Comparison of transrectal prostate digital aspiration and ultrasound-guided core biopsies in 99 men

We compared digital transrectal needle aspiration and transrectal core prostate biopsies obtained with ultrasound guidance in 99 men. Both procedures were effective in identifying prostate cancer; complete sensitivity was 94 percent for aspiration and 90 percent for core biopsy. Aspiration confirmed 87 percent of 38 known cancers and 94 percent of 81 cancers overall, compared with 82 percent and 90 percent with core biopsies. The greatest number of cancers was found when both procedures were considered (95% of known and 98% of all cancers). Grading of both specimens was performed but was not equivalent. Unsatisfactory or inconclusive results by either procedure often obtained when cancer was present. We suggest digital transrectal needle aspiration as a first means of identifying most palpable prostate lesions. Transrectal core biopsies guided by ultrasonography should be used when suspicion of cancer cannot be confirmed by aspiration and when there is no palpable lesion (but clinical suspicion of cancer).     

Needle aspiration and needle biopsy procedures

Needle biopsy of the prostate, employing large "core" needles and performed via the transperineal or transrectal routes, is a well-established method for diagnosing prostatic malignancy. This procedure can be performed safely under local anesthesia in an outpatient setting. Rectal cleansing and prophylactic antibiotics have minimized infectious complications following transrectal biopsy, and it remains the favored technique in patients with small lesions. Repeat biopsy under anesthesia is indicated when the clinical suspicion of malignancy remains high despite negative biopsies. In contrast to "core" needle biopsy, which obtains a cylinder of tissue for histologic examination, the fine-needle biopsy obtains a specimen for cytologic examination. If cytologic expertise is unavailable locally, the specimen may be fixed in the office and shipped to a major medical center for interpretation. Fine-needle aspiration may be safely employed to biopsy the prostate, pelvic masses, and inguinal and pelvic lymph nodes. Biopsy of palpable masses can be done simply and safely with morbidity akin to venipuncture. Nonpalpable tissues may be biopsied under radiographic guidance. Fine-needle aspiration biopsy is safe and cost-effective, has resulted in a significant improvement in the accuracy of our clinical staging, and has spared many patients unnecessary surgical procedures.     

Prostatic aspiration biopsy: an assessment of accuracy based on long-term observations

We present the results of transrectal thin needle aspiration biopsy of the prostate in 133 patients. Test specificity was 94 per cent and sensitivity also appeared to be high initially. However, with repeated rectal examinations and biopsies during an 11-year period a number of additional false negatives became apparent, which resulted in an apparent test sensitivity of 82 per cent, lower than most previously published reports. Our data suggest that aspiration biopsy has specificity and sensitivity similar to core biopsy, it is important to re-test patients who have a palpable abnormality and an initially benign biopsy, and aspiration biopsy simplicity allows for a low threshold of suspicion of subtle abnormalities and for repeating biopsies after negative findings.     

A study of transrectal aspiration biopsy of the prostate

We studied 35 needle aspiration biopsies of the prostatic cancer to evaluate the reliability for screening, as compared with the transrectal or transperineal needle biopsy of the same patients. Eight specimens were unsatisfactory for cytological study, only 77.4% of the 35 aspirations being cytologically evaluable. False negative aspiration biopsies occupied 22.7%. Histopathological evaluation was possible for all of the needle biopsies and the false negative rate was 5.7%. To examine how accurately aspiration biopsy or needle biopsy reflects the true histologic grade of prostatic cancer, both the cytologic grade of the aspirations and histologic grade of the biopsies were compared with the grade of the prostatectomy specimens. The aspiration biopsy was undergraded in 2 (11.8%) overgraded in 2 (11.8%) and correctly graded in 14 (82.4%) out of 17 cases. The needle biopsy was undergraded in 1 (3.2%), overgraded in 2 (6.5%) and correctly graded in 28 (90.3%) out of 31 cases. There was no significant difference in grading accuracy rate between cytology of the aspiration and histology of the needle biopsy. We conclude that the cytological grade is as reliable as needle biopsy, but aspiration biopsy is not a more efficient screening test for prostatic neoplasms than needle biopsy, considering the higher percentage of speciments unsatisfactory for aspiration and false negative in this small series.     

