Kien T; Robertson, Susan J

    2016-09-01

    Selected patients with Gleason score (GS) 3 + 4 = 7 prostate cancer (PCa) detected on transrectal ultrasound (TRUS)-guided biopsies may be considered for active surveillance (AS); however, a proportion of these will harbor more aggressive disease. The purpose of this study was to determine if morphologies of Gleason pattern 4 PCa may predict upgrading and/or upstaging after radical prostatectomy (RP). A database search for men with GS 3 + 4 = 7 PCa diagnosed on TRUS-guided biopsy that underwent RP between January 2010 and October 2015 identified 152 patients. Two blinded genitourinary pathologists independently reviewed the biopsies and assessed ill-defined glands (IDG), fused glands, small or large cribriform patterns, and glomerulations. Patient age, serum prostate-specific antigen (PSA), percentage (%) of biopsy sites involved by 3 + 4 = 7 PCa, and overall extent of pattern 4 were also recorded. GS and stage (presence or absence of extraprostatic extension [EPE]) were retrieved from RP reports. Data were compared using independent t tests and chi-square. Inter-observer agreement was calculated using Cohen's Kappa statistic. Percent of biopsy sites and extent of pattern 4 were compared to statistically significant morphologies using the Spearman correlation. 28.3 % (43/152) of patients were upgraded to GS >3 + 4 = 7 at RP (GS 4 + 3 = 7 [N = 17], GS 4 + 3 = 7 with tertiary pattern 5 [N = 25], and GS 4 + 5 = 9 [N = 1]) and 44.1 % (67/152) showed EPE after RP. PSA was associated with both upgrading (8.5 ± 5.4 vs. 6.9 ± 3.2 ng/mL, [p = 0.04]) and EPE (8.2 ± 4.6 vs. 6.7 ± 3.2 ng/mL, [p = 0.03]). IDG, fused glands, and glomerulations were not associated with upgrading or EPE (p > 0.05) with moderate to strong inter-observer agreement (K = 0.76-0.88). There was strong inter-observer agreement for small and large cribriform formations (K = 0.93 and 0.94, respectively) and both patterns were strongly associated

  7. Validation of International Society of Urological Pathology (ISUP) grading for prostatic adenocarcinoma in thin core biopsies using TROG 03.04 'RADAR' trial clinical data.

    PubMed

    Delahunt, B; Egevad, L; Srigley, J R; Steigler, A; Murray, J D; Atkinson, C; Matthews, J; Duchesne, G; Spry, N A; Christie, D; Joseph, D; Attia, J; Denham, J W

    2015-10-01

    In 2014 a consensus conference convened by the International Society of Urological Pathology (ISUP) adopted amendments to the criteria for Gleason grading and scoring (GS) for prostatic adenocarcinoma. The meeting defined a modified grading system based on 5 grading categories (grade 1, GS 3+3; grade 2, GS 3+4; grade 3, GS 4+3; grade 4, GS 8; grade 5, GS 9-10). In this study we have evaluated the prognostic significance of ISUP grading in 496 patients enrolled in the TROG 03.04 RADAR Trial. There were 19 grade 1, 118 grade 2, 193 grade 3, 88 grade 4 and 79 grade 5 tumours in the series, with follow-up for a minimum of 6.5 years. On follow-up 76 patients experienced distant progression of disease, 171 prostate specific antigen (PSA) progression and 39 prostate cancer deaths. In contrast to the 2005 modified Gleason system (MGS), the hazards of the distant and PSA progression endpoints, relative to grade 2, were significantly greater for grades 3, 4 and 5 of the 2014 ISUP grading scheme. Comparison of predictive ability utilising Harrell's concordance index, showed 2014 ISUP grading to significantly out-perform 2005 MGS grading for each of the three clinical endpoints.

  8. Gastric adenocarcinoma with prostatic metastasis.

    PubMed

    Roshni, S; Anoop, Tm; Preethi, Tr; Shubanshu, G; Lijeesh, Al

    2014-06-01

    Metastasis of gastric adenocarcinoma to the prostate gland is extremely rare. Herein, we report a case of gastric adenocarcinoma in a 56-year-old man with prostatic metastasis diagnosed through the analysis of biopsy specimens from representative lesions in the stomach and prostate gland. Immunohistochemistry of the prostatic tissue showed positive staining for cytokeratin 7 and negative staining for prostate-specific antigen (PSA), whereas the serum PSA level was normal, confirming the diagnosis of prostatic metastasis from carcinoma of the stomach. PMID:25061542

  9. Gastric Adenocarcinoma with Prostatic Metastasis

    PubMed Central

    Roshni, S; Preethi, TR; Shubanshu, G; Lijeesh, AL

    2014-01-01

    Metastasis of gastric adenocarcinoma to the prostate gland is extremely rare. Herein, we report a case of gastric adenocarcinoma in a 56-year-old man with prostatic metastasis diagnosed through the analysis of biopsy specimens from representative lesions in the stomach and prostate gland. Immunohistochemistry of the prostatic tissue showed positive staining for cytokeratin 7 and negative staining for prostate-specific antigen (PSA), whereas the serum PSA level was normal, confirming the diagnosis of prostatic metastasis from carcinoma of the stomach. PMID:25061542

  10. Synovial biopsy

    MedlinePlus

    ... small incision. After anesthesia, an instrument called a trocar is inserted into the joint space. This tool ... area. A biopsy grasper is inserted through the trocar and turned to cut out a tissue segment. ...

  11. Stromal microcalcification in prostate.

    PubMed

    Muezzinoglu, B; Gurbuz, Y

    2001-06-01

    Prostatic calcification is most commonly encountered as calculus or intraluminal calcifications within atypical small glandular proliferations. This study was undertaken to detect stromal microcalcifications in prostate tissue. All slides from 194 needle biopsies were retrospectively reviewed. Six cases (3.1%) had stromal microcalcifications constantly associated with mononuclear inflammatory infiltrate around the each focus. Association with prostatic glands was not seen in any of the microcalcification foci. Three cases had simultaneous adenocarcinoma and one had high-grade prostatic intraepithelial neoplasia, all of which were apart from the microcalcification foci. In conclusion, stromal microcalcification is a dystrophic, inflammation-mediated, benign process.

  12. Prostate MRI can reduce overdiagnosis and overtreatment of prostate cancer.

    PubMed

    Rosenkrantz, Andrew B; Taneja, Samir S

    2015-08-01

    The contemporary management of prostate cancer (PCa) has been criticized as fostering overdetection and overtreatment of indolent disease. In particular, the historical inability to identify those men with an elevated PSA who truly warrant biopsy, and, for those needing biopsy, to localize aggressive tumors within the prostate, has contributed to suboptimal diagnosis and treatment strategies. This article describes how modern multi-parametric MRI of the prostate addresses such challenges and reduces both overdiagnosis and overtreatment. The central role of diffusion-weighted imaging (DWI) in contributing to MRI's current impact is described. Prostate MRI incorporating DWI achieves higher sensitivity than standard systematic biopsy for intermediate-to-high risk tumor, while having lower sensitivity for low-grade tumors that are unlikely to impact longevity. Particular applications of prostate MRI that are explored include selection of a subset of men with clinical suspicion of PCa to undergo biopsy as well as reliable confirmation of only low-risk disease in active surveillance patients. Various challenges to redefining the standard of care to incorporate solely MRI-targeted cores, without concomitant standard systematic cores, are identified. These include needs for further technical optimization of current systems for performing MRI-targeted biopsies, enhanced education and expertise in prostate MRI among radiologists, greater standardization in prostate MRI reporting across centers, and recognition of the roles of pre-biopsy MRI and MRI-targeted biopsy by payers. Ultimately, it is hoped that the medical community in the United States will embrace prostate MRI and MRI-targeted biopsy, allowing all patients with known or suspected prostate cancer to benefit from this approach.

  13. Lymph node biopsy

    MedlinePlus

    Biopsy - lymph nodes; Open lymph node biopsy; Fine needle aspiration biopsy; Sentinel lymph node biopsy ... then sent to the laboratory for examination. A needle biopsy involves inserting a needle into a lymph ...

  14. Testicular biopsy

    MedlinePlus

    ... egg in the lab. This process is called in vitro fertilization. Testicular biopsy may also be done if you have found a lump during testicular self-examination . If tests ... the lump may be in the testicle, surgery may be needed to look ...

  15. [Prostate cancer].

    PubMed

    Morote, Joan; Maldonado, Xavier; Morales-Bárrera, Rafael

    2016-02-01

    The Vall d'Hebron multidisciplinary prostate cancer (PC) team reviews recent advances in the management of this neoplasm. Screening studies with long follow-up show a reduction in mortality, whereas active surveillance is emerging as a therapeutic approach of non-aggressive cancers. New markers increase the specificity of PSA and also allow targeting suspected aggressive cancers. Multiparametric magnetic resonance (mMRI) has emerged as the most effective method in the selection of patients for biopsy and also for local tumor staging. The paradigm of random prostatic biopsy is changing through the fusion techniques that allow guiding ultrasonography-driven biopsy of suspicious areas detected in mMRI. Radical prostatectomy (RP) and radiotherapy (RT) are curative treatments of localized PC and both have experienced significant technological improvements. RP is highly effective and the incorporation of robotic surgery is reducing morbidity. Modern RT allows the possibility of high tumor dose with minimal adjacent dose reducing its toxicity. Androgen deprivation therapy with LHRH analogues remains the treatment of choice for advanced PC, but should be limited to this indication. The loss of bone mass and adverse metabolic effects increases the frequency of fractures and cardiovascular morbimortality. After castration resistance in metastatic disease, new hormone-based drugs have demonstrated efficacy even after chemotherapy resistance.

  16. [Prostate cancer].

    PubMed

    Morote, Joan; Maldonado, Xavier; Morales-Bárrera, Rafael

    2016-02-01

    The Vall d'Hebron multidisciplinary prostate cancer (PC) team reviews recent advances in the management of this neoplasm. Screening studies with long follow-up show a reduction in mortality, whereas active surveillance is emerging as a therapeutic approach of non-aggressive cancers. New markers increase the specificity of PSA and also allow targeting suspected aggressive cancers. Multiparametric magnetic resonance (mMRI) has emerged as the most effective method in the selection of patients for biopsy and also for local tumor staging. The paradigm of random prostatic biopsy is changing through the fusion techniques that allow guiding ultrasonography-driven biopsy of suspicious areas detected in mMRI. Radical prostatectomy (RP) and radiotherapy (RT) are curative treatments of localized PC and both have experienced significant technological improvements. RP is highly effective and the incorporation of robotic surgery is reducing morbidity. Modern RT allows the possibility of high tumor dose with minimal adjacent dose reducing its toxicity. Androgen deprivation therapy with LHRH analogues remains the treatment of choice for advanced PC, but should be limited to this indication. The loss of bone mass and adverse metabolic effects increases the frequency of fractures and cardiovascular morbimortality. After castration resistance in metastatic disease, new hormone-based drugs have demonstrated efficacy even after chemotherapy resistance. PMID:25727526

  17. Mitochondrial DNA haplotyping revealed the presence of mixed up benign and neoplastic tissue sections from two individuals on the same prostatic biopsy slide.

    PubMed

    Alonso, A; Alves, C; Suárez-Mier, M P; Albarrán, C; Pereira, L; Fernández de Simón, L; Martín, P; García, O; Gusmão, L; Sancho, M; Amorim, A

    2005-01-01

    DNA typing was requested to investigate a presumptive cancer diagnosis error by confirming whether benign and cancerous prostatic tissue in the same presurgical haematoxylin and eosin stained slide belonged to the same person. After independent histological re-examination of the slide by a pathologist, manual slide dissection was used to guarantee independent and high recovery DNA isolation from each tissue section, avoiding carryover and background contamination. Nuclear DNA quantification performed by real time polymerase chain reaction (PCR) revealed the absence of human DNA for short tandem repeat (STR) typing. Mitochondrial DNA was only obtained by performing PCR of very short fragments ( approximately 100 bp), indicating high DNA degradation. Different low frequency hypervariable region I haplotypes were obtained from each tissue section (normal tissue section haplotype: 16224C, 16234T, 16311C, 16356C; cancer tissue section haplotype: 16256T, 16270T, 16293G). Only the normal tissue section haplotype matched that obtained from the patient's blood sample, indicating that the cancer tissue section originated from an unknown patient. These results supported the hypothesis of sample mix up during block processing or slide preparation by a carryover mechanism. Mitochondrial genetic typing is recommended to exclude the possibility of carryover artefacts when low DNA content and high degradation compromise conventional STR typing.

  18. High-Grade Prostatic Intraepithelial Neoplasia

    PubMed Central

    Bostwick, David G; Liu, Lina; Brawer, Michael K; Qian, Junqi

    2004-01-01

    High-grade prostatic intraepithelial neoplasia is considered the most likely precursor of prostatic carcinoma. The only method of detection is biopsy; prostatic intraepithelial neoplasia (PIN) does not significantly elevate serum prostate-specific antigen concentration and cannot be detected by ultra-sonography. The incidence of PIN in prostate biopsies averages 9% (range, 4%–16%), representing 115,000 new cases of PIN diagnosed each year in United States. PIN has a high predictive value as a marker for adenocarcinoma, and its identification warrants repeated biopsy for concurrent or subsequent invasive carcinoma. Carcinoma will develop in most patients with PIN within 10 years. PIN is associated with progressive abnormalities of phenotype and genotype that are intermediate between normal prostatic epithelium and cancer, indicating impairment of cell differentiation and regulatory control with advancing stages of prostatic carcinogenesis. Androgen deprivation therapy decreases the prevalence and extent of PIN, suggesting that this form of treatment may play a role in chemoprevention. PMID:16985598

  19. Rapid diagnostic imaging and pathologic evaluation of whole core biopsies at the point-of-care using structured illumination microscopy

    NASA Astrophysics Data System (ADS)

    Wang, Mei; Sholl, Andrew B.; Kimbrell, Hillary; Tulman, David B.; Elfer, Katherine N.; Brown, J. Quincy

    2015-07-01

    Video-rate structured illumination microscopy (VR-SIM) of fluorescently stained prostate biopsies is demonstrated as a potential tool for rapid diagnosis of prostate biopsies at the point of care. Images of entire biopsies at 1.3 micron lateral resolution are rendered in seconds, and pathologist review of the resulting images achieves 90% accuracy as compared to gold standard histopathology.

  20. PSA Velocity Does Not Improve Prostate Cancer Detection

    Cancer.gov

    A rapid increase in prostate-specific antigen (PSA) levels is not grounds for automatically recommending a prostate biopsy, according to a study published online February 24, 2011, in the Journal of the National Cancer Institute.

  1. Nasal mucosal biopsy

    MedlinePlus

    Biopsy - nasal mucosa; Nose biopsy ... to fast for a few hours before the biopsy. ... Nasal mucosal biopsy is usually done when abnormal tissue is seen during examination of the nose. It may also be done ...

  2. Biopsy - biliary tract

    MedlinePlus

    Cytology analysis - biliary tract; Biliary tract biopsy ... A sample for a biliary tract biopsy can be obtained in different ways. A needle biopsy can be done if you have a well-defined tumor. The biopsy site ...

  3. Biopsy needle detection in transrectal ultrasound.

    PubMed

    Ayvaci, Alper; Yan, Pingkun; Xu, Sheng; Soatto, Stefano; Kruecker, Jochen

    2011-01-01

    Using the fusion of pre-operative MRI and real time intra-procedural transrectal ultrasound (TRUS) to guide prostate biopsy has been shown as a very promising approach to yield better clinical outcome than the routinely performed TRUS only guided biopsy. In several situations of the MRI/TRUS fusion guided biopsy, it is important to know the exact location of the deployed biopsy needle, which is imaged in the TRUS video. In this paper, we present a method to automatically detect and segment the biopsy needle in TRUS. To achieve this goal, we propose to combine information from multiple resources, including ultrasound probe stability, TRUS video background model, and the prior knowledge of needle orientation and position. The proposed algorithm was tested on TRUS video sequences which have in total more than 25,000 frames. The needle deployments were successfully detected and segmented in the sequences with high accuracy and low false-positive detection rate.

  4. Prostatic and dietary omega-3 fatty acids and prostate cancer progression during active surveillance.

    PubMed

    Moreel, Xavier; Allaire, Janie; Léger, Caroline; Caron, André; Labonté, Marie-Ève; Lamarche, Benoît; Julien, Pierre; Desmeules, Patrice; Têtu, Bernard; Fradet, Vincent

    2014-07-01

    The association between omega-3 (ω-3) fatty acids and prostate cancer has been widely studied. However, little is known about the impact of prostate tissue fatty acid content on prostate cancer progression. We hypothesized that compared with the estimated dietary ω-3 fatty acids intake and the ω-3 fatty acids levels measured in red blood cells (RBC), the prostate tissue ω-3 fatty acid content is more strongly related to prostate cancer progression. We present the initial observations from baseline data of a phase II clinical trial conducted in a cohort of 48 untreated men affected with low-risk prostate cancer, managed under active surveillance. These men underwent a first repeat biopsy session within 6 months after the initial diagnosis of low-risk prostate cancer, at which time 29% of the men had progressed from a Gleason score of 6 to a Gleason score of 7. At the first repeat biopsy session, fatty acid levels were assessed with a food-frequency questionnaire, and determined in the RBC and in the prostate tissue biopsy. We found that eicosapentaenoic acid (EPA) was associated with a reduced risk of prostate cancer progression when measured directly in the prostate tissue. Thus, this initial interim study analysis suggests that prostate tissue ω-3 fatty acids, especially EPA, may be protective against prostate cancer progression in men with low-risk prostate cancer.

  5. Precursors of prostate cancer.

    PubMed

    Bostwick, David G; Cheng, Liang

    2012-01-01

    High-grade prostatic intraepithelial neoplasia (PIN) is the only accepted precursor of prostatic adenocarcinoma, according to numerous studies of animal models and man; other proposed precursors include atrophy and malignancy-associated changes (with no morphologic changes). PIN is characterized by progressive abnormalities of phenotype and genotype that are intermediate between benign prostatic epithelium and cancer, indicating impairment of cell differentiation and regulatory control with advancing stages of prostatic carcinogenesis. The only method of detection of PIN is biopsy because it does not significantly elevate serum prostate-specific antigen concentration and cannot be detected by ultrasonography. The mean incidence of PIN in biopsies is 9% (range, 4%-16%), representing about 115,000 new cases of isolated PIN diagnosed each year in the United States. The clinical importance of PIN is its high predictive value as a marker for adenocarcinoma, and its identification warrants repeat biopsy for concurrent or subsequent carcinoma, especially when multifocal or observed in association with atypical small acinar proliferation (ASAP). Carcinoma develops in most patients with PIN within 10 years. Androgen deprivation therapy and radiation therapy decrease the prevalence and extent of PIN, suggesting that these forms of treatment may play a role in prevention of subsequent cancer. Multiple clinical trials to date of men with PIN have had modest success in delaying or preventing subsequent cancer. PMID:22212075

  6. Prostate Cancer

    MedlinePlus

    ... version of this page please turn Javascript on. Prostate Cancer What is Prostate Cancer? How Tumors Form The body is made up ... the Escape (Esc) button on your keyboard.) How Prostate Cancer Occurs Prostate cancer occurs when a tumor forms ...

  7. Open lung biopsy

    MedlinePlus

    Biopsy - open lung ... An open lung biopsy is done in the hospital using general anesthesia , which means you are asleep and pain- ... The open lung biopsy is done to evaluate lung problems seen on x-ray or CT scan .

  8. Bone biopsy (image)

    MedlinePlus

    A bone biopsy is performed by making a small incision into the skin. A biopsy needle retrieves a sample of bone and it ... examination. The most common reasons for bone lesion biopsy are to distinguish between benign and malignant bone ...

  9. Muscle biopsy (image)

    MedlinePlus

    A muscle biopsy involves removal of a plug of tissue usually by a needle to be later used for examination. Sometimes ... there is a patchy condition expected an open biopsy may be used. Open biopsy involves a small ...

  10. Ultrasound- and MRI-Guided Prostate Biopsy

    MedlinePlus

    ... are examined, sometimes also with the help of computer-aided detection (CAD) software to pinpoint specific areas ... Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a ...

  11. Metabolomic Imaging for Human Prostate Cancer Detection

    PubMed Central

    Wu, Chin-Lee; Jordan, Kate W.; Ratai, Eva M.; Sheng, Jinhua; Adkins, Christen B.; DeFeo, Elita M; Jenkins, Bruce G.; Ying, Leslie; McDougal, W. Scott; Cheng, Leo L.

    2010-01-01

    As current radiological approaches cannot accurately localize prostate cancer in vivo, biopsies are conducted at random within prostates for at-risk patients, leading to high false-negative rates. Metabolomic imaging can map cancer-specific biomolecular profile values onto anatomical structures to direct biopsy. In this preliminary study, we evaluated five prostatectomy-removed whole prostates from biopsy-proven cancer patients on a 7 Tesla human, whole-body magnetic resonance scanner. Localized, multi-cross-sectional, multi-voxel magnetic resonance spectra were used to construct a malignancy index based on prostate cancer metabolomic profiles obtained from previous, intact tissue analyses by a 14 Tesla spectrometer. This calculated Malignancy Index shows linear correlation with lesion size (p<0.013) and demonstrates a 93–97% overall accuracy for detecting the presence of prostate cancer lesions. PMID:20371475

  12. Accuracy evaluation of a 3D ultrasound-guided biopsy system

    NASA Astrophysics Data System (ADS)

    Wooten, Walter J.; Nye, Jonathan A.; Schuster, David M.; Nieh, Peter T.; Master, Viraj A.; Votaw, John R.; Fei, Baowei

    2013-03-01

    Early detection of prostate cancer is critical in maximizing the probability of successful treatment. Current systematic biopsy approach takes 12 or more randomly distributed core tissue samples within the prostate and can have a high potential, especially with early disease, for a false negative diagnosis. The purpose of this study is to determine the accuracy of a 3D ultrasound-guided biopsy system. Testing was conducted on prostate phantoms created from an agar mixture which had embedded markers. The phantoms were scanned and the 3D ultrasound system was used to direct the biopsy. Each phantom was analyzed with a CT scan to obtain needle deflection measurements. The deflection experienced throughout the biopsy process was dependent on the depth of the biopsy target. The results for markers at a depth of less than 20 mm, 20-30 mm, and greater than 30 mm were 3.3 mm, 4.7 mm, and 6.2 mm, respectively. This measurement encapsulates the entire biopsy process, from the scanning of the phantom to the firing of the biopsy needle. Increased depth of the biopsy target caused a greater deflection from the intended path in most cases which was due to an angular incidence of the biopsy needle. Although some deflection was present, this system exhibits a clear advantage in the targeted biopsy of prostate cancer and has the potential to reduce the number of false negative biopsies for large lesions.

  13. Skin biopsy: Biopsy issues in specific diseases.

    PubMed

    Elston, Dirk M; Stratman, Erik J; Miller, Stanley J

    2016-01-01

    Misdiagnosis may result from biopsy site selection, technique, or choice of transport media. Important potential sources of error include false-negative direct immunofluorescence results based on poor site selection, uninformative biopsy specimens based on both site selection and technique, and spurious interpretations of pigmented lesions and nonmelanoma skin cancer based on biopsy technique. Part I of this 2-part continuing medical education article addresses common pitfalls involving site selection and biopsy technique in the diagnosis of bullous diseases, vasculitis, panniculitis, connective tissue diseases, drug eruptions, graft-versus-host disease, staphylococcal scalded skin syndrome, hair disorders, and neoplastic disorders. Understanding these potential pitfalls can result in improved diagnostic yield and patient outcomes.

  14. Prostate brachytherapy

    MedlinePlus

    Implant therapy - prostate cancer; Radioactive seed placement; Internal radiation therapy - prostate; High dose radiation (HDR) ... plan and then place the seeds that deliver radiation into your prostate. The seeds are placed with ...

  15. Cold knife cone biopsy

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/003910.htm Cold knife cone biopsy To use the sharing features on this page, please enable JavaScript. A cold knife cone biopsy (conization) is surgery to remove ...

  16. Nerve biopsy (image)

    MedlinePlus

    Nerve biopsy is the removal of a small piece of nerve for examination. Through a small incision, a sample ... is removed and examined under a microscope. Nerve biopsy may be performed to identify nerve degeneration, identify ...

  17. Detection of prostate cancer with a blood-based assay for early prostate cancer antigen.

    PubMed

    Paul, Barbara; Dhir, Rajiv; Landsittel, Douglas; Hitchens, Moira R; Getzenberg, Robert H

    2005-05-15

    Prostate-specific antigen lacks specificity for prostate cancer, so the identification and characterization of a unique blood-based marker for the disease would provide for a more accurate diagnosis, reducing both unnecessary biopsies and patient uncertainty. We previously identified a novel biomarker for prostate cancer, early prostate cancer antigen (EPCA). EPCA antibodies positively stained the negative biopsies of men who, as much as 5 years later, were diagnosed with prostate cancer. The goal of this study was to determine whether EPCA antibodies could be used in a clinically applicable plasma-based immunoassay to specifically detect prostate cancer. Using an EPCA-based ELISA, the protein was measured in the plasma of 46 individuals, including prostate cancer patients, healthy individuals, other cancer patients, spinal cord injury victims, and patients with prostatitis. With a predetermined cutoff value of 1.7 absorbance at 450 nm, only the prostate cancer population, as a whole, expressed plasma-EPCA levels above the cutoff. Statistical analysis showed a significant difference in EPCA levels between the prostate cancer population and each of the other groups, specifically the healthy donors (P < 0.0001), bladder cancer patients (P = 0.03), and spinal cord injury patients (P = 0.001). Sensitivity of the EPCA assay for prostate cancer patients was 92% whereas the overall specificity was 94%. Specificity for the healthy donors was 100%. Although larger trials are required, this initial study shows the potential of EPCA to serve as a highly specific blood-based marker for prostate cancer. EPCA, when coupled with prostate-specific antigen, may help reduce the number of both unnecessary biopsies and undetected prostate tumors.

  18. Acute Bacterial Prostatitis: Diagnosis and Management.

    PubMed

    Coker, Timothy J; Dierfeldt, Daniel M

    2016-01-15

    Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise. Although the true incidence is unknown, acute bacterial prostatitis is estimated to comprise approximately 10% of all cases of prostatitis. Most acute bacterial prostatitis infections are community acquired, but some occur after transurethral manipulation procedures, such as urethral catheterization and cystoscopy, or after transrectal prostate biopsy. The physical examination should include abdominal, genital, and digital rectal examination to assess for a tender, enlarged, or boggy prostate. Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern. Additional laboratory studies can be obtained based on risk factors and severity of illness. Radiography is typically unnecessary. Most patients can be treated as outpatients with oral antibiotics and supportive measures. Hospitalization and broad-spectrum intravenous antibiotics should be considered in patients who are systemically ill, unable to voluntarily urinate, unable to tolerate oral intake, or have risk factors for antibiotic resistance. Typical antibiotic regimens include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam. The risk of nosocomial bacterial prostatitis can be reduced by using antibiotics, such as ciprofloxacin, before transrectal prostate biopsy. PMID:26926407

  19. Photoacoustic biopsy: a feasibility study

    NASA Astrophysics Data System (ADS)

    Xu, Guan; Tomlins, Scott A.; Siddiqui, Javed; Davis, Mandy A.; Kunju, Lakshmi P.; Wei, John T.; Wang, Xueding

    2015-03-01

    Photoacoustic (PA) measurements encode the information associated with both physical microstructures and chemical contents in biological tissues. A two-dimensional physio-chemical spectrogram (PCS) can be formulated by combining the power spectra of PA signals acquired at a series of optical wavelengths. The analysis of PCS, or namely PA physio-chemical analysis (PAPCA), enables the quantification of the concentrations and the spatial distributions of a variety of chemical components in the tissue. The chemical components and their distribution are the two major features observed in the biopsy procedures which have been regarded as the gold standard of the diagnosis of many diseases. Taking non-alcoholic fatty liver disease and prostate cancer for example, this study investigates the feasibility of PAPCA in characterizing the histopathological changes in the diseased conditions in biological tissue. A catheter based setup facilitating measurement in deep tissues was also proposed and tested.

  20. Percutaneous liver biopsy.

    PubMed

    Rustagi, Tarun; Newton, Eric; Kar, Premashish

    2010-01-01

    Percutaneous liver biopsy has been performed for more than 120 years, and remains an important diagnostic procedure for the management of hepatobiliary disorders. Modern biochemical, immunologic, and radiographic techniques have facilitated the diagnosis and management of liver diseases but have not made liver biopsy obsolete. This comprehensive review article will discuss the history of development of percutaneous liver biopsy, its indications, contraindications, complications and the various aspects of the biopsy procedure in detail.

