• Korean Journal of Radiology
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• v.21 no.9
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• pp.1087-1094
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• 2020

Transrectal ultrasound (TRUS)-guided systematic biopsy, the current gold standard for the detection of prostate cancer, suffers from low sensitivity for clinically significant cancer. The use of diagnostic multiparametric MRI has increased the relevance of targeted biopsy techniques such as MRI-TRUS fusion biopsy and direct (in-bore) MRI-guided biopsy, which have higher detection rate for clinically significant cancer. Although primarily used in patients who remain at high clinical suspicion for prostate cancer despite a negative systematic biopsy, with the increasing use of upfront diagnostic MRI, these biopsies are expected to replace routine systematic biopsies. This pictorial essay aims to enhance our understanding of the concepts of these biopsy techniques so that they can be performed safely and provide maximum diagnostic yield.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.7
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• pp.3087-3091
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• 2014

Purpose: To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen (tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men with lower urinary tract symptoms (LUTS). Materials and Methods: All patients with abnormal DRE, TRUS, or serum tPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue were obtained from different areas of the peripheral prostate and examined histopathologically for the nature of the pathology. Results: PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changes with or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) of patients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCa had abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA >20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among 209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%). Conclusions: The incidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can be further improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.

• Kosin Medical Journal
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• v.33 no.3
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• pp.391-395
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• 2018

We report a case of a patient with locally advanced prostate cancer who had only lymph node involvement without bone metastasis on F-18 FDG PET/CT. A 62-year-old Korean male was admitted to our hospital due to dysuria. His PSA level on admission was 79.35 ng/mL. A transrectal ultrasound-guided prostate biopsy confirmed prostate cancer and his Gleason score was 10 (5+5). F-18 FDG PET/CT demonstrated a hypermetabolic mass lesion with SUVmax 7.0 in the prostate and hypermetabolism with SUVmax 4.7 of the abdominal and pelvic lymph nodes. Tc-99m HDP bone scan showed no significant bone metastasis. The patient underwent hormonal therapy for 9 months. Follow-up F-18 FDG PET/CT showed significantly reduced size and FDG uptake in the prostate and abdominal and pelvic lymph nodes. In this case, treatment monitoring with F-18 FDG PET/CT showed decreased mass size and FDG uptake in the prostate and abdominal and pelvic lymph nodes.

• Korean Journal of Radiology
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• v.21 no.4
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• pp.422-430
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• 2020

The Korean Society of Urogenital Radiology (KSUR) aimed to present a consensus statement for patient preparation, standard technique, and pain management in relation to transrectal ultrasound-guided prostate biopsy (TRUS-Bx) to reduce the variability in TRUS-Bx methodologies and suggest a nationwide guideline. The KSUR guideline development subcommittee constructed questionnaires assessing prebiopsy anticoagulation, the cleansing enema, antimicrobial prophylaxis, local anesthesia methods such as periprostatic neurovascular bundle block (PNB) or intrarectal lidocaine gel application (IRLA), opioid usage, and the number of biopsy cores and length and diameter of the biopsy needle. The survey was conducted using an Internet-based platform, and responses were solicited from the 90 members registered on the KSUR mailing list as of 2018. A comprehensive search of relevant literature from Medline database was conducted. The strength of each recommendation was graded on the basis of the level of evidence. Among the 90 registered members, 29 doctors (32.2%) responded to this online survey. Most KSUR members stopped anticoagulants (100%) and antiplatelets (76%) one week before the procedure. All respondents performed a cleansing enema before TRUS-Bx. Approximately 86% of respondents administered prophylactic antibiotics before TRUS-Bx. The most frequently used antibiotics were third-generation cephalosporins. PNB was the most widely used pain control method, followed by a combination of PNB plus IRLA. Opioids were rarely used (6.8%), and they were used only as an adjunctive pain management approach during TRUS-Bx. The KSUR members mainly chose the 12-core biopsy method (89.7%) and 18G 16-mm or 22-mm (96.5%) needles. The KSUR recommends the 12-core biopsy scheme with PNB with or without IRLA as the standard protocol for TRUS-Bx. Anticoagulants and antiplatelet agents should be discontinued at least 5 days prior to the procedure, and antibiotic prophylaxis is highly recommended to prevent infectious complications. Glycerin cleansing enemas and administration of opioid analogues before the procedure could be helpful in some situations. The choice of biopsy needle is dependent on the practitioners' situation and preferences.

• Urogenital Tract Infection
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• v.13 no.3
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• pp.72-78
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• 2018

Purpose: This retrospective study was undertaken to investigate whether increasing amikacin dosage for ciprofloxacin prophylaxis in patients with fluoroquinolone (FQ)-resistant rectal flora reduce infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB). Materials and Methods: A total of 430 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups. Patients in both groups were administered ciprofloxacin (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and one day after biopsy. However, whereas group 1 patients (n=202) were administered a single injection of amikacin (1 g, IV) one hour before TRUSPB, patients in group 2 (n=228) were administered two injections of amikacin (1 g, IV) before one hour TRUSPB and again on the day after TRUSPB. Results: Of the 430 study subjects, 129 (30.0%) showed extended-spectrum beta-lactamase (ESBL) positivity. The overall incidence rate of infectious complications was 2.8% (12/430). Infectious complication rates were 4.0% (8/202) in group 1 and 1.3% (3/228) in group 2 (p=0.075). Urinary tract infection and acute prostatitis were more frequent in group 1 (3.5% vs. 0.4%, p=0.029). Infectious complication rates in ESBL negative patients were 3.4% (5/145) in group 1 and 1.3% (2/156) in group 2, whereas those in ESBL positive patients were 7.0% (4/57) in group 1 and 1.4% (1/72) in group 2. Conclusions: Increasing the dosage of amikacin for ciprofloxacin prophylaxis reduce infectious complications in patients with FQ-resistant rectal flora and to be more effective in ESBL positive patients with FQ-resistant rectal flora.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.18
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• pp.7781-7784
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• 2014