Ultrasound-guided prostate biopsy. Biopty gun superior to aspiration

We used a 7 MHz transrectal ultrasound scanner to perform guided core biopsy and aspiration cytologies on 292 patients with findings suspicious for prostate cancer. One hundred two cancers were identified, 35 of which were not palpable and were detected only by ultrasound. Aspiration needles were guided by ultrasound through the center of the suspicious lesion. Core biopsies were performed using an 18-gauge Tru-Cut type of needle with an automatic, spring-powered needle biopsy device (Biopty). All patients received only local anesthetic and biopsies were done as an outpatient office procedure. The core biopsies gave excellent specimens which detected 89 percent of the cancers, whereas the aspiration method detected 51 percent (P less than 0.001). Aspiration cytology was significantly less sensitive among well-differentiated compared with moderately differentiated cancers. High-resolution transrectal ultrasound and the Biopty device are detecting and documenting prostate cancer with much greater sensitivity than preceding techniques have achieved.     

超声引导前列腺12针系统穿刺活检术

目的　探讨经直肠超声引导下前列腺12针系统穿刺活检术诊断前列腺癌的临床价值。　方法　对220例行经直肠B超引导下前列腺12针(在传统6针基础上增加前列腺两侧外周带外侧底、中、尖部各1针)系统穿刺活检术的患者资料进行回顾性分析。　结果　前列腺癌患者73例(33. 2% ),临床分期T1 4例、T2 21例、T3 15例、T4 33例,如按传统6针穿刺方法穿刺,检出率为31. 4%,将有4例早期癌(T1 3例、T2 1例,体积均<0. 5ml)患者漏诊, 6针较12针穿刺漏诊早期癌16% (4 /25)。220例患者均未出现严重并发症。　结论　12针较6针系统穿刺活检可以增加早期癌和小体积癌( <0. 5ml)的检出,应重视对前列腺外周带外侧6点的穿刺。     

Transrectal fine-needle aspiration and truecut needle biopsy of the prostate: a blinded comparison of accuracy

Transrectal needle aspiration biopsy and core biopsy of the prostate were performed simultaneously on 88 men with prostatic nodules. Cytologic and histologic assessments were made in a blinded, independent fashion, and the results were compared. All patients with positive findings on aspiration also had positive findings on core biopsy, for a positive predictive value for aspiration of 100%. However, five negative and six "insufficient" results obtained by aspiration were positive on core biopsy, for a negative predictive value for aspiration of 88%. This experience support the use of needle aspiration as an initial diagnostic maneuver in the assessment of prostatic nodules.     

Ciprofloxacin versus gentamicin in prophylaxis against bacteremia in transrectal prostate needle biopsy

Consecutive patients with abnormal rectal examinations underwent transrectal needle prostate biopsy at VA Medical Center, New Orleans. Each patient was randomized to receive either gentamicin 1.5 mg/kg intravenously (IV) or 500 mg ciprofloxacin (Cipro-Miles) p.o., before and after the biopsy. Serum and prostate tissue levels of ciprofloxacin and gentamicin were measured by high-pressure liquid chromatography and by competitive binding immunoassay, respectively. Blood cultures were obtained, and the patients were observed for twenty-four hours after biopsy. After discharge the patients were followed up by telephone. The incidence of bacteremia and postbiopsy symptoms were less with ciprofloxacin. Prostate tissue levels of this drug were higher than gentamicin, while serum levels were roughly equivalent. Ciprofloxacin is less nephrotoxic, can be given orally, and has a better antimicrobial spectrum. We, therefore, recommend it as prophylaxis against bacteremia in transrectal prostate needle biopsy. Furthermore, it appears that prostatic drug levels are more important than serum levels in preventing bacteremia.     