  1. Prostate calculi in cancer and BPH in a cohort of Korean men: presence of calculi did not correlate with cancer risk

    PubMed Central

    Hwang, Eu-Chang; Choi, Hyang-Sik; Im, Chang-Min; Jung, Seung-Il; Kim, Sun-Ouck; Kang, Taek-Won; Kwon, Dong-Deuk; Park, Kwang-Sung; Ryu, Soo-Bang

    2010-01-01

    Prostatic calculi are common and are associated with inflammation of the prostate. Recently, it has been suggested that this inflammation may be associated with prostate carcinogenesis. The aim of this study was to investigate the relationship between prostatic calculi and prostate cancer (PCa) in prostate biopsy specimens. We retrospectively analyzed 417 consecutive patients who underwent transrectal ultrasonography (TRUS) and prostate biopsies between January 2005 and January 2008. Based on the biopsy findings, patients were divided into benign prostatic hyperplasia and PCa groups. TRUS was used to detect prostatic calculi and to measure prostate volume. The correlations between PCa risk and age, serum total PSA levels, prostate volume, and prostatic calculi were analyzed. Patient age and PSA, as well as the frequency of prostatic calculi in the biopsy specimens, differed significantly between both the groups (P < 0.05). In the PCa group, the Gleason scores (GSs) were higher in patients with prostatic calculi than in patients without prostatic calculi (P = 0.023). Using multivariate logistic regression analysis, we found that patient age, serum total PSA and prostate volume were risk factors for PCa (P = 0.001), but that the presence of prostatic calculi was not associated with an increased risk of PCa (P = 0.13). In conclusion, although the presence of prostatic calculi was not shown to be a risk factor for PCa, prostatic calculi were more common in patients with PCa and were associated with a higher GS among these men. PMID:20037598

  2. Transrectal Ultrasound of Prostatic Carcinoma

    PubMed Central

    Murray, Daniel J.; Cooperberg, Peter L.; Goldenberg, S. Larry; Toi, Ants

    1991-01-01

    The purpose of this paper is to review the indications for transrectal ultrasound; to briefly describe the sonographic technique; to describe the sonographic findings of prostatic carcinoma; to review the indications for transrectal sonographic-guided biopsy; and to discuss the controversles of routine screening and staging. ImagesFigures 1-3 PMID:21229044

  3. Circulating Prostate Cells Found in Men with Benign Prostate Disease Are P504S Negative: Clinical Implications

    PubMed Central

    Murray, Nigel P.; Reyes, Eduardo; Badínez, Leonardo; Orellana, Nelson; Fuentealba, Cynthia; Olivares, Ruben; Porcell, José; Dueñas, Ricardo

    2013-01-01

    Introduction. Developments in immunological and quantitative real-time PCR-based analysis have enabled the detection, enumeration, and characterization of circulating tumor cells (CTCs). It is assumed that the detection of CTCs is associated with cancer, based on the finding that CTCs can be detected in all major cancer and not in healthy subjects or those with benign disease. Methods and Patients. Consecutive men, with suspicion of prostate cancer, had blood samples taken before prostate biopsy; mononuclear cells were obtained using differential gel centrifugation and CPCs detecting using anti-PSA immunocytochemistry. Positive samples underwent further classification with anti-P504S. Results. 329 men underwent prostate biopsy; of these men 83 underwent a second biopsy and 44 a third one. Of those with a biopsy negative for cancer, 19/226 (8.4%) had CPCs PSA (+) P504S (−) detected at first biopsy, 6/74 (8.1%) at second biopsy, and 5/33 (15.2%) at third biopsy. Men with cancer-positive biopsies did not have PSA (+) P504S (−) CPCs detected. These benign cells were associated with chronic prostatitis. Conclusions. Patients with chronic prostatitis may have circulating prostate cells detected in blood, which do not express the enzyme P504S and should be thought of as benign in nature. PMID:23690774

  4. Markers for Detection of Prostate Cancer

    PubMed Central

    Clarke, Raymond A.; Schirra, Horst J.; Catto, James W.; Lavin, Martin F.; Gardiner, Robert A.

    2010-01-01

    Early detection of prostate cancer is problematic, not just because of uncertainly whether a diagnosis will benefit an individual patient, but also as a result of the imprecise and invasive nature of establishing a diagnosis by biopsy. Despite its low sensitivity and specificity for identifying patients harbouring prostate cancer, serum prostate specific antigen (PSA) has become established as the most reliable and widely-used diagnostic marker for this condition. In its wake, many other markers have been described and evaluated. This review focuses on the supporting evidence for the most prominent of these for detection and also for predicting outcome in prostate cancer. PMID:24281110

  5. When prostate cancer remains undetectable: The dilemma.

    PubMed

    Mustafa, Mahmoud Othman; Pisters, Louis

    2015-03-01

    Since the first report on the efficacy of sextant biopsy under transrectal ultrasound guidance, there have been many modifications related to the total number of cores and the localization of biopsies to improve the prostate cancer (PCa) detection rate. The 2010 National Comprehensive Cancer Network Early PCa Detection Guidelines noted the 12-core biopsy scheme as the standard. However, this extended biopsy scheme still fails to detect 20% of high-grade PCa that can be detected by detailed pathological evaluation of radical prostatectomy; therefore, there is need for saturation biopsies. The existence of suspicions of PCa after previous negative biopsy or biopsies represents a valid indication for saturation biopsy. There has been no significant increment in morbidity or in insignificant PCa detection rates when a saturation biopsy scheme was used with an extended biopsy scheme. Along with the improvement in the PCa detection rate, accurate oncological mapping of PCa is another important consideration of saturation biopsies. The ideal number of cores and the diagnostic value of saturation biopsy after the failure of initial therapy are some of the issues that need to be addressed. Preliminary reports have shown that magnetic resonance imaging can improve the PCa detection rate, save patients from unnecessary biopsies, and decrease the need for a high number of cores; however, multiple limitations continue to exist. PMID:26328196

  6. Discovery and validation of urinary biomarkers for prostate cancer

    PubMed Central

    Theodorescu, Dan; Schiffer, Eric; Bauer, Hartwig W.; Douwes, Friedrich; Eichhorn, Frank; Polley, Reinhard; Schmidt, Thomas; Schöfer, Wolfgang; Zürbig, Petra; Good, David M.; Coon, Joshua J.

    2009-01-01

    Only 30% of patients with elevated serum prostate specific antigen (PSA) levels who undergo prostate biopsy are diagnosed with prostate cancer (PCa). Novel methods are needed to reduce the number of unnecessary biopsies. We report on the identification and validation of a panel of 12 novel biomarkers for prostate cancer (PCaP), using CE coupled MS. The biomarkers could be defined by comparing first void urine of 51 men with PCa and 35 with negative prostate biopsy. In contrast, midstream urine samples did not allow the identification of discriminatory molecules, suggesting that prostatic fluids may be the source of the defined biomarkers. Consequently, first void urine samples were tested for sufficient amounts of prostatic fluid, using a prostatic fluid indicative panel (“informative” polypeptide panel; IPP). A combination of IPP and PCaP to predict positive prostate biopsy was evaluated in a blinded prospective study. Two hundred thirteen of 264 samples matched the IPP criterion. PCa was detected with 89% sensitivity, 51% specificity. Including age and percent free PSA to the proteomic signatures resulted in 91% sensitivity, 69% specificity. PMID:19759844

  7. Prostatic carcinosarcoma with lung metastases.

    PubMed

    Furlan, Stefanie R; Kang, David J; Armas, Armando

    2013-01-01

    Carcinosarcoma of the prostate is an uncommon malignancy with poor long-term prognosis. The cancer is typically discovered at an advanced stage, and with less than 100 reported cases, there is limited literature concerning treatment options. Our patient presented with a history of benign prostatic hypertrophy, erectile dysfunction, and nocturia. Biopsy of his prostate indicated that the patient had prostatic adenocarcinoma, but histopathology after prostatectomy revealed carcinosarcoma. It has been over six years since this patient's diagnosis of carcinosarcoma. Over this span of time, he has received a radical prostatectomy, radiotherapy, and androgen ablative therapy. The patient also developed multiple lung metastases that have been treated with video-assisted thoracic surgery and stereotactic body radiosurgery. Overall, he has remained unimpaired and in good condition despite his aggressive form of cancer. PMID:24294528

  8. Prostatic carcinosarcoma with lung metastases.

    PubMed

    Furlan, Stefanie R; Kang, David J; Armas, Armando

    2013-01-01

    Carcinosarcoma of the prostate is an uncommon malignancy with poor long-term prognosis. The cancer is typically discovered at an advanced stage, and with less than 100 reported cases, there is limited literature concerning treatment options. Our patient presented with a history of benign prostatic hypertrophy, erectile dysfunction, and nocturia. Biopsy of his prostate indicated that the patient had prostatic adenocarcinoma, but histopathology after prostatectomy revealed carcinosarcoma. It has been over six years since this patient's diagnosis of carcinosarcoma. Over this span of time, he has received a radical prostatectomy, radiotherapy, and androgen ablative therapy. The patient also developed multiple lung metastases that have been treated with video-assisted thoracic surgery and stereotactic body radiosurgery. Overall, he has remained unimpaired and in good condition despite his aggressive form of cancer.

  9. Application of statistical cancer atlas for 3D biopsy

    NASA Astrophysics Data System (ADS)

    Narayanan, Ramkrishnan; Shen, Dinggang; Davatzikos, Christos; Crawford, E. David; Barqawi, Albaha; Werahera, Priya; Kumar, Dinesh; Suri, Jasjit S.

    2008-02-01

    Prostate cancer is the most commonly diagnosed cancer in males in the United States and the second leading cause of cancer death. While the exact cause is still under investigation, researchers agree on certain risk factors like age, family history, dietary habits, lifestyle and race. It is also widely accepted that cancer distribution within the prostate is inhomogeneous, i.e. certain regions have a higher likelihood of developing cancer. In this regard extensive work has been done to study the distribution of cancer in order to perform biopsy more effectively. Recently a statistical cancer atlas of the prostate was demonstrated along with an optimal biopsy scheme achieving a high detection rate. In this paper we discuss the complete construction and application of such an atlas that can be used in a clinical setting to effectively target high cancer zones during biopsy. The method consists of integrating intensity statistics in the form of cancer probabilities at every voxel in the image with shape statistics of the prostate in order to quickly warp the atlas onto a subject ultrasound image. While the atlas surface can be registered to a pre-segmented subject prostate surface or instead used to perform segmentation of the capsule via optimization of shape parameters to segment the subject image, the strength of our approach lies in the fast mapping of cancer statistics onto the subject using shape statistics. The shape model was trained from over 38 expert segmented prostate surfaces and the atlas registration accuracy was found to be high suggesting the use of this method to perform biopsy in near real time situations with some optimization.

  10. Gradient field microscopy for label-free diagnosis of human biopsies [Invited].

    PubMed

    Kim, Taewoo; Sridharan, Shamira; Kajdacsy-Balla, André; Tangella, Krishnarao; Popescu, Gabriel

    2013-01-01

    We introduce a label-free method for detecting high-grade prostatic intraepithelial neoplasia (HGPIN) in unstained biopsies. We image this condition based on the identification of basal cells in biopsies that otherwise would resemble prostate cancer by unassisted histologic examination. Gradient field microscopy (GFM) is used as a label-free imaging method which increases the contrast of a transparent sample by taking the first-order phase derivative that is very sensitive to rapid refractive index changes. GFM is able to image the basal cell layers in HGPIN biopsies because of their rapid refractive index changes at the periphery of small glandular structures.

  11. Ureteral Metastasis Secondary to Prostate Cancer: A Case Report

    PubMed Central

    Morales, I.; Bassa, C.; Pavlovic, A.; Morales, C.

    2015-01-01

    Prostate cancer is very frequent, but secondary ureteral metastasis are extremely rare. We present a 55 year old man with a 2 month history of right flank pain and lower urinary tract symptoms. Prostatic specific antigen of 11.3 ng/mL. Computed tomography showed right hydroureteronephrosis, a developing urinoma and right iliac adenopathies. He underwent right ureteronephrectomy, iliac lymphadenectomy and prostate biopsy. Pathology revealed prostatic carcinoma infiltrating the ureteral muscularis propria, without mucosal involvement. There are 46 reported cases of prostate cancer with ureteral metastases. Ureteral metastasis are a rare cause of renal colic and need of a high index of suspicion. PMID:26793587

  12. Bone marrow biopsy

    MedlinePlus

    Biopsy - bone marrow ... A bone marrow biopsy may be done in the health care provider's office or in a hospital. The sample may ... This captures a tiny sample, or core, of bone marrow within the needle. The sample and needle are ...

  13. Prostate Cancer

    MedlinePlus

    ... man's bladder that produces fluid for semen. Prostate cancer is common among older men. It is rare ... younger than 40. Risk factors for developing prostate cancer include being over 65 years of age, family ...

  14. Solitary fibrous tumor of the prostate: a report of two cases.

    PubMed

    Talvitie, Heidi; Aström, Kristina; Larsson, Olle; Ahlén, Jan; Bergh, Anders; Egevad, Lars

    2011-09-01

    We here report two cases of solitary fibrous tumor (SFT) arising in the prostate. Two men, 66 and 69 years old, with urinary tract symptoms were diagnosed with SFT on transrectal needle biopsy and transurethral resection of the prostate, respectively. The tumors were removed by a low anterior resection including tumor, prostate and rectum en bloc and cystoprostatectomy, respectively. Both tumors were well-circumscribed but also showed some infiltration of the prostate glands. They were composed of storiform bundles of bland spindle cells that stained strongly for CD34 and vimentin but negative for muscle markers. Although rare, SFT should be considered as differential diagnosis of spindle cell lesions on prostate biopsies.

  15. [Significance of various examination methods in the management of prostatic cancer].

    PubMed

    Romics, I; Kaldenbach, R; Bach, D

    1994-05-29

    The authors investigated the sensitivity and specificity of four methods: rectal digital examination, prostate specific antigen (PSA), prostatic acid phosphatase (PAP) and transrectal ultrasound in the diagnosis of 100 prostate cancer and 50 suffering in benign prostatic hypertrophy patients. In 21 patients the prostate cancer was proved by perineal punch biopsy and in 79 cases by biopsy and by TUR as well. Because of its simplicity the rectal investigation has to be first one, after that the PSA has to be determined. The specificity of transrectal ultrasound is low. The determination of PAP in addition of PSA is not necessary.

  16. Molecular image-directed biopsies: improving clinical biopsy selection in patients with multiple tumors

    NASA Astrophysics Data System (ADS)

    Harmon, Stephanie A.; Tuite, Michael J.; Jeraj, Robert

    2016-10-01

    Site selection for image-guided biopsies in patients with multiple lesions is typically based on clinical feasibility and physician preference. This study outlines the development of a selection algorithm that, in addition to clinical requirements, incorporates quantitative imaging data for automatic identification of candidate lesions for biopsy. The algorithm is designed to rank potential targets by maximizing a lesion-specific score, incorporating various criteria separated into two categories: (1) physician-feasibility category including physician-preferred lesion location and absolute volume scores, and (2) imaging-based category including various modality and application-specific metrics. This platform was benchmarked in two clinical scenarios, a pre-treatment setting and response-based setting using imaging from metastatic prostate cancer patients with high disease burden (multiple lesions) undergoing conventional treatment and receiving whole-body [18F]NaF PET/CT scans pre- and mid-treatment. Targeting of metastatic lesions was robust to different weighting ratios and candidacy for biopsy was physician confirmed. Lesion ranked as top targets for biopsy remained so for all patients in pre-treatment and post-treatment biopsy selection after sensitivity testing was completed for physician-biased or imaging-biased scenarios. After identifying candidates, biopsy feasibility was evaluated by a physician and confirmed for 90% (32/36) of high-ranking lesions, of which all top choices were confirmed. The remaining cases represented lesions with high anatomical difficulty for targeting, such as proximity to sciatic nerve. This newly developed selection method was successfully used to quantitatively identify candidate lesions for biopsies in patients with multiple lesions. In a prospective study, we were able to successfully plan, develop, and implement this technique for the selection of a pre-treatment biopsy location.

  17. Prostate Diseases

    MedlinePlus

    The prostate is a gland in men. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from ... and out of the body. A young man's prostate is about the size of a walnut. It ...

  18. Small cell carcinoma of the prostate

    PubMed Central

    Nadal, Rosa; Schweizer, Michael; Kryvenko, Oleksandr N.; Epstein, Jonathan I.; Eisenberger, Mario A.

    2015-01-01

    Pure small-cell carcinoma (SCC) of the prostate is a rare entity and one of the most aggressive malignancies of the prostate. Histologically, prostatic SCCs of the prostate are part of a spectrum of anaplastic tumours of the prostate and are similar to SCCs of the lungs. In most cases, SCC of the prostate is associated with conventional prostatic adenocarcinoma. Both components of these mixed tumours frequently share molecular alterations such as ERG gene rearrangements or AURKA and MYCN amplifications, suggesting a common clonal origin. The clinical behaviour of small-cell prostate carcinomas is characterized by extensive local disease, visceral disease, and low PSA levels despite large metastatic burden. Commonly, the emergence of the SCC occurs in patients with high-grade adenocarcinoma who are often treated with androgen deprivation treatment (ADT). However, SCCs do not usually benefit from ADT. A biopsy of accessible lesions is strongly recommended to identify those with SCC pathological features, as management is undoubtedly affected by this finding. Chemotherapy is the standard approach for treating patients with either localized or advanced prostatic SCC. Despite the emergence of more-aggressive treatment modalities, the prognosis of men with prostatic SCC remains dismal. PMID:24535589

  19. Metastatic prostatic pulmonary nodules with normal bone image

    SciTech Connect

    Petras, A.F.; Wollett, F.C.

    1983-11-01

    Asymptomatic prostatic caricnoma presented as multiple bilateral pulmonary modules in a patient without any evidence of skeletal involvement by normal bone image. Percutaneous biopsy provided the initial clue to diagnosis. The authors recommend that asymptomatic prostatic carcinoma be included in the differential diagnosis of pulmonary nodules, even when there is no evidence of skeletal metastasis.

  20. Evolution of the concept of focal therapy for prostate cancer.

    PubMed

    Tsivian, Matvey; Abern, Michael R; Polascik, Thomas J

    2013-01-01

    The landscape of prostate cancer has been rapidly evolving, and technological advances in imaging and biopsy tools offer novel approaches to focal therapy. In this dynamic environment, the role of focal therapy for prostate cancer is being shaped both by advances in technology and by reconsidering the epidemiological and outcomes data for available treatments. Here we focus on the evolution of the concept of focal therapy and its potential roles in the management of prostate cancer.

  1. Prostate cancer diagnosis in a resource-poor setting: the changing role of digital rectal examination.

    PubMed

    Ahmed, Muhammed

    2011-07-01

    We undertook this study in order to determine the current role of digital rectal examination (DRE) in the diagnosis of prostate cancer in a resource-poor setting. The diagnosis of prostate cancer has been revolutionized by the introduction of prostate-specific antigen (PSA), transrectal ultrasound (TRUS) for biopsy guidance and more efficient biopsy equipment, but they are not readily available in most developing countries. This is a prospective study of 131 patients with suspected prostate cancer based on clinical presentation, DRE and elevated PSA. The presence or absence of cancer was confirmed by biopsy and histologic examination. Patients with screen- or incidentally-detected prostate cancer were excluded. The most common symptom was the development of lower urinary tract symptoms (LUTS). All patients had abnormal DRE and indurated prostate was the most frequent finding (50%). The mean PSA was 33.9 ng/mL: of the 131 patients, 80 (61.1%) had a malignant histology following biopsy, 47 (35.9%) were benign and four (3.0%) were prostate intraepithelial neoplasia (PIN). The low specificity of DRE in the diagnosis of prostate cancer requires that it should be combined with other diagnostic modalities such as PSA and TRUS-guided prostate biopsy. Thus government and health-care providers in resource-poor countries must strive to make these facilities available in order to improve prostate cancer diagnosis.

  2. IL-8 secretion in primary cultures of prostate cells is associated with prostate cancer aggressiveness

    PubMed Central

    Neveu, Bertrand; Moreel, Xavier; Deschênes-Rompré, Marie-Pier; Bergeron, Alain; LaRue, Hélène; Ayari, Cherifa; Fradet, Yves; Fradet, Vincent

    2014-01-01

    Background Chronic inflammation is believed to be a major factor in prostate cancer initiation and promotion and has been studied using prostate cancer cells and immortalized cell lines. However, little is known about the contribution of normal cells to the prostatic microenvironment and inflammation. We aim to study the contribution of normal prostate epithelial cells to prostate inflammation and to link the inflammatory status of normal cells to prostate cancer aggressiveness. Materials and methods Short-term primary cell cultures of normal epithelial prostate cells were derived from prostate biopsies from 25 men undergoing radical prostatectomy, cystoprostatectomy, or organ donation. Cells were treated with polyinosinic:polycytidylic acid, a mimic of double-stranded viral RNA and a potent inducer of the inflammatory response. Secretion of interleukin (IL)-8 in the cell culture medium by untreated and treated cells was measured and we determined the association between IL-8 levels in these primary cell cultures and prostate cancer characteristics. The Fligner–Policello test was used to compare the groups. Results Baseline and induced IL-8 secretion were highly variable between cultured cells from different patients. This variation was not related to drug use, past medical history, age, or preoperative prostate-specific antigen value. Nonetheless, an elevated secretion of IL-8 from normal cultured epithelial cells was associated with prostate cancer aggressiveness (P=0.0005). Conclusion The baseline secretion of IL-8 from normal prostate epithelial cells in culture is strongly correlated with cancer aggressiveness and may drive prostate cancer carcinogenesis. A better characterization of individual prostate microenvironment may provide a basis for personalized treatment and for monitoring the effects of strategies aimed at preventing aggressive prostate cancer. PMID:24892030

  3. Salivary gland biopsy

    MedlinePlus

    Biopsy - salivary gland ... You have several pairs of salivary glands that drain into your mouth: A major pair in front of the ears (parotid glands) Another major pair beneath your jaw (submandibular ...

  4. Colposcopy - directed biopsy

    MedlinePlus

    ... squamous cells - colposcopy; Pap smear - colposcopy; HPV - colposcopy; Human papilloma virus - colposcopy; Cervix - colposcopy; Colposcopy ... also called cervical dysplasia) Cervical warts (infection with human papilloma virus , or HPV) If the biopsy does not determine ...

  5. Mediastinoscopy with biopsy

    MedlinePlus

    ... procedure is also done for certain infections (tuberculosis, sarcoidosis) and autoimmune disorders . Normal Results Biopsies of lymph ... findings may indicate: Hodgkin disease Lung cancer Lymphoma Sarcoidosis The spread of disease from one body part ...

  6. Biopsy catheter (image)

    MedlinePlus

    ... examination, a heart biopsy can be performed. A catheter is carefully threaded into an artery or vein to gain access into the heart. A bioptome (catheter with jaws in its tip) is then introduced. ...

  7. What is Prostate Cancer?

    MedlinePlus

    ... Topic Key statistics for prostate cancer What is prostate cancer? Cancer starts when cells in the body begin ... through the center of the prostate. Types of prostate cancer Almost all prostate cancers are adenocarcinomas . These cancers ...

  8. Multiparametric magnetic resonance imaging of prostate cancer.

    PubMed

    Hedgire, Sandeep S; Oei, Tamara N; McDermott, Shaunagh; Cao, Kai; Patel M, Zena; Harisinghani, Mukesh G

    2012-07-01

    In India, prostate cancer has an incidence rate of 3.9 per 100,000 men and is responsible for 9% of cancer-related mortality. It is the only malignancy that is diagnosed with an apparently blind technique, i.e., transrectal sextant biopsy. With increasing numbers of high-Tesla magnetic resonance imaging (MRI) equipment being installed in India, the radiologist needs to be cognizant about endorectal MRI and multiparametric imaging for prostate cancer. In this review article, we aim to highlight the utility of multiparamteric MRI in prostate cancer. It plays a crucial role, mainly in initial staging, restaging, and post-treatment follow-up. PMID:23599562

  9. Magnetic resonance-guided prostate interventions.

    PubMed

    Haker, Steven J; Mulkern, Robert V; Roebuck, Joseph R; Barnes, Agnieska Szot; Dimaio, Simon; Hata, Nobuhiko; Tempany, Clare M C

    2005-10-01

    We review our experience using an open 0.5-T magnetic resonance (MR) interventional unit to guide procedures in the prostate. This system allows access to the patient and real-time MR imaging simultaneously and has made it possible to perform prostate biopsy and brachytherapy under MR guidance. We review MR imaging of the prostate and its use in targeted therapy, and describe our use of image processing methods such as image registration to further facilitate precise targeting. We describe current developments with a robot assist system being developed to aid radioactive seed placement. PMID:16924169

  10. [An unusual presentation of prostate cancer].

    PubMed

    Joual, A; Rabii, R; Aboutaeib, R; el Moussaoui, A; Benjelloun, S

    1996-01-01

    The authors report an uncommon case of a 74-year old man with prostatic cancer revealed by pelvic mass. Ultrasound exam and CT-scan showed a bilateral laterorectal mass with high density. Presence of such a mass in an old patient is very suggestive of lymph nodes than retroperitoneal tumor. Serum prostate specific antigen (PSA) is rather helpful in such conditions. Biopsy of the mass allows confirmation of the prostatic cancer diagnosis. Bilateral Surgical pulpectomy is performed in combination with oral hormonal therapy. Follow-up after 6 months showed a good course or ultrasound exam and PSA level. PMID:8975593

  11. Prospective Evaluation of Operating Characteristics of Prostate Cancer Detection Biomarkers

    PubMed Central

    Liang, Yuanyuan; Ankerst, Donna P.; Ketchum, Norma S.; Ercole, Barbara; Shah, Girish; Shaughnessy, John D.; Leach, Robin J.; Thompson, Ian M.

    2016-01-01

    Purpose We assessed the independent predictive values of the serum markers free prostate specific antigen, proenzyme prostate specific antigen, neuroendocrine marker and Dickkopf-1 compared to serum prostate specific antigen and other standard risk factors for early prostate cancer detection. Materials and Methods From the prospectively collected SABOR cohort 250 prostate cancer cases, and 250 mean age matched and proportion of African-American race/ethnicity matched controls were selected who had a prior available prostate specific antigen and digital rectal examination. Serum samples were obtained, and free prostate specific antigen, [−2]proenzyme prostate specific antigen, Dickkopf-1 and neuroendocrine marker were measured. AUC, sensitivities and specificities were calculated, and multivariable logistic regression was used to assess the independent predictive value compared to prostate specific antigen, digital rectal examination, family history, prior biopsy history, race/ethnicity and age. Results The AUCs (95% CI) were 0.76 (0.71, 0.8) for free prostate specific antigen, 0.72 (0.67, 0.76) for [−2]proenzyme prostate specific antigen, 0.76 (0.72, 0.8) for %free prostate specific antigen, 0.61 (0.56, 0.66) for %[−2]proenzyme prostate specific antigen, 0.73 (0.68, 0.77) for prostate health index, 0.53 (0.48, 0.58) for Dickkopf-1 and 0.53 (0.48, 0.59) for neuroendocrine marker. In the 2 to 10 ng/ml prostate specific antigen range the AUCs (95% CI) were 0.58 (0.49, 0.67) for free prostate specific antigen, 0.53 (0.44, 0.62) for [−2]proenzyme prostate specific antigen, 0.67 (0.59, 0.75) for %free prostate specific antigen, 0.57 (0.49, 0.65) for %[−2]proenzyme prostate specific antigen and 0.59 (0.51, 0.67) for phi. Only %free prostate specific antigen retained independent predictive value compared to the traditional risk factors. Conclusions Free prostate specific antigen retained independent diagnostic usefulness for prostate cancers detected through

  12. Can Urinary PCA3 Supplement PSA in the Early Detection of Prostate Cancer?

    PubMed Central

    Wei, John T.; Feng, Ziding; Partin, Alan W.; Brown, Elissa; Thompson, Ian; Sokoll, Lori; Chan, Daniel W.; Lotan, Yair; Kibel, Adam S.; Busby, J. Erik; Bidair, Mohamed; Lin, Daniel W.; Taneja, Samir S.; Viterbo, Rosalia; Joon, Aron Y.; Dahlgren, Jackie; Kagan, Jacob; Srivastava, Sudhir; Sanda, Martin G.

    2014-01-01

    Purpose Given the limited sensitivity and specificity of prostate-specific antigen (PSA), its widespread use as a screening tool has raised concerns for the overdiagnosis of low-risk and the underdiagnosis of high-grade prostate cancer. To improve early-detection biopsy decisions, the National Cancer Institute conducted a prospective validation trial to assess the diagnostic performance of the prostate cancer antigen 3 (PCA3) urinary assay for the detection of prostate cancer among men screened with PSA. Patients and Methods In all, 859 men (mean age, 62 years) from 11 centers scheduled for a diagnostic prostate biopsy between December 2009 and June 2011 were enrolled. The primary outcomes were to assess whether PCA3 could improve the positive predictive value (PPV) for an initial biopsy (at a score > 60) and the negative predictive value (NPV) for a repeat biopsy (at a score < 20). Results For the detection of any cancer, PPV was 80% (95% CI, 72% to 86%) in the initial biopsy group, and NPV was 88% (95% CI, 81% to 93%) in the repeat biopsy group. The addition of PCA3 to individual risk estimation models (which included age, race/ethnicity, prior biopsy, PSA, and digital rectal examination) improved the stratification of cancer and of high-grade cancer. Conclusion These data independently support the role of PCA3 in reducing the burden of prostate biopsies among men undergoing a repeat prostate biopsy. For biopsy-naive patients, a high PCA3 score (> 60) significantly increases the probability that an initial prostate biopsy will identify cancer. PMID:25385735

  13. Efficacy of lower cut off value of serum prostate specific antigen in diagnosis of prostate cancer.

    PubMed

    Rashid, M M; Alam, A K M K; Habib, A K M K; Rahman, H; Hossain, A K M S; Salam, M A; Rahman, S

    2012-12-01

    Indications of prostate biopsy are high serum prostate specific antigen (PSA) value and or abnormal digital rectal examination (DRE) findings. Although serum PSA value of 4 ng/ml is the most commonly used threshold for recommending prostate biopsy, significant proportion of men harbor prostate cancer even when their serum PSA values are less than 4.0 ng/ml. Therefore present study was designed to determine the performance status of serum PSA in lower cut-off values. This hospital based prospective study was conducted in the Department of Urology of Bangabandhu Sheikh Mujib Medical University (BSMMU) and Comfort Nursing Home Pvt. Ltd, Dhaka from July 2009 to October 2010. Two hundred six male patients aged over 50 years having lower urinary tract symptoms (LUTS) and serum PSA more than 2.5 ng/ml were prepared for prostate biopsy. Trans rectal ultrasound (TRUS) guided biopsy was done. The test statistics used to analyze the data were descriptive statistics, sensitivity, specificity, positive and negative predictive value, ROC curve. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. In 2.5-4 serum PSA range, 28.26% (13 out of 46) of all malignancy were found, which would be missed if we take cut off value 4. At 2.5 PSA cut-off, Sensitivity 91.3%, Specificity 14.37%, PPV 23.46%, NPV 85.18%, Efficacy 31.55%. At 4 PSA cut-off value, Sensitivity 71.73%, Specificity 46.25%, PPV 27.73%, NPV 85.05%, Efficacy 51.94%. So it can be concluded that, for early diagnosis of prostate cancer cut-off value of serum PSA of 2.5 ng/ml can be recommended as an indication for prostate biopsy.

