Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The purpose of this report is to show our own results of repeat transrectal ultrasound guided biopsies, with special reference to the prevalence of newly diagnosed carcinoma in the transition zone of the prostate. Transrectal ultrasound guided repeat biopsies (six cores laterally plus two cores from transition zones) were performed in 64 patients. Indications for repeat biopsy were persistently elevated prostate specific antigen (PSA) levels of 4.0 ng/ml or more, premalignant lesions noted in previous biopsy result (PIN, prostatic intraepithelial neoplasia; ASAP, atypical small acinar proliferation; and AAH, atypical adenomatous hyperplasia), PSA velocity of 0.75 ng/ml per year or more, PSA density of 0.15 ng/ml/ccm or more, and free/total P.A ratio less than 18%. Twenty-one (32%) patients had positive biopsies for prostate cancer, and the rest of 43 (68%) patients were diagnosed as having benign prostate hyperplasia, inflammation, normal prostate tissue, or suspect lesions. When stratified according to anatomic location of positive cores, 19.1% of patients had isolated transition zone tumors on repeat biopsy, and 28.6% had both transition and peripheral zone tumors. A total of 23 (35.93%) patients with premalignant lesions on initial biopsy were also included. Of these, repeat biopsy pathologic specimens indicated malignancy in nine (39.1%) patients. There is a significant false-negative rate for initial transrectal ultrasound guided biopsy. Therefore, repeat biopsy is recommended in all patients who meet the criteria for transrectal ultrasound guided biopsy and in those in whom initial biopsy is negative. Also, classic sextant biopsy laterally plus two cores from each transition zone of the prostate is recommended to reduce the false-negative rate in repeat biopsies due to the high detection rate of cancer in the transition zone of the prostate. Recent literature on the topic is reviewed and discussed.U članku se opisuju vlastiti rezultati kod prve ponavljane, transrektalnim ultrazvukom vođene biopsije prostate, uz poseban osvrt na učestalost novodijagnosticiranog karcinoma u prijelaznoj zoni. Ponavljane transrektalnim ultrazvukom vođene biopsije prostate (6 cilindara lateralno i 2 iz prijelazne zone) učinjene su u 64 bolesnika. Indikacije za ponavljanu biopsiju prostate bile su tvrdokorno povišene vrijednosti za prostatu specifičnog antigena (PSA), brzina porasta PSA kroz godinu dana, gustoća PSA veća od 15 ng/ml/ccm i omjer slobodno i ukupnog PSA manji od 18%, prethodna biopsija s predmalignim lezijama, te sumnjivi digitorektalni nalaz. U 21 (32%) bolesnika na ponavljanoj biopsiji otkriven je karcinom prostate, a u ostalih 43 (68%) nalaz je bio upala, benigna prostatična hipertrofija ili predmaligna lezija. U 19,1% bolesnika na ponavljanoj biopsiji tumor je zabilježen u prijelaznoj zoni, a u 28,6% tumor je nađen u prijelaznoj i perifernoj zoni. U 23 (35,93%) bolesnika s predmalignim lezijama na inicijalnoj biopsiji učinjena je ponavljana biopsija, te je karcinom prostate otkriven u 9 (39,1%) bolesnika. Na inicijalnoj biopsiji prostate značajan je broj lažno negativnih nalaza. Ponavljana transrektalnim ultrazvukom vođena biopsija preporuča se u svih bolesnika koji zadovoljavaju kriterije za biopsiju prostate, te u kojih je inicijalna biopsija negativna. Također se preporuča učiniti klasičnu sekstant biopsiju lateralnije uz dva dodatna cilindra iz prijelazne zone prostate upravo zbog visoke razine otkrivanja karcinoma u prijelaznoj zoni. Prikazan je i kritički pregled novije literature o ovoj problematici
