Deficiencies of TRUS biopsy? *
- Risk of infection
- Unguided 'blind' biopsy - Prostate cancer is the only solid tumor diagnosed without image guidance in the hopes of accidentally hitting the tumor
- - Overdiagnosis / Underdiagnosis
- Prostate Evasive Anterior tumors.
- Often found late
- Often extracapsular
- If initial pathologyy GS6, 60% upgraded on subsequent biopsy
Advantages of transperineal biopsies? *
- Safer, with better access to anterior zone
- Avoids 'Transfecal' biopsy.
- No life threatening sepsis or rectal bleeding
- Requires Regional anesthesia / General anesthesia
Indications of repeat biopsy after initial negative biopsy? *
- Rising and/or persistently elevated PSA
- Supsicious DRE - 5-30% cancer risk
- ASAP - Atypical small acinar proliferation - 40% risk
- Multifocal HGPIN (multiple biopsy sites i.e >3) - 30% risk
- Positive mpMRI findings
Templete mapping biopsy?
- 1 core per cc of prostate (40-90 cores)
- Transperineal + saturation + easier to sample anterior zone
PROMIS trial - TRUS biopsy vs Templete biopsy? *
Cores of biopsy? *
- 24 cores for <30 cc
- 32 cores for 30-50 cc
- 38 cores for >50 cc
What are the indications of MRI in prostate carcinoma? *
For positive biopsy - staging, risk stratification in active surveillance, focal therapy
Negative biopsy - look for PEATS, rule out significant disease, targeted biopsies
Emerging indication - Prior to biopsy
Can MRI detect all prostate carcinoma?*
- Multiparametric MRI may miss prostate cancers
- Very dependent on center and radiologists skill/experience
- PROMIS - 5 possible centers excluded because unable to provide sufficient quality despite expert training and support for setup
- MRI performs better than TRUS biopsy.
- TRUS biopsy is still standard of care of initial biopsy
- PI-RADS 1: very low (clinically significant cancer is highly unlikely to be present)
- PI-RADS 2: low (clinically significant cancer is unlikely to be present)
- PI-RADS 3: intermediate (the presence of clinically significant cancer is equivocal)
- PI-RADS 4: high (clinically significant cancer is likely to be present)
- PI-RADS 5: very high (clinically significant cancer is highly likely to be present)
USG for Biopsy? *
BK medical USG machine
What are corpora amylacea?
- Calcifications along the surgical capsule
- Plane between the PZ and TZ
- Small, multiple diffuse calcifications area normal, often incidental ultrasonographic finding in the prostate and represent a result of age rather than a pathologic entity.
Size of normal seminal vesical?
- 4.5 to 5.5 cm long
- 2 cm in width.
Normal prostate USG image?
A, Transverse view. B, Sagittalview. AFS, anterior fibromuscular stroma;CZ, central zone; DV, dorsal veincomplex; EJD, ejaculatory ducts; NVB,neurovascular bundle; L, levator muscles;PZ, peripheral zone; TZ, transition zone;U, urethra.