  14. Temporal Changes in the Pathologic Assessment of Prostate Cancer

    PubMed Central

    2012-01-01

    Thirty years have witnessed dramatic changes in the manner in which we diagnose and manage prostate cancer. With prostate-specific antigen screening, there was a shift towards smaller, clinically localized tumors. Tumors are often multifocal and display phenotypic and molecular heterogeneity. Pathologic evaluation of tissue obtained by needle biopsy remains the gold standard for the diagnosis and risk assessment of prostate cancer. Years of experience with grading, along with changes in the amount of biopsy tissue obtained and diagnostic tools available, have produced shifts in grading practices among genitourinary pathologists. Trends in Gleason grading and advances in pathological risk assessment are reviewed with particular emphasis on recent Gleason grading modifications of the International Society of Urologic Pathology. Efforts to maximize the amount of information from pathological specimens, whether it be morphometric, histochemical, or molecular, may improve predictive accuracy of prostate biopsies. New diagnostic techniques are needed to optimize management decisions. PMID:23271767

  15. Biopsy Misidentification Identified by DNA Profiling in a Large Multicenter Trial

    PubMed Central

    Marberger, Michael; McConnell, John D.; Fowler, Ivy; Andriole, Gerald L.; Bostwick, David G.; Somerville, Matthew C.; Rittmaster, Roger S.

    2011-01-01

    Purpose The Reduction by Dutasteride of Prostate Cancer Events (REDUCE) prostate cancer risk reduction study randomly assigned 8,231 men to dutasteride or placebo for 4 years. Protocol-mandated biopsies were obtained after 2 and 4 years. After the discovery of three cases of biopsy sample misidentification in the first 2 years, all protocol-mandated biopsy samples were DNA tested to verify biopsy identity. Methods Biopsy and blood DNA profiling was performed retrospectively for the year 2 scheduled biopsies and prospectively for the year 4 scheduled biopsies. Toward the end of year 2, multiple changes were made to improve sample handling and chain of custody. Results Of the 6,458 year 2 and 4,777 year 4 biopsies, 26 biopsies reflecting 13 sample handling errors at year 2 (0.4%) and one biopsy reflecting one sample handling error at year 4 (0.02%) were confirmed to be mismatched to the patient for whom they were originally submitted. Of 6,733 reference blood samples profiled, 31 (0.5%) were found to be mismatched to the patient's verified identity profile. Sample identification errors occurred at local research sites and central laboratories. Conclusion Biopsy misidentification is a potential problem in clinical laboratories and clinical trials. Until now, biopsy misidentification has not been studied in the setting of a large, multinational clinical trial. In the REDUCE study, process improvement initiatives halfway through the trial dramatically reduced biopsy mismatches. The potential for biopsy mismatches in clinical trials and clinical practice is an under-recognized problem that requires rigorous attention to details of chain of custody and consideration of more widespread DNA identity testing. PMID:21444877

  16. Primary Circulating Prostate Cells Are Not Detected in Men with Low Grade Small Volume Prostate Cancer

    PubMed Central

    Murray, Nigel P.; Reyes, Eduardo; Fuentealba, Cynthia; Orellana, Nelson; Jacob, Omar

    2014-01-01

    Objective. To determine if primary circulating prostate cells (CPCs) are found in all men with prostate cancer. Methods and Patients. A prospective study, to analyze all men with an elevated PSA between 4.0 and 10.0 ng/mL undergoing initial biopsy. Primary CPCs were obtained by differential gel centrifugation and detected using standard immunocytochemistry using anti-PSA; positive samples underwent a second process with anti-P504S. A malignant primary CPC was defined as PSA (+) P504S (+) and a test positive if 1 cell/4 mL was detected. Biopsy results were registered as cancer/no-cancer, number of cores positive, and percent infiltration of the cores. Results. 328/1123 (29.2%) of the study population had prostate cancer diagnosed on initial biopsy, and 42/328 (12.8%) were negative for primary CPCs. CPC negative men were significantly older, and had lower PSA levels, lower Gleason scores, and fewer positive cores and with infiltration by the cancer. 38/42 (91%) of CPC negative men complied with the criteria for active surveillance in comparison with 34/286 (12%) of CPC positive men. Conclusions. Using primary CPC detection as a sequential test to select men with an elevated PSA for biopsy, the risk of missing clinically significant prostate cancer is minimal when the patient is primary CPC negative; less than 0.5% of all primary CPC negative men had a clinically significant prostate cancer. PMID:25210517

  17. Breast Biopsy System

    NASA Technical Reports Server (NTRS)

    1994-01-01

    Charge Coupled Devices (CCDs) are high technology silicon chips that connect light directly into electronic or digital images, which can be manipulated or enhanced by computers. When Goddard Space Flight Center (GSFC) scientists realized that existing CCD technology could not meet scientific requirements for the Hubble Space Telescope Imagining Spectrograph, GSFC contracted with Scientific Imaging Technologies, Inc. (SITe) to develop an advanced CCD. SITe then applied many of the NASA-driven enhancements to the manufacture of CCDs for digital mammography. The resulting device images breast tissue more clearly and efficiently. The LORAD Stereo Guide Breast Biopsy system incorporates SITe's CCD as part of a digital camera system that is replacing surgical biopsy in many cases. Known as stereotactic needle biopsy, it is performed under local anesthesia with a needle and saves women time, pain, scarring, radiation exposure and money.

  18. Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

    PubMed Central

    Doluoglu, Omer Gokhan; Ceylan, Cavit; Kilinc, Fatih; Gazel, Eymen; Resorlu, Berkan; Odabas, Oner

    2016-01-01

    ABSTRACT Purpose We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. Materials and Methods The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. Results In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5–20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6–20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). Conclusions Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa. PMID:27256190

  19. MR-Guided Prostate Interventions

    PubMed Central

    Tempany, Clare; Straus, Sarah; Hata, Nobuhiko; Haker, Steven

    2009-01-01

    In this article the current issues of diagnosis and detection of prostate cancer are reviewed. The limitations for current techniques are highlighted and some possible solutions with MR imaging and MR-guided biopsy approaches are reviewed. There are several different biopsy approaches under investigation. These include transperineal open magnet approaches to closed-bore 1.5T transrectal biopsies. The imaging, image processing, and tracking methods are also discussed. In the arena of therapy, MR guidance has been used in conjunction with radiation methods, either brachytherapy or external delivery. The principles of the radiation treatment, the toxicities, and use of images are outlined. The future role of imaging and image-guided interventions lie with providing a noninvasive surrogate for cancer surveillance or monitoring treatment response. The shift to minimally invasive focal therapies has already begun and will be very exciting when MR-guided focused ultrasound surgery reaches its full potential. PMID:18219689

  20. MR-guided prostate interventions.

    PubMed

    Tempany, Clare; Straus, Sarah; Hata, Nobuhiko; Haker, Steven

    2008-02-01

    In this article the current issues of diagnosis and detection of prostate cancer are reviewed. The limitations for current techniques are highlighted and some possible solutions with MR imaging and MR-guided biopsy approaches are reviewed. There are several different biopsy approaches under investigation. These include transperineal open magnet approaches to closed-bore 1.5T transrectal biopsies. The imaging, image processing, and tracking methods are also discussed. In the arena of therapy, MR guidance has been used in conjunction with radiation methods, either brachytherapy or external delivery. The principles of the radiation treatment, the toxicities, and use of images are outlined. The future role of imaging and image-guided interventions lie with providing a noninvasive surrogate for cancer surveillance or monitoring treatment response. The shift to minimally invasive focal therapies has already begun and will be very exciting when MR-guided focused ultrasound surgery reaches its full potential. PMID:18219689

  1. High grade prostatic intraepithelial neoplasia with squamous differentiation

    PubMed Central

    Melissari, M; Beltran, A Lopez; Mazzucchelli, R; Froio, E; Bostwick, D G; Montironi, R

    2006-01-01

    An unusual variant of prostatic intraepithelial neoplasia with prominent and extensive squamous differentiation is described. The lesion was identified in the transition zone of a 79 year old man with a three year history of increasing urinary obstructive symptoms and a clinical diagnosis of benign prostatic hyperplasia who underwent simple prostatectomy. Two years after surgery, prostatic biopsies showed atrophy and mild chronic inflammation, with no evidence of malignancy. This unusual intraepithelial lesion seems not to have been described before and may represent a new variant of high grade prostatic intraepithelial neoplasia (HGPIN) with squamous differentiation. PMID:16567473

  2. Thyroid gland biopsy (image)

    MedlinePlus

    The thyroid is a gland located in the neck. It is a part of the endocrine (hormone) system, and plays a major role in regulating ... sample of cells is needed from the thyroid gland a fine needle biopsy can be performed. During ...

  3. Prostate cancer early detection, version 1.2014. Featured updates to the NCCN Guidelines.

    PubMed

    Carroll, Peter R; Parsons, J Kellogg; Andriole, Gerald; Bahnson, Robert R; Barocas, Daniel A; Catalona, William J; Dahl, Douglas M; Davis, John W; Epstein, Jonathan I; Etzioni, Ruth B; Giri, Veda N; Hemstreet, George P; Kawachi, Mark H; Lange, Paul H; Loughlin, Kevin R; Lowrance, William; Maroni, Paul; Mohler, James; Morgan, Todd M; Nadler, Robert B; Poch, Michael; Scales, Chuck; Shanefelt, Terrence M; Vickers, Andrew J; Wake, Robert; Shead, Dorothy A; Ho, Maria

    2014-09-01

    The NCCN Guidelines for Prostate Cancer Early Detection provide recommendations for men choosing to participate in an early detection program for prostate cancer. These NCCN Guidelines Insights highlight notable recent updates. Overall, the 2014 update represents a more streamlined and concise set of recommendations. The panel stratified the age ranges at which initiating testing for prostate cancer should be considered. Indications for biopsy include both a cutpoint and the use of multiple risk variables in combination. In addition to other biomarkers of specificity, the Prostate Health Index has been included to aid biopsy decisions in certain men, given recent FDA approvals. PMID:25190691

  4. FDA Approves Test to Aid Post-PSA Biopsy Decisions | Division of Cancer Prevention

    Cancer.gov

    The Food and Drug Administration (FDA) has approved a test to help men with elevated prostate-specific antigen (PSA) test scores decide whether to have a biopsy to test for prostate cancer. The Access Hybritech p2PSA test is approved for use in men aged 50 or older who have a PSA test score between 4 and 10 ng/ml but who show no signs of cancer during a digital rectal exam. |

  5. Skin metastasis, an uncommon course of prostate carcinoma: a report of two cases.

    PubMed

    Telis, L; Wolf, V; Yaskiv, O; Pearson, B J; Katsigeorgis, M; Jazayeri, S B; Samadi, D B; Unger, P D

    2016-08-01

    Prostate cancer is one of the most common cancers among men worldwide and in the USA. Most prostate cancer progression either locally invades to seminal vesicles or metastasizes distally to bone. Skin is not a common site of metastasis for the majority of malignancies including prostate cancer. This paper reports two extremely rare cases of prostate carcinoma metastatic to the skin: a 74-year-old man previously treated with radiation for prostate cancer with cutaneous metastases to the shoulder and a 68-year-old man with prostate adenocarcinoma and cutaneous metastases to the groin. Both patients were diagnosed with skin punch biopsy and later confirmed with immunohistochemical staining for PSA and prostate specific acid phosphatase, specific for prostatic carcinoma. Although unusual, development of multiple skin lesions in patients with prostate adenocarcinoma should raise the flags of cutaneous metastases. PMID:27568675

  6. Smoking Is Associated with Acute and Chronic Prostatic Inflammation: Results from the REDUCE Study.

    PubMed

    Moreira, Daniel M; Nickel, J Curtis; Gerber, Leah; Muller, Roberto L; Andriole, Gerald L; Castro-Santamaria, Ramiro; Freedland, Stephen J

    2015-04-01

    Both anti- and proinflammatory effects of cigarette smoking have been described. As prostate inflammation is common, we hypothesized smoking could contribute to prostate inflammation. Thus, we evaluated the association of smoking status with acute and chronic inflammation within the prostate of men undergoing prostate biopsy. We retrospectively analyzed 8,190 men ages 50 to 75 years with PSA levels between 2.5 and 10 ng/mL enrolled in the Reduction by Dutasteride of Prostate Cancer Events study. Smoking status was self-defined as never, former, or current. Prostate inflammation was assessed by systematic central review blinded to smoking status. The association of smoking with inflammation in the baseline, 2-year, and 4-year biopsies was evaluated with univariable and multivariable logistic regressions. At study enrollment, 1,233 (15%), 3,203 (39%), and 3,754 (46%) men were current, former, and never smokers, respectively. Current smokers were significantly younger and had smaller prostates than former and never smokers (all P < 0.05). Former smokers were significantly heavier than current and never smokers (P < 0.001). Acute and chronic prostate inflammations were identified in 1,261 (15%) and 6,352 (78%) baseline biopsies, respectively. In univariable analysis, current smokers were more likely to have acute inflammation than former (OR, 1.35; P, 0.001) and never smokers (OR, 1.36; P, 0.001). The results were unchanged at 2- and 4-year biopsies. In contrast, current smoking was linked with chronic inflammation in the baseline biopsy, but not at 2- and 4-year biopsies. In conclusion, among men undergoing prostate biopsy, current smoking was independently associated with acute and possibly chronic prostate inflammations. PMID:25644151

  7. Prostate-Specific Antigen Velocity for Early Detection of Prostate Cancer

    PubMed Central

    Vickers, Andrew J.; Wolters, Tineke; Savage, Caroline J.; Cronin, Angel M.; O’Brien, M. Frank; Pettersson, Kim; Roobol, Monique J.; Aus, Gunnar; Scardino, Peter T.; Hugosson, Jonas; Schröder, Fritz H.; Lilja, Hans

    2009-01-01

    Background It has been suggested that changes in prostate-specific antigen (PSA) over time (ie, PSA velocity [PSAV]) aid prostate cancer detection. Some guidelines do incorporate PSAV cut points as an indication for biopsy. Objective To evaluate whether PSAV enhances prediction of biopsy outcome in a large, representative, population-based cohort. Design, setting, and participants There were 2742 screening-arm participants with PSA <3 ng/ml at initial screening in the European Randomized Study of Screening for Prostate Cancer in Rotterdam, Netherlands, or Göteborg, Sweden, and who were subsequently biopsied during rounds 2[en]6 due to elevated PSA. Measurements Total, free, and intact PSA and human kallikrein 2 were measured for 1[en]6 screening rounds at intervals of 2 or 4 yr. We created logistic regression models to predict prostate cancer based on age and PSA, with or without free-to-total PSA ratio (%fPSA). PSAV was added to each model and any enhancement in predictive accuracy assessed by area under the curve (AUC). Results and limitations PSAV led to small enhancements in predictive accuracy (AUC of 0.569 vs 0.531; 0.626 vs 0.609 if %fPSA was included), although not for high-grade disease. The enhancement depended on modeling a nonlinear relationship between PSAV and cancer. There was no benefit if we excluded men with higher velocities, which were associated with lower risk. These results apply to men in a screening program with elevated PSA; men with prior negative biopsy were not evaluated in this study. Conclusions In men with PSA of about ≥3 ng/ml, we found little justification for formal calculation of PSAV or for use of PSAV cut points to determine biopsy. Informal assessment of PSAV will likely aid clinical judgment, such as a sudden rise in PSA suggesting prostatitis, which could be further evaluated before biopsy. PMID:19682790

  8. Prostate Cancer Detection and Diagnosis: The Role of MR and its Comparison to other Diagnostic Modalities – A Radiologist's Perspective

    PubMed Central

    Penzkofer, Tobias; Tempany-Afdhal, Clare M.

    2013-01-01

    It is now universally recognized that many prostate cancers are over-diagnosed and over-treated. The European Randomized Study of Screening for Prostate Cancer (ERSPC) from 2009 evidenced that, to save one man from death of prostate cancer, over 1,400 men had to be screened, and 48 had to undergo treatment. Detection of prostate cancer is traditionally based upon digital rectal examination (DRE) and measuring serum prostate specific antigen (PSA), followed by ultrasound guided biopsy. The primary role of imaging for the detection and diagnosis of prostate cancer has been transrectal ultrasound (TRUS) guidance during biopsy. MRI has traditionally been used primarily for staging disease in men with biopsy proven cancer. It is has a well-established role in detecting T3 disease, planning radiation therapy, especially 3D conformal or intensity modulated external beam radiation therapy (IMRT), and planning and guiding interstitial seed implant or brachytherapy. New advances have now established prostate MRI can accurately characterize focal lesions within the gland, an ability that has led to new opportunities for improved cancer detection and guidance for biopsy. There are two new approaches to prostate biopsy are under investigation both use pre-biopsy MRI to define potential targets for sampling and then the biopsy is performed either with direct real-time MR guidance (in-bore) or MR fusion/registration with TRUS images (out-of-bore). In-bore or out-of-bore MRI-guided prostate biopsies have the advantage of using the MR target definition for accurate localization and sampling of targets or suspicious lesions. The out-of-bore method uses combined MRI/TRUS with fusion software that provided target localization and increases the sampling accuracy for TRUS-guided biopsies by integrating prostate MRI information with TRUS. Newer parameters for each imaging modality such as sonoelastography or shear wave elastography (SWE), contrast enhanced US (CEUS) and MRI

  9. A Clinicopathological Profile of Prostate Cancer in Trinidad and Tobago

    PubMed Central

    Sukhraj, Rajendra; Goetz, Lester

    2016-01-01

    Aim. To conduct a clinicopathological review of all prostate biopsies performed in a tertiary referral centre in Trinidad and Tobago over a period of 30 months. Methods. The records of all patients who had prostate biopsies from January 2012 to July 2014 were reviewed. Clinical and pathologic data were compiled and subsequently analysed using SPSS version 20. Results. From January 2012 to July 2014, 617 transrectal ultrasound guided prostate biopsies were performed. Pathological data were found for 546 patients of whom 283 (51.8%) were confirmed carcinoma of the prostate. Moderately differentiated tumors (Gleason 7) were the most common group. Using the D'Amico risk classification, most cases were found to be high risk (63.1%). Afro-Trinidadians comprised 72.1% of the patients with prostate cancer. Afro-Trinidadians were also more likely to have high risk and high grade disease as well as high PSA values. Conclusion. This study demonstrates that over half of our biopsies are eventually positive for cancer and most cases were high risk. Afro-Trinidadians comprised a disproportionate number of those diagnosed with prostate cancer and had a greater risk of high risk disease. PMID:27493662

  10. Low Prostate Concentration of Lycopene Is Associated with Development of Prostate Cancer in Patients with High-Grade Prostatic Intraepithelial Neoplasia

    PubMed Central

    Mariani, Simone; Lionetto, Luana; Cavallari, Michele; Tubaro, Andrea; Rasio, Debora; De Nunzio, Cosimo; Hong, Gena M.; Borro, Marina; Simmaco, Maurizio

    2014-01-01

    Prostate cancer (PC) is a frequent male malignancy and represents the second most diagnosed cancer in men. Since pre-cancerous lesions, i.e., the high-grade prostatic intraepithelial neoplasia (HGPIN), can be detected years before progression to PC, early diagnosis and chemoprevention are targeted strategies to reduce PC rates. Animal studies have shown that lycopene, a carotenoid contained in tomatoes, is a promising candidate for the chemoprevention of PC. However, its efficacy in humans remains controversial. The present study aimed to investigate the relevance of plasma and prostate concentration of lycopene after a lycopene-enriched diet in patients diagnosed with HGPIN. Thirty-two patients diagnosed with HGPIN were administered a lycopene-enriched diet (20–25 mg/day of lycopene; through 30 g/day of triple concentrated tomato paste) for 6 months. A 6-month follow-up prostate biopsy assessed progression to PC. Patients were classified into three groups according to the histopathological features of the 6-month follow-up biopsy results: prostatitis; HGPIN and PC. PSA and plasma lycopene levels were measured before and after the dietary lycopene supplementation. Prostatic lycopene concentration was only assessed after the supplementation diet. Only prostatic lycopene concentration showed significant differences between the three groups (p = 0.03). Prostatic lycopene concentration below a 1 ng/mg threshold was associated with PC at 6-month follow-up biopsy (p = 0.003). We observed no overall benefits from a 6-month lycopene supplementation, as the rate of HGPIN progression to PC in our population (9/32, 28%) was similar to rates reported in the literature. Baseline PSA levels also showed no significant changes after a lycopene-enriched diet. Our findings point to prostatic lycopene concentration as a promising biomarker of PC. Further prospective longitudinal studies are needed to assess the prognostic role of prostatic lycopene in PC. PMID:24451130

  11. Stereotactic (Mammographically Guided) Breast Biopsy

    MedlinePlus

    ... Z Stereotactic Breast Biopsy Stereotactic breast biopsy uses mammography – a specific type of breast imaging that uses ... the breast are often detected by physical examination, mammography, or other imaging studies. However, it is not ...

  12. Celiac Disease Diagnosis: Endoscopic Biopsy

    MedlinePlus

    ... This is done in a procedure called a biopsy: the physician eases a long, thin tube called ... the tissue using instruments passed through the endoscope. Biopsy of the small intestine is the only way ...

  13. Prostate Radiotherapy in the Era of Advanced Imaging and Precision Medicine

    PubMed Central

    Dulaney, Caleb R.; Osula, Daniel O.; Yang, Eddy S.; Rais-Bahrami, Soroush

    2016-01-01

    Tremendous technological advancements in prostate radiotherapy have decreased treatment toxicity and improved clinical outcomes for men with prostate cancer. While these advances have allowed for significant treatment volume reduction and whole-organ dose escalation, further improvement in prostate radiotherapy has been limited by classic techniques for diagnosis and risk stratification. Developments in prostate imaging, image-guided targeted biopsy, next-generation gene expression profiling, and targeted molecular therapies now provide information to stratify patients and select treatments based on tumor biology. Image-guided targeted biopsy improves detection of clinically significant cases of prostate cancer and provides important information about the biological behavior of intraprostatic lesions which can further guide treatment decisions. We review the evolution of prostate magnetic resonance imaging (MRI) and MRI-ultrasound fusion-guided prostate biopsy. Recent advancements in radiation therapy including dose escalation, moderate and extreme hypofractionation, partial prostate radiation therapy, and finally dose escalation by simultaneous integrated boost are discussed. We also review next-generation sequencing and discuss developments in targeted molecular therapies. Last, we review ongoing clinical trials and future treatment paradigms that integrate targeted biopsy, molecular profiling and therapy, and prostate radiotherapy. PMID:27022486

  14. Beyond Prostate Adenocarcinoma: Expanding the Differential Diagnosis in Prostate Pathologic Conditions.

    PubMed

    Li, Yi; Mongan, John; Behr, Spencer C; Sud, Seema; Coakley, Fergus V; Simko, Jeffry; Westphalen, Antonio C

    2016-01-01

    Recent advances in magnetic resonance (MR) imaging of the prostate gland have dramatically improved the ability to detect and stage adenocarcinoma of the prostate, one of the most frequently diagnosed cancers in men and one of the most frequently diagnosed pathologic conditions of the prostate gland. A wide variety of nonadenocarcinoma diseases can also be seen with MR imaging, ranging from benign to malignant diseases, as well as infectious and inflammatory manifestations. Many of these diseases have distinctive imaging features that allow differentiation from prostate acinar adenocarcinoma. Early recognition of these entities produces a more accurate differential diagnosis and may enable more expeditious clinical workup. Benign neoplasms of the prostate include plexiform neurofibroma and cystadenoma, both of which demonstrate distinctive imaging features. Stromal neoplasms of uncertain malignant potential are rare tumors of uncertain malignant potential that are often difficult to distinguish at imaging from more-malignant prostate sarcomas. Other malignant neoplasms of the prostate include urothelial carcinoma, primary prostatic carcinoid, carcinosarcoma, endometrioid or ductal adenocarcinoma, and mucinous adenocarcinoma. Prostatic infections can lead to abscesses of pyogenic, tuberculous, or fungal origins. Finally, miscellaneous idiopathic disorders of the prostate include amyloidosis, exophytic benign prostatic hyperplasia, and various congenital cysts. Considerable overlap can exist in the clinical history and imaging findings associated with these prostate pathologic conditions, and biopsy is often required for ultimate confirmation of the diagnosis. However, many diagnoses, including cystadenoma, mucinous adenocarcinoma, sarcoma, and abscesses, have distinct imaging features, which can enable the informed radiologist to identify the diagnosis and recommend appropriate clinical workup and management. (©)RSNA, 2016. PMID:27315446

  15. Prostate MRI – an update for the referring urologist

    PubMed Central

    Jakuciński, Maciej; Królicki, Leszek

    2016-01-01

    Introduction Prostate MRI is a new and important tool which has a role in prostate cancer guidelines worldwide. The amount of articles published and studies currently taking place on the subject requires urologists to understand how the examination is performed and its possible applications. This article explains prostate MRI and standardized reporting schemes, as well as its applications according to patients’ staging and history. Material and methods The use of prostate MRI prior to biopsy, MRI-guided biopsy and its use in active surveillance, surgery staging and planning, as well as in cases with biochemical recurrence are discussed. Results The application of prostate MRI are not limited to initial diagnosis, but also has a developing role in biopsy and planning further treatment. Recently, its diagnostic applications have been included in EAU prostate cancer guidelines and new applications are in development. Conclusions Practicing urologists are seeing an emerging role of MRI in prostate cancer. Its current and future applications may have an impact on patient care, which mandates healthcare professionals to be vigilant about the method's new developments. PMID:27551553

  16. Aspiration and Biopsy: Bone Marrow

    MedlinePlus

    ... Help a Friend Who Cuts? Aspiration and Biopsy: Bone Marrow KidsHealth > For Teens > Aspiration and Biopsy: Bone Marrow Print A A A Text Size What's in ... Risks If You Have Questions What It Is Bone marrow aspirations and biopsies are performed to examine bone ...

  17. Recent advances in imaging-guided interventions for prostate cancers

    PubMed Central

    Wu, Xia; Zhang, Feng; Chen, Ran; Zheng, Weiliang; Yang, Xiaoming

    2014-01-01

    The numbers of patients diagnosed with prostate cancers is increasing due to the widespread application of prostate-specific antigen screening and subsequent prostate biopsies. The methods of systemic administration of therapeutics are not target-specific and thus cannot efficiently destroy prostate tumour cells while simultaneously sparing the surrounding normal tissues and organs. Recent advances in imaging-guided minimally invasive therapeutic techniques offer considerable potential for the effective management of prostate cancers. An objective understanding of the feasibility, effectiveness, morbidity, and deficiencies of these interventional techniques is essential for both clinical practice and scientific progress. This review presents the recent advances in imaging-guided interventional techniques for the diagnosis and treatment of prostate cancers. PMID:24769076

  18. Benign prostate hyperplasia (BPH) - resources

    MedlinePlus

    Resources - benign prostatic hyperplasia (BPH); Prostate enlargement resources; BPH resources ... organizations provide information on benign prostatic hyperplasia ( prostate enlargement ): National Kidney and Urologic Diseases Information Clearinghouse -- www. ...

  19. Prostate Cancer

    PubMed Central

    Vickers, Andrew J.; Lilja, Hans

    2010-01-01

    Two groundbreaking trials have this year reported conflicting results as to the benefit of screening for prostate cancer. Careful interpretation in the light of contemporary data might, however, reveal the true value of this intervention. PMID:19498406

  20. Enlarged prostate

    MedlinePlus

    ... Possible side effects include decreased sex drive and impotence . Antibiotics may be prescribed to treat chronic prostatitis ( ... less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with ...

  1. Prostatitis - bacterial

    MedlinePlus

    ... emptying the bladder Foul-smelling urine Weak urine stream Other symptoms that may occur with this condition: ... the risk of spreading bacteria into the blood stream. The exam may reveal that the prostate is: ...

  2. Newer potential biomarkers in prostate cancer.

    PubMed

    Wright, Jonathan L; Lange, Paul H

    2007-01-01

    Prostate-specific antigen (PSA) screening has led to a significant rise in the number of men diagnosed with prostate cancer and an associated increase in biopsies performed. Despite its limitations, including a positive predictive value of only 25%-40%, PSA remains the only generally accepted biomarker for prostate cancer. There is a need for better tools to not only identify men with prostate cancer, but also to recognize those with potentially lethal disease who will benefit from intervention. A great deal of work has been done worldwide to improve our knowledge of the genetics behind prostate cancer and the specificity of PSA by developing assays for different PSA isoforms. Common genetic alterations in prostate cancer patients have been identified, including CpG hypermethylation of GSPT1 and TMPRSS2:ERG gene fusion. Serum and urine detection of RNA biomarkers (eg, PCA3) and prostate cancer tissue protein antibodies (eg, EPCA) are being evaluated for detection and prognostic tools. This article reviews some of the promising developments in biomarkers.

