Interpretation of Prostatic Biopsy at a tertiary care centre

Abstract

Introduction: Worldwide prostatic carcinoma is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. Prostate-specific antigen (PSA), digital rectal examination, and transrectal ultrasound are the tools most commonly used to screen for prostate cancer. Prostatic biopsy is most often preceded by abnormalities found on digital rectal examination (DRE) or serum prostate specific antigen (S.PSA) elevation. This study was planned to know proportion of malignant and benign lesions in histopathologic examination for prostatic lesions in patient who attend OPD/IPD and to analyze the usefulness of serum PSA & ultrasound examination by histopathological confirmation. Methods: Patients visited to urology department with urinary incontinence and other complaints were evaluated which includes clinical history, signs and symptoms. Rectal examination of patients was done. Serum PSA level and prostatic biopsy were sent of those who were suspected for prostatic disease. Prostate biopsy was obtained by using any one of the following method 1.Transurethral resection biopsy 2. Transrectal biopsy Trucut biopsy. Results: Out of 300 cases of prostatic biopsy 265 (88.33%) are benign and 35 (11.66%) cases are malignant lesions. Out of 300 cases, 191 (63.66%) are pure benign prostatic hyperplasia, 48(16%) are BPH with chronic prostatitis and 11(3.66%) are BPH with severe prostatitis. Out of 35 cases of prostatic carcinoma 33 (94.28%) cases are adenocarcinoma and 2 cases (5.71%) are transitional cell carcinoma. Out of 262 cases with clinically benign lesions, 258 cases proved benign histopathologically but 4 cases (1.52%) are diagnose malignant. 151 patients have S.PSA less than 4 ng/ml, out of 151, 149 turned to be benign on histopathological examination. 52 patient have S.PSA above 10 ng/ml, out of these 52 cases, 29 have malignancy in HPE examination. Out of 278 cases diagnosed as benign isoechoic by ultra sonography 262 cases have benign lesion on histologic diagnosis and 16 have malignant lesion. Out of 22 cases diagnosed as malignant (hypoechoic asymmetrical) by ultrasonographicaly 19 proved malignant histologically. Conclusion: The results of this study indicate that transrectal ultrasound, serum prostate specific antigen and digital rectal examination were good tool to differentiate between malignant and benign lesions of prostate. Proportion of malignancies are quiet significant in prostatic lesions and increased with age. Key words: Prostae, Malignancy, Biopsy, PSA, DRE