An-Najah Staff

Since the first report on the efficacy of sextant biopsy under transrectal ultrasound guidance, there have been many modifications related to the total number of cores and the localization of biopsies to improve the prostate cancer (PCa) detection rate. The 2010 National Comprehensive Cancer Network Early PCa Detection Guidelines noted the 12-core biopsy scheme as the standard. However, this extended biopsy scheme still fails to detect 20% of high-grade PCa that can be detected by detailed pathological evaluation of radical prostatectomy; therefore, there is need for saturation biopsies. The existence of suspicions of PCa after previous negative biopsy or biopsies represents a valid indication for saturation biopsy. There has been no significant increment in morbidity or in insignificant PCa detection rates when a saturation biopsy scheme was used with an extended biopsy scheme. Along with the improvement in the PCa detection rate, accurate oncological mapping of PCa is another important consideration of saturation biopsies. The ideal number of cores and the diagnostic value of saturation biopsy after the failure of initial therapy are some of the issues that need to be addressed. Preliminary reports have shown that magnetic resonance imaging can improve the PCa detection rate, save patients from unnecessary biopsies, and decrease the need for a high number of cores; however, multiple limitations continue to exist

Objeetive: To evaluate the diagnostic value of prostate specific antigen (PSA) and its derivatives in detecting prostate cancer at biopsies. Materials and methods: Between July 2004 and March 2005, 1,05patients who underwent transrectal ultrasound-guided (TRUSO) systemic sextant core biopsies were included. All patients had PSA values 4-20 ng/ml ± abnormal digital rectal examinations (DRE) findings. PSA density (PSAD) and PSA density of the transition zone(TZPSAD) were calculated for each patient. Comparison between the clinical variables of patients with prostate cancer and benign prostatic hyperplasia (BPH) in terms of TPSA, total volume, TPSAD, TZPSAD, TRUS findings and DRE findings, "vas done. The diagnostic value of TRUS and DRE were also evaluated. Results: Out of 105 patients 11 had prostatic cancer (10.47%). There was no significant difference between subjects with BPH and subjects with prostate cancer in terms of total prostate volume, TPSA values, TRUS findings and DRE findings. However the values ofTPSAD and TZPSAD for patients with BPH differs significantly from that of patients with prostate cancer (P = 0.0001, P = 0.009 respectively). The accuracy ofDRE and TRUSO were 59.04% and 50.470/0respectively, both of them are poor predictors with insignificant difference (P= 0.25). Conclusion: Total PSA is of no diagnostic value in detecting prostate cancer in Egyptian patients with PSA < 20 ng/ml. However TPSAD and TZPSAD could be considered as accurate parameters with clinical significant for prostate cancer prediction in patients with PSA below 20 ng/ml. TRUS and DRE are poor predictor of prostate cancer with no significant difference.