  3. Emerging biomarkers of prostate cancer (Review)

    PubMed Central

    MARTIN, SARAH K.; VAUGHAN, TAYLOR B.; ATKINSON, TIMOTHY; ZHU, HAINING; KYPRIANOU, NATASHA

    2012-01-01

    Prostate cancer progression involves activation of signaling pathways controlling cell proliferation, apoptosis, anoikis, angiogenesis and metastasis. The current PSA-based test for the diagnosis of prostate cancer lacks sensitivity and specificity, resulting in missed diagnoses and unnecessary biopsies. Intense research efforts to identify serum and tissue biomarkers will expand the opportunities to understand the functional activation of cancer-related pathways and consequently lead to molecular therapeutic targeting towards inhibition of tumor growth. Current literature describes multiple biomarkers that indicate the properties of prostate cancer including its presence, stage, metastatic potential and prognosis. Used singly, assays detecting these biomarkers have their respective shortcomings. Several recent studies evaluating the clinical utilization of multiple markers show promising results in improving prostate cancer profiling. This review discusses the current understanding of biomarker signature cluster-based approaches for the diagnosis and therapeutic response of prostate cancer derived from panels of biomarker tests that provide a selective molecular signature characteristic of the tumor. As these signatures are robustly defined and their pathways are exhaustively dissected, prostate cancer can be more accurately diagnosed, characterized, staged and targeted with inhibitory antitumor agents. The growing promise surrounding the recent evidence in identifying and utilizing such biomarker panels, will lead to improvement in cancer prognosis and management of the therapeutic response of prostate cancer patients. PMID:22641253

  4. Newer Potential Biomarkers in Prostate Cancer

    PubMed Central

    Wright, Jonathan L; Lange, Paul H

    2007-01-01

    Prostate-specific antigen (PSA) screening has led to a significant rise in the number of men diagnosed with prostate cancer and an associated increase in biopsies performed. Despite its limitations, including a positive predictive value of only 25%–40%, PSA remains the only generally accepted biomarker for prostate cancer. There is a need for better tools to not only identify men with prostate cancer, but also to recognize those with potentially lethal disease who will benefit from intervention. A great deal of work has been done worldwide to improve our knowledge of the genetics behind prostate cancer and the specificity of PSA by developing assays for different PSA isoforms. Common genetic alterations in prostate cancer patients have been identified, including CpG hypermethylation of GSPT1 and TMPRSS2:ERG gene fusion. Serum and urine detection of RNA biomarkers (eg, PCA3) and prostate cancer tissue protein antibodies (eg, EPCA) are being evaluated for detection and prognostic tools. This article reviews some of the promising developments in biomarkers. PMID:18231617

  5. Metastasis of Prostate Adenocarcinoma to the Testis

    PubMed Central

    Campara, Zoran; Simic, Dejan; Aleksic, Predrag; Spasic, Aleksandar; Milicevic, Snjezana

    2016-01-01

    Introduction: Prostate carcinoma is the most frequently diagnosed carcinoma in the male population. The most typical places of the metastases are pelvic lymphatic glands, bones and lungs, and very rarely it metastasizes into a testis. The prognostic importance of testicular metastasis of prostate cancer is not yet well-known, due to a very few published cases. According to the known facts, it is certain that a metastasis of the prostate carcinoma into a testis is a sign of an advanced disease. Case report: This work presents a 48-year-old patient, to whom an adenocarcinoma of the prostate has been proven by the pathohistological finding of transrectal biopsy, performed due to the elevated level of prostate-specific antigen (PSA). Nine years after the initial diagnosis, due to a gradual rise of PSA and tumorous enlargement of the left testis, left inguinal orchectomy and right orchectomy were performed. Metastatic dissemination of prostate adenocarcinoma into a testis was determined by a pathohistological analysis of the left testis. Conclusion: The metastasis of the prostate carcinoma into a testis, as a rare localization of the metastatic dissemination, after additionally performed orchectomy along with further oncological therapy, can provide a continuation of a good life quality as well as a control of the disease in a longer time period. PMID:27703299

  6. Prostate cancer presenting as an endobronchial mass: a case report with literature review.

    PubMed

    Garai, Shakhee; Pandey, Urmila

    2010-12-01

    Endobronchial metastasis from a prostate cancer is uncommon. Diagnosis of prostate carcinoma after primary presentation with an endobronchial mass is very rare. The authors describe the case of an 84-year-old man with endobronchial metastases from prostatic carcinoma presenting primarily with pulmonary symptoms. The diagnosis of prostate cancer and endobronchial metastases was made by a bronchoscopic bronchial biopsy and confirmed by immunohistological staining with prostate-specific antigen. The importance of this manifestation along with clinical and therapeutic implications is discussed here.

  7. Evaluating localized prostate cancer and identifying candidates for focal therapy.

    PubMed

    Sartor, A Oliver; Hricak, Hedvig; Wheeler, Thomas M; Coleman, Jonathan; Penson, David F; Carroll, Peter R; Rubin, Mark A; Scardino, Peter T

    2008-12-01

    Can focal therapy successfully control prostate cancer? Also, if so, which patients should be considered eligible? With limited data available from relatively few patients, these questions are difficult to answer. At this writing, the most likely candidates for focal therapy are patients with low-risk, small-volume tumors, located in 1 region or sector of the prostate, who would benefit from early intervention. The difficulty lies in reliably identifying these men. The larger number of cores obtained in each needle biopsy session has increased both the detection of prostate cancer and the potential risk of overtreating many patients whose cancers pose very little risk to life or health. Urologists typically perform at least a 12-core template biopsy. Although the debate continues about the optimal template, laterally and peripherally directed biopsies have been shown to improve the diagnostic yield. However, as many as 25% of tumors arise anteriorly and can be missed with peripherally directed techniques. Prostate cancer tends to be multifocal, even in its earliest stages. However, the secondary cancers are usually smaller and less aggressive than the index cancer. They appear similar to the incidental cancers found in cystoprostatectomy specimens and appear to have little effect on prognosis in surgical series. When a single focus of cancer is found in 1 core, physicians rightly suspect that more foci of cancer are present in the prostate. Assessing the risk in these patients is challenging when determined by the biopsy data alone. To predict the presence of a very low-risk or "indolent" cancer, nomograms have been developed to incorporate clinical stage, Gleason grade, prostate-specific antigen levels, and prostate volume, along with the quantitative analysis of the biopsy results. Transperineal "mapping" or "saturation" biopsies have been advocated to detect cancers missed or underestimated by previous transrectal biopsies. This approach could provide the

  8. The endomyocardial biopsy.

    PubMed

    Schneiderman, H; Hager, W D; Gondos, B

    1986-01-01

    Endomyocardial biopsy (EMB) provides a safe, simple method of gathering unique information. Although the role of EMB continues to evolve rapidly, present consensus includes the following indications, based on the ability of EMB to provide diagnoses unobtainable by other means: assessment of early rejection following cardiac transplantation; determination of myocarditis as etiology of clinically obscure cardiac dysfunction; quantification of chemotherapeutic (especially anthracycline) cardiotoxicity; and distinction between constrictive and restrictive heart disease. Each of these indications carries major therapeutic as well as prognostic implications. Methods of processing EMB are presented, complications listed, artifacts described, findings and uses illustrated, and suggestions for future development addressed briefly.

  9. Telepathology and Optical Biopsy

    PubMed Central

    Ferrer-Roca, Olga

    2009-01-01

    The ability to obtain information about the structure of tissue without taking a sample for pathology has opened the way for new diagnostic techniques. The present paper reviews all currently available techniques capable of producing an optical biopsy, with or without morphological images. Most of these techniques are carried out by physicians who are not specialized in pathology and therefore not trained to interpret the results as a pathologist would. In these cases, the use of telepathology or distant consultation techniques is essential. PMID:20339507

  10. Methodology of stereotactic biopsy.

    PubMed

    Carapella, C M; Mastrostefano, R; Raus, L; Riccio, A

    1989-01-01

    The great technological improvement in the neurosurgical tools and in the neuroradiological imaging has brought about the diffusion of the stereotactic techniques. They are crucial for the diagnosis and treatment of intracranial expanding lesions of small dimensions or located in sites inaccessible to conventional techniques. The Authors describe the most common systems and methodologies for the stereotactic biopsy. They stress the importance of performing serial explorations which can provide evidence of the heterogeneity of the neoplastic lesion and of the infiltration of the brain adjacent to the tumor.

  11. Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI.

    PubMed

    Rouvière, Olivier; Girouin, Nicolas; Glas, Ludivine; Ben Cheikh, Alexandre; Gelet, Albert; Mège-Lechevallier, Florence; Rabilloud, Muriel; Chapelon, Jean-Yves; Lyonnet, Denis

    2010-01-01

    The objective was to evaluate T2-weighted (T2w) and dynamic contrast-enhanced (DCE) MRI in detecting local cancer recurrences after prostate high-intensity focused ultrasound (HIFU) ablation. Fifty-nine patients with biochemical recurrence after prostate HIFU ablation underwent T2-weighted and DCE MRI before transrectal biopsy. For each patient, biopsies were performed by two operators: operator 1 (blinded to MR results) performed random and colour Doppler-guided biopsies ("routine biopsies"); operator 2 obtained up to three cores per suspicious lesion on MRI ("targeted biopsies"). Seventy-seven suspicious lesions were detected on DCE images (n = 52), T2w images (n = 2) or both (n = 23). Forty patients and 41 MR lesions were positive at biopsy. Of the 36 remaining MR lesions, 20 contained viable benign glands. Targeted biopsy detected more cancers than routine biopsy (36 versus 27 patients, p = 0.0523). The mean percentages of positive cores per patient and of tumour invasion of the cores were significantly higher for targeted biopsies (p < 0.0001). The odds ratios of the probability of finding viable cancer and viable prostate tissue (benign or malignant) at targeted versus routine biopsy were respectively 3.35 (95% CI 3.05-3.64) and 1.38 (95% CI 1.13-1.63). MRI combining T2-weighted and DCE images is a promising method for guiding post-HIFU biopsy towards areas containing recurrent cancer and viable prostate tissue.

  12. Relationship of ultrasonographic findings to histology in prostate cancer.

    PubMed

    Hasegawa, Y; Sakamoto, N

    1994-01-01

    We compared ultrasonic findings and histology in 25 patients with prostate cancer. Ultrasonically guided transperineal biopsy of focal prostatic lesions was performed in 19 patients, in whom prostate cancer was suspected. Six of them had two different echogenic areas in the same focal lesion, so a total of 25 echogenic areas were assessed. Fourteen of these 25 areas were hypoechoic. The Gleason score varied, but residual prostatic glands and cancer glands with slightly enlarged lumen did not exist. Six of the areas were slightly more echogenic than the above 14 areas, and cribriform cancer with slightly enlarged glands occupied the greater part of these specimens. Four of the areas were isoechoic, and they contained residual prostatic glands showing a normal distribution, regardless of the Gleason score or grade of tumor infiltration. The only hyperechoic lesion contained numerous tiny areas of calcification. In the 6 patients without focal lesions, the peripheral and transition zones showed a normal echogenicity. Two of these patients had cancer in the transition zone, and biopsy showed tumor glands with slightly enlarged lumens. In the 4 patients, various-sized tumors were seen, but there was a normal distribution of residual prostatic glands and stroma. These results indicated that prostatic echogenicity is determined by the presence of tumor glands with enlarged lumina as well as residual prostatic glands and stroma.

  13. Prostate cancer biomarkers: an update.

    PubMed

    Romero Otero, Javier; Garcia Gomez, Borja; Campos Juanatey, Felix; Touijer, Karim A

    2014-04-01

    Many aspects of prostate cancer diagnosis and treatment could be greatly advanced with new, effective biomarkers. Prostate-specific antigen (PSA) has multiple weaknesses as a biomarker, such as not distinguishing well between cancer and benign prostatic hyperplasia or between indolent and aggressive cancers, thus leading to overtreatment, especially unnecessary biopsies. PSA also often fails to indicate accurately which patients are responding to a given treatment. Yet PSA is the only prostate cancer biomarker routinely used by urologists. Here, we provide updated information on the most relevant of the other biomarkers currently in use or in development for prostate cancer. Recent research shows improvement over using PSA alone by comparing total PSA (tPSA) or free PSA (fPSA) with new, related markers, such as prostate cancer antigen (PCA) 3, the individual molecular forms of PSA (proPSA, benign PSA, and intact PSA), and kallikreins other than PSA. Promising results have also been seen with the use of the fusion gene TMPRSS2:ERG and with various forms of the urokinase plasminogen activation receptor. Initially, there were high hopes for early PCA, but those data were not reproducible and thus research on early PCA has been abandoned. Much work remains to be done before any of these biomarkers are fully validated and accepted. Currently, the only markers discussed in this paper with Food and Drug Administration-approved tests are PCA 3 and an isoform of proPSA, [-2]proPSA. Assays are in development for most of the other biomarkers described in this paper. While the biomarker validation process can be long and filled with obstacles, the rewards will be great-in terms of both patient care and costs to the health care system.

  14. Metastatic Breast Carcinoma to the Prostate Gland.

    PubMed

    Kapp, Meghan E; Giannico, Giovanna A; Desouki, Mohamed Mokhtar

    2016-01-01

    Cancer of the male breast is an uncommon event with metastases to the breast occurring even less frequently. Prostate carcinoma has been reported as the most frequent primary to metastasize to the breast; however, the reverse has not been previously reported. Herein, we present, for the first time, a case of breast carcinoma metastasizing to the prostate gland. Prostate needle core biopsy revealed infiltrative nests of neoplastic epithelioid cells, demonstrated by immunohistochemistry (IHC) to be positive for GATA3 and ER and negative for PSA and P501S. A prostate cocktail by IHC study demonstrated lack of basal cells (p63 and CK903) and no expression of P501S. The patient's previous breast needle core biopsy showed strong ER positivity and negative staining for PR and HER2. Similar to the prostate, the breast was negative for CK5/6, p63, and p40. This case demonstrates the importance of considering a broad differential diagnosis and comparing histology and IHC to prior known malignancies in the setting of atypical presentation or rare tumors. PMID:27429817

  15. [Testosterone replacement therapy and prostate cancer: the downfall of a paradigm?].

    PubMed

    Castillo, Octavio A; López-Fontana, Gastón; Vidal-Mora, Ivar; López Laur, José Daniel

    2015-04-06

    For six decades, it has been a part of the conventional medical wisdom that higher levels of testosterone increase the risk of prostate cancer. This belief is mostly derived from the well-documented regression of prostate cancer after surgical or pharmacological castration. However, there is an absence of scientific data supporting the concept that higher testosterone levels are associated with an increased risk of prostate cancer. Moreover, men with hypogonadism have substantial rates of prostate cancer in prostatic biopsies, suggesting that low testosterone has no protective effect against the development of prostate cancer. Moreover, prostate cancer rate is higher in elderly patients when hormonal levels are low. These results argue against an increased risk of prostate cancer with testosterone replacement therapy.

  16. Finasteride Concentrations and Prostate Cancer Risk: Results from the Prostate Cancer Prevention Trial

    PubMed Central

    Till, Cathee; Goodman, Phyllis J.; Chen, Xiaohong; Leach, Robin J.; Johnson-Pais, Teresa L.; Hsing, Ann W.; Hoque, Ashraful; Tangen, Catherine M.; Chu, Lisa; Parnes, Howard L.; Schenk, Jeannette M.; Reichardt, Juergen K. V.; Thompson, Ian M.; Figg, William D.

    2015-01-01

    Objective In the Prostate Cancer Prevention Trial (PCPT), finasteride reduced the risk of prostate cancer by 25%, even though high-grade prostate cancer was more common in the finasteride group. However, it remains to be determined whether finasteride concentrations may affect prostate cancer risk. In this study, we examined the association between serum finasteride concentrations and the risk of prostate cancer in the treatment arm of the PCPT and determined factors involved in modifying drug concentrations. Methods Data for this nested case-control study are from the PCPT. Cases were drawn from men with biopsy-proven prostate cancer and matched controls. Finasteride concentrations were measured using a liquid chromatography-mass spectrometry validated assay. The association of serum finasteride concentrations with prostate cancer risk was determined by logistic regression. We also examine whether polymorphisms in the enzyme target and metabolism genes of finasteride are related to drug concentrations using linear regression. Results and Conclusions Among men with detectable finasteride concentrations, there was no association between finasteride concentrations and prostate cancer risk, low-grade or high-grade, when finasteride concentration was analyzed as a continuous variable or categorized by cutoff points. Since there was no concentration-dependent effect on prostate cancer, any exposure to finasteride intake may reduce prostate cancer risk. Of the twenty-seven SNPs assessed in the enzyme target and metabolism pathway, five SNPs in two genes, CYP3A4 (rs2242480; rs4646437; rs4986910), and CYP3A5 (rs15524; rs776746) were significantly associated with modifying finasteride concentrations. These results suggest that finasteride exposure may reduce prostate cancer risk and finasteride concentrations are affected by genetic variations in genes responsible for altering its metabolism pathway. Trial Registration ClinicalTrials.gov NCT00288106 PMID:25955319

  17. Incidental prostate ¹⁸F-FDG uptake without calcification indicates the possibility of prostate cancer.

    PubMed

    Seino, Hiroko; Ono, Shuichi; Miura, Hiroyuki; Morohashi, Satoko; Wu, Yunyan; Tsushima, Fumiyasu; Takai, Yoshihiro; Kijima, Hiroshi

    2014-04-01

    Incidental 18F-fluorodeoxyglucose (18F-FDG) uptake in the prostate is often experienced in clinical practice; however, it is difficult to determine whether incidental uptake is indicative of a malignancy or benign state based on the maximum standardized uptake value (SUVmax). In the present study, we investigated the clinical significance of incidental prostate uptake by 18F-FDG positron emission tomography (PET)/CT, and examined the differences between malignant and benign uptake from a clinicopathological viewpoint. We reviewed 3,236 male subjects who underwent 18F-FDG PET/CT scans at Hirosaki University Hospital (Japan) from 2008 to 2012 in order to identify cases of incidental prostate FDG uptake. The final diagnosis was made by serum prostate-specific antigen (PSA) levels, biopsy, imaging studies and clinical follow-up with PET findings. Incidental FDG uptake of the prostate was observed in 53 cases (2%). Four cases were excluded due to insufficient clinical data, and 49 cases were included in the present study. Of the 49 cases, 8 (16%) had prostate cancer, while 41 (84%) were benign. All 8 malignant cases had high uptake areas, e.g. in the prostate peripheral zone, where there was no coexistence of calcification or FDG uptake. Of the 41 benign cases, 19 had high uptake in the inner zone, 17 in the peripheral zone, and 5 in both the inner and peripheral zones. Of the 41 cases, 18 (44%) showed FDG uptake coexisting with prostatic calcification. Incidental prostate 18F-FDG uptake infrequently signifies prostate cancer; however, FDG uptake not coexisting with calcification indicates the possibility of prostate cancer and should be included in the differential diagnosis for performing other clinical examinations.

  18. Minimally invasive prostate cancer detection test using FISH probes

    PubMed Central

    Tinawi-Aljundi, Rima; Knuth, Shannon T; Gildea, Michael; Khal, Joshua; Hafron, Jason; Kernen, Kenneth; Di Loreto, Robert; Aurich-Costa, Joan

    2016-01-01

    Purpose The ability to test for and detect prostate cancer with minimal invasiveness has the potential to reduce unnecessary prostate biopsies. This study was conducted as part of a clinical investigation for the development of an OligoFISH® probe panel for more accurate detection of prostate cancer. Materials and methods One hundred eligible male patients undergoing transrectal ultrasound biopsies were enrolled in the study. After undergoing digital rectal examination with pressure, voided urine was collected in sufficient volume to prepare at least two slides using ThinPrep. Probe panels were tested on the slides, and 500 cells were scored when possible. From the 100 patients recruited, 85 had more than 300 cells scored and were included in the clinical performance calculations. Results Chromosomes Y, 7, 10, 20, 6, 8, 16, and 18 were polysomic in most prostate carcinoma cases. Of these eight chromosomes, chromosomes 7, 16, 18, and 20 were identified as having the highest clinical performance as a fluorescence in situ hybridization test and used to manufacture the fluorescence in situ hybridization probe panels. The OligoFISH® probes performed with 100% analytical specificity. When the OligoFISH® probes were compared with the biopsy results for each individual, the test results highly correlated with positive and negative prostate biopsy pathology findings, supporting their high specificity and accuracy. Probes for chromosomes 7, 16, 18, and 20 showed in the receiver operator characteristics analysis an area under the curve of 0.83, with an accuracy of 81% in predicting the biopsy result. Conclusion This investigation demonstrates the ease of use with high specificity, high predictive value, and accuracy in identifying prostate cancer in voided urine after digital rectal examination with pressure. The test is likely to have positive impact on clinical practice and advance approaches to the detection of prostate cancer. Further evaluation is warranted. PMID

  19. A MR-TRUS registration method for ultrasound-guided prostate interventions

    NASA Astrophysics Data System (ADS)

    Yang, Xiaofeng; Rossi, Peter; Mao, Hui; Jani, Ashesh B.; Ogunleye, Tomi; Curran, Walter J.; Liu, Tian

    2015-03-01

    In this paper, we reported a MR-TRUS prostate registration method that uses a subject-specific prostate strain model to improve MR-targeted, US-guided prostate interventions (e.g., biopsy and radiotherapy). The proposed algorithm combines a subject-specific prostate strain model with a Bspline transformation to register the prostate gland of the MRI to the TRUS images. The prostate strain model was obtained through US elastography and a 3D strain map of the prostate was generated. The B-spline transformation was calculated by minimizing Euclidean distance between MR and TRUS prostate surfaces. This prostate stain map was used to constrain the B-spline-based transformation to predict and compensate for the internal prostate-gland deformation. This method was validated with a prostate-phantom experiment and a pilot study of 5 prostate-cancer patients. For the phantom study, the mean target registration error (TRE) was 1.3 mm. MR-TRUS registration was also successfully performed for 5 patients with a mean TRE less than 2 mm. The proposed registration method may provide an accurate and robust means of estimating internal prostate-gland deformation, and could be valuable for prostate-cancer diagnosis and treatment.

  20. PSA Velocity Does Not Improve Prostate Cancer Detection | Division of Cancer Prevention

    Cancer.gov

    A rapid increase in prostate-specific antigen (PSA) levels is not grounds for automatically recommending a prostate biopsy, according to a study published online February 24 in the Journal of the National Cancer Institute. |

  1. Image-guided diagnosis of prostate cancer can increase detection of tumors

    Cancer.gov

    In the largest prospective study to date of image-guided technology for identifying suspicious regions of the prostate to biopsy, researchers compared the ability of this technology to detect high-risk prostate cancer with that of the current standard of

  2. Robotic Image-Guided Needle Interventions of the Prostate

    PubMed Central

    Mozer, Pierre C; Partin, Alan W; Stoianovici, Dan

    2009-01-01

    Prostate biopsy and needle-directed prostate therapies are currently performed free-handed or with needle external templates under ultrasound guidance. Direct image-guided intervention robots are modern instruments that have the potential to substantially enhance these procedures. These may increase the accuracy and repeatability with which needles are placed in the gland. The authors’ group has developed a robot for precise prostate targeting that operates remotely alongside the patient in the magnetic resonance imaging scanner, as guided according to the image. PMID:19390670

  3. NCCN Guidelines Insights: Prostate Cancer Early Detection, Version 2.2016.

    PubMed

    Carroll, Peter R; Parsons, J Kellogg; Andriole, Gerald; Bahnson, Robert R; Castle, Erik P; Catalona, William J; Dahl, Douglas M; Davis, John W; Epstein, Jonathan I; Etzioni, Ruth B; Farrington, Thomas; Hemstreet, George P; Kawachi, Mark H; Kim, Simon; Lange, Paul H; Loughlin, Kevin R; Lowrance, William; Maroni, Paul; Mohler, James; Morgan, Todd M; Moses, Kelvin A; Nadler, Robert B; Poch, Michael; Scales, Chuck; Shaneyfelt, Terrence M; Smaldone, Marc C; Sonn, Geoffrey; Sprenkle, Preston; Vickers, Andrew J; Wake, Robert; Shead, Dorothy A; Freedman-Cass, Deborah A

    2016-05-01

    The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prostate Cancer Early Detection provide recommendations for prostate cancer screening in healthy men who have elected to participate in an early detection program. The NCCN Guidelines focus on minimizing unnecessary procedures and limiting the detection of indolent disease. These NCCN Guidelines Insights summarize the NCCN Prostate Cancer Early Detection Panel's most significant discussions for the 2016 guideline update, which included issues surrounding screening in high-risk populations (ie, African Americans, BRCA1/2 mutation carriers), approaches to refine patient selection for initial and repeat biopsies, and approaches to improve biopsy specificity. PMID:27160230

  4. Imaging techniques for prostate cancer: implications for focal therapy

    PubMed Central

    Turkbey, Baris; Pinto, Peter A.; Choyke, Peter L.

    2012-01-01

    The multifocal nature of prostate cancer has necessitated whole-gland therapy in the past; however, since the widespread use of PSA screening, patients frequently present with less-advanced disease. Many men with localized disease wish to avoid the adverse effects of whole-gland therapy; therefore, focal therapy for prostate cancer is being considered as a treatment option. For focal treatment to be viable, accurate imaging is required for diagnosis, staging, and monitoring of treatment. Developments in MRI and PET have brought more attention to prostate imaging and the possibility of improving the accuracy of focal therapy. In this Review, we discuss the advantages and disadvantages of conventional methods for imaging the prostate, new developments for targeted imaging, and the possible role of image-guided biopsy and therapy for localized prostate cancer. PMID:19352394

  5. Surface-based prostate registration with biomechanical regularization

    NASA Astrophysics Data System (ADS)

    van de Ven, Wendy J. M.; Hu, Yipeng; Barentsz, Jelle O.; Karssemeijer, Nico; Barratt, Dean; Huisman, Henkjan J.

    2013-03-01

    Adding MR-derived information to standard transrectal ultrasound (TRUS) images for guiding prostate biopsy is of substantial clinical interest. A tumor visible on MR images can be projected on ultrasound by using MRUS registration. A common approach is to use surface-based registration. We hypothesize that biomechanical modeling will better control deformation inside the prostate than a regular surface-based registration method. We developed a novel method by extending a surface-based registration with finite element (FE) simulation to better predict internal deformation of the prostate. For each of six patients, a tetrahedral mesh was constructed from the manual prostate segmentation. Next, the internal prostate deformation was simulated using the derived radial surface displacement as boundary condition. The deformation field within the gland was calculated using the predicted FE node displacements and thin-plate spline interpolation. We tested our method on MR guided MR biopsy imaging data, as landmarks can easily be identified on MR images. For evaluation of the registration accuracy we used 45 anatomical landmarks located in all regions of the prostate. Our results show that the median target registration error of a surface-based registration with biomechanical regularization is 1.88 mm, which is significantly different from 2.61 mm without biomechanical regularization. We can conclude that biomechanical FE modeling has the potential to improve the accuracy of multimodal prostate registration when comparing it to regular surface-based registration.

  6. Localized Prostate Cancer

    MedlinePlus

    ... a decision aid for men with clinically localized prostate cancer (available at http://effectivehealthcare.ahrq.gov/prostate_da) ... A Decision Aid for Men With Clinically Localized Prostate Cancer Page 1 of 24 Introduction Men with clinically ...

  7. Prostate Cancer Prevention

    MedlinePlus

    ... finasteride who did have prostate cancer had more aggressive tumors . The number of deaths from prostate cancer ... men that did not. The number of less aggressive prostate cancers was lower, but the number of ...

  8. Prostate cancer

    MedlinePlus

    ... spread of the cancer. But it does not cure the cancer. If prostate cancer spreads even after hormone therapy, ... the Gleason score) when you are diagnosed. A cure is possible if the cancer has not spread. Hormone treatment can improve survival, ...

  9. Evaluation of prostatic cancer prevalence in patients with prostatic-specific antigen between 4 and 10 and normal digital rectal examination

    PubMed Central

    Tadayon, Farhad; Arezegar, Hamid Reza; Khorrami, Mohammad Hatef; Hashemi Juzdani, Rasoul; Shahdoost, Amir Abbas; Mellat, Mehdi

    2016-01-01

    Background: Prostate cancer is one of the most common male cancers. The prevalence of prostate cancer is different due to genetic and environmental factors. Diagnosis of prostate cancer is by biopsy due to prostate-specific antigen (PSA) and Digital Rectal Examination (DRE). Controversy about decision making for prostate biopsy in PSA between 4 and 10 and normal DRE, is one of the problems in this time. In this study we evaluated the prevalence of prostate cancer in males with PSA between 4 and 10 and normal DRE. We also evaluated the PSA density and percent of free PSA in patients with prostate cancer. Materials and Methods: A total of 121 males with PSA between 4 and 10 and normal DRE, were evaluated. Then, transrectal ultrasonography (TRUS) andprostate biopsy from 12 points of peripheral zone, was done. These data were analyzed by Chi-square, t-test and ANOVA and Roc curve. Results: In this study, the prevalence of prostate cancer in PSA between 4 and 10 and normal DRE, was evaluated, 29.8%. With use of Roc curve, PSA density cutoff point was calculated 0.12 and percent of free PSA cutoff point, was calculated, 18%. Conclusion: In males with PSA between 4 and 10 and normal DRE, PSA density smaller than 0.12-0.15, and percent of free PSA greater than 18%, the prevalence of prostate cancer is very few and we can safely ignore the TRUS and prostate biopsy in these males and eliminate its costs and side effects. PMID:27403407

  10. Renal biopsy: methods and interpretation.

    PubMed

    Vaden, Shelly L

    2004-07-01

    Renal biopsy most often is indicated in the management of dogs and cats with glomerular disease or acute renal failure. Renal biopsy can readily be performed in dogs and cats via either percutaneous or surgical methods. Care should be taken to ensure that proper technique is used. When proper technique is employed and patient factors are properly addressed, renal biopsy is a relatively safe procedure that minimally affects renal function. Patients should be monitored during the post biopsy period for severe hemorrhage, the most common complication. Accurate diagnosis of glomerular disease, and therefore, accurate treatment planning,requires that the biopsy specimens not only be evaluated by light microscopy using special stains but by electron and immunofluorescent microscopy. PMID:15223207

  11. Prostatitis and male infertility.

    PubMed

    Alshahrani, Saad; McGill, John; Agarwal, Ashok

    2013-11-01

    The prostate gland plays an important role in male reproduction. Inflammation of the prostate gland (prostatitis) is a common health problem affecting many young and middle aged men. Prostatitis is considered a correctable cause of male infertility, but the pathophysiology and appropriate treatment options of prostatitis in male infertility remain unclear. This literature review will focus on current data regarding prostatitis and its impact on male infertility.

  12. The pattern of prostate cancer local recurrence after radiation and salvage cryoablation

    PubMed Central

    Ng, Chee Kwan; Touma, Naji J.; Chalasani, Venu; Moussa, Madeleine; Downey, Donal B.; Chin, Joseph L.

