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Table of Contents
EDITORIAL COMMENT
Year : 2018  |  Volume : 29  |  Issue : 3  |  Page : 134-135

Editorial comment: Outcomes and complications after transrectal ultrasound-guided prostate biopsy: A single-center study involving 425 consecutive patients


Department of Surgery, Division of Urology, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi, Taiwan

Date of Web Publication27-Jun-2018

Correspondence Address:
Chih-Shou Chen
Department of Surgery, Division of Urology, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/UROS.UROS_88_18

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How to cite this article:
Chen CS. Editorial comment: Outcomes and complications after transrectal ultrasound-guided prostate biopsy: A single-center study involving 425 consecutive patients. Urol Sci 2018;29:134-5

How to cite this URL:
Chen CS. Editorial comment: Outcomes and complications after transrectal ultrasound-guided prostate biopsy: A single-center study involving 425 consecutive patients. Urol Sci [serial online] 2018 [cited 2018 Nov 15];29:134-5. Available from: http://www.e-urol-sci.com/text.asp?2018/29/3/134/235384

This retrospective study included 425 patients categorized as four groups according to prostate-specific antigen (PSA) serum level. In addition to cancer detection rate (17.6%), the authors concluded that optimal cutoff values of PSA density were 0.19, 0.29, and 0.78 in the subgroups (PSA 4–10 ng/ml, 10–20 ng/ml, and >20 ng/ml, respectively). The overall infection complication rate is 5.17% which included two patients with septic shock after prostate biopsy.

As we know, the causes of elevated PSA include prostate cancer, prostatitis, acute urine retention, and even digital rectal examination. Therefore, we need some more parameters, in addition to the PSA, to help physicians to make a shared decision to do prostate biopsy. Age-specific PSA, PSA density (PSAD), free-PSA ratio, PSA velocity, prostate cancer antigen 3, et al. had also been recommended before. The authors raised a cutoff reference of PSAD according to the calculated receiver operating characteristic. This is true for us to advise prostate biopsy according to the different PSADs in different PSA serum level categories. This makes sense since the larger size of prostate may have higher PSA serum level. However, the prostate health index and magnetic resonance imaging (MRI) fusion-guided prostate biopsy may be a more promising method in the future, which increases the prostate cancer detection rate and hence decreases the unnecessary prostate biopsy.[1],[2] In this retrospective study, the clinical detection rating (CDR) is relative lower than other available groups. In fact, author did not consider the abnormality of digital rectal examination, which may further discriminate the cancer detection rate. Positive CDR may be as higher as 50% in patient with higher PSA with abnormal digital examination.[3] The average CDR is about 1/3, and the re-biopsy using MRI registration is much high in CDR as compared with convention transrectal ultrasound-guided (TRUS) biopsy (44.26% vs. 21.18%, respectively).[4]

In terms of the post-transrectal echo-guided prostate biopsy, the pre-operative prophylactic antibiotics, rectal preparation, and biopsy techniques may be taken into consideration. In this group, authors use single dose of fluoroquinolone (intravenous) or gentamicin (intramuscular) and followed by fluoroquinolone (oral) or third-generation cephalosporin for 3 days as the practice prescription. The rectal preparation is monosodium phosphate anhydrous enema. This issue is still controversial, especially in the era of antibiotic resistance and mechanical preparation. As authors mentioned, the abuse of antibiotics make lots of Escherichia coli infection resistant to fluoroquinolone. Selection of adequate antibiotics needs to consider the infection-resistant patterns in the hospital and the previous exposure of fluoroquinolone of this patient. In the previous publication, rectal preparation with phosphate enema and povidone-iodine administered at the hospital could significantly decrease the infection rate after prostate biopsy.[5],[6] Of course, the route of biopsy and infected bacterium is totally different between transrectum and trans-perineum. The less infection rate may be expected, but transperineal route need anesthesia, additional admission cost and patients discomfort should also be taken into consideration.

Due to the development of da Vinci radical prostatectomy, radiation therapy may be replaced by excellent operation in the future. Therefore, the accurate diagnosis of prostate cancer is an issue merited to be discussed. We expect a standard protocol to lessen the patients' risk and, on the other hand, increase the cancer detection rate with cost effectiveness.

 
  References Top

1.
Chiu HC, Hsieh PF, Huang CP, Wu HC, Chang CH. The clinical value of cognitive registration magnetic resonance image trans-rectal ultrasound biopsy in clinical prostate cancer detection. Urol Sci 2016;27 Suppl 1:S8.  Back to cited text no. 1
    
2.
Loeb S, Catalona WJ. The prostate health index: A new test for the detection of prostate cancer. Ther Adv Urol 2014;6:74-7.  Back to cited text no. 2
    
3.
Marks L, Young S, Natarajan S. MRI-ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol 2013;23:43-50.  Back to cited text no. 3
    
4.
Wu KY, Tsai YS, Yang WH, Tsai TS. Analysis of prostate cancer foci in patients with transrectal 10-core systemic biopsy and we predict pathological stage of prostate cancer through TRUS biopsy? Urol Sci 2015;26:289.  Back to cited text no. 4
    
5.
Huang YC, Ho DR, Wu CF, Shee JJ, Lin WY, Chen CS, et al. Modified bowel preparation to reduce infection after prostate biopsy. Chang Gung Med J 2006;29:395-400.  Back to cited text no. 5
    
6.
Chen PH, Chang CP, Wang BF, Lin J, Chiang HC, et al. Standardized protocol in preventing postoperative infectious complications after transrectal ultrasound-guided prostate biopsy: A retrospective study of 246 patients. Urol Sci 2016;27:140-3.  Back to cited text no. 6
    




 

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