Wednesday, October 3, 2012

Prostate biopsy ( transrectal US-guided and Transgluteal CT-guided prostate biopsy) part 1

Clinical Features
 Prostate cancer is the most common noncutaneous cancer in men, and the second leading
cause of male cancer mortality.
 No routine screening guidelines for prostate cancer have been established. Digital rectal
examination (DRE) and serum prostate-specific antigen (PSA) levels should be offered
to asymptomatic men 40 years of age or older who wish to be screened with an estimated
life expectancy of more than 10 years. Determination of future screening intervals
is based upon the first DRE findings and PSA levels.
 Ninety-five percent of prostate cancers are adenocarcinomas that develop in the acini of
the prostatic ducts.
 Cancer is found in the peripheral zone of the prostate in approximately 60-70%, in the
transition zone in 10-20%, and in the central zone in 5-10%.

Diagnostic Evaluation
 The digital rectal exam has a high false-negative rate of 25–45% and only 20% of palpable
lesions are curable.

 PSA, in conjunction with DRE, is used for early diagnosis of prostate cancer and for
monitoring for disease recurrence. Men with a PSA level greater than 2.5 ng/mL have
a 20% chance of finding prostate cancer at biopsy, and this increases to 50% if the PSA
is greater than 10 ng/mL.

M. Pectasides Radiology Department, Massachusetts General Hospital, Boston, MA, USA

 The established radiological sign of prostate cancer is the hypoechoic nodule on transrectal
ultrasound (TRUS). However, the positive predictive value of the hypoechoic
lesion in the average urologic population is low, ranging between 18% and 53%.
Moreover, up to 30% of all prostate cancers are isoechoic.
 Since detection and localization of prostate tumors using greyscale ultrasound is poor,
TRUS is mainly used to guide systematic biopsies.



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