    2011-01-01

    Objective: We assessed the pattern of local recurrence after salvage cryoablation of the prostate, and the impact of local recurrence on intermediate-term outcome. Methods: One hundred twenty-two patients who underwent salvage cryoablation were studied after a mean follow-up of 56 months. Serial prostate biopsy was carried out after cryoablation. The histopathology of prostate biopsies before and after cryoablation were compared. The prognostic value of post-cryoablation biopsy was assessed with the Cox regression method. Results: 23.1% of patients had a positive biopsy for prostate cancer following salvage cryoablation. Most cancer recurrences occurred in the apex (51.5%), base (21.2%) and seminal vesicles (18.2%). The presence of cancer at the base of the prostate was found to be a prognostic factor for eventual biochemical failure. Overall 5-year biochemical disease-free survival (bDFS) was 28%, however patients with cancer at the base of the prostate had a 5-year bDFS of 0%. Conclusion: Cancer recurrences occurred in areas where aggressive freezing was avoided as it might result in serious problems (e.g., urethro-rectal fistula and incontinence). Post-cryoablation biopsies and the location of persistent disease are of prognostic value. PMID:21251474

  13. [Detection of tumors in the central zone of the prostate with 11C-Choline PET/CT].

    PubMed

    Garcia, J R; Soler, M; Moragas, M; Ponce, A; Moreno, C; Riera, E

    2014-01-01

    Prostate tumors originate 68% in the peripheral region and 24% in the transitional region where tumors originating in the central zone are rare (8%). However, diagnosis of the tumors in the central zone is important since they exhibit greater aggressiveness conditioned by their location and different biological behavior. Magnetic resonance imaging shows problems in identifying lesions in the central prostate zone, since this region has a heterogeneous signal, mainly after the primary treatment. Ultrasound guided sextant biopsy shows a negative result in 28% of prostate tumors. Therefore, it is advisable to repeat or even to perform saturation biopsies. We present two patients, one of them with suspected biochemical prostate cancer and one with biochemical recurrence after radical treatment. In both, (11)C-Choline PET/CT allowed detection of the tumor focus in the central zone of the prostate, with negative complementary diagnostic test and biopsies. PMID:24119550

  14. Unsupervised segmentation of the prostate using MR images based on level set with a shape prior.

    PubMed

    Liu, Xin; Langer, D L; Haider, M A; Van der Kwast, T H; Evans, A J; Wernick, M N; Yetik, I S

    2009-01-01

    Prostate cancer is the second leading cause of cancer death in American men. Current prostate MRI can benefit from automated tumor localization to help guide biopsy, radiotherapy and surgical planning. An important step of automated prostate cancer localization is the segmentation of the prostate. In this paper, we propose a fully automatic method for the segmentation of the prostate. We firstly apply a deformable ellipse model to find an ellipse that best fits the prostate shape. Then, this ellipse is used to initiate the level set and constrain the level set evolution with a shape penalty term. Finally, certain post processing methods are applied to refine the prostate boundaries. We apply the proposed method to real diffusion-weighted (DWI) MRI images data to test the performance. Our results show that accurate segmentation can be obtained with the proposed method compared to human readers.

  15. Evolving Recommendations on Prostate Cancer Screening.

    PubMed

    Brawley, Otis W; Thompson, Ian M; Grönberg, Henrik

    2016-01-01

    Results of a number of studies demonstrate that the serum prostate-specific antigen (PSA) in and of itself is an inadequate screening test. Today, one of the most pressing questions in prostate cancer medicine is how can screening be honed to identify those who have life-threatening disease and need aggressive treatment. A number of efforts are underway. One such effort is the assessment of men in the landmark Prostate Cancer Prevention Trial that has led to a prostate cancer risk calculator (PCPTRC), which is available online. PCPTRC version 2.0 predicts the probability of the diagnosis of no cancer, low-grade cancer, or high-grade cancer when variables such as PSA, age, race, family history, and physical findings are input. Modern biomarker development promises to provide tests with fewer false positives and improved ability to find high-grade cancers. Stockholm III (STHLM3) is a prospective, population-based, paired, screen-positive, prostate cancer diagnostic study assessing a combination of plasma protein biomarkers along with age, family history, previous biopsy, and prostate examination for prediction of prostate cancer. Multiparametric MRI incorporates anatomic and functional imaging to better characterize and predict future behavior of tumors within the prostate. After diagnosis of cancer, several genomic tests promise to better distinguish the cancers that need treatment versus those that need observation. Although the new technologies are promising, there is an urgent need for evaluation of these new tests in high-quality, large population-based studies. Until these technologies are proven, most professional organizations have evolved to a recommendation of informed or shared decision making in which there is a discussion between the doctor and patient. PMID:27249774

  16. The high prevalence of undiagnosed prostate cancer at autopsy: implications for epidemiology and treatment of prostate cancer in the Prostate-specific Antigen-era.

    PubMed

    Jahn, Jaquelyn L; Giovannucci, Edward L; Stampfer, Meir J

    2015-12-15

    Widespread prostate-specific antigen (PSA) screening detects many cancers that would have otherwise gone undiagnosed. To estimate the prevalence of unsuspected prostate cancer, we reviewed 19 studies of prostate cancer discovered at autopsy among 6,024 men. Among men aged 70-79, tumor was found in 36% of Caucasians and 51% of African-Americans. This enormous prevalence, coupled with the high sensitivity of PSA screening, has led to the marked increase in the apparent incidence of prostate cancer. The impact of PSA screening on clinical practice is well-recognized, but its effect on epidemiologic research is less appreciated. Before screening, a larger proportion of incident prostate cancers had lethal potential and were diagnosed at advanced stage. However, in the PSA era, overall incident prostate cancer mainly is indolent disease, and often reflects the propensity to be screened and biopsied. Studies must therefore focus on cancers with lethal potential, and include long follow-up to accommodate the lead time induced by screening. Moreover, risk factor patterns differ markedly for potentially lethal and indolent disease, suggesting separate etiologies and distinct disease entities. Studies of total incident or indolent prostate cancer are of limited clinical utility, and the main focus of research should be on prostate cancers of lethal potential.

  17. Multiattribute probabilistic prostate elastic registration (MAPPER): Application to fusion of ultrasound and magnetic resonance imaging

    SciTech Connect

    Sparks, Rachel Barratt, Dean; Nicolas Bloch, B.; Feleppa, Ernest; Moses, Daniel; Ponsky, Lee; Madabhushi, Anant

    2015-03-15

    Purpose: Transrectal ultrasound (TRUS)-guided needle biopsy is the current gold standard for prostate cancer diagnosis. However, up to 40% of prostate cancer lesions appears isoechoic on TRUS. Hence, TRUS-guided biopsy has a high false negative rate for prostate cancer diagnosis. Magnetic resonance imaging (MRI) is better able to distinguish prostate cancer from benign tissue. However, MRI-guided biopsy requires special equipment and training and a longer procedure time. MRI-TRUS fusion, where MRI is acquired preoperatively and then aligned to TRUS, allows for advantages of both modalities to be leveraged during biopsy. MRI-TRUS-guided biopsy increases the yield of cancer positive biopsies. In this work, the authors present multiattribute probabilistic postate elastic registration (MAPPER) to align prostate MRI and TRUS imagery. Methods: MAPPER involves (1) segmenting the prostate on MRI, (2) calculating a multiattribute probabilistic map of prostate location on TRUS, and (3) maximizing overlap between the prostate segmentation on MRI and the multiattribute probabilistic map on TRUS, thereby driving registration of MRI onto TRUS. MAPPER represents a significant advancement over the current state-of-the-art as it requires no user interaction during the biopsy procedure by leveraging texture and spatial information to determine the prostate location on TRUS. Although MAPPER requires manual interaction to segment the prostate on MRI, this step is performed prior to biopsy and will not substantially increase biopsy procedure time. Results: MAPPER was evaluated on 13 patient studies from two independent datasets—Dataset 1 has 6 studies acquired with a side-firing TRUS probe and a 1.5 T pelvic phased-array coil MRI; Dataset 2 has 7 studies acquired with a volumetric end-firing TRUS probe and a 3.0 T endorectal coil MRI. MAPPER has a root-mean-square error (RMSE) for expert selected fiducials of 3.36 ± 1.10 mm for Dataset 1 and 3.14 ± 0.75 mm for Dataset 2. State

  18. Methylation in benign prostate and risk of disease progression in men subsequently diagnosed with prostate cancer.

    PubMed

    Rybicki, Benjamin A; Rundle, Andrew; Kryvenko, Oleksandr N; Mitrache, Nicoleta; Do, Kieu C; Jankowski, Michelle; Chitale, Dhananjay A; Trudeau, Sheri; Belinsky, Steven A; Tang, Deliang

    2016-06-15

    In DNA from prostate tumors, methylation patterns in gene promoter regions can be a biomarker for disease progression. It remains unclear whether methylation patterns in benign prostate tissue--prior to malignant transformation--may provide similar prognostic information. To determine whether early methylation events predict prostate cancer outcomes, we evaluated histologically benign prostate specimens from 353 men who eventually developed prostate cancer and received "definitive" treatment [radical prostatectomy (58%) or radiation therapy (42%)]. Cases were drawn from a large hospital-based cohort of men with benign prostate biopsy specimens collected between 1990 and 2002. Risk of disease progression associated with methylation was estimated using time-to-event analyses. Average follow-up was over 5 years; biochemical recurrence (BCR) occurred in 91 cases (26%). In White men, methylation of the APC gene was associated with increased risk of BCR, even after adjusting for standard clinical risk factors for prostate cancer progression (adjusted hazard ratio (aHR) = 2.26; 95%CI 1.23-4.16). APC methylation was most strongly associated with a significant increased risk of BCR in White men with low prostate specific antigen at cohort entry (HR = 3.66; 95%CI 1.51-8.85). In additional stratified analyses, we found that methylation of the RARB gene significantly increased risk of BCR in African American cases who demonstrated methylation of at least one of the other four genes under study (HR = 3.80; 95%CI 1.07-13.53). These findings may have implications in the early identification of aggressive prostate cancer as well as reducing unnecessary medical procedures and emotional distress for men who present with markers of indolent disease. PMID:26860439

  19. Methylation in benign prostate and risk of disease progression in men subsequently diagnosed with prostate cancer.

    PubMed

    Rybicki, Benjamin A; Rundle, Andrew; Kryvenko, Oleksandr N; Mitrache, Nicoleta; Do, Kieu C; Jankowski, Michelle; Chitale, Dhananjay A; Trudeau, Sheri; Belinsky, Steven A; Tang, Deliang

    2016-06-15

    In DNA from prostate tumors, methylation patterns in gene promoter regions can be a biomarker for disease progression. It remains unclear whether methylation patterns in benign prostate tissue--prior to malignant transformation--may provide similar prognostic information. To determine whether early methylation events predict prostate cancer outcomes, we evaluated histologically benign prostate specimens from 353 men who eventually developed prostate cancer and received "definitive" treatment [radical prostatectomy (58%) or radiation therapy (42%)]. Cases were drawn from a large hospital-based cohort of men with benign prostate biopsy specimens collected between 1990 and 2002. Risk of disease progression associated with methylation was estimated using time-to-event analyses. Average follow-up was over 5 years; biochemical recurrence (BCR) occurred in 91 cases (26%). In White men, methylation of the APC gene was associated with increased risk of BCR, even after adjusting for standard clinical risk factors for prostate cancer progression (adjusted hazard ratio (aHR) = 2.26; 95%CI 1.23-4.16). APC methylation was most strongly associated with a significant increased risk of BCR in White men with low prostate specific antigen at cohort entry (HR = 3.66; 95%CI 1.51-8.85). In additional stratified analyses, we found that methylation of the RARB gene significantly increased risk of BCR in African American cases who demonstrated methylation of at least one of the other four genes under study (HR = 3.80; 95%CI 1.07-13.53). These findings may have implications in the early identification of aggressive prostate cancer as well as reducing unnecessary medical procedures and emotional distress for men who present with markers of indolent disease.

  20. Diagnosis of Prostate Cancer Using Differentially Expressed Genes in Stroma

    PubMed Central

    Jia, Zhenyu; Wang, Yipeng; Sawyers, Anne; Yao, Huazhen; Rahmatpanah, Farahnaz; Xia, Xiao-Qin; Xu, Qiang; Pio, Rebecca; Turan, Tolga; Koziol, James A.; Goodison, Steve; Carpenter, Philip; Wang-Rodriquez, Jessica; Simoneau, Anne; Meyskens, Frank; Sutton, Manuel; Lernhardt, Waldemar; Beach, Thomas; Monforte, Joseph; McClelland, Michael; Mercola, Dan

    2011-01-01

    Over one million prostate biopsies are performed in the U.S. every year. A failure to find cancer is not definitive in a significant percentage of patients due to the presence of equivocal structures or continuing clinical suspicion. We have identified gene expression changes in stroma that can detect tumor nearby. We compared gene expression profiles of 13 biopsies containing stroma near tumor and 15 biopsies from volunteers without prostate cancer. About 3800 significant expression changes were found and thereafter filtered using independent expression profiles to eliminate possible age-related genes and genes expressed at detectable levels in tumor cells. A stroma-specific classifier for nearby tumor was constructed based on 114 candidate genes and tested on 364 independent samples, including 243 tumor-bearing samples and 121 non-tumor samples (normal biopsies, normal autopsies, remote stroma, as well as stroma within a few millimeters of tumor). The classifier predicted the tumor status of patients using tumor-free samples with an average accuracy of 97% (sensitivity = 98% and specificity = 88%) whereas classifiers trained with sets of 100 randomly generated genes had no diagnostic value. These results indicate that the prostate cancer microenvironment exhibits reproducible changes useful for categorizing the presence of tumor in patients when a prostate sample is derived from near the tumor but does not contain any recognizable tumor. PMID:21459804

  1. The relationship between histological prostatitis and lower urinary tract symptoms and sexual function

    PubMed Central

    Kumsar, Sukru; Kose, Osman; Aydemir, Huseyin; Halis, Fikret; Gokce, Ahmet; Adsan, Oztug; Akkaya, Zeynep Kahyaoglu

    2016-01-01

    ABSTRACT This prospective analysis assessed the effect of histological prostatitis on lower urinary tract functions and sexual function. The patients were separated into two groups as histologically observed prostatitis (Group A) and no prostatitis (Group B) according to the biopsy outcomes. International prostate symptom score, international index of erectile function-5 scores, maximal and average flow rate, and residual urine volumes were compared statistically between groups. There was no significant difference (P>0.05) in baseline age (t=0.64), body mass index value (t=0.51), prostate volume (t=0.87), prostate-specific antigen levels (t=0.43), maximal (t=0.84) and average flow rate (t=0.59), and post-void residual urine volume (t=0.71). Mean international prostate symptom score in patients with prostatitis was numerically but not significantly higher than that in those without prostatitis (t=0.794, P=0.066). Mean international index of erectile function-5 score in the prostatitis group was significantly lower than that in those without prostatitis (t=1.854, P=0.013). Histological prostatitis notably affected sexual function of patients and may serve as a major risk factor for sexual dysfunction while having little effect on lower urinary tract symptoms. PMID:27286118

  2. Prostate cancer marker panel with single cell sensitivity in urine

    PubMed Central

    Nickens, Kristen P.; Ali, Amina; Scoggin, Tatiana; Tan, Shyh‐Han; Ravindranath, Lakshmi; McLeod, David G.; Dobi, Albert; Tacha, David; Sesterhenn, Isabell A.; Srivastava, Shiv

    2015-01-01

    Background Over one million men undergo prostate biopsies annually in the United States, a majority of whom due to elevated serum PSA. More than half of the biopsies turn out to be negative for prostate cancer (CaP). The limitations of both the PSA test and the biopsy procedure have led to the development for more precise CaP detection assays in urine (e.g., PCA3, TMPRSS2‐ERG) or blood (e.g., PHI, 4K). Here, we describe the development and evaluation of the Urine CaP Marker Panel (UCMP) assay for sensitive and reproducible detection of CaP cells in post‐digital rectal examination (post‐DRE) urine. Methods The cellular content of the post‐DRE urine was captured on a translucent filter membrane, which is placed on Cytoclear slides for direct evaluation by microscopy and immuno‐cytochemistry (ICC). Cells captured on the membrane were assayed for PSA and Prostein expression to identify prostate epithelial cells, and for ERG and AMACR to identify prostate tumor cells. Immunostained cells were analyzed for quantitative and qualitative features and correlated with biopsy positive and negative status for malignancy. Results The assay was optimized for single cell capture sensitivity and downstream evaluations by spiking a known number of cells from established CaP cell lines, LNCaP and VCaP, into pre‐cleared control urine. The cells captured from the post‐DRE urine of subjects, obtained prior to biopsy procedure, were co‐stained for ERG, AMACR (CaP specific), and Prostein or PSA (prostate epithelium specific) rendering a whole cell based analysis and characterization. A feasibility cohort of 63 post‐DRE urine specimens was assessed. Comparison of the UCMP results with blinded biopsy results showed an assay sensitivity of 64% (16 of 25) and a specificity of 68.8% (22 of 32) for CaP detection by biopsy. Conclusions This pilot study assessing a minimally invasive CaP detection assay with single cell sensitivity cell‐capture and characterization from the

  3. Bone biopsy in haematological disorders.

    PubMed Central

    Burkhardt, R; Frisch, B; Bartl, R

    1982-01-01

    Bone marrow biopsies are now widely used in the investigation and follow-up of many diseases. Semi-thin sections of 8216 undecalcified biopsies of patients with haematological disorders were studied. Observations were made on the cytopenias and the myelodysplastic syndromes, the acute leukaemias the myeloproliferative disorders, Hodgkin's disease and the malignant lymphomas including multiple myeloma, hairy cell leukaemia and angioimmunoblastic lymphadenopathy. Bone marrow biopsies are essential for the differential diagnosis of most cytopenias and for the early recognition of fibrosis which most frequently occurred as a consequence of megakaryocytic proliferation in the myeloproliferative disorders. Different patterns of bone marrow involvement were found in the lymphoproliferative disorders and both their type and extent constituted factors of prognostic significance. A survey of the literature is given and the conclusion is drawn that bone marrow biopsies provide indispensible information for the diagnostic evaluation and the follow-up of patients with haematological disorders. Images PMID:7040489

  4. Gram stain of tissue biopsy

    MedlinePlus

    ... stain of tissue biopsy test involves using crystal violet stain to test a sample of tissue taken ... microscope slide. The specimen is stained with crystal violet stain and goes through more processing before it ...

  5. Experience with transjugular liver biopsy.

    PubMed Central

    Bull, H J; Gilmore, I T; Bradley, R D; Marigold, J H; Thompson, R P

    1983-01-01

    The results of 193 transjugular liver biopsies performed with a modified needle are described. An adequate specimen was obtained in 97%, and complications were rare, although puncture of the liver capsule does occur and caused bleeding in two patients. Fever after the procedure was reduced by ultrasonic cleaning of the needle. Although not easy, this technique is safe and preferable in the management of selected patients, but in most patients percutaneous biopsy is to be preferred. PMID:6629116

  6. Computer Aided Detection of Prostate Cancer Using T2, DWI and DCE MRI: Methods and Clinical Applications

    NASA Astrophysics Data System (ADS)

    Huisman, Henkjan; Vos, Pieter; Litjens, Geert; Hambrock, Thomas; Barentsz, Jelle

    One in 10 men will be diagnosed with prostate cancer during their life. PSA screening in combination with MR is likely to save lifes at low biopsy and overtreatment rates. Computer Aided Diagnosis for prostate MR will become mandatory in a high volume screening application. This paper presents an overview including our recent work in this area. It includes screening MR setup, quantitative imaging features, prostate segmentation, and pattern recognition.

  7. Prostate cancer: multiparametric MR imaging for detection, localization, and staging.

    PubMed

    Hoeks, Caroline M A; Barentsz, Jelle O; Hambrock, Thomas; Yakar, Derya; Somford, Diederik M; Heijmink, Stijn W T P J; Scheenen, Tom W J; Vos, Pieter C; Huisman, Henkjan; van Oort, Inge M; Witjes, J Alfred; Heerschap, Arend; Fütterer, Jurgen J

    2011-10-01

    This review presents the current state of the art regarding multiparametric magnetic resonance (MR) imaging of prostate cancer. Technical requirements and clinical indications for the use of multiparametric MR imaging in detection, localization, characterization, staging, biopsy guidance, and active surveillance of prostate cancer are discussed. Although reported accuracies of the separate and combined multiparametric MR imaging techniques vary for diverse clinical prostate cancer indications, multiparametric MR imaging of the prostate has shown promising results and may be of additional value in prostate cancer localization and local staging. Consensus on which technical approaches (field strengths, sequences, use of an endorectal coil) and combination of multiparametric MR imaging techniques should be used for specific clinical indications remains a challenge. Because guidelines are currently lacking, suggestions for a general minimal protocol for multiparametric MR imaging of the prostate based on the literature and the authors' experience are presented. Computer programs that allow evaluation of the various components of a multiparametric MR imaging examination in one view should be developed. In this way, an integrated interpretation of anatomic and functional MR imaging techniques in a multiparametric MR imaging examination is possible. Education and experience of specialist radiologists are essential for correct interpretation of multiparametric prostate MR imaging findings. Supportive techniques, such as computer-aided diagnosis are needed to obtain a fast, cost-effective, easy, and more reproducible prostate cancer diagnosis out of more and more complex multiparametric MR imaging data. PMID:21931141

  8. Prostate segmentation with local binary patterns guided active appearance models

    NASA Astrophysics Data System (ADS)

    Ghose, Soumya; Oliver, Arnau; Martí, Robert; Lladó, Xavier; Freixenet, Jordi; Vilanova, Joan C.; Meriaudeau, Fabrice

    2011-03-01

    Real-time fusion of Magnetic Resonance (MR) and Trans Rectal Ultra Sound (TRUS) images aid in the localization of malignant tissues in TRUS guided prostate biopsy. Registration performed on segmented contours of the prostate reduces computational complexity and improves the multimodal registration accuracy. However, accurate and computationally efficient segmentation of the prostate in TRUS images could be challenging in the presence of heterogeneous intensity distribution inside the prostate gland, and other imaging artifacts like speckle noise, shadow regions and low Signal to Noise Ratio (SNR). In this work, we propose to enhance the texture features of the prostate region using Local Binary Patterns (LBP) for the propagation of a shape and appearance based statistical model to segment the prostate in a multi-resolution framework. A parametric model of the propagating contour is derived from Principal Component Analysis (PCA) of the prior shape and texture information of the prostate from the training data. The estimated parameters are then modified with the prior knowledge of the optimization space to achieve an optimal segmentation. The proposed method achieves a mean Dice Similarity Coefficient (DSC) value of 0.94+/-0.01 and a mean segmentation time of 0.68+/-0.02 seconds when validated with 70 TRUS images of 7 datasets in a leave-one-patient-out validation framework. Our method performs computationally efficient and accurate prostate segmentation in the presence of intensity heterogeneities and imaging artifacts.

  9. Texture Guided Active Appearance Model Propagation for Prostate Segmentation

    NASA Astrophysics Data System (ADS)

    Ghose, Soumya; Oliver, Arnau; Martí, Robert; Lladó, Xavier; Freixenet, Jordi; Vilanova, Joan C.; Meriaudeau, Fabrice

    Fusion of Magnetic Resonance Imaging (MRI) and Trans Rectal Ultra Sound (TRUS) images during TRUS guided prostate biopsy improves localization of the malignant tissues. Segmented prostate in TRUS and MRI improve registration accuracy and reduce computational cost of the procedure. However, accurate segmentation of the prostate in TRUS images can be a challenging task due to low signal to noise ratio, heterogeneous intensity distribution inside the prostate, and imaging artifacts like speckle noise and shadow. We propose to use texture features from approximation coefficients of Haar wavelet transform for propagation of a shape and appearance based statistical model to segment the prostate in a multi-resolution framework. A parametric model of the propagating contour is derived from Principal Component Analysis of prior shape and texture informations of the prostate from the training data. The parameters are then modified with prior knowledge of the optimization space to achieve optimal prostate segmentation. The proposed method achieves a mean Dice Similarity Coefficient value of 0.95±0.01, and mean segmentation time of 0.72±0.05 seconds when validated on 25 TRUS images, grabbed from video sequences, in a leave-one-out validation framework. Our proposed model performs computationally efficient accurate prostate segmentation in presence of intensity heterogeneity and imaging artifacts.

  10. Penile Rehabilitation Strategies Among Prostate Cancer Survivors.

    PubMed

    Aoun, Fouad; Peltier, Alexandre; van Velthoven, Roland

    2015-01-01

    Despite advances in technical and surgical approaches, erectile dysfunction (ED) remains the most common complication among prostate cancer survivors, adversely impacting quality of life. This article analyzes the concept and rationale of ED rehabilitation programs in prostate cancer patients. Emphasis is placed on the pathophysiology of ED after diagnosis and treatment of prostate cancer to understand the efficacy of rehabilitation programs in clinical practice. Available evidence shows that ED is a transient complication following prostate biopsy and cancer diagnosis, with no evidence to support rehabilitation programs in these patients. A small increase in ED and in the use of phosphodiesterase type 5 (PDE5) inhibitors was reported in patients under active surveillance. Patients should be advised that active surveillance is unlikely to severely affect erectile function, but clinically significant changes in sexual function are possible. Focal therapy could be an intermediate option for patients demanding treatment/refusing active surveillance and invested in maintaining sexual activity. Unlike radical prostatectomy, there is no support for PDE5 inhibitor use to prevent ED after highly conformal external radiotherapy or low-dose rate brachytherapy. Despite progress in the understanding of the pathophysiologic mechanisms responsible for ED in prostate cancer patients, the success rates of rehabilitation programs remain low in clinical practice. Alternative strategies to prevent ED appear warranted, with attention toward neuromodulation, nerve grafting, nerve preservation, stem cell therapy, investigation of neuroprotective interventions, and further refinements of radiotherapy dosing and delivery methods. PMID:27222641

  11. Penile Rehabilitation Strategies Among Prostate Cancer Survivors

    PubMed Central

    Aoun, Fouad; Peltier, Alexandre; van Velthoven, Roland

    2015-01-01

    Despite advances in technical and surgical approaches, erectile dysfunction (ED) remains the most common complication among prostate cancer survivors, adversely impacting quality of life. This article analyzes the concept and rationale of ED rehabilitation programs in prostate cancer patients. Emphasis is placed on the pathophysiology of ED after diagnosis and treatment of prostate cancer to understand the efficacy of rehabilitation programs in clinical practice. Available evidence shows that ED is a transient complication following prostate biopsy and cancer diagnosis, with no evidence to support rehabilitation programs in these patients. A small increase in ED and in the use of phosphodiesterase type 5 (PDE5) inhibitors was reported in patients under active surveillance. Patients should be advised that active surveillance is unlikely to severely affect erectile function, but clinically significant changes in sexual function are possible. Focal therapy could be an intermediate option for patients demanding treatment/refusing active surveillance and invested in maintaining sexual activity. Unlike radical prostatectomy, there is no support for PDE5 inhibitor use to prevent ED after highly conformal external radiotherapy or low-dose rate brachytherapy. Despite progress in the understanding of the pathophysiologic mechanisms responsible for ED in prostate cancer patients, the success rates of rehabilitation programs remain low in clinical practice. Alternative strategies to prevent ED appear warranted, with attention toward neuromodulation, nerve grafting, nerve preservation, stem cell therapy, investigation of neuroprotective interventions, and further refinements of radiotherapy dosing and delivery methods. PMID:27222641

  12. Model-supported virtual environment for prostate cancer pattern analysis

    NASA Astrophysics Data System (ADS)

    Yu, Ping; McClain, Maxine A.; Xuan, Jianhua; Wang, Yue J.; Sesterhenn, Isabell A.; Moul, Judd W.; Zhang, Wei; Mun, Seong K.

    1999-05-01

    As a step toward understanding complex spatial distribution patterns of prostate cancers, a 3D master model of the prostate, showing major anatomical structures and probability maps of the location of tumors, has been pilot developed. A virtual environment supported by the 3D master model and in vivo imaging features, will be used to evaluate, simulate, and optimize the image guided needle biopsy and radiation therapy, thus potentially improving the efficacy of prostate cancer diagnosis, staging, and treatment. A deformable graphics algorithm has been developed to reconstruct the graphics models from 200 serially sectioned whole mount radical prostatectomy specimens and to support computerized needle biopsy simulations. For the construction of a generic model, a principal-axes 3D registration technique has been developed. Simulated evaluation and real data experiment have shown the satisfactory performance of the method in constructing initial generic model with localized prostate cancer placement. For the construction of statistical model, a blended model registration technique is advanced to perform a non-linear warping of the individual model to the generic model so that the prostate cancer probability distribution maps can be accurately positioned. The method uses a spine- surface model and a linear elastic model to dynamically deform both the surface and volume where object re-slicing is required. For the interactive visualization of the 3D master model, four modes of data display are developed: (1) transparent rendering of the generic model, (2) overlaid rendering of cancer distributions, (3) stereo rendering, and (4) true volumetric display, and a model-to-image registration technique using synthetic image phantoms is under investigation. Preliminary results have shown that use of this master model allows correct understanding of prostate cancer distribution patterns and rational optimization of prostate biopsy and radiation therapy strategies.

  13. Transurethral resection of the prostate

    MedlinePlus

    TURP; Prostate resection - transurethral ... used to remove the inside part of your prostate gland using electricity. ... if you have benign prostatic hyperplasia ( BPH ). The prostate gland often grows larger as men get older. ...

  14. Statistical modeling and visualization of localized prostate cancer

    NASA Astrophysics Data System (ADS)

    Wang, Yue J.; Xuan, Jianhua; Sesterhenn, Isabell A.; Hayes, Wendelin S.; Ebert, David S.; Lynch, John H.; Mun, Seong K.

