Trans rectal ultra sound guided prostate biopsies: a single centre experience in Sri Lanka

Abstract

Background Trans rectal ultrasound guided prostate biopsy (TRUS) was introduced to Sri Lanka in 2002. Objectives 1. To study clinicopathological features of males subjected to TRUS biopsy 2. To compare estimation of tumour burden by two methods in carcinoma prostate (CaP). Methods 749 symptomatic males subjected to TRUS biopsy over 64 months at a single centre. Information was retrieved from case records. Tumour burden in CaP was calculated as: 1. Calculated tumour burden (CTB)total percentage tumour in each core/total number of cores 2. Percentage positive biopsy cores (PPBC)number of positive cores / total number of cores X 100. SPSS 15.0, student's t test and Spearman's rank correlation coefficients were used for statistical analysis. Results 35.2% had CaP, microacinar in type. 34.88% were poorly differentiated. CaP was frequent among older patients (P<0.00001). The prostate volume in CaP was significantly lower than in the benign group (P<0.05). Prostate specific antigen (PSA) level was significantly higher in CaP (P<0.00001). A 99.6% sensitivity and 4.7% specificity was observed at PSA of 4ng/ml for detecting CaP. Specificity was 98% at 25.5ng/ml, with a sensitivity of 44.4%. CTB and PPBC had similar correlations with biochemical/histological parameters of CaP and were strongly correlated (0.786). Interpretation Males with CaP were older, had higher PSA levels and smaller prostates. A cut off level of PSA >4ng/ml could be used for directing symptomatic patients for TRUS biopsy to detect CaP, keeping in mind that specificity is 98% only at 25.5ng/ml. Both CTB and PPBC could be used to calculate tumour burden in TRUS with CaP.

Study on Correlation between Serum Prostate Specific Antigen and Various Prostatic Pathology

“…All of them were those of prostatic adenocarcinoma. [9][10][11][12] Benign Prostatic Hyperplasia was the most common diagnosis in our study(n=117,66.85%) which was similar to the study done by Hirachand et al8, Alpesh M et al13 and Lakhey et al 9…”

Serum total prostate-specific antigen values in men with symptomatic prostate enlargement in Nigeria: role in clinical decision-making

“…Applying a serum tPSA of >4 ng/mL, the sensitivity and specificity of tPSA for detecting prostate cancer were 96.3% and 18.2%, respectively, with a negative predictive value of 85.7%. These were similar to the findings of Lokuhetty et al 9 Therefore, in this study, using a serum tPSA >4 ng/mL alone, 81.8% of benign prostates would have been subjected to unnecessary transrectal biopsy. However, applying a serum tPSA of >10 ng/mL alone, with a sensitivity of 85.2% and a specificity of 33.3%, the negative predictive value decreased to 73.3%.…”

“… 7 , 8 The sensitivity of serum tPSA in detecting prostate cancer has been put at 25% in screening programs 8 and as high as 99.6% in patients with symptoms. 9 …”

Diagnostic yield and outcome of transrectal ultrasound-guided prostate biopsy in Sri Lanka

“…Comparison of previous studies are shown in table S2 which had a PCa rate of 8.7-44.8% [5,[7][8][9][10]. In a previous study from Sri Lanka, the prevalence of PCa in 749 symptomatic males subjected to TRUSPB was 35.2%, which was lower than the current study [5].…”

“…Transrectal ultrasound-guided prostate biopsy (TRUSPB) is the key diagnostic method used to confirm the presence of PCa among men in Sri Lanka. However, the data regarding the diagnostic yield and outcome of TRUSPB is limited in Sri Lanka [5]. The available single study is based on pathology reports, and is lacking clinical data as well as follow-up outcome.…”