[Ecology and fluoroquinolon resistance profiles in febrile urinary tract infections (FUTI) after prostate needle biopsy: A retrospective study in 466 biopsies]

Ultrasound-guided prostate biopsy: indication, morbidity and outcome at Hopital General Idrissa Pouye

Background

Magnetic resonance imaging (MRI)-guided prostate biopsy has a higher sensitivity than the ultrasound-guided biopsy, but its realization requires a dedicated interventional MRI, specific material, which is not available in our context; hence, ultrasound-guided biopsy remains of great interest. Currently, ultrasound-guided biopsy outside of a clinical trial is the gold standard for the diagnosis of prostate cancer. The objective of our work is to evaluate our practice of transrectal ultrasound-guided prostate biopsy using an endorectal probe by describing the technique and evaluating the morbidity and results.

Methods

This is a descriptive study of ultrasound-guided prostatic biopsies performed over a 2-year period. The parameters studied were frequency of the procedure, age, rectal examination findings, total PSA level, prostate biopsy morbidities and results. Descriptive statistics were performed, and comparison of qualitative variables was made by the Chi-square test with statistical significance set for α < 5%

Results

Two hundred and thirty-one patients were included over a two-year period. The mean age of our patients was 65 ± 8.2 years. Rectal examination finding was suspicious in 36.9% and the median total PSA was 19.8 ng/ml (0.1-5936 ng/ml). Seventy-seven percent of patients reported their pathology results. Prostatic adenocarcinoma was the most common finding accounting for 53.7% of results. Complications were observed in 16 patients (6.9%) with a predominance of initial hematuria, voiding pain and fever.

Conclusion

In our series, the cancer detection rate was significant and the complications rate was acceptable at 6.9%.

[Evaluation and results of ablative therapies in prostate cancer]

OBJECTIVE

To perform a state of the art about methods of evaluation and present results in ablative therapies for localized prostate cancer.

METHODS

A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 102 articles were analysed.

RESULTS

Analyse the results of ablative therapies is presently difficult considering the heterogeneity of indications, techniques and follow-up. However, results from the most recent and homogeneous studies are encouraging. Oncologically, postoperative biopsies (the most important criteria) are negative (without any tumor cells in the treated area) in 75 to 95%. Functionally, urinary and sexual pre-operative status is spared (or recovered early) in more than 90% of the patients treated. More and more studies underline also the correlation between the results and the technique used considering the volume of the gland and, moreover, the "index lesion" localization.

CONCLUSION

The post-treatment pathological evaluation by biopsies (targeted with MRI or, perhaps in a near future, with innovative ultrasonography) is the corner stone of oncological evaluation of ablative therapies. Ongoing trials will allow to standardize the follow-up and determine the best indication and the best techniques in order to optimize oncological and functional results for each patient treated.

[Indications and limits of ablative therapies in prostate cancer]

OBJECTIVE

To perform a state of the art about indications and limits of ablative therapies for localized prostate cancer.

METHODS

A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 107 articles were analysed.

RESULTS

The objective to combine reduction of side effects and oncological control has induced recent development of several ablative therapies. Beyond this heterogeneity, some preferential indications appear: unilateral cancer of low risk (but with significant volume, excluding active surveillance) or intermediate risk (excluding majority of grade 4); treatment targeted the index lesion, by quarter or hemi-ablation, based on biopsy and mpMRI. In addition, indications must considered specific limits of each energy, such as gland volume and tumor localization.

CONCLUSION

Based on new imaging and biopsy, ablative therapies will probably increased its role in the future in management of localize prostate cancer. The multiple ongoing trials will certainly be helpful to better define their indications and limits.