    1997-05-01

    In this paper, a statistically significant master model of localized prostate cancer is developed with pathologically- proven surgical specimens to spatially guide specific points in the biopsy technique for a higher rate of prostate cancer detection and the best possible representation of tumor grade and extension. Based on 200 surgical specimens of the prostates, we have developed a surface reconstruction technique to interactively visualize in the clinically significant objects of interest such as the prostate capsule, urethra, seminal vesicles, ejaculatory ducts and the different carcinomas, for each of these cases. In order to investigate the complex disease pattern including the tumor distribution, volume, and multicentricity, we created a statistically significant master model of localized prostate cancer by fusing these reconstructed computer models together, followed by a quantitative formulation of the 3D finite mixture distribution. Based on the reconstructed prostate capsule and internal structures, we have developed a technique to align all surgical specimens through elastic matching. By labeling the voxels of localized prostate cancer by '1' and the voxels of other internal structures by '0', we can generate a 3D binary image of the prostate that is simply a mutually exclusive random sampling of the underlying distribution f cancer to gram of localized prostate cancer characteristics. In order to quantify the key parameters such as distribution, multicentricity, and volume, we used a finite generalized Gaussian mixture to model the histogram, and estimate the parameter values through information theoretical criteria and a probabilistic self-organizing mixture. Utilizing minimally-immersive and stereoscopic interactive visualization, an augmented reality can be developed to allow the physician to virtually hold the master model in one hand and use the dominant hand to probe data values and perform a simulated needle biopsy. An adaptive self- organizing

  15. Correlation between Gleason Scores in Needle Biopsy and Corresponding Radical Prostatectomy Specimens: A Twelve-Year Review

    PubMed Central

    Khoddami, Maliheh; Khademi, Yassaman; Kazemi Aghdam, Maryam; Soltanghoraee, Haleh

    2016-01-01

    Background: Presence of discordance between the Gleason score on needle biopsy and the score of radical prostatectomy specimen is common and universal. In this study, we determined the accuracy of Gleason grading of biopsies in predicting histological grading of radical prostatectomy specimens and the degree of overgrading and undergrading of prostatic adenocarcinoma in our center, which is one of the referral centers in Tehran. Methods: In this retrospective study, we analyzed the results of prostate needle biopsies and subsequent prostatectomies diagnosed at the Pathobiology Laboratory Center, Tehran, Iran in 45 patients between 2002 and 2013. Preoperative clinical data and the information from biopsy and prostatectomy specimens were collected. The accuracy, sensitivity, specificity, and positive and negative predictive values of different grades and groups were assessed. Pearson and Spearman correlation coefficient were used to determine the relation of different variables. Results: The biopsy Gleason score was identical to the scores in prostatectomy specimens in 68.2% cases, while 31.8% were discrepant by 1 or 2 Gleason score. We had 9.1% downgrading and 22.7% cases upgraded after prostatectomy. The sensitivity and positive predictive value was 86% and 79% for low grade, 67% and 75% for moderate grade, and 80% and 80% for high-grade tumors, respectively. Conclusion: Overall, the reliability of Gleason grading of needle biopsies in predicting final pathology was satisfavory. Moderate grade group was the most difficult to diagnose in needle biopsy. PMID:27499772

  16. The Role of Anxiety in Prostate Carcinoma

    PubMed Central

    Dale, William; Bilir, Pinar; Han, Misop; Meltzer, David

    2010-01-01

    Although the impact of anxiety on patients with some types of cancer is well recognized, to the authors knowledge its impact on patients with prostate carcinoma has not been studied as thoroughly. The authors conducted a systematic review of the medical literature for high-quality articles that quantified anxiety levels in men with prostate carcinoma and identified 29 articles. Using the clinical timeline of prostate carcinoma to organize the articles, cross-sectional studies that reflected anxiety prevalence in populations and longitudinal studies that reflected changes in anxiety over time were identified. Anxiety appeared to fluctuate over the clinical timeline in response to stressors and uncertainty (such as at the time of screening and/or biopsy), rising before these times and falling afterward. Although anxiety levels in men age > 55 years who were at risk for prostate carcinoma were modest (10–15%), multiple studies found that these levels were substantially higher in men who presented for screening (> 50%), and “seeking peace of mind” was the motivation cited most frequently for pursuing screening. Most studies demonstrated a significant decrease in anxiety levels after a normal screening or biopsy result, although the proportion of men who remained anxious afterward did not fall to baseline levels (20–36%). Men who presented for prostate-specific antigen monitoring after treatment had elevated anxiety levels at the time of testing (23–33%). Many years after therapy for localized disease, anxiety levels were lower after prostatectomy (23%) compared with the levels after watchful waiting (31%). PMID:15959911

  17. [Flexible bronchoscopy techniques: bronchoalveolar lavage, bronchial biopsy and transbronchial biopsy].

    PubMed

    Escribano Montaner, A; Moreno Galdó, A

    2005-04-01

    This article completes previous recommendations of the Techniques Group of the Spanish Society of Pediatric Pulmonologists on the practice of flexible bronchoscopy in children. We review the most frequently performed diagnostic and therapeutic procedures applied through the flexible bronchoscope: bronchoalveolar lavage, bronchial biopsy and transbronchial biopsy. Recommendations are also provided on the practice of nonbronchoscopic bronchoalveolar lavage. We review the indications and contraindications of these techniques, the equipment required, and the preparation and monitoring of the patient before, during and after the procedure. The complications of these techniques are also discussed. These recommendations may be adopted, modified or rejected according to clinical needs and constraints.

  18. Body mass index in relation to serum prostate-specific antigen levels and prostate cancer risk.

    PubMed

    Bonn, Stephanie E; Sjölander, Arvid; Tillander, Annika; Wiklund, Fredrik; Grönberg, Henrik; Bälter, Katarina

    2016-07-01

    High Body mass index (BMI) has been directly associated with risk of aggressive or fatal prostate cancer. One possible explanation may be an effect of BMI on serum levels of prostate-specific antigen (PSA). To study the association between BMI and serum PSA as well as prostate cancer risk, a large cohort of men without prostate cancer at baseline was followed prospectively for prostate cancer diagnoses until 2015. Serum PSA and BMI were assessed among 15,827 men at baseline in 2010-2012. During follow-up, 735 men were diagnosed with prostate cancer with 282 (38.4%) classified as high-grade cancers. Multivariable linear regression models and natural cubic linear regression splines were fitted for analyses of BMI and log-PSA. For risk analysis, Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) and natural cubic Cox regression splines producing standardized cancer-free probabilities were fitted. Results showed that baseline Serum PSA decreased by 1.6% (95% CI: -2.1 to -1.1) with every one unit increase in BMI. Statistically significant decreases of 3.7, 11.7 and 32.3% were seen for increasing BMI-categories of 25 < 30, 30 < 35 and ≥35 kg/m(2), respectively, compared to the reference (18.5 < 25 kg/m(2)). No statistically significant associations were seen between BMI and prostate cancer risk although results were indicative of a positive association to incidence rates of high-grade disease and an inverse association to incidence of low-grade disease. However, findings regarding risk are limited by the short follow-up time. In conclusion, BMI was inversely associated to PSA-levels. BMI should be taken into consideration when referring men to a prostate biopsy based on serum PSA-levels.

  19. Extended use of Prostate Health Index and percentage of [-2]pro-prostate-specific antigen in Chinese men with prostate specific antigen 10–20 ng/mL and normal digital rectal examination

    PubMed Central

    Chiu, Peter Ka-Fung; Teoh, Jeremy Yuen-Chun; Lee, Wai-Man; Yee, Chi-Hang; Chan, Eddie Shu-Yin; Hou, See-Ming

    2016-01-01

    Purpose We investigated the extended use of Prostate Health Index (PHI) and percentage of [-2]pro-prostate-specific antigen (%p2PSA) in Chinese men with prostate-specific antigen (PSA) 10–20 ng/mL and normal digital rectal examination (DRE). Materials and Methods All consecutive Chinese men with PSA 10–20 ng/mL and normal DRE who agreed for transrectal ultrasound (TRUS)-guided 10-core prostate biopsy were recruited. Blood samples were taken immediately before TRUS-guided prostate biopsy. The performances of total PSA (tPSA), %free-to-total PSA (%fPSA), %p2PSA, and PHI were compared using logistic regression, receiver operating characteristic, and decision curve analyses (DCA). Results From 2008 to 2015, 312 consecutive Chinese men were included. Among them, 53 out of 312 (17.0%) men were diagnosed to have prostate cancer on biopsy. The proportions of men with positive biopsies were 6.7% in PHI<35, 22.8% in PHI 35–55, and 54.5% in PHI>55 (chi-square test, p<0.001). The area under curves (AUC) of the base model including age, tPSA and status of initial/repeated biopsy was 0.64. Adding %p2PSA and PHI to the base model improved the AUC to 0.79 (p<0.001) and 0.78 (p<0.001), respectively, and provided net clinical benefit in DCA. The positive biopsy rates of Gleason 7 or above prostate cancers were 2.2% for PHI<35, 7.9% for PHI 35–55, and 36.4% for PHI>55 (chi-square test, p<0.001). By utilizing the PHI cutoff of 35 to men with PSA 10–20 ng/mL and normal DRE, 57.1% (178 of 312) biopsies could be avoided. Conclusions Both PHI and %p2PSA performed well in predicting prostate cancer and high grade prostate cancer. The use of PHI and %p2PSA should be extended to Chinese men with PSA 10–20 ng/mL and normal DRE. PMID:27617315

  20. Extended use of Prostate Health Index and percentage of [-2]pro-prostate-specific antigen in Chinese men with prostate specific antigen 10–20 ng/mL and normal digital rectal examination

    PubMed Central

    Chiu, Peter Ka-Fung; Teoh, Jeremy Yuen-Chun; Lee, Wai-Man; Yee, Chi-Hang; Chan, Eddie Shu-Yin; Hou, See-Ming

    2016-01-01

    Purpose We investigated the extended use of Prostate Health Index (PHI) and percentage of [-2]pro-prostate-specific antigen (%p2PSA) in Chinese men with prostate-specific antigen (PSA) 10–20 ng/mL and normal digital rectal examination (DRE). Materials and Methods All consecutive Chinese men with PSA 10–20 ng/mL and normal DRE who agreed for transrectal ultrasound (TRUS)-guided 10-core prostate biopsy were recruited. Blood samples were taken immediately before TRUS-guided prostate biopsy. The performances of total PSA (tPSA), %free-to-total PSA (%fPSA), %p2PSA, and PHI were compared using logistic regression, receiver operating characteristic, and decision curve analyses (DCA). Results From 2008 to 2015, 312 consecutive Chinese men were included. Among them, 53 out of 312 (17.0%) men were diagnosed to have prostate cancer on biopsy. The proportions of men with positive biopsies were 6.7% in PHI<35, 22.8% in PHI 35–55, and 54.5% in PHI>55 (chi-square test, p<0.001). The area under curves (AUC) of the base model including age, tPSA and status of initial/repeated biopsy was 0.64. Adding %p2PSA and PHI to the base model improved the AUC to 0.79 (p<0.001) and 0.78 (p<0.001), respectively, and provided net clinical benefit in DCA. The positive biopsy rates of Gleason 7 or above prostate cancers were 2.2% for PHI<35, 7.9% for PHI 35–55, and 36.4% for PHI>55 (chi-square test, p<0.001). By utilizing the PHI cutoff of 35 to men with PSA 10–20 ng/mL and normal DRE, 57.1% (178 of 312) biopsies could be avoided. Conclusions Both PHI and %p2PSA performed well in predicting prostate cancer and high grade prostate cancer. The use of PHI and %p2PSA should be extended to Chinese men with PSA 10–20 ng/mL and normal DRE.

  1. PDEF in prostate cancer.

    PubMed

    Sood, Ashwani K; Kim, Hyung; Geradts, Joseph

    2012-05-01

    Prostate-derived Ets factor (PDEF) is a relatively recently described member of the Ets family of transcription factors. It differs from other family members in its restricted and epithelial-specific expression in normal tissues and its unique DNA-binding motif that together may impart interesting specificity to its function. This communication reviews our current understanding of the expression characteristics of PDEF in normal prostate and in prostate cancer. Also, the biochemical and genetic evidence relating to the role of this transcription factor in prostate cancer is reviewed. Most evidence is consistent with an oncogenic role for PDEF in prostate cancer. Specific observations about the loss of PDEF expression in prostate tumors and its apparent role as a prostate tumor suppressor are also discussed. PDEF is one of the few transcription factors with potential to have a significant impact on the management of prostate cancer. A better understanding of its biology and its role in prostate cancer is urgently needed.

  2. Prostate kallikrein markers in diagnosis, risk stratification and prognosis

    PubMed Central

    Ulmert, David; O’Brien, M. Frank; Bjartell, Anders S.; Lilja, Hans

    2015-01-01

    Summary The kallikrein, prostate-specific antigen (PSA), is one of the world’s most frequently used disease biomarkers. After almost two decades of research and clinical experience, we are now starting to comprehend its diagnostic and monitoring limitations. Most physicians are aware of PSA’s low cancer-specificity among older men with benign prostatic conditions, but fewer are aware of recent data showing that a prior negative biopsy or a prior PSA below cut-off may have even stronger negative impact. Furthermore, a subtle PSA rise at early middle age strongly correlates to prostate cancer of unquestionable significance. We thoroughly review current and past reports on prostate kallikreins in relation to pathology and epidemiology. PMID:19578355

  3. Morphofunctional analysis of the prostate exposed to chemical manufacture factors.

    PubMed

    Lapii, G A; Nepomnyashchikh, L M; Kiptilov, A V; Neimark, A I

    2014-07-01

    The structural characteristics of the prostate and the blood flow in the organ were studied in chemical plant workers suffering from chronic prostatitis. The prostate echostructure was characterized by vast zones of fibrosis and calcinosis, the hemodynamic ultrasonic parameters were low. Degenerative changes in the acinar structures and stromal fibrosis predominated in the biopsy specimens, these shifts were the most pronounced in the peripheral and transitory zones. Foci of common and small-acinar degeneration of the glands, abundant concrements, and significant collagenization with periglandular and perivascular sclerosis without or with slight inflammatory infiltration were detected. We hypothesize that long exposure to adverse factors of sulfuric acid manufacture contributed to the development of pathological changes in the prostate.

  4. Oral biopsy: oral pathologist's perspective.

    PubMed

    Kumaraswamy, K L; Vidhya, M; Rao, Prasanna Kumar; Mukunda, Archana

    2012-01-01

    Many oral lesions may need to be diagnosed by removing a sample of tissue from the oral cavity. Biopsy is widely used in the medical field, but the practice is not quite widespread in dental practice. As oral pathologists, we have found many artifacts in the tissue specimen because of poor biopsy technique or handling, which has led to diagnostic pitfalls and misery to both the patient and the clinician. This article aims at alerting the clinicians about the clinical faults arising preoperatively, intraoperatively and postoperatively while dealing with oral biopsy that may affect the histological assessment of the tissue and, therefore, the diagnosis. It also reviews the different techniques, precautions and special considerations necessary for specific lesions.

  5. Pancreatic cancer: Are "liquid biopsies" ready for prime-time?

    PubMed

    Lewis, Alexandra R; Valle, Juan W; McNamara, Mairead G

    2016-08-28

    Pancreatic cancer is a disease that carries a poor prognosis. Accurate tissue diagnosis is required. Tumours contain a high content of stromal tissue and therefore biopsies may be inconclusive. Circulating tumour cells (CTCs) have been investigated as a potential "liquid biopsy" in several malignancies and have proven to be of prognostic value in breast, prostate and colorectal cancers. They have been detected in patients with localised and metastatic pancreatic cancer with sensitivities ranging from 38%-100% using a variety of platforms. Circulating tumour DNA (ctDNA) has also been detected in pancreas cancer with a sensitivity ranging from 26%-100% in studies across different platforms and using different genetic markers. However, there is no clear consensus on which platform is the most effective for detection, nor which genetic markers are the most useful to use. Potential roles of liquid biopsies include diagnosis, screening, guiding therapies and prognosis. The presence of CTCs or ctDNA has been shown to be of prognostic value both at diagnosis and after treatment in patients with pancreatic cancer. However, more prospective studies are required before this promising technology is ready for adoption into routine clinical practice. PMID:27621566

  6. Pancreatic cancer: Are "liquid biopsies" ready for prime-time?

    PubMed

    Lewis, Alexandra R; Valle, Juan W; McNamara, Mairead G

    2016-08-28

    Pancreatic cancer is a disease that carries a poor prognosis. Accurate tissue diagnosis is required. Tumours contain a high content of stromal tissue and therefore biopsies may be inconclusive. Circulating tumour cells (CTCs) have been investigated as a potential "liquid biopsy" in several malignancies and have proven to be of prognostic value in breast, prostate and colorectal cancers. They have been detected in patients with localised and metastatic pancreatic cancer with sensitivities ranging from 38%-100% using a variety of platforms. Circulating tumour DNA (ctDNA) has also been detected in pancreas cancer with a sensitivity ranging from 26%-100% in studies across different platforms and using different genetic markers. However, there is no clear consensus on which platform is the most effective for detection, nor which genetic markers are the most useful to use. Potential roles of liquid biopsies include diagnosis, screening, guiding therapies and prognosis. The presence of CTCs or ctDNA has been shown to be of prognostic value both at diagnosis and after treatment in patients with pancreatic cancer. However, more prospective studies are required before this promising technology is ready for adoption into routine clinical practice.

  7. Prostate Cancer Specificity of PCA3 Gene Testing: Examples from Clinical Practice

    PubMed Central

    Marks, Leonard S; Bostwick, David G

    2008-01-01

    A specific marker for early prostate cancer would fill an important void. In initial evaluations of the prostate cancer antigen 3 (PCA3) gene vis-à-vis serum prostate-specific antigen (PSA) levels, the gene offers great promise. At the cellular level, PCA3 specificity for cancer is nearly perfect because of the gross overexpression of the gene by cancer cells. As a clinical test for early prostate cancer, heightened specificity is also seen in urine containing prostate cells from men with the disease. PCA3 gene testing holds valuable potential in PSA quandary situations: (1) men with elevated PSA levels but no cancer on initial biopsy; (2) men found to have cancer despite normal levels of PSA; (3) men with PSA elevations associated with varying degrees of prostatitis; and (4) men undergoing active surveillance for presumed microfocal disease. PMID:18836536

  8. The characteristics and spatial distributions of initially missed and rebiopsy-detected prostate cancers

    PubMed Central

    2016-01-01

    Purpose: The purpose of this study was to analyze the characteristics of initially missed and rebiopsy-detected prostate cancers following 12-core transrectal biopsy. Methods: A total of 45 patients with prostate cancers detected on rebiopsy and 45 patients with prostate cancers initially detected on transrectal ultrasound-guided biopsy were included in the study. For result analysis, the prostate was divided into six compartments, and the cancer positive rates, estimated tumor burden, and agreement rates between biopsy and surgical specimens, along with clinical data, were evaluated. Results: The largest mean tumor burden was located in the medial apex in both groups. There were significantly more tumors in this location in the rebiopsy group (44.9%) than in the control group (30.1%, P=0.015). The overall sensitivity of biopsy was significantly lower in the rebiopsy group (22.5% vs. 43.4%, P<0.001). The agreement rate of cancer positive cores between biopsy and surgical specimens was significantly lower in the medial apex in the rebiopsy group compared with that of the control group (50.0% vs. 65.6%, P=0.035). The cancer positive rates of target biopsy cores and premalignant lesions in the rebiopsy group were 63.1% and 42.3%, respectively. Conclusion: Rebiopsy-detected prostate cancers showed different spatial distribution and lower cancer detection rate of biopsy cores compared with initially diagnosed cancers. To overcome lower cancer detection rate, target biopsy of abnormal sonographic findings, premalignant lesions and medial apex which revealed larger tumor burden would be recommended when performing rebiopsy. PMID:27048261

  9. An approach to duodenal biopsies

    PubMed Central

    Serra, S; Jani, P A

    2006-01-01

    The introduction of endoscopy of the upper digestive tract as a routine diagnostic procedure has increased the number of duodenal biopsy specimens. Consequently, the pathologist is often asked to evaluate them. In this review, a practical approach to the evaluation of a duodenal biopsy specimen is discussed. An overview of the handling of specimens is given and the normal histology and commonly encountered diseases are discussed. Finally, a description of commonly seen infections is provided, together with an algorithmic approach for diagnosis. PMID:16679353

  10. Danish Prostate Cancer Registry – methodology and early results from a novel national database

    PubMed Central

    Helgstrand, JT; Klemann, N; Røder, MA; Toft, BG; Brasso, K; Vainer, B; Iversen, P

    2016-01-01

    Background Systematized Nomenclature of Medicine (SNOMED) codes are computer-processable medical terms used to describe histopathological evaluations. SNOMED codes are not readily usable for analysis. We invented an algorithm that converts prostate SNOMED codes into an analyzable format. We present the methodology and early results from a new national Danish prostate database containing clinical data from all males who had evaluation of prostate tissue from 1995 to 2011. Materials and methods SNOMED codes were retrieved from the Danish Pathology Register. A total of 26,295 combinations of SNOMED codes were identified. A computer algorithm was developed to transcode SNOMED codes into an analyzable format including procedure (eg, biopsy, transurethral resection, etc), diagnosis, and date of diagnosis. For validation, ~55,000 pathological reports were manually reviewed. Prostate-specific antigen, vital status, causes of death, and tumor-node-metastasis classification were integrated from national registries. Results Of the 161,525 specimens from 113,801 males identified, 83,379 (51.6%) were sets of prostate biopsies, 56,118 (34.7%) were transurethral/transvesical resections of the prostate (TUR-Ps), and the remaining 22,028 (13.6%) specimens were derived from radical prostatectomies, bladder interventions, etc. A total of 48,078 (42.2%) males had histopathologically verified prostate cancer, and of these, 78.8% and 16.8% were diagnosed on prostate biopsies and TUR-Ps, respectively. Future perspectives A validated algorithm was successfully developed to convert complex prostate SNOMED codes into clinical useful data. A unique database, including males with both normal and cancerous histopathological data, was created to form the most comprehensive national prostate database to date. Potentially, our algorithm can be used for conversion of other SNOMED data and is available upon request. PMID:27729813

  11. Role for 11C-choline PET in active surveillance of prostate cancer

    PubMed Central

    Boychak, Oleksandr; Vos, Larissa; Makis, William; Buteau, Francois-Alexandre; Pervez, Nadeem; Parliament, Matthew; McEwan, Alexander J.B.; Usmani, Nawaid

    2015-01-01

    Introduction: Active surveillance (AS) is an increasingly popular management strategy for men diagnosed with low-risk indolent prostate cancer. Current tests (prostate-specific antigen [PSA], clinical staging, and prostate biopsies) to monitor indolent disease lack accuracy. 11C-choline positron emission tomography (PET) has excellent detection rates in local and distant recurrence of prostate cancer. We examine 11C-choline PET for identifying aggressive prostate cancer warranting treatment in the AS setting. Methods: In total, 24 patients on AS had clinical assessment and PSA testing every 6 months and 11C-choline PET and prostate biopsies annually. The sensitivity and specificity to identify prostate cancer and progressive disease (PD) were calculated for each 11C-choline PET scan. Results: In total, 62 biopsy-paired, serial 11C-choline PET scans were analyzed using a series of standard uptake value-maximum (SUVmax) cut-off thresholds. During follow-up (mean 25.3 months), 11 of the 24 low-risk prostate cancer patients developed PD and received definitive treatment. The prostate cancer detection rate with 11C-choline PET had moderate sensitivity (72.1%), but low specificity (45.0%). PD prediction from baseline 11C-choline PET had satisfactory sensitivity (81.8%), but low specificity (38.5%). The addition of clinical parameters to the baseline 11C-choline PET improved specificity (69.2%), with a slight reduction in sensitivity (72.7%) for PD prediction. Conclusions: Addition of 11C-choline PET imaging during AS may help to identify aggressive disease earlier than traditional methods. However, 11C-choline PET alone has low specificity due to overlap of SUV values with benign pathologies. Triaging low-risk prostate cancer patients into AS versus therapy will require further optimization of PET protocols or consideration of alternative strategies (i.e., magnetic resonance imaging, biomarkers). PMID:25844108

  12. Prostate-Specific Antigen: Any Successor in Sight?

    PubMed Central

    Obort, Aniebietabasi S; Ajadi, Mary B; Akinloye, Oluyemi

    2013-01-01

    Abstract Prostate cancer (PCa) is the most frequently diagnosed malignancy and the second leading cause of cancer death in men in the United States and other parts of the world. The lifetime risk of being diagnosed with PCa is approximately 16%. At present, the only widely accepted screening tools for PCa are prostate-specific antigen (PSA) and digital rectal examination. PSA is known to be prostate specific, but not PCa specific, and hence lacks the sensitivity to detect a large number of tumors, especially during the early stages. The PSA level is also known to be affected by many factors, such as medication, inflammation (benign prostatic hyperplasia and prostatitis), and urologic manipulation; hence, the controversy regarding the appropriate level of serum PSA that should trigger a biopsy or have clinical relevance to prostate metastases. Attempts to determine the level of prostate cells in peripheral blood by reverse transcriptase polymerase chain reaction did not significantly improve cancer diagnosis or predict postoperative failure. Therefore, the search continues for a novel biomarker or a panel of markers as well as other possible interventions to improve the use of PSA. This article reviews several possibilities. PMID:24223021

  13. Vacuum enhanced cutaneous biopsy instrument

    DOEpatents

    Collins, Joseph

    2000-01-01

    A syringe-like disposable cutaneous biopsy instrument equipped with a tubular blade at its lower end, and designed so that a vacuum is created during use, said vacuum serving to retain undeformed a plug of tissue cut from a patient's skin.

  14. Biopsy techniques for intraocular tumors

    PubMed Central

    Rishi, Pukhraj; Dhami, Abhinav; Biswas, Jyotirmay

    2016-01-01

    Biopsy involves the surgical removal of a tissue specimen for histopathologic evaluation. Most intraocular tumors are reliably diagnosed based on the clinical evaluation or with noninvasive diagnostic techniques. However, accurately diagnosing a small percentage of tumors can be challenging. A tissue biopsy is thus needed to establish a definitive diagnosis and plan the requisite treatment. From fine-needle aspiration biopsy (FNAB) to surgical excision, all tissue collection techniques have been studied in the literature. Each technique has its indications and limitations. FNAB has been reported to provide for 88–95% reliable and safe ophthalmic tumor diagnosis and has gained popularity for prognostic purposes and providing eye conserving treatment surgeries. The technique and instrumentation for biopsy vary depending upon the tissue involved (retina, choroid, subretinal space, vitreous, and aqueous), suspected diagnosis, size, location, associated retinal detachment, and clarity of the media. The cytopathologist confers a very important role in diagnosis and their assistance plays a key role in managing and planning the treatment for malignancies. PMID:27488148

  15. Vacuum Enhanced Cutaneous Biopsy Instrument

    SciTech Connect

    Collins, Joseph

    1999-06-25

    A syringe-like disposable cutaneous biopsy instrument equipped with a tubular blade at its lower end, and designed so that a vacuum is created during use, said vacuum serving to retain undeformed a plug of tissue cut from a patient's skin.

  16. Differential Gene Expression in Benign Prostate Epithelium of Men with and without Prostate Cancer: Evidence for a Prostate Cancer Field Effect

    PubMed Central

    Risk, Michael C; Knudsen, Beatrice S; Coleman, Ilsa; Dumpit, Ruth F; Kristal, Alan R; LeMeur, Nolwenn; Gentleman, Robert C; True, Lawrence D; Nelson, Peter S; Lin, Daniel W

    2010-01-01

    Background Several malignancies are known to exhibit a “field-effect” whereby regions beyond tumor boundaries harbor histological or molecular changes that are associated with cancer. We sought to determine if histologically benign prostate epithelium collected from men with prostate cancer exhibits features indicative of pre-malignancy or field effect. Methods Prostate needle biopsies from 15 men with high grade(Gleason 8–10) prostate cancer and 15 age- and BMI-matched controls were identified from a biospecimen repository. Benign epithelia from each patient were isolated by laser capture microdissection. RNA was isolated, amplified, and used for microarray hybridization. Quantitative PCR(qPCR) was used to determine the expression of specific genes of interest. Alterations in protein expression were analyzed through immunohistochemistry. Results Overall patterns of gene expression in microdissected benign-associated benign epithelium (BABE) and cancer-associated benign epithelium (CABE) were similar. Two genes previously associated with prostate cancer, PSMA and SSTR1, were significantly upregulated in the CABE group(FDR <1%). Expression of other prostate cancer-associated genes, including ERG, HOXC4, HOXC5 and MME, were also increased in CABE by qRT-PCR, although other genes commonly altered in prostate cancer were not different between the BABE and CABE samples. The expression of MME and PSMA proteins on IHC coincided with their mRNA alterations. Conclusion Gene expression profiles between benign epithelia of patients with and without prostate cancer are very similar. However, these tissues exhibit differences in the expression levels of several genes previously associated with prostate cancer development or progression. These differences may comprise a field effect and represent early events in carcinogenesis. PMID:20935156

  17. Prostate resection - minimally invasive

    MedlinePlus

    Laser prostatectomy; Transurethral needle ablation; TUNA; Transurethral incision; TUIP; Holmium laser enucleation of the prostate; HoLep; Interstitial laser coagulation; ILC; Photoselective vaporization of the prostate; PVP; Transurethral ...

  18. Screening for Prostate Cancer

    MedlinePlus

    ... of Internal Medicine Summaries for Patients Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee ... Physicians The full report is titled “Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee ...

  19. Prostate cancer screenings

    MedlinePlus

    ... not do an accurate job of screening for prostate cancer. ... and anxiety, even if you do not have prostate cancer. Side effects from further testing. If your PSA test is higher than normal, you may need to ...

  20. Enlarged prostate - after care

    MedlinePlus

    BPH - self-care; Benign prostatic hypertrophy - self-care; Benign prostatic hyperplasia - self-care ... Your health care provider may have you take a medicine called alpha-1- blocker. Most people find that these drugs help ...