Detection rate of histologically insignificant prostate cancer with systematic sextant biopsies and fine needle aspiration cytology

PURPOSE: We evaluate the detection rate of insignificant prostate cancer and the rate of significant prostate cancer overlooked in the results of systematic sextant biopsy and fine needle aspiration biopsy of the prostate of asymptomatic men with serum prostate specific antigen concentrations less than 4.0 ng./ml. MATERIALS AND METHODS: We analyzed specimens from 133 consecutive patients with a mean age of 60 years undergoing cystoprostatectomy for bladder cancer. Six systematic biopsy specimens and 2 fine needle aspiration cytology samples were taken from the prostate immediately after cystoprostatectomy. The specimens were step sectioned and examined for prostate cancer. Insignificant prostate cancer was defined as any cancer with an aggregate volume 0.5 cm.3 or less. RESULTS: Incidental prostate cancer was found in 58 of the 133 patients (44%). Tumor volume was 0.5 cm.3 or less in 47 cases. Sextant biopsy detected 7 cancers, including 4 of 47 (9%) that were insignificant and 3 of 11 (27%) that were significant. Fine needle aspiration cytology also detected 7 cancers, including 3 (6%) and 4 (36%) that were insignificant and significant, respectively. CONCLUSIONS: Systematic sextant biopsy and fine needle aspiration cytology each diagnose prostate cancer in about 5% of asymptomatic men who have normal digital rectal examination and serum prostate specific antigen less than 4.0 ng./ml. However, many of the cancers thus detected are insignificant and most of the significant cancers are missed. Therefore, routine screening of such patients with sextant biopsy or aspiration cytology does not appear to be justified.     

Transrectal ultrasonography in the diagnosis and staging of carcinoma of the prostate

Transrectal prostatic ultrasonography is a potentially valuable means to evaluate the prostate of men with suspected carcinoma. We studied 118 patients with this modality before histological evaluation of the prostate (20 underwent radical prostatectomy, 75 core needle biopsy and aspiration cytology, and 23 transurethral resection of the prostate). Transrectal ultrasonography was more efficient than digital rectal examination in the staging of carcinoma of the prostate before radical prostatectomy. The value of transrectal ultrasonography in the diagnosis of prostatic cancer in men with an abnormal-feeling prostate on digital rectal examination is less certain, since 10 of 75 patients (13 per cent) in this group had a falsely positive scan. The predictive value of a scan positive for malignancy was 37 per cent. Further refinements in the technique of transrectal prostatic ultrasonography are needed to realize fully the diagnostic potential of this imaging modality.     

Transrectal ultrasound and fine needle aspiration for malacoplakia of the prostate

Clinically, malacoplakia of the prostate gland may mimic prostatic carcinoma. We report a case of prostatic malacoplakia in which transrectal ultrasound of the prostate was most compatible with carcinoma. However, fine needle aspiration cytology and biopsy revealed the classical histopathological features of malacoplakia so that a correct diagnosis could be made.     

A comparison of fine needle aspiration and core biopsy in diagnosis and preoperative grading of prostate cancer

Fine needle aspiration biopsy has been documented to be safe and accurate for the diagnosis of prostate cancer. A study was done based on 3 objectives to determine 1) whether performing core biopsies and fine needle aspiration in each patient with a prostate nodule increases the detection rate of prostate cancer, 2) the accuracy of preoperative grading by fine needle aspiration in predicting the final pathological grade in radical prostatectomy specimens and 3) the usefulness of fine needle aspiration in screening for unsuspected stage A prostate cancer. Of 203 consecutive patients undergoing prostate biopsies core and fine needle aspiration biopsies were performed in 121. An additional 58 patients underwent prostate biopsies just before transurethral resection of the prostate and 24 underwent radical prostatectomy. The diagnostic accuracy of fine needle aspiration was superior to that of core biopsy (82 versus 74 per cent). Performance of both biopsies yielded a higher percentage of positive diagnoses than either biopsy alone (32.2 per cent versus 24 and 28 per cent). Except in poorly differentiated cancers, fine needle aspiration is a poor predictor of final pathological grade. Fine needle aspiration is not useful in detecting stage A1 prostate cancer. Although fine needle aspiration has several distinct advantages over core biopsies, there is a definite learning curve before its use can be fully exploited. It is important to have an experienced pathologist and to perform both biopsies at each center until sufficient experience is accumulated.     

