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Prostate cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Jurgen J Fütterer, Fillip Kossov, Henkjan Huisman
Morphologic MRI of the prostate is based on T1-weighted (T1W) and T2-weighted (T2W) techniques. The signal intensity (SI) of the prostate on T1-weighted images (T1WI) is homogeneous intermediate SI. Therefore, it is not possible to appreciate the zonal anatomy on T1WI (Figure 17.6). The role of T1WI is to provide evaluation of the presence or absence of pelvic lymphadenopathy (Figure 17.7) and bone lesions (Figure 17.8). Post-biopsy haemorrhage may be differentiated on the basis of its high signal intensity of methemoglobin on T1WI (Figure 17.9). Preferably, MRI of patients suspected of having prostate cancer should be avoided for 8–12 weeks after prostate biopsy to allow reduction of artefacts due to post-biopsy haemorrhage (57–59). Although, such change can persist for up to 18 weeks after biopsy.
Urology
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Investigations➣ Serum PSA - Screening test with high sensitivity, but low specificity. It is an indication to consider prostate biopsy.➣ Transrectal ultrasound (TRUS) and biopsy with prophylactic PO ciprofloxacin +/- IV gentamicin if additional risk factors for infection such as diabetes➣ Pelvic and prostate MRI - To detect the presence of extracapsular extension➣ Isotope bone scan - to assess for bone metastases.➣ Staging CT TAP in high risk cases.PSMA PET scan
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Prostate cancer is a very common disease of elderly men. Many cases present early or are indolent in nature and require nothing more than regular surveillance. Treatment for more active disease ranges from hormonal treatment and radiotherapy to chemotherapy, minimally invasive surgery and brachytherapy. The role of PSA has been called into question for possibly causing many patients to be investigated for diseases that would not go on to kill them. Prostate biopsy is an uncomfortable experience for patients, but can be undertaken in the outpatients’ department. Eventually, prostate carcinoma becomes resistant to LHRH agonists and anti-androgens. At this stage, treatment is palliative, with a median survival of 6-12 months. Other treatments are needed for complications such as bony metastases pain and chronic urinary retention. An oncological emergency may arise from spinal cord compression in patients with bone metastases.
The effect of povidone-iodine rectal cleansing on post-biopsy infectious complications
Published in Scandinavian Journal of Urology, 2023
The main goal of prostate biopsy should be to detect clinically significant prostate cancers with a high accuracy rate and minimal complications. However, our cancer detection rate is under 50%. Our low cancer detection rate is probably due to it being small-sized and a single-center study. Also, anteriorly located prostate cancers are probably missed by TRUS-P. Another possible reason is that we have lately started to use mp-MRI as a triage before the biopsy procedure, which might avoid unnecessary biopsies [5]. Some studies showed that the clinically significant cancer detection rate of TRUS-P is lower than targeted MR fusion biopsies [30], and TRUS-P has more significant post-biopsy infection risks. EAU guidelines recommend both mpMRI before the biopsy procedure and targeted MR fusion biopsy together with systematic biopsy for any suspicious lesion on mpMRI [11].
Association of Serum Carotenoids and Retinoids with Intraprostatic Inflammation in Men without Prostate Cancer or Clinical Indication for Biopsy in the Placebo Arm of the Prostate Cancer Prevention Trial
Published in Nutrition and Cancer, 2022
Susan Chadid, Xiaoling Song, Jeannette M. Schenk, Bora Gurel, M. Scott Lucia, Ian M. Thompson, Marian L. Neuhouser, Phyllis J. Goodman, Howard L. Parnes, Scott M. Lippman, William G. Nelson, Angelo M. De Marzo, Elizabeth A. Platz
A major strength of our study is that prostate tissue inflammation was measured in men most of whom did not have a clinical indication for a prostate biopsy; results were comparable after excluding the 7% of men with a conventional clinical indication for biopsy. Since inflammation can cause serum PSA to rise, and a high PSA can lead to a biopsy recommendation, selecting men without a clinical indication for biopsy minimizes the bias of over-selecting tissue biopsies in men who are likely to be inflamed. Another strength is that carotenoid and retinol concentrations were measured in samples that were pooled over two time points, thus reducing intra-participant variability. We expect that our overall findings may be generalizable to other population of men, since circulating carotenoid, including beta-cryptoxanthin, and retinol concentrations did not notably differ from those reported in other large cohorts (27, 38) aside from higher carotenoid concentrations in our study when compared with a cohort of current and former smokers (4). Limitations include that we were not able to assess whether circulating carotenoids reflect prostate tissue levels, and that the circulating levels (pooled serum from Years 1 and 4) and tissue inflammation (Year 7) were not measured concurrently. Further, we visually assessed inflammation on H&E slides but did not measured immune cell function or cellular phenotypes. Thus, we cannot rule out other influences of carotenoids on, say, the balance of effector vs. suppressor cells in the prostate stroma.
Evaluation of the Forsvall biopsy needle in an ex vivo model of transrectal prostate biopsy – a novel needle design with the objective to reduce the risk of post-biopsy infection
Published in Scandinavian Journal of Urology, 2021
Andreas Forsvall, Jane Fisher, José Francisco Pereira Cardoso, Magnus Wagenius, Jonas Tverring, Bo Nilson, Andreas Dahlin, Ola Bratt, Adam Linder, Tirthankar Mohanty
Prostate cancer is mainly diagnosed and monitored using tissue obtained by a Tru-Cut biopsy needle [1]. Transrectal prostate biopsy (TRbx) is the most common biopsy method [1]. In TRbx, the biopsy needle transfers colonic bacteria through the rectal wall into the prostate and periprostatic tissue, potentially causing infectious complications, including sepsis [1–3]. Currently, the risk of post-biopsy infection is 2–10% [1,4]. Although the use of pre-biopsy MRI, nomograms and biomarkers has reduced the need for prostate biopsies, huge numbers of men still undergo a prostate biopsy. Antibiotic prophylaxis reduces the risk of post-biopsy infection and is routinely used, but antimicrobial resistance has led to increasing rates of infections [1,5]. Current recommendations of antibiotic prophylaxis vary [1,6]. Escherichia coli (E. coli) is by far the most common bacterium isolated from patients with post-TRbx sepsis [7].