  1. Prostate Cancer Screening

    MedlinePlus

    ... treat. There is no standard screening test for prostate cancer. Researchers are studying different tests to find those ... PSA level may be high if you have prostate cancer. It can also be high if you have ...

  2. Cryotherapy for prostate cancer

    MedlinePlus

    ... the needles to the prostate gland. Then, very cold gas passes through the needles, creating ice balls that destroy the prostate gland. Warm salt water will flow through the catheter to keep your urethra (the tube from the bladder to ...

  3. Prostate cancer - resources

    MedlinePlus

    Resources - prostate cancer ... The following organizations are good resources for information on prostate cancer : American Cancer Society -- www.cancer.org/cancer/prostatecancer/index National Cancer Institute -- www.cancer.gov/cancertopics/ ...

  4. Promoter Methylation in Prostate Cancer and its Application for the Early Detection of Prostate Cancer Using Serum and Urine Samples

    PubMed Central

    Ahmed, Hafiz

    2010-01-01

    Prostate cancer is the second most common cancer and the second leading cause of cancer death in men. However, prostate cancer can be effectively treated and cured, if it is diagnosed in its early stages when the tumor is still confined to the prostate. Combined with the digital rectal examination, the PSA test has been widely used to detect prostate cancer. But, the PSA screening method for early detection of prostate cancer is not reliable due to the high prevalence of false positive and false negative results. Epigenetic alterations including hypermethylation of gene promoters are believed to be the early events in neoplastic progression and thus these methylated genes can serve as biomarkers for the detection of cancer from clinical specimens. This review discusses DNA methylation of several gene promoters during prostate carcinogenesis and evaluates the usefulness of monitoring methylated DNA sequences, such as GSTP1, RASSF1A, RARβ2 and galectin-3, for early detection of prostate cancer in tissue biopsies, serum and urine. PMID:20657713

  5. New serum biomarkers for prostate cancer diagnosis

    PubMed Central

    Chadha, Kailash C.; Miller, Austin; Nair, Bindukumar B.; Schwartz, Stanley A.; Trump, Donald L.; Underwood, Willie

    2014-01-01

    Background Prostate-specific antigen (PSA) is currently used as a biomarker for diagnosis and management of prostate cancer (CaP). However, PSA typically lacks the sensitivity and specificity desired of a diagnostic marker. Objective The goal of this study was to identify an additional biomarker or a panel of biomarkers that is more sensitive and specific than PSA in differentiating benign versus malignant prostate disease and/or localized CaP versus metastatic CaP. Methods Concurrent measurements of circulating interleukin-8 (IL-8), Tumor necrosis factor-α (TNF-α) and soluble tumor necrosis factor-α receptors 1 (sTNFR1) were obtained from four groups of men: (1) Controls (2) with elevated prostate-specific antigen with a negative prostate biopsy (elPSA_negBx) (3) with clinically localized CaP and (4) with castration resistant prostate cancer. Results TNF-α Area under the receiver operating characteristic curve (AUC = 0.93) and sTNFR1 (AUC = 0.97) were strong predictors of elPSA_negBx (vs. CaP). The best predictor of elPSA_negBx vs CaP was sTNFR1 and IL-8 combined (AUC = 0.997). The strongest single predictors of localized versus metastatic CaP were TNF-α (AUC = 0.992) and PSA (AUC = 0.963) levels. Conclusions The specificity and sensitivity of a PSA-based CaP diagnosis can be significantly enhanced by concurrent serum measurements of IL-8, TNF-α and sTNFR1. In view of the concerns about the ability of PSA to distinguish clinically relevant CaP from indolent disease, assessment of these biomarkers in the larger cohort is warranted. PMID:25593898

  6. DNA damage phenotype and prostate cancer risk

    PubMed Central

    Kosti, O.; Goldman, L.; Saha, D.T.; Orden, R.A.; Pollock, A.J.; Madej, H.L.; Hsing, A.W.; Chu, L.W.; Lynch, J.H.; Goldman, R.

    2010-01-01

    The capacity of an individual to process DNA damage is considered a crucial factor in carcinogenesis. The comet assay is a phenotypic measure of the combined effects of sensitivity to a mutagen exposure and repair capacity. In this paper, we evaluate the association of the DNA repair kinetics, as measured by the comet assay, with prostate cancer risk. In a pilot study of 55 men with prostate cancer, 53 men without the disease, and 71 men free of cancer at biopsy, we investigated the association of DNA damage with prostate cancer risk at early (0-15 min) and later (15-45 min) stages following gamma-radiation exposure. Although residual damage within 45 min was the same for all groups (65% of DNA in comet tail disappeared), prostate cancer cases had a slower first phase (38% vs 41%) and faster second phase (27% vs 22%) of the repair response compared to controls. When subjects were categorized into quartiles, according to efficiency of repairing DNA damage, high repair-efficiency within the first 15 min after exposure was not associated with prostate cancer risk while higher at the 15-45 min period was associated with increased risk (OR for highest-to-lowest quartiles = 3.24, 95% CI=0.98-10.66, p-trend =0.04). Despite limited sample size, our data suggest that DNA repair kinetics marginally differ between prostate cancer cases and controls. This small difference could be associated with differential responses to DNA damage among susceptible individuals. PMID:21095241

  7. The impact of prostate cancer on men's everyday life.

    PubMed

    Appleton, L; Wyatt, D; Perkins, E; Parker, C; Crane, J; Jones, A; Moorhead, L; Brown, V; Wall, C; Pagett, M

    2015-01-01

    Prostate cancer impacts on the daily lives of men, particularly their physical and emotional health, relationships and social life. This paper highlights how men cope with disease and treatment and the strategies they employ to manage their diagnosis alongside daily life. Twenty-seven men were interviewed at different stages in their disease pathway: nine men prior to radiotherapy, eight men at 6-8 months post radiotherapy and 10 men at 12-18 months post radiotherapy. A grounded theory approach was used to collect and analyse the data. Regardless of the point at which they were interviewed four areas emerged as important to the men: the pathway to diagnosis; the diagnosis; the impact of prostate cancer and its treatment on daily life; and living with prostate cancer. Prostate cancer was diagnosed using the prostate-specific antigen (PSA) test, rectal examination and biopsy. Many men did not understand the consequences of a high PSA reading before they undertook the test. Painful investigative biopsies were viewed as the worst part of the disease experience. Radiotherapy was considered less invasive than other treatments, although preparatory regimes were associated with stress and inconvenience. Men used various strategies to deal with treatment-induced threats to their masculinity in the long term.

  8. Prostate cancer magnetic resonance imaging (MRI): multidisciplinary standpoint

    PubMed Central

    Li, Liang; Feng, Zhaoyan; Hu, Zhiquan; Wang, Guoping; Yuan, Xianglin; Wang, He; Hu, Daoyu

    2013-01-01

    Prostate cancer is the most common cancer diagnosed in men and a leading cause of death. Accurate assessment is a prerequisite for optimal clinical management and therapy selection of prostate cancer. There are several parameters and nomograms to differentiate between patients with clinically insignificant disease and patients in need of treatment. Magnetic resonance imaging (MRI) is a technique which provides more detailed anatomical images due to high spatial resolution, superior contrast resolution, and multiplanar capability. State-of-the-art MRI techniques, such as diffusion weighted imaging (DWI), MR spectroscopic imaging (MRSI), dynamic contrast enhanced MRI (DCE-MRI), improve interpretation of prostate cancer imaging. In this article, we review the major role of MRI in the advanced management of prostate cancer to noninvasively improve tumor staging, biologic potential, treatment planning, therapy response, local recurrence, and to guide target biopsy for clinical suspected cancer with previous negative biopsy. Finally, future challenges and opportunities in prostate cancer management in the area of functional MRI are discussed as well. PMID:23630657

  9. Magnetic resonance imaging detected prostate evasive anterior tumours: Further insights

    PubMed Central

    Edwan, Ghazi Al; Ghai, Sangeet; Margel, David; Kulkarni, Girish; Hamilton, Rob; Toi, Ants; Haidar, Masoom A.; Finelli, Antonio; Fleshner, Neil E.

    2015-01-01

    Introduction: Clinical confusion continues to exist regarding the underestimation of cancers among patients on active surveillance and among men with repeated negative prostate biopsies despite worrisome prostate-specific antigen (PSA) levels. We have previously described our initial experience with magnetic resonance imaging (MRI)-based detection of tumours in the anterior prostate gland. In this report, we update and expand our experience with these tumours in terms of multiparametric-MRI findings, staging, and grading. Furthermore, we report early treatment outcomes with these unique cancers. Methods: We reviewed our prostate MRI dataset of 1117 cases from January 2006 until December 2012 and identified 189 patients who fulfilled criteria for prostate evasive anterior tumors (PEATS). Descriptive analyses were performed on multiple covariates. Kaplan-Meier actuarial technique was used to plot the treatment-related outcomes from PEATS tumours. Results: Among the 189 patients who had MRI-detectable anterior tumours, 148 had biopsy proven disease in the anterior zone. Among these tumours, the average PSA was 18.3 ng/mL and most cancers were Gleason 7. In total, 68 patients chose surgical therapy. Among these men, most of their cancers had extra prostatic extension and 46% had positive surgical margins. Interestingly, upgrading of tumours that were biopsy Gleason 6 in the anterior zone was common, with 59% exhibiting upgrading to Gleason 7 or higher. Biochemical-free survival among men who elected surgery was not ideal, with 20% failing by 20 months. Conclusion: PEATS tumours are found late and are disproportionally high grade tumours. Careful consideration to MRI testing should be given to men at risk for PEATS. PMID:26029293

  10. Enlarged Prostate (BPH)

    MedlinePlus

    The prostate is a gland in men. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine out of the body. As men age, their prostate grows bigger. If it gets too large, it ...

  11. Current early diagnostic biomarkers of prostate cancer

    PubMed Central

    Qu, Min; Ren, Shan-Cheng; Sun, Ying-Hao

    2014-01-01

    Prostate cancer (PCa) has become to have the highest incidence and the second mortality rate in western countries, affecting men's health to a large extent. Although prostate-specific antigen (PSA) was discovered to help diagnose the cancer in an early stage for decades, its specificity is relative low, resulting in unnecessary biopsy for healthy people and over-treatment for patients. Thus, it is imperative to identify more and more effective biomarkers for early diagnosis of PCa in order to distinguish patients from healthy populations, which helps guide an early treatment to lower disease-related mortality by noninvasive or minimal invasive approaches. This review generally describes the current early diagnostic biomarkers of PCa in addition to PSA and summarizes the advantages and disadvantages of these biomarkers. PMID:24830695

  12. Leptin increases prostate cancer aggressiveness.

    PubMed

    López Fontana, Constanza M; Maselli, María E; Pérez Elizalde, Rafael F; Di Milta Mónaco, Nicolás A; Uvilla Recupero, Ana L; López Laur, José D

    2011-12-01

    Recent studies indicate that adipose tissue and adipocytokines might affect the development of prostate cancer (PCa). Leptin would have a stimulating effect on prostate cancer cells by inducing promotion and progression, whereas adiponectin would have a protective effect. The aim of this study was to determine the relation between body composition, leptin, and adiponectin levels with the prevalence and aggressiveness of PCa in men of Mendoza, Argentina. Seventy volunteers between 50 and 80 years (35 healthy men as control group and 35 with PCa) were selected. The PCa group was subclassified according to the Gleason Score (GS). Digital rectal examination, transrectal ultrasound, and prostatic biopsy were performed; PSA, testosterone, leptin, and adiponectin levels were determined; and a nutritional interview including anthropometric measurements and a food frequency questionnaire was carried out. Statistical analysis was performed by Student t test, ANOVA I, and Bonferroni (p < 0.05). Body mass index and percentage of body fat mass were not statistically different between PCa and control groups. However, body fat mass was higher in subjects with more aggressive tumors (p = 0.032). No differences were observed regarding leptin levels between the groups. Nevertheless, leptin levels were higher in subjects with high GS (p < 0.001). Adiponectin levels showed no statistical differences regarding the presence and aggressiveness of the tumor (p = 0.131). Finally, consumption and nutrient intake did not differ in the studied groups. In conclusion, body composition and leptin are related to the PCa aggressiveness but not with its prevalence.

  13. Metformin use and risk of prostate cancer: results from the REDUCE study.

    PubMed

    Feng, Tom; Sun, Xizi; Howard, Lauren E; Vidal, Adriana C; Gaines, Alexis R; Moreira, Daniel M; Castro-Santamaria, Ramiro; Andriole, Gerald L; Freedland, Stephen J

    2015-11-01

    The role of metformin in prostate cancer chemoprevention remains unclear. REDUCE, which followed biopsy-negative men with protocol-dictated PSA-independent biopsies at 2- and 4-years, provides an opportunity to evaluate the link between metformin use and prostate cancer diagnosis with minimal confounding from screening biases. In diabetic men from REDUCE, we tested the association between metformin use, use of other antidiabetic medications, versus no antidiabetic medication use, and prostate cancer diagnosis as well as prostate cancer grade (low-grade Gleason 4-6 and high-grade Gleason 7-10) using logistic regression. Of the 540 diabetic men with complete data, 205 (38%) did not report use of any antidiabetic medications, 141 (26%) reported use of at least one antidiabetic medication other than metformin, and 194 (36%) reported use of metformin. During the 4-year study, 122 men (23%) were diagnosed with prostate cancer. After adjusting for various clinical and demographic characteristics, we found that metformin use was not significantly associated with total (OR, 1.19; P = 0.50), low- (OR, 1.01; P = 0.96), or high-grade (OR, 1.83; P = 0.19) prostate cancer diagnosis. Likewise, there was no significant association between the use of non-metformin antidiabetic medications and prostate cancer risk in both crude (OR, 1.02; P = 0.95) and multivariable analysis (OR, 0.85; P = 0.56). Furthermore, the interactions between antidiabetic medication use and BMI, geographic location, coronary artery disease, smoking, and treatment group were not significant (all P > 0.05). Among diabetic men with a negative prestudy biopsy who all underwent biopsies largely independent of PSA, metformin use was not associated with reduced risk of prostate cancer diagnosis.

  14. DIAGNOSIS AND MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA IN A PIED TAMARIN (SAGUINUS BICOLOR).

    PubMed

    Barbon, Alberto Rodriguez; Ordóñez, Israel Alamilla; Haworth, Peter; Glendewar, Gale; Routh, Andrew; Pocknell, Ann

    2016-06-01

    An intact male pied tamarin (Saguinus bicolor) presented with a hunched posture while moving, dysuria, pollakiuria, and hematuria. After diagnostic imaging assessment and prostate biopsy, benign prostatic hyperplasia was diagnosed. Treatments with delmadinone acetate and osaterone caused clinical signs and hematuria to resolve temporarily for a variable period of time. Because of frequent recurrence, elective surgical castration was performed, leading to resolution of the clinical signs. PMID:27468035

  15. Fully Automated Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Fusion via a Probabilistic Registration Metric.

    PubMed

    Sparks, Rachel; Bloch, B Nicolas; Feleppa, Ernest; Barratt, Dean; Madabhushi, Anant

    2013-03-01

    In this work, we present a novel, automated, registration method to fuse magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) images of the prostate. Our methodology consists of: (1) delineating the prostate on MRI, (2) building a probabilistic model of prostate location on TRUS, and (3) aligning the MRI prostate segmentation to the TRUS probabilistic model. TRUS-guided needle biopsy is the current gold standard for prostate cancer (CaP) diagnosis. Up to 40% of CaP lesions appear isoechoic on TRUS, hence TRUS-guided biopsy cannot reliably target CaP lesions and is associated with a high false negative rate. MRI is better able to distinguish CaP from benign prostatic tissue, but requires special equipment and training. MRI-TRUS fusion, whereby MRI is acquired pre-operatively and aligned to TRUS during the biopsy procedure, allows for information from both modalities to be used to help guide the biopsy. The use of MRI and TRUS in combination to guide biopsy at least doubles the yield of positive biopsies. Previous work on MRI-TRUS fusion has involved aligning manually determined fiducials or prostate surfaces to achieve image registration. The accuracy of these methods is dependent on the reader's ability to determine fiducials or prostate surfaces with minimal error, which is a difficult and time-consuming task. Our novel, fully automated MRI-TRUS fusion method represents a significant advance over the current state-of-the-art because it does not require manual intervention after TRUS acquisition. All necessary preprocessing steps (i.e. delineation of the prostate on MRI) can be performed offline prior to the biopsy procedure. We evaluated our method on seven patient studies, with B-mode TRUS and a 1.5 T surface coil MRI. Our method has a root mean square error (RMSE) for expertly selected fiducials (consisting of the urethra, calcifications, and the centroids of CaP nodules) of 3.39 ± 0.85 mm. PMID:24353393

  16. Biopsies

    MedlinePlus

    ... computed tomography (CT) , fluoroscopy , ultrasound , or MRI . A mammography unit is a rectangular box that houses the ... seen. Some lesions, such as clustered calcifications on mammography are not as clearly shown with ultrasound as ...

  17. Biopsy

    MedlinePlus

    ... Sections of the JAOCD JAOCD Archive Published Members Online Dermatology Journals Edit This Favorite Name: Category: Share: Yes ... 2/2017 2017 AOCD Spring Current Concepts in Dermatology Meeting more Latest News ... Surveys About AOCD The AOCD was recognized in ...

  18. Liquid biopsy in liver cancer.

    PubMed

    Labgaa, Ismail; Villanueva, Augusto

    2015-04-01

    Liver cancer has become the second cause of cancer-related death worldwide. Most patients are still diagnosed at intermediate or advanced stage, where potentially curative treatment options are not recommended. Unlike other solid tumors, there are no validated oncogenic addiction loops and the only systemic agent to improve survival in advanced disease is sorafenib. All phase 3 clinical trials testing molecular therapies after sorafenib have been negative, none of which selected patients based on predictive biomarkers of response. Theoretically, analysis of circulating cancer byproducts (e.g., circulating tumor cells, cell-free nucleic acids), namely "liquid biopsy," could provide easy access to molecular tumor information, improve patients' stratification and allow to assess tumor dynamics over time. Recent technical developments and preliminary data from other malignancies indicate that liquid biopsy might have a role in the future management of cancer patients. PMID:25977189

  19. 20 CFR 718.106 - Autopsy; biopsy.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... DUE TO PNEUMOCONIOSIS Criteria for the Development of Medical Evidence § 718.106 Autopsy; biopsy. (a... does not have pneumoconiosis. However, where positive findings are obtained on biopsy, the results will constitute evidence of the presence of pneumoconiosis....

  20. 20 CFR 718.106 - Autopsy; biopsy.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... DUE TO PNEUMOCONIOSIS Criteria for the Development of Medical Evidence § 718.106 Autopsy; biopsy. (a... does not have pneumoconiosis. However, where positive findings are obtained on biopsy, the results will constitute evidence of the presence of pneumoconiosis....

  1. Testing Biopsy and Cytology Specimens for Cancer

    MedlinePlus

    ... articles window. My Saved Articles » My ACS » Testing Biopsy and Cytology Specimens for Cancer Download Printable Version [ ... on the topics below to get started. Testing Biopsy and Cytology Specimens for Cancer How is cancer ...

  2. Biomarkers for prostate cancer.

    PubMed

    Makarov, Danil V; Loeb, Stacy; Getzenberg, Robert H; Partin, Alan W

    2009-01-01

    The development of biomarkers for prostate cancer screening, detection, and prognostication has revolutionized the management of this disease. Prostate-specific antigen (PSA) is a useful, though not specific, biomarker for detecting prostate cancer. We review the literature on prostate cancer biomarkers, including serum markers (PAP, tPSA, fPSA, proPSA, PSAD, PSAV, PSADT, EPCA, and EPCA-2), tissue markers (AMACR, methylated GSTP1, and the TMPRSS2-ETS gene rearrangement), and a urine marker (DD3PCA3/UPM-3). Future research should focus on validation of already existing biomarkers and the discovery of new markers to identify men with aggressive prostate cancer.

  3. Comparison of transrectal photoacoustic, Doppler, and magnetic resonance imaging for prostate cancer detection

    NASA Astrophysics Data System (ADS)

    Ishihara, Miya; Horiguchi, Akio; Shinmoto, Hiroshi; Tsuda, Hitoshi; Irisawa, Kaku; Wada, Takatsugu; Asano, Tomohiko

    2016-03-01

    Transrectal ultrasonography (TRUS) is the most popular imaging modality for diagnosing and treating prostate cancer. TRUS-guided prostate biopsy is mandatory for the histological diagnosis of patients with elevated serum prostatespecific antigen (PSA), but its diagnostic accuracy is not satisfactory due to TRUS's low resolution. As a result, a considerable number of patients are required to undergo an unnecessary repeated biopsy. Photoacoustic imaging (PAI) can be used to provide microvascular network imaging using hemoglobin as an intrinsic, optical absorption molecule. We developed an original TRUS-type PAI probe consisting of a micro-convex array transducer with an optical illumination system to provide superimposed PAI and ultrasound images. TRUS-type PAI has the advantage of having much higher resolution and greater contrast than does Doppler TRUS. The purpose of this study was to demonstrate the clinical feasibility of the transrectal PAI system. We performed a clinical trial to compare the image of the cancerous area obtained by transrectal PAI with that obtained by TRUS Doppler during prostate biopsy. The obtained prostate biopsy cores were stained with anti-CD34 antibodies to provide a microvascular distribution map. We also confirmed its consistency with PAI and pre-biopsy MRI findings. Our study demonstrated that transrectal identification of tumor angiogenesis under superimposed photoacoustic and ultrasound images was easier than that under TRUS alone. We recognized a consistent relationship between PAI and MRI findings in most cases. However, there were no correspondences in some cases.

  4. The role of transrectal ultrasound in the diagnosis of prostate cancer: new contributions

    PubMed Central

    Lopes, Pedro Marinho; Sepúlveda, Luís; Ramos, Rui; Sousa, Pedro

    2015-01-01

    Objective The present study was aimed at evaluating the contribution of transrectal prostate ultrasound in the screening for prostate neoplasias and in the guidance of prostate biopsies. Materials and Methods Prospective study developed over a one-year period. All the patients with indication for prostate biopsy were evaluated. Regardless of PSA values, the patients underwent ultrasound in order to identify suspicious nodules (confirmed by two observers). Sextant biopsy was subsequently performed. In cases of finding suspicious nodules, an additional puncture directed to such nodules was done. Results In a total of 155 cases the prevalence of malignancy was of 53%. Suspicious nodules were detected in 34 patients, and 25 where malignant (positive predictive value of 74%). The specificity and sensitivity for suspicious nodules were 88% and 31% respectively. Comparatively with the randomly obtained sextant specimens, the rate of findings of neoplasia was higher in the specimens obtained with puncture directed to the nodule (p = 0.032). No statistically significant difference was observed in the Gleason score for both types of specimens (p = 0.172). Conclusion The high positive predictive value and the high rate of findings of neoplasia in specimens of suspicious nodules should be taken into consideration in the future. The authors suggest a biopsy technique similar to the one described in the present study (sextant biopsy plus puncture directed to the suspicious nodule). PMID:25798001

  5. Castration Therapy of Prostate Cancer Results in Downregulation of HIF-1{alpha} Levels

    SciTech Connect

    Al-Ubaidi, Firas L.T.; Schultz, Niklas; Egevad, Lars; Granfors, Torvald; Helleday, Thomas

    2012-03-01

    Background and Purpose: Neoadjuvant androgen deprivation in combination with radiotherapy of prostate cancer is used to improve radioresponsiveness and local tumor control. Currently, the underlying mechanism is not well understood. Because hypoxia causes resistance to radiotherapy, we wanted to test whether castration affects the degree of hypoxia in prostate cancer. Methods and Materials: In 14 patients with locally advanced prostate cancer, six to 12 prostatic needle core biopsy specimens were taken prior to castration therapy. Bilateral orchidectomy was performed in 7 patients, and 7 were treated with a GnRH-agonist (leuprorelin). After castrationm two to four prostatic core biopsy specimens were taken, and the level of hypoxia-inducible factor-1{alpha} (HIF-1{alpha}) in cancer was determined by immunofluorescence. Results: Among biopsy specimens taken before castration, strong HIF-1{alpha} expression (mean intensity above 30) was shown in 5 patients, weak expression (mean intensity 10-30) in 3 patients, and background levels of HIF-1{alpha} (mean intensity 0-10) in 6 patients. Downregulation of HIF-1{alpha} expression after castration was observed in all 5 patients with strong HIF-1{alpha} precastration expression. HIF-1{alpha} expression was also reduced in 2 of 3 patients with weak HIF-1{alpha} precastration expression. Conclusions: Our data suggest that neoadjuvant castration decreases tumor cell hypoxia in prostate cancer, which may explain increased radiosensitivity after castration.

  6. High intensity focused ultrasound (HIFU) for treatment of T1/T2 prostate cancer

    NASA Astrophysics Data System (ADS)

    Sanghvi, N.; Gardner, T.; Koch, M.

    2003-04-01

    This FDA approved phase I/II clinical trial is to evaluate the safety and efficacy of the Sonablate device (Focus Surgery, Inc.) for the treatment of organ confined prostate cancer. 20 patients with biopsy proven prostate cancer, Gleason <=7 and PSA <=10 were treated under general anesthesia. Outcome data included serum PSA collected at day 3, 14, 30, 90, 180, PSA nadir (mean/median), and biopsy results at 6 months. Quality of life was assessed using the International Prostate Symptom Score, International Impotence and Erectile Function score, and the SF-36 health survey. The mean patient age is 62.0, Gleason score of 6.18, PSA of 5.2, and prostate size 26.0 gm. Mean PSA results were 5.62, 44, 20, 1.68, 0.87, and 0.44 ng/ml at screening, 48-72 hours, 14 days, 30 days, 90 days and 180 days, respectively. There was one patient (9%) with a positive TRUS biopsy at 6 months, which resulted in a retreatment. There were no rectal injuries. Average pre-treatment IPSS, IIEF, and SF-36 scores were 9.55, 16.1, and 103.5. At the 30 day follow-up, they were 18.3, 3, and 97.4, respectively. HIFU is a minimally invasive modality that achieves complete prostatic ablation and is efficacious in the treatment of low-stage prostate cancer.

  7. Optical biopsy - a new armamentarium to detect disease using light

    NASA Astrophysics Data System (ADS)

    Pu, Yang; Alfano, Robert R.

    2015-03-01

    Optical spectroscopy has been considered a promising method for cancer detection for past thirty years because of its advantages over the conventional diagnostic methods of no tissue removal, minimal invasiveness, rapid diagnoses, less time consumption and reproducibility since the first use in 1984. It offers a new armamentarium. Human tissue is mainly composed of extracellular matrix of collagen fiber, proteins, fat, water, and epithelial cells with key molecules in different structures. Tissues contain a number of key fingerprint native endogenous fluorophore molecules, such as tryptophan, collagen, elastin, reduced nicotinamide adenine dinucleotide (NADH), flavin adenine dinucleotide (FAD) and porphyrins. It is well known that abnormalities in metabolic activity precede the onset of a lot of main diseases: carcinoma, diabetes mellitus, atherosclerosis, Alzheimer, and Parkinson's disease, etc. Optical spectroscopy may help in detecting various disorders. Conceivably the biochemical or morphologic changes that cause the spectra variations would appear earlier than the histological aberration. Therefore, "optical biopsy" holds a great promise as clinical tool for diagnosing early stage of carcinomas and other deceases by combining with available photonic technology (e.g. optical fibers, photon detectors, spectrographs spectroscopic ratiometer, fiber-optic endomicroscope and nasopharyngoscope) for in vivo use. This paper focuses on various methods available to detect spectroscopic changes in tissues, for example to distinguish cancerous prostate tissues and/or cells from normal prostate tissues and/or cells. The methods to be described are fluorescence, stokes shift, scattering, Raman, and time-resolved spectroscopy will be reviewed. The underlying physical and biological basis for these optical approaches will be discussed with examples. The idea is to present some of the salient works to show the usefulness and methods of Optical Biopsy for cancer detection and

  8. The Prostate Tumor Microenvironment Exhibits differentially expressed Genes Useful for Diagnosis — EDRN Public Portal

    Cancer.gov

    To develop a multi-site prospective clinical validation trial of the multigene diagnostic signature for the diagnosis of prostate cancer from non tumor containing biopsy tissue. Prostate cancer now affects one in five men in the U.S. It is diagnosed by examination of a biopsy sample of the prostate gland by a pathologist and treatment decisions such as the choice of surgery are usually not made without direct visualization of the presence of cancer by a pathologist. There are about one million such biopsy procedures in the U.S. every year. However about 1-200,000 are ambiguous owing to the absence of tumor but the presence of small changes such as atypical small acinar proliferations (ASAP) or proliferations within otherwise normal glands (PIN, prostate intraepithelial neoplasia) that are highly suspicious for cancer. Studies by the UCI/NCI SPECS project on prostate cancer have led to a new way to diagnosis the presence of prostate cancer in these ambiguous changes. Researchers of the UCI/NCI SPECS project observed that the tissue around a tumor called stroma has many altered gene activities that are caused by molecules secreted by the tumor cells. Indeed these studies revealed that 114 genes exhibited altered activity in stroma near tumor compared to normal stroma. These changes can be used as a “signature” to examine new samples to determine the “presence of-tumor”. Such a test has many applications. Currently ambiguous cases are asked to return for a repeat biopsy in 3 to 12 months – an agonizing period for patients during which they receive no guidance and during which any tumor may continue to grow and spread. Thus, the new test would detect tumor 3 to 12 months prior to conventional practice. This will avoid repeated biopsy procedures. Patients who are positive by the new test may consider whether immediate medical treatment or neo adjuvant treatment is appropriate. In addition the ability to detect presence-of-tumor early will avoid the necessity

  9. Enlarged prostate - what to ask your doctor

    MedlinePlus

    ... body? What does the prostate gland do? What causes the prostate gland to enlarge? Do many other men have prostate problems? How do I know my problem is not prostate cancer? What are the symptoms of an enlarged prostate? ...

