Impact of Prostate Size on Cancer Detection Values of two different Prostate Biopsy Strategies amongst Nigerian Men
No Thumbnail Available
Background: Prostate cancer is the commonest malignancy in men beyond middle age. With concerted efforts at improving cancer detection, the positive role of extended biopsy strategies is well established. However, the rationale for allocating patients to different strategies is not yet defined. Objective: This study aims at assessing the role of prostate size on the cancer detection rate of two different biopsy. Methods: A prospective study of one hundred and sixty- two patients undergoing prostate biopsy for an elevated PSA of >4ng/ml or abnormal DRE findings or both. A transrectal ten-core extended prostate biopsy consisting of two sets of specimens; the initial sextant biopsies and additional four lateral biopsies was performed on all patients. Each set of specimens was analyzed separately. Patients were categorized into two groups according to their prostate volumes. The cancer detection rates of the sextant and the extended 10-core strategies were compared at different prostatic volumes. The effect of increasing prostate volume on cancer detection rates of both strategies was determined. R e s u l t s : T h e r a n g e o f p r o s t a t e v o l u m e was19.9–197cm3with a mean of 66.5cm3. Cancer detection rates of sextant and extended strategies were 37.0 and 43.2% respectively. More cancers were found in patients with prostatic volume <60cm3 than in those with ≥ 60cm3 with over all cancer detection rates of 55% versus 36.3% respectively. There is significant improvement in the cancer detection value of extended over the sextant strategy in the category of patients with bigger prostates than those with smaller ones (23.3 vs. 10%, P < 0.05). Average Gleason score in these two categories of patients also differ significantly, 7.2 and 5.7 respectively (P < 0.05). Conclusion: Smaller prostates are more likely to harbour cancers than bigger ones in patients with suspected cancer of the prostate. Cancers found in smaller prostates also have higher Gleason scores comparatively. Extended biopsy strategy detected more cancers in bigger prostates which would have been missed by the traditional sextant strategy and is therefore recommended for patients with bigger prostatic volume with higher likelihood of under- sampling.
Prostate volume , Prostate biopsy , Prostate cancer , Detection rate , Sextant , Research Subject Categories::MEDICINE::Surgery
Ojewola R.W, Tijani K.H., Jeje E.A.,Anunobi C.C., Ogunjimi M.A., Balogun O.S. Impact of prostate volume on cancer detection rate of two different prostate biopsy strategies. Nig Q J Hosp Med. 2014; 24(1): 31-36.