Ultrasound guided transrectal polyfocal biopsy in prostate cancer diagnosis

Abstract

Background: prostate cancer (PCa) is a topic of special interest in the modern urologic oncology. PCa is associated with high rates of morbidity and mortality among the male population in Russia and worldwide. The current diagnostic algorithm for PCa detection includes a digital rectal examination to check the prostate, and a PSA test to measure levels of prostate specific antigen (PSA) in the blood, and a prostate biopsy followed by morphological verification. Aim: to analyze the results of transrectal ultrasound guided polyfocal biopsies of the prostate, performed from 2021 to 2022 in patients who underwent diagnosis and treatment at the Clinical Hospital "RZD-Meditsina" of the city of Krasnoyarsk. Patients and Methods: in all cases the evaluation of patients included the measurement of a total PSA (PSAtotal) concentration, standard examination, and the preparation for biopsy. The ultrasound guided prostate biopsy was performed in the hospital setting. After the procedure, all patients were followed up to control and prevent possible complications. Histological examination of the biomaterial included the verification of malignant neoplasms or benign lesions in the prostate tissue, Gleason score, and other morphological characteristics. Results: findings of 220 transrectal ultrasound guided prostate biopsies were analyzed. The median age of patients was 64 (44–89) years. Benign prostatic hyperplasia (BPH) was diagnosed in 112 (51%) patients, prostate cancer — in 108 (49%) patients. PSA level varied from 0.48 to 37.9 ng/ml in the BPH patients, and from 4.48 to 100.0 ng/ml in the PCa group. The median prostate volume was 74.61 (10.26–134.80) cm3 in the PCa group, and 153.45 (116.22–185.50) cm3 in the patients with BPH. Most of PCa patients had Gleason score ≤7 representing moderately differentiated tumors. Post-biopsy complications were observed in 141 (64.09%) patients and included hematuria, short-term rectal bleeding, chronic prostatitis exacerbation. All complications were cured successfully treated using conservative therapy. Conclusion: PCa can be diagnosed even in patients with low PSATotal levels or the normal prostate volume . Moderately differentiated tumors (Gleason score ≤7) predominated in the population of patients. These data are consistent with the effective early detection of PCa. Patients should be closely monitored in the early post-operative period after a diagnostic prostate biopsy to prevent potential complications. KEYWORDS: prostate cancer, biopsy, prostate, transrectal puncture biopsy, ultrasound navigation. FOR CITATION: Berezhnoy A.G., Dunaevskaya S.S., Auzina S.I. Ultrasound guided transrectal polyfocal biopsy in prostate cancer diagnosis. Russian Medical Inquiry. 2022;6(6):309–313 (in Russ.). DOI: 10.32364/2587-6821-2022-6-6-309-313.