  10. Hepatic splenosis diagnosed after inappropriate metastatic evaluation in patient with low-risk prostate cancer.

    PubMed

    Li, Hanhan; Snow-Lisy, Devon; Klein, Eric A

    2012-05-01

    A man interested in active surveillance of low-risk prostate cancer sought a second opinion after having undergone an inappropriate metastatic evaluation that demonstrated multiple enhancing liver masses. Because of his history of splenectomy for trauma, hepatic splenosis was suspected. Despite reassurance, the patient desired biopsy of the masses to confirm splenosis. The imaging features and pathophysiology of hepatic splenosis are presented. Owing to the low rates of metastatic disease, the current guidelines do not recommend diagnostic imaging for low-risk prostate cancer. The present case illustrates the dangers of the current widespread practice of inappropriate diagnostic imaging of patients with low-risk prostate cancer.

  11. Intraductal carcinoma of the prostate: a distinct histopathological entity with important prognostic implications.

    PubMed

    Henry, P C; Evans, A J

    2009-07-01

    Intraductal carcinoma of the prostate (IDCP) has been described as a lesion associated with poor prognostic features in prostate cancer. Its recognition and reporting in prostate specimens, particularly in needle biopsies, is critical as it carries significant implications for patient management. Recent histological definitions have been proposed to assist in the recognition of IDCP and to help distinguish it from lesions with similar appearance, but different clinical behaviour. In this review, a historical overview of the description of IDCP will be presented followed by a summary of the current histological diagnostic criteria and the recommendations for management and reporting of IDCP. PMID:19246509

  12. Monophasic Synovial Sarcoma of Prostatic Fascia: Case Report and Literature Review

    PubMed Central

    Benecchi, Luigi; Corti, Serena; Del Boca, Carlo; Ferrari, Matteo; Sergio, Pietro; Bercich, Luisa; Tanzi, Giulia

    2015-01-01

    Synovial sarcoma (SS) primarily occurs in the para-articular soft tissue of the lower extremities in young adults and it is extremely rare in the prostatic region. We report a case of a 46-year-old man who presented with urinary retention. Pelvic ultrasound (US) examination, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated an 8.5 cm mass that appeared to originate in the prostatic fascia of the right lobe. Preoperative prostatic ultrasound transrectal needle biopsy revealed mesenchymal neoplastic tissue. Patient underwent surgery. The final pathologic findings were consistent with the diagnosis of monophasic synovial sarcoma. PMID:26075135

  13. The Present and Future of Prostate Cancer Urine Biomarkers

    PubMed Central

    Rigau, Marina; Olivan, Mireia; Garcia, Marta; Sequeiros, Tamara; Montes, Melania; Colás, Eva; Llauradó, Marta; Planas, Jacques; de Torres, Inés; Morote, Juan; Cooper, Colin; Reventós, Jaume; Clark, Jeremy; Doll, Andreas

    2013-01-01

    In order to successfully cure patients with prostate cancer (PCa), it is important to detect the disease at an early stage. The existing clinical biomarkers for PCa are not ideal, since they cannot specifically differentiate between those patients who should be treated immediately and those who should avoid over-treatment. Current screening techniques lack specificity, and a decisive diagnosis of PCa is based on prostate biopsy. Although PCa screening is widely utilized nowadays, two thirds of the biopsies performed are still unnecessary. Thus the discovery of non-invasive PCa biomarkers remains urgent. In recent years, the utilization of urine has emerged as an attractive option for the non-invasive detection of PCa. Moreover, a great improvement in high-throughput “omic” techniques has presented considerable opportunities for the identification of new biomarkers. Herein, we will review the most significant urine biomarkers described in recent years, as well as some future prospects in that field. PMID:23774836

  14. Current role of multiparametric magnetic resonance imaging for prostate cancer

    PubMed Central

    Chevallier, Olivier; Moulin, Morgan; Favelier, Sylvain; Genson, Pierre-Yves; Pottecher, Pierre; Crehange, Gilles; Cochet, Alexandre; Cormier, Luc

    2015-01-01

    Multiparametric magnetic resonance imaging (mp-MRI) has shown promising results in diagnosis, localization, risk stratification and staging of clinically significant prostate cancer, and targeting or guiding prostate biopsy. mp-MRI consists of T2-weighted imaging (T2WI) combined with several functional sequences including diffusion-weighted imaging (DWI), perfusion or dynamic contrast-enhanced imaging (DCEI) and spectroscopic imaging. Recently, mp-MRI has been used to assess prostate cancer aggressiveness and to identify anteriorly located tumors before and during active surveillance. Moreover, recent studies have reported that mp-MRI is a reliable imaging modality for detecting local recurrence after radical prostatectomy or external beam radiation therapy. Because assessment on mp-MRI can be subjective, use of the newly developed standardized reporting Prostate Imaging and Reporting Archiving Data System (PI-RADS) scoring system and education of specialist radiologists are essential for accurate interpretation. This review focuses on the current place of mp-MRI in prostate cancer and its evolving role in the management of prostate cancer. PMID:26682144

  15. Intraductal Carcinoma of the Prostate Gland: Recent Advances

    PubMed Central

    Divatia, Mukul K.

    2016-01-01

    Intraductal carcinoma of the prostate (IDC-P) is characterized by prostatic carcinoma involving ducts and/or acini. The presence of IDC-P is usually associated with a high-grade Gleason score, large tumor volume, and adverse prognostic parameters, including extraprostatic extension and seminal vesicle invasion. When present, IDC-P is associated with worse outcomes, regardless of treatment status. IDC-P is included in a broader diagnostic category of atypical cribriform lesions of the prostate gland. This category of lesions also includes high-grade prostatic intraepithelial neoplasia (HGPIN), urothelial carcinoma involving prostatic ducts or acini, and prostatic ductal adenocarcinoma, amongst other intraductal proliferations. Differentiating between these entities is important as they have differing therapeutic and prognostic implications for patients, although differential diagnosis thereof is not always straightforward. The present review discusses IDC-P in regards to its morphological characteristics, molecular features, and clinical outcomes. Given the current state of knowledge, the presence of IDC-P should be evaluated and documented correctly in both radical prostatectomy and needle biopsy specimens, and the clinical implications thereof should be taken into consideration during treatment and follow up. PMID:27401634

  16. Solitary fibrous tumor of the prostate: case report and review of the literature.

    PubMed

    Moureau-Zabotto, Laurence; Chetaille, Bruno; Bladou, Franck; Dauvergne, Pierre-Yves; Marcy, Myriam; Perrot, Delphine; Guiramand, Jérôme; Sarran, Anthony; Bertucci, François

    2012-01-01

    Solitary fibrous tumor (SFT), usually described in the pleura, is exceedingly rare in the prostate. We report a 60-year-old man with prostatic SFT revealed by obstructive urinary symptoms, and detected by ultrasonography. Computed tomography (CT) and magnetic resonance imaging suggested a prostatic origin. CT-guided tumor biopsy diagnosed a SFT. A cystoprostatectomy was performed. Pathologic examination showed a 15-cm tumor arising from the prostate and showing histological criteria suggestive of aggressiveness. The surgical resection margins were tumor-free. The patient was then regularly monitored and is still alive in complete remission, 28 months after surgery. In conclusion, we report a new exceptional case of prostatic SFT. We review the literature and discuss the challenging issues of misdiagnosis, prognosis and treatment.

  17. Vaccine Treatment for Prostate Cancer

    MedlinePlus

    ... Preventing and treating prostate cancer spread to bones Vaccine treatment for prostate cancer Sipuleucel-T (Provenge) is ... less advanced prostate cancer. Possible side effects of vaccine treatment Side effects from the vaccine tend to ...

  18. 6 Common Cancers - Prostate Cancer

    MedlinePlus

    ... Bar Home Current Issue Past Issues 6 Common Cancers - Prostate Cancer Past Issues / Spring 2007 Table of Contents For ... early screening. Photo: AP Photo/Danny Moloshok Prostate Cancer The prostate gland is a walnut-sized structure ...

  19. [Multiparametric MRI. The role of MRI techniques in the diagnosis, staging and follow up of prostate cancer].

    PubMed

    Vilanova, Joan C; Luna-Alcalá, Antonio; Boada, Maria; Barceló, Joaquim

    2015-04-01

    The current diagnosis of prostate cancer based on PSA values and systematic biopsy has limitations in its efficacy of detection and staging. Technical advances on imaging over the last decade, mainly MRI, enable improvements in the strategy of prostate cancer management in diagnosis, staging, follow up and therapy monitoring. MRI enables the combination of morphological (T2 sequences) and, at the same time, functional information by means of the application of sequences such as spectroscopy (SMRI), diffusion and dynamic intravenous contrast (CMRI) in the same study, giving the multiparametric MRI (mpMRI). Currently, it is not necessary to apply all sequences to obtain an mpMR study of optimal efficacy, so that a time shorter than 30 minutes is enough to obtain the necessary information depending on the clinical indication. The main clinical indications of prostatic MRI are a) local, regional or distance staging; b) Detection or guide for diagnostic biopsy for clinical risk suspicion or negative result in previous biopsies; c) active surveillance; and d) therapeutic monitoring. Furthermore, one of the most relevant features of prostate cancer, and a challenge for the mpMRI techniques is to be able to differentiate aggressive and non-significant neoplasias (latent). This update tries to review the current role of mpMRI in the management of prostate cancer using in combination the anatomical (T2) and functional (SMRI, DMRI and CMRI) information. We also describe the European prostate mpMRI guidelines, PI-RADS (Prostate imaging reporting data System). PMID:25948803

  20. Pancreatic cancer: Are "liquid biopsies" ready for prime-time?

    PubMed Central

    Lewis, Alexandra R; Valle, Juan W; McNamara, Mairead G

    2016-01-01

    Pancreatic cancer is a disease that carries a poor prognosis. Accurate tissue diagnosis is required. Tumours contain a high content of stromal tissue and therefore biopsies may be inconclusive. Circulating tumour cells (CTCs) have been investigated as a potential “liquid biopsy” in several malignancies and have proven to be of prognostic value in breast, prostate and colorectal cancers. They have been detected in patients with localised and metastatic pancreatic cancer with sensitivities ranging from 38%-100% using a variety of platforms. Circulating tumour DNA (ctDNA) has also been detected in pancreas cancer with a sensitivity ranging from 26%-100% in studies across different platforms and using different genetic markers. However, there is no clear consensus on which platform is the most effective for detection, nor which genetic markers are the most useful to use. Potential roles of liquid biopsies include diagnosis, screening, guiding therapies and prognosis. The presence of CTCs or ctDNA has been shown to be of prognostic value both at diagnosis and after treatment in patients with pancreatic cancer. However, more prospective studies are required before this promising technology is ready for adoption into routine clinical practice. PMID:27621566

  1. Fast Diagnostics of BRAF Mutations in Biopsies from Malignant Melanoma.

    PubMed

    Huber, François; Lang, Hans Peter; Glatz, Katharina; Rimoldi, Donata; Meyer, Ernst; Gerber, Christoph

    2016-09-14

    According to the American skin cancer foundation, there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung, and colon each year, and malignant melanoma represents its deadliest form. About 50% of all cases are characterized by a particular mutation BRAF(V600E) in the BRAF (Rapid Acceleration of Fibrosarcoma gene B) gene. Recently developed highly specific drugs are able to fight BRAF(V600E) mutated tumors but require diagnostic tools for fast and reliable mutation detection to warrant treatment efficiency. We completed a preliminary clinical trial applying cantilever array sensors to demonstrate identification of a BRAF(V600E) single-point mutation using total RNA obtained from biopsies of metastatic melanoma of diverse sources (surgical material either frozen or fixated with formalin and embedded in paraffin). The method is faster than the standard Sanger or pyrosequencing methods and comparably sensitive as next-generation sequencing. Processing time from biopsy to diagnosis is below 1 day and does not require PCR amplification, sequencing, and labels. PMID:27490749

  2. Pancreatic cancer: Are "liquid biopsies" ready for prime-time?

    PubMed Central

    Lewis, Alexandra R; Valle, Juan W; McNamara, Mairead G

    2016-01-01

    Pancreatic cancer is a disease that carries a poor prognosis. Accurate tissue diagnosis is required. Tumours contain a high content of stromal tissue and therefore biopsies may be inconclusive. Circulating tumour cells (CTCs) have been investigated as a potential “liquid biopsy” in several malignancies and have proven to be of prognostic value in breast, prostate and colorectal cancers. They have been detected in patients with localised and metastatic pancreatic cancer with sensitivities ranging from 38%-100% using a variety of platforms. Circulating tumour DNA (ctDNA) has also been detected in pancreas cancer with a sensitivity ranging from 26%-100% in studies across different platforms and using different genetic markers. However, there is no clear consensus on which platform is the most effective for detection, nor which genetic markers are the most useful to use. Potential roles of liquid biopsies include diagnosis, screening, guiding therapies and prognosis. The presence of CTCs or ctDNA has been shown to be of prognostic value both at diagnosis and after treatment in patients with pancreatic cancer. However, more prospective studies are required before this promising technology is ready for adoption into routine clinical practice.

  3. Optimizing prostate specimen handling for diagnosis and prognosis.

    PubMed

    Bostwick, David G; Day, Christina E; Meiers, Isabelle

    2014-01-01

    Optimal processing, handling, and sampling of prostatic biopsies, transurethral resections, and radical prostatectomy specimens ensure accurate diagnosis and staging. Prognostic factors derived from careful examination of tissue samples are critical for patient management, including cancer volume, extraprostatic extension, surgical margins, vascular/lymphatic invasion, and perineural invasion. This chapter addresses these important issues, including recent recommendations of a consensus panel of the International Society of Urologic Pathologists. PMID:25015158

  4. Disseminated tuberculosis with involvement of prostate--a case report.

    PubMed

    Mittal, Rashmi; Sudha, R; Veeraraghavan, Mahalakshmi; Murugan, S; Adikrishnan, S; Krishnakanth, M; Shobana, S; Anandan, S; Pandey, S

    2010-01-01

    We present a 55-year-old male who presented with painful non-healing ulcers on the lower lip and scrotum associated with productive cough, fever, anorexia and dysuria. Erythrocyte sedimentation rate was raised, sputum was positive for acid fast bacilli. Chest X-ray was suggestive of pulmonary tuberculosis. A prostate biopsy was also suggestive of tuberculosis. A diagnosis of disseminated tuberculosis was made and the patient showed a good response in two weeks. PMID:20420045

  5. Use of shear waves for diagnosis and ablation monitoring of prostate cancer: a feasibility study

    NASA Astrophysics Data System (ADS)

    Gomez, A.; Rus, G.; Saffari, N.

    2016-01-01

    Prostate cancer remains as a major healthcare issue. Limitations in current diagnosis and treatment monitoring techniques imply that there is still a need for improvements. The efficacy of prostate cancer diagnosis is still low, generating under and over diagnoses. High intensity focused ultrasound ablation is an emerging treatment modality, which enables the noninvasive ablation of pathogenic tissue. Clinical trials are being carried out to evaluate its longterm efficacy as a focal treatment for prostate cancer. Successful treatment of prostate cancer using non-invasive modalities is critically dependent on accurate diagnostic means and is greatly benefited by a real-time monitoring system. While magnetic resonance imaging remains the gold standard for prostate imaging, its wider implementation for prostate cancer diagnosis remains prohibitively expensive. Conventional ultrasound is currently limited to guiding biopsy. Elastography techniques are emerging as a promising real-time imaging method, as cancer nodules are usually stiffer than adjacent healthy prostatic tissue. In this paper, a new transurethral approach is proposed, using shear waves for diagnosis and ablation monitoring of prostate cancer. A finite-difference time domain model is developed for studying the feasibility of the method, and an inverse problem technique based on genetic algorithms is proposed for reconstructing the location, size and stiffness parameters of the tumour. Preliminary results indicate that the use of shear waves for diagnosis and monitoring ablation of prostate cancer is feasible.

  6. Gonadotropin-releasing hormone agonist use in men without a cancer registry diagnosis of prostate cancer

    PubMed Central

    Kuo, Yong-fang; Goodwin, James S; Shahinian, Vahakn B

    2008-01-01

    Background Use of gonadotropin-releasing hormone (GnRH) agonists has become popular for virtually all stages of prostate cancer. We hypothesized that some men receive these agents after only a limited work-up for their cancer. Such cases may be missed by tumor registries, leading to underestimates of the total extent of GnRH agonist use. Methods We used linked Surveillance, Epidemiology and End-Results (SEER)-Medicare data from 1993 through 2001 to identify GnRH agonist use in men with either a diagnosis of prostate cancer registered in SEER, or with a diagnosis of prostate cancer based only on Medicare claims (from the 5% control sample of Medicare beneficiaries residing in SEER areas without a registered diagnosis of cancer). The proportion of incident GnRH agonist users without a registry diagnosis of prostate cancer was calculated. Factors associated with lack of a registry diagnosis were examined in multivariable analyses. Results Of incident GnRH agonist users, 8.9% had no diagnosis of prostate cancer registered in SEER. In a multivariable logistic regression model, lack of a registry diagnosis of prostate cancer in GnRH agonist users was significantly more likely with increasing comorbidity, whereas it was less likely in men who had undergone either inpatient admission or procedures such as radical prostatectomy, prostate biopsy, or transurethral resection of the prostate. Conclusion Reliance solely on tumor registry data may underestimate the rate of GnRH agonist use in men with prostate cancer. PMID:18620606

  7. Long term organ culture of human prostate tissue in a NASA-designed rotating wall bioreactor

    NASA Technical Reports Server (NTRS)

    Margolis, L.; Hatfill, S.; Chuaqui, R.; Vocke, C.; Emmert-Buck, M.; Linehan, W. M.; Duray, P. H.

    1999-01-01

    PURPOSE: To maintain ex vivo integral prostatic tissue including intact stromal and ductal elements using the NASA-designed Rotating Wall Vessel (RWV) which maintains colocalized cells in an environment that promotes both three-dimensional cellular interactions together with the uniform mass transfer of nutrients and metabolic wastes. MATERIALS AND METHODS: Samples of normal prostate were obtained as a byproduct of transurethral prostatectomy or needle biopsy. Prostatic tissue dissected into small 1 x 1 mm. blocks was cultured in the Rotating Wall Vessel (RWV) Bioreactor for various time periods and analyzed using histological, immunochemical, and total cell RNA assays. RESULTS: We report the long term maintenance of benign explanted human prostate tissue grown in simple culture medium, under the simulated microgravity conditions afforded by the RWV bioreactor. Mesenchymal stromal elements including blood vessels and architecturally preserved tubuloglandular acini were maintained for a minimum of 28 days. Cytokeratins, vimentin and TGF-beta2 receptor and ligand were preserved through the entire culture period as revealed by immunocytochemistry. Prostatic acid phosphatase (PAP) was continuously expressed during the culture period, although somewhat decreased. Prostatic specific antigen (PSA) and its transcript were down regulated over time of culture. Prostatic carcinoma cells from the TSU cell line were able to invade RWV-cultured benign prostate tissue explants. CONCLUSIONS: The RWV bioreactor represents an additional new technology for culturing prostate tissue for further investigations concerning the basic physiology and pathobiology of this clinically important tissue.

  8. Prostatic Artery Embolization as a Primary Treatment for Benign Prostatic Hyperplasia: Preliminary Results in Two Patients

    SciTech Connect

    Carnevale, Francisco Cesar; Antunes, Alberto Azoubel; Motta Leal Filho, Joaquim Mauricio da; Oliveira Cerri, Luciana Mendes de; Baroni, Ronaldo Hueb; Marcelino, Antonio Sergio Zafred; Freire, Geraldo Campos; Moreira, Airton Mota; Srougi, Miguel; Cerri, Giovanni Guido

    2010-04-15

    Symptomatic benign prostatic hyperplasia (BPH) typically occurs in the sixth and seventh decades, and the most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, sensation of incomplete emptying, nocturia, frequency, and urgency. Various medications, specifically 5-{alpha}-reductase inhibitors and selective {alpha}-blockers, can decrease the severity of the symptoms secondary to BPH, but prostatectomy is still considered to be the traditional method of management. We report the preliminary results for two patients with acute urinary retention due to BPH, successfully treated by prostate artery embolization (PAE). The patients were investigated using the International Prostate Symptom Score, by digital rectal examination, urodynamic testing, prostate biopsy, transrectal ultrasound (US), and magnetic resonance imaging (MRI). Uroflowmetry and postvoid residual urine volume complemented the investigation at 30, 90, and 180 days after PAE. The procedure was performed under local anesthesia; embolization of the prostate arteries was performed with a microcatheter and 300- to 500-{mu}m microspheres using complete stasis as the end point. One patient was subjected to bilateral PAE and the other to unilateral PAE; they urinated spontaneously after removal of the urethral catheter, 15 and 10 days after the procedure, respectively. At 6-month follow-up, US and MRI revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5 and 27.8%, respectively, for the patient submitted to unilateral PAE. The early results, at 6-month follow-up, for the two patients with BPH show a promising potential alternative for treatment with PAE.

  9. Prostate Adenocarcinomas Aberrantly Expressing p63 Are Molecularly Distinct from Usual-Type Prostatic Adenocarcinomas

    PubMed Central

    Tan, Hsueh-Li; Haffner, Michael C.; Esopi, David M.; Vaghasia, Ajay M.; Giannico, Giovanna A.; Ross, Hillary M.; Ghosh, Susmita; Hicks, Jessica; Zheng, Qizhi; Sangoi, Ankur R.; Yegnasubramanian, Srinivasan; Osunkoya, Adeboye O.; De Marzo, Angelo M.; Epstein, Jonathan I.; Lotan, Tamara L.

    2014-01-01

    We have described a rare group of prostate adenocarcinomas that show aberrant expression of p63, a protein strongly expressed in prostatic basal cells and absent from usual-type acinar prostate cancers. The partial basal-like immunophenotype of these tumors is intriguing in light of the persistent debate surrounding the cell-of-origin for prostate cancer, however their molecular phenotype is unknown. We collected 37 of these tumors on radical prostatectomy and biopsy and assessed subsets for a diverse panel of molecular markers. The majority of p63-expressing tumors were positive for the ΔNp63 isoform (6/7) by immunofluorescence and p63 mRNA (7/8) by chromogenic in situ hybridization. Despite p63 positivity, these tumors uniformly expressed luminal-type cytokeratin proteins such as CK18 (13/13), CK8 (8/8) and markers of androgen axis signaling commonly seen in luminal cells, including androgen receptor (10/11), NKX3.1 (8/8) and prostein (12/13). Conversely, basal cytokeratins such as CK14 and CK15 were negative in all cases (0/8) and CK5/6 was weakly and focally positive in 36% (4/11) of cases. Pluripotency markers including β-catenin, Oct4 and c-kit were negative in p63-expressing tumors (0/11). Despite nearly universal expression of androgen receptor and downstream androgen signaling targets, p63-expressing tumors lacked ERG rearrangements by fluorescence in situ hybridization (0/14) and ERG protein expression (0/37). No tumors expressed SPINK1 or showed PTEN protein loss (0/19). Surprisingly, 74% (14/19) of p63-expressing tumors expressed GSTP1 protein at least focally, and 33% (2/6) entirely lacked GSTP1 CpG island hypermethylation by bisulfite sequencing. In contrast to usual prostatic adenocarcinomas, prostate tumors with p63-expression show a mixed luminal/basal immunophenotype, uniformly lack ERG gene rearrangement and frequently express GSTP1. These data strongly suggest that p63-expressing prostate tumors represent a molecularly distinct subclass and

  10. The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy

    SciTech Connect

    Niehaus, Angela; Merrick, Gregory S. . E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M.; Wallner, Kent E.; Allen, Zachariah A.; Galbreath, Robert W.; Adamovich, Edward

    2006-01-01

    Purpose: To evaluate the influence of isotope and prostate size on International Prostate Symptom Score (IPSS) normalization, catheter dependency, and the need for surgical intervention secondary to bladder outlet obstruction after prostate brachytherapy. Methods and Materials: Between January 1998 and June 2003, 976 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (2002 American Joint Committee on Cancer) prostate cancer. Seven hundred eighty-nine (80.8%) were implanted with {sup 103}Pd and 187 (19.2%) with {sup 125}I. The median follow-up was 41.2 months. Patients were stratified into size cohorts {<=}25 cm{sup 3}, 25.1-35 cm{sup 3}, 35.1-45 cm{sup 3}, and >45 cm{sup 3}. Four hundred eighteen patients (42.8%) received androgen deprivation therapy (ADT). Four hundred eighty-six patients (49.7%) received supplemental external-beam radiation therapy (XRT). In all patients, an alpha blocker was initiated before implantation and continued at least until the IPSS returned to baseline. IPSS resolution was defined as a return to within one point of baseline. The median number of IPSS determinations per patient was 21. Clinical, treatment, and dosimetric parameters evaluated included patient age, pretreatment PSA, Gleason score, clinical T stage, percent positive biopsies, preimplant IPSS, ultrasound volume, planning volume, isotope, V{sub 100/150/20}, D{sub 9}, urethral dose (average and maximum), supplemental XRT, ADT, and the duration of ADT ({<=}6 months vs. >6 months). Catheter dependency and the need for postsurgical intervention were also evaluated. Results: For both isotopes and all prostate size cohorts, IPSS peaked 1 month after implantation and returned to baseline at a mean of 1.9 months. Stratification of prostate size cohorts by isotope demonstrated no significant differences in prolonged catheter dependency ({>=}5 days), IPSS resolution, or postimplant surgical intervention. In Cox regression analysis, IPSS normalization was best

  11. Role of serial multiparametric magnetic resonance imaging in prostate cancer active surveillance

    PubMed Central

    Vos, Larissa J; Janoski, Michele; Wachowicz, Keith; Yahya, Atiyah; Boychak, Oleksandr; Amanie, John; Pervez, Nadeem; Parliament, Matthew B; Pituskin, Edith; Fallone, B Gino; Usmani, Nawaid

    2016-01-01

    AIM: To examine whether addition of 3T multiparametric magnetic resonance imaging (mpMRI) to an active surveillance protocol could detect aggressive or progressive prostate cancer. METHODS: Twenty-three patients with low risk disease were enrolled on this active surveillance study, all of which had Gleason score 6 or less disease. All patients had clinical assessments, including digital rectal examination and prostate specific antigen (PSA) testing, every 6 mo with annual 3T mpMRI scans with gadolinium contrast and minimum sextant prostate biopsies. The MRI images were anonymized of patient identifiers and clinical information and each scan underwent radiological review without the other results known. Descriptive statistics for demographics and follow-up as well as the sensitivity and specificity of mpMRI to identify prostate cancer and progressive disease were calculated. RESULTS: During follow-up (median 24.8 mo) 11 of 23 patients with low-risk prostate cancer had disease progression and were taken off study to receive definitive treatment. Disease progression was identified through upstaging of Gleason score on subsequent biopsies for all 11 patients with only 2 patients also having a PSA doubling time of less than 2 years. All 23 patients had biopsy confirmed prostate cancer but only 10 had a positive index of suspicion on mpMRI scans at baseline (43.5% sensitivity). Aggressive disease prediction from baseline mpMRI scans had satisfactory specificity (81.8%) but low sensitivity (58.3%). Twenty-two patients had serial mpMRI scans and evidence of disease progression was seen for 3 patients all of whom had upstaging of Gleason score on biopsy (30% specificity and 100% sensitivity). CONCLUSION: Addition of mpMRI imaging in active surveillance decision making may help in identifying aggressive disease amongst men with indolent prostate cancer earlier than traditional methods. PMID:27158428

  12. A four-kallikrein panel predicts prostate cancer in men with recent screening: data from the European Randomized Study of Prostate Cancer Screening, Rotterdam

    PubMed Central

    Vickers, Andrew J.; Cronin, Angel M; Roobol, Monique J.; Savage, Caroline J.; Peltola, Mari; Pettersson, Kim; Scardino, Peter T.; Schröder, Fritz H.; Lilja, Hans

    2010-01-01

    Purpose We have developed a statistical prediction model for prostate cancer based on four kallikrein markers in blood: total, free, and intact prostate specific antigen (PSA) and kallikrein-related peptidase 2 (hK2). Although this model accurately predicts the result of biopsy in unscreened men, its properties for men with a history of PSA screening have not been fully characterized. Experimental Design 1501 previously screened men with elevated PSA underwent initial biopsy during rounds 2 and 3 of the European Randomized Study of Prostate Cancer Screening, Rotterdam, with 388 cancers diagnosed. Biomarker levels were measured in serum samples taken before biopsy. The prediction model developed on the unscreened cohort was then applied and predictions compared to biopsy outcome. Results The previously developed four-kallikrein prediction model had much higher predictive accuracy than PSA and age alone (area-under-the-curve of 0.711 vs. 0.585 and 0.713 vs. 0.557 with and without digital rectal exam, respectively; both p<0.001). Similar statistically significant enhancements were seen for high-grade cancer. Applying the model with a cut-off of 20% cancer risk as the criterion for biopsy would reduce the biopsy rate by 362 for every 1000 men with elevated PSA. Although diagnosis would be delayed for 47 cancers, these would be predominately low stage and low grade (83% Gleason 6 T1c). Conclusions A panel of four kallikreins can help predict the result of initial biopsy in previously screened men with elevated PSA. Use of a statistical model based on the panel would substantially decrease rates of unnecessary biopsy. PMID:20400522

  13. Hormone therapy for prostate cancer

    MedlinePlus

    Androgen deprivation therapy; ADT; Androgen suppression therapy; Combined androgen blockade ... Androgens cause prostate cancer cells to grow. Hormone therapy for prostate cancer lowers the effect level of ...

  14. Advances in biomarkers for the early diagnosis of prostate cancer.

    PubMed

    Cao, Da-Long; Yao, Xu-Dong

    2010-02-01

    More and more studies have revealed that the level of serum prostate specific antigen(PSA) has little value for early diagnosis of prostate cancer (PCa). For example, negative prostate biopsies are as high as 70%-80% for patients with serum PSA ranging between 4 ng/mL and 1