Diagnosis of salivary gland tumors by fine needle aspiration biopsy

The cytologic findings of 51 smears obtained by fine needle aspiration biopsy from salivary gland masses were compared with the histologic findings of permanent sections. The overall concurrence rate between cytologic and histologic findings for benign and malignant lesions was 91%. The diagnostic accuracy (exact histologic diagnosis) for the benign lesions was 87% and for the malignant tumors 60%. One case showed false-positive results and 1 case false-negative results. Fine needle aspiration biopsy has been found to be safe, free of complications, and helpful in the planning of treatment.     

Transrectal ultrasound and biopsy in diagnosis of malakoplakia of prostate.

We report our experience with the use of transrectal ultrasound and ultrasound-guided needle biopsy in the diagnosis of 4 cases of malakoplakia of the prostate. Prostatic malakoplakia is rare with a total of 25 cases reported in the literature. It may simulate carcinoma on digital rectal examination and transrectal ultrasound. Herein are 4 additional cases in which transrectal ultrasound of the prostate was compatible with carcinoma. Subsequent needle biopsy of the suspicious regions revealed the classic pathologic features of malakoplakia. Malakoplakia is a difficult pathologic diagnosis, and the prevalence of this disease may be underestimated. As the use of transrectal ultrasound becomes more common in diagnosing carcinoma of the prostate, and due to the difficulty in diagnosing malakoplakia pathologically, we recommend maintaining a high index of suspicion for malakoplakia to avoid possible unnecessary radical surgery.     

Prostate cancer screening with prostate specific antigen in spinal cord injured men

PURPOSE: As the spinal cord injured population ages, prostate cancer becomes a more significant cause of potential mortality. Consequently due to various bladder management techniques the validity of standard prostate specific antigen (PSA) screening values in this population must be evaluated. We compared screening PSA values in a large population of spinal cord injured patients with those in age matched, nonspinal cord injured men. MATERIALS AND METHODS: Screening PSA values were obtained using the AxSYM assay (Abbott Laboratories, Abbott Park, Illinois) in 366 spinal cord injured men 40 to 79 years old. In those with PSA elevated to greater than 4 ng./ml. who consented to further evaluation standard sextant needle biopsy of the prostate were performed under transrectal ultrasound guidance. Data were compared with data on 371 randomly selected, age matched controls from the Baylor College of Medicine community screening program database of more than 19,000 patient-tests. Analysis was performed with the unpaired Student t test. RESULTS: When we divided patients 40 to 80 years old into 4 age groups by decade and compared them with normal controls by decade, there was no statistically significant difference in mean PSA in the 2 groups. Of 18 spinal cord injured patients with PSA greater than 4 ng./ml. 12 underwent transrectal ultrasound guided needle biopsy of the prostate and 6 refused further evaluation. Five of these biopsies (1.3% overall) were positive and 7 were negative for adenocarcinoma. CONCLUSIONS: As in healthy men, PSA and digital rectal examination can be performed in spinal cord injured men to screen for prostate cancer. None of the various bladder management techniques in these cases seemed to affect screening results.     

Comparison of transrectal fine-needle aspiration cytology and core needle biopsy in diagnosis of prostate cancer

One hundred sixty-nine transrectal fine-needle aspirations of the prostate gland were performed in 166 patients over a two-year period. The results were compared with simultaneous core needle biopsy performed in all but 4 patients. Forty-seven (28%) aspirations were either unsatisfactory or inconclusive. Of the remaining 122 (72%) patients in whom a cytologic diagnosis could be made, core biopsy was available in 120. Aspiration cytology was 87 percent sensitive and 96 percent specific with an overall agreement of 93 percent with core biopsy. No major complications occurred. We conclude that fine-needle aspiration of the prostate is accurate, safe, and cost-effective, and greater application of this technique is encouraged.     