Background: The aims of this study were to investigate the utility of red blood cell distribution width (RDW) as a simple and readily available marker in prostate cancer, as well as to evaluate RDW as a predictor of progression in prostate cancer patients. Materials and Methods: We evaluated 62 newly diagnosed prostate cancer patients who underwent transrectal ultrasound (TRUS)-guided biopsy and 62 healthy controls of mean age 64 (range, 45-75) years at the Urology Clinic of Bozok University Hospital. Data collection was performed using our laboratory information system database to retrieve findings regarding RDW, hemoglobin, prostatespecific antigen (PSA), and age. The RDW values were compared between the healthy control group and prostate cancer patients. A high risk of progression as defined as a Gleason score (GS) >6, total number of cores positive for cancer >33%, each core containing >50% cancer cells, and a prostate-specific antigen (PSA) level >10 ng/mL. Patients were classified according to risk of progression, as well as divided into subgroups according to the RDW quartile. Results: The mean RDW value of prostate cancer patients was 14.6, compared with 13.7 in the healthy control group (p=0.001). A higher RDW was associated with an increased risk of progression, whereas a lower RDW value was correlated with a low risk of progression. Conclusions: RDW is an easily derived measure that might, in combination with other markers, help predict prostate cancer risk and progression. We suggest that RDW may be used in combination with other parameters in the assessment of prostate cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.21
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• pp.9125-9130
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• 2014

Background: This study aimed to determine the incidence of prostate cancer in Turkey in a population-based sample, and to determine clinical and pathological characteristics of the cases. Materials and Methods: All newly diagnosed prostate cancer patients were included in this national, multi-centered, prospective and non-interventional epidemiological registry study conducted in 12 cities representing the 12 regions of Turkey from July 2008 to June 2009. The population-based sample comprised 4,150 patients with a recent prostate cancer diagnosis. Results: Age-adjusted prostate cancer incidence rate was 35 cases per 100,000 in Turkey. At the time of diagnosis, median age was 68, median PSA level was 10.0 ng/mL. Digital rectal examination was abnormal in 36.2% of 3,218 tested cases. Most patients had urologic complaints. The main diagnostic method was transrectal ultrasound guided biopsy (87.8%). Gleason score was ${\leq}6$ in 49.1%, 7 in 27.8% and >7 in 20.6% of the cases. There was a statistically significant positive correlation between serum PSA level and Gleason score (p=0.000). The majority of patients (54.4%) had clinical stage T1c. Conclusions: This is the first population-based national data of incidence with the histopathological characteristics of prostate cancer in Turkey. Prostate cancer remains an important public health concern in Turkey with continual increase in the incidence and significant burden on healthcare resources.

• Journal of Yeungnam Medical Science
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• v.22 no.2
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• pp.199-210
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• 2005

Background: The role of obesity in prostate cancer etiology remains controversial. The aim of this study was to evaluate the relationship between obesity and prostate cancer risk. Materials and methods: Between January 2000 and June 2005, 286 patients suspected of having prostate cancer underwent prostate biopsy. The clinical records of the 286 study patients were retrospectively reviewed with regard to age, Body Mass Index (BMI), serum PSA, TRUS, and prostate biopsy results. They were stratified by BMI into three groups according to the cutoffs recommended for Asian populations: normal, BMI less than 23 $kg/m^2$; overweight, BMI 23 to 25 $kg/m^2$; and obese, BMI greater than 25 $kg/m^2$. Results: As for BMIs, 132 (46.2%) were normal, 95 (33.2%) overweight and 59 (20.6%) were obese. A total of 99 (34.6%) patients were diagnosed as having prostate cancer. In multivariate logistic regression analyses, no significant association was observed between BMI and prostate cancer detection. Conclusion: We initially hypothesized that obesity may be biologically associated with increased prostate cancer development. However, our study did not show a significant association between BMI and prostate cancer.

• Investigative Magnetic Resonance Imaging
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• v.17 no.3
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• pp.192-199
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• 2013

Purpose : To retrospectively evaluate the diagnostic performance of dynamic contrast-enhanced MR imaging (DCE-MRI) in detecting recurrent prostate cancer after HIFU of clinically localized cancer, as compared with T2-weighted imaging (T2WI). Materials and Methods: Twenty-six patients with increased prostate-specific antigen levels after HIFU were included in this study. All MR examinations were performed using T2WI and DCE-MRI, followed by transrectal ultrasound-guided biopsy. MRI and biopsy results were correlated in six prostate sectors. Residual or recurrent cancer after HIFU was defined as local tumor progression if biopsy results showed any cancer foci. Two independent readers interpreted the MR images. Results: Of 156 prostate sectors, 51 (33%) were positive for cancer in 17 patients. For detecting local tumor progression, the sensitivity of DCE-MRI and T2WI was 80% and 57% for reader 1 (P < 0.001) versus 84% and 61% for reader 2 (P < 0.001), respectively. The specificity and overall accuracy between DCE-MRI and T2WI showed no statistical difference in both readers (P > 0.05). Interobserver agreement of DCE-MRI and T2WI was moderate and fair, respectively. Conclusion: For detecting local tumor progression of prostate cancer after HIFU, DCE-MRI was more sensitive than T2WI, with less interobserver variability.