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- Title
Analiză comparativă retrospectivă a protocolului extins versus protocolul de saturaţie la al doilea set de biopsii prostatice.
- Authors
Sinescu, I.; Voinea, S.; Harza, M.; Gingu, C.; Oerbanescu, B.; Chibelean, C.; Manea, I.; Gagiu, C.; Haineala, B.
- Abstract
Introduction and Objectives: Increasing of specific prostatic antigen and a suspicious rectal examination are the main causes to perform prostatic biopsy. After a first prostatic biopsy with negative result, some patients have high risk of having cancer and therefore is indicated to repeat biopsy. There is much debate on the subject of how many cores should be obtained after a first negative biopsy results. Extended and saturation biopsy protocols are the most frequent used procedures for second biopsy set. The aim of this study is to compare the cancer detection, pain level, and complications after extended versus saturation biopsy protocols. Material and methods: 108 patients for whom a second set of prostate biopsy was performed between 2007 and 2010 were analyzed retrospectively. Out of 108 patients, an extended protocol was used for 66 patients and a saturation protocol for 42 patients. The indications for the second set of biopsies were suspicious rectal examination for 12 patients, persistent high tPSA for 73 patients, atipia for 8 patients and high-grade PIN for 15 patients. Topic (lidocain gel 2g) and bilateral apexian periprostatic nerve block anesthesia (10 ml lidocain 1%) were performed prior to biopsy for all patients. Extended biopsy protocol included 12 -18 cores from peripheral zone and saturation protocol included 26 - 28 cores from peripheral zone and transitional zone. All biopsy was performed by the same urologist and all specimens were analyzed in our center by the same pathologist. The pain level during biopsy was determined using a visual analog scale graded from 0 to 10. We recorded both minor (haematuria, haematospermia, urethroragy, rectal bleeding, acute urinary retention) and major (fever, septic shock) complications after this procedure. Results: The mean age of the patients was 62.6 (betwen 47 asnd 74 years) and the mean tPSA level was 8.6 ng/ml (range between 4 and 22 ng/ml). Detection of prostate cancer using extended and saturation biopsy technique was 18.1 % versus 33.3 %. The mean visual analog scale pain score was 2.5 and 2.7 for extended respectively saturation biopsy. There were no differences in minor and major complications between two groups except the urethroragy. The incidence of urethroragy was 0% and 3% for extended protocol and saturation protocol. None of these patients required hospitalization for any complication after prostatic biopsy. Conclusion: The prostate cancer detection rate after saturation biopsy was better then after extended biopsy protocol with no significant increasing of morbidity. Additionally, it was no significant difference in the level of the pain during these procedures. The low rate of complications after saturation biopsy recommends this technique to be safely performed after the first negative biopsy. We believe that the saturation biopsy protocol can be performed in the outpatient department with periprostatic nerve block anesthesia, avoiding the potential risks of intravenous anesthesia.
- Subjects
PROSTATE-specific antigen; RECTAL gland; BIOPSY; CANCER research; PAIN; URINARY organ diseases
- Publication
Romanian Journal of Urology, 2011, Vol 10, Issue 4, p57
- ISSN
1223-0650
- Publication type
Article