To evaluate the effectiveness of PSA density in distinguishing between benign prostatic hyperplasia (BPH) and prostate cancer in patients with intermediate PSA levels (4 - 10 ng/ml) and to reduce unnecessary biopsies....To evaluate the effectiveness of PSA density in distinguishing between benign prostatic hyperplasia (BPH) and prostate cancer in patients with intermediate PSA levels (4 - 10 ng/ml) and to reduce unnecessary biopsies. Patients and Methods: 90 patients with PSA levels in the “Gray Zone” PSA (4 - 10 ng/ml) were included. Prostate volumes were estimated using transrectal ultrasonography. Serum PSA levels were measured using an enzyme immunoassay. PSA density was calculated and compared with histopathological results. Statistical analysis was performed using SPSS, t-test, and Contingency Coefficient test. Results: A PSA density cutoff of 0.15 ng/ml/cm3 was used for prostate cancer detection. Mean PSA density for BPH patients: 0.0844 ng/ml/cm3. Mean PSA density for prostate cancer patients: 0.172 ng/ml/cm3. Sensitivity: 92.3%, Specificity: 93.5%, Positive Predictive Value: 70.5%, Accuracy: 93.3%. PSA density significantly reduced unnecessary biopsies (p Conclusions: PSA density can be effective in reducing unnecessary biopsies in patients with intermediate PSA levels, particularly those with organ-confined prostate cancer who are candidates for radical treatment.展开更多
Background Freehand transperineal prostate biopsy(TPPBx)using a coaxial needle technique offers an alternative to probe-mounted freehand or template-guided techniques in the diagnosis of prostate cancer(PCa).It only r...Background Freehand transperineal prostate biopsy(TPPBx)using a coaxial needle technique offers an alternative to probe-mounted freehand or template-guided techniques in the diagnosis of prostate cancer(PCa).It only requires the same equipment used for transrectal ultrasound-guided(TRUS)biopsy.Our study is the first in Malaysia to report this experience and its outcomes.We aim to determine PCa detection rate and pain tolerability of freehand TPPBx utilizing a coaxial needle under local anesthesia(LA).Methods Institutional review board approval was obtained from National Medical Research Register(NMRR ID-21-02052-VIL).We retrospectively reviewed the medical records of patients who underwent TPPBx between August 2020 and April 2022.Records were reviewed for patients’characteristics,prostate volume,prostate-specific antigen(PSA)results,biopsy results and pain tolerability.Data was analyzed to determine PCa and clinically significant prostate cancer(csPCa)detection rate.LA was achieved using perineal skin infiltration and a periprostatic nerve block.The commonly used standard side-firing transrectal ultrasound with its Prostate Biplane Transducer was used as an imaging guide.The principles of the Ginsburg protocol were followed.Pain tolerability was assessed using a visual analog scale.Results A total of 55 patients with elevated PSA levels underwent freehand TPPBx under LA.The mean age was 67.3 years,the median PSA was 14.2 ng/mL,and the median PSA density(PSAD)was 0.33 ng/mL/cc.The optimal PSAD cutoff for predicting csPCa was 0.35 ng/mL/cc(area under the curve[AUC],0.792;sensitivity,87.5%;specificity,69.2%).PCa was detected in 24 patients(43.6%),of whom 16(29.1%)had csPCa.The median pain scores during LA infiltration and biopsy were four and two,respectively,which were significant different(P<0.05).TPPBx exhibited an infection rate of zero.Conclusion The PCa detection rate and patient tolerability of freehand TPPBx using a coaxial needle are similar to those of a contemporary published series.The use of existing equipment that is used for TRUS biopsy allows for widespread use and transition from TRUS biopsy.展开更多
文摘To evaluate the effectiveness of PSA density in distinguishing between benign prostatic hyperplasia (BPH) and prostate cancer in patients with intermediate PSA levels (4 - 10 ng/ml) and to reduce unnecessary biopsies. Patients and Methods: 90 patients with PSA levels in the “Gray Zone” PSA (4 - 10 ng/ml) were included. Prostate volumes were estimated using transrectal ultrasonography. Serum PSA levels were measured using an enzyme immunoassay. PSA density was calculated and compared with histopathological results. Statistical analysis was performed using SPSS, t-test, and Contingency Coefficient test. Results: A PSA density cutoff of 0.15 ng/ml/cm3 was used for prostate cancer detection. Mean PSA density for BPH patients: 0.0844 ng/ml/cm3. Mean PSA density for prostate cancer patients: 0.172 ng/ml/cm3. Sensitivity: 92.3%, Specificity: 93.5%, Positive Predictive Value: 70.5%, Accuracy: 93.3%. PSA density significantly reduced unnecessary biopsies (p Conclusions: PSA density can be effective in reducing unnecessary biopsies in patients with intermediate PSA levels, particularly those with organ-confined prostate cancer who are candidates for radical treatment.
文摘Background Freehand transperineal prostate biopsy(TPPBx)using a coaxial needle technique offers an alternative to probe-mounted freehand or template-guided techniques in the diagnosis of prostate cancer(PCa).It only requires the same equipment used for transrectal ultrasound-guided(TRUS)biopsy.Our study is the first in Malaysia to report this experience and its outcomes.We aim to determine PCa detection rate and pain tolerability of freehand TPPBx utilizing a coaxial needle under local anesthesia(LA).Methods Institutional review board approval was obtained from National Medical Research Register(NMRR ID-21-02052-VIL).We retrospectively reviewed the medical records of patients who underwent TPPBx between August 2020 and April 2022.Records were reviewed for patients’characteristics,prostate volume,prostate-specific antigen(PSA)results,biopsy results and pain tolerability.Data was analyzed to determine PCa and clinically significant prostate cancer(csPCa)detection rate.LA was achieved using perineal skin infiltration and a periprostatic nerve block.The commonly used standard side-firing transrectal ultrasound with its Prostate Biplane Transducer was used as an imaging guide.The principles of the Ginsburg protocol were followed.Pain tolerability was assessed using a visual analog scale.Results A total of 55 patients with elevated PSA levels underwent freehand TPPBx under LA.The mean age was 67.3 years,the median PSA was 14.2 ng/mL,and the median PSA density(PSAD)was 0.33 ng/mL/cc.The optimal PSAD cutoff for predicting csPCa was 0.35 ng/mL/cc(area under the curve[AUC],0.792;sensitivity,87.5%;specificity,69.2%).PCa was detected in 24 patients(43.6%),of whom 16(29.1%)had csPCa.The median pain scores during LA infiltration and biopsy were four and two,respectively,which were significant different(P<0.05).TPPBx exhibited an infection rate of zero.Conclusion The PCa detection rate and patient tolerability of freehand TPPBx using a coaxial needle are similar to those of a contemporary published series.The use of existing equipment that is used for TRUS biopsy allows for widespread use and transition from TRUS biopsy.