超声引导下经不同针数直肠前列腺穿刺活检对前列腺癌的早期诊断效果对比

目的探讨超声引导下经直肠前列腺穿刺活检在诊断前列腺癌的价值。方法选取2013年1月至2016年12月在本院就诊的疑似前列腺癌患者62例，均超声引导下经直肠前列腺穿刺活检，分析不同穿刺法的阳性检出情况。结果本组研究62例患者，穿刺活检病理结果为前列腺癌患者25例（40.32%），其中34例接受10针法穿刺，28例接受12+1针法穿刺，两种穿刺的阳性率分别为35.29%（12/34）和46.43%（13/28），差异无统计学意义（P＞0.05）；前列腺体积≥90 mL患者10针法阳性检出率为33.33%（5/15），明显低于12+1针法的87.50%（7/8），差异比较有统计学意义（P＜0.05）；10针法和12+1针法在不同年龄、前列腺特异性抗原（PSA）及指诊情况下阳性检测率比较差异无统计学意义（P＞0.05）；10针法和12+1针法穿刺后血尿、血便、疼痛、尿潴留及感染发生比例差异比较无统计学意义（P＞0.05）。结论 应根据患者具体情况选取穿刺方法，当患者前列腺体积超过90 mL时，应采取12+1针法穿刺，有助于前列腺癌的检出，而当＜90 mL时，选取10针法穿刺较适宜。     

The accuracy of transrectal aspiration biopsy of the prostate: an analysis of 452 cases

This study compares cytological findings obtained by transrectal aspiration biopsy of the prostate with histological findings obtained by simultaneously performed transperineal punch biopsy. All interventions were performed on outpatients. Complications such as hematuria, urinary infection, or epididymitis occurred in 4.4% of the cases, the majority of them being attributed to punch biopsies. Exact correspondence was found in 78.8% of 433 usable specimens, the accuracy for carcinoma amounting to 71.1%. Specimens cytologically judged either false "negative" or "suspicious" were histologically mostly well-differentiated (G1 and G2) carcinomas (96.1%). The value of fine needle biopsy of the prostate as nonstaining diagnostic procedure will be discussed.     

Transrectal fine-needle aspiration biopsy for cytologic diagnosis and grading of prostatic carcinoma

In this article, the Karolinska experience of transrectal fine-needle aspiration biopsy of prostatic carcinoma, which now extends over more than twenty years, is evaluated. The cytologic criteria for diagnosing prostatic carcinoma in aspirates are well defined. While accuracy for cytodiagnosis is similar to that of histopathologic diagnosis, fine-needle aspiration is a less traumatic, cheaper procedure compared with histologic biopsy methods. Accuracy depends very much upon the skill of the examiner taking the cell samples and on the alertness of the cytopathologist for possible diagnostic pitfalls. Cytologic grading of prostatic carcinoma into well, moderately, and poorly differentiated types has been shown to be correlated significantly not only to histopathologic grading, but also to clinical stage, response to hormonal therapy and survival. The degree of tumor differentiation is well reproduced by independent observers. Cytochemical parameters, such as DNA measurement, constitute a potential refinement of cytologic grading, especially in moderately differentiated carcinomas. In medical centers with long experience of fine-needle aspiration biopsy, the method has a central role in diagnosis and management of prostatic carcinoma, including posttherapy follow-up.     

Robot-assisted laparoscopic radical prostatectomy after fluoroquinolone resistant Escherichia coli sepsis following a transrectal ultrasonography-guided prostate biopsy

The incidence of febrile urinary tract infection after transrectal ultrasonography-guided prostate biopsy has been reported to range from 0.1% to 7%, with Escherichia coli being the most common organism identified. The conventional wisdom is to recommend an interval of more than 4 to 6 weeks after the transrectal prostate biopsy before treating patients with radical prostatectomy. This allows time for resolution of the biopsy-induced inflammation, which might complicate the surgical planes for dissection. We present a 58-year-old man with an elevated prostate-specific antigen, who developed near-fatal sepsis following transrectal ultrasonography-guided prostate biopsy despite quinolone prophylaxis. The patient underwent a robot-assisted laparoscopic radical prostatectomy 31 days after the prostate biopsy.