Published date: May 28 2017

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 12 (2017), Issue No. 1

Pages: 25-32

DOI: 10.18502/sjms.v12i1.856

Walaa Eldin Ibraheemsamimahj@gmail.com

Sami Mahjoub Taha

Mustafa Omran Mansour

Mohammed El Imam Mohamed Ahmed

Background: Prostate cancer prevalent cancer in males above sixty-five worldwide, this lead to the introduction of screening of the PSA and using of the transrectal ultrasound scanning, and sextant biopsy of the prostate.

Objectives: To compare the accuracy of the Transrectal Ultrasound guided biopsy (TRUS/BX) in the diagnosis of prostate cancer in Gezira Hospital for Renal Diseases and Surgery (GHRDS), with specific considerations to the digital rectal examination (DRE) findings and prostate specific antigen (PSA) level.                      .

Materials and Methods:  This is a prospective, descriptive small-scale hospital based study.  A total of 297 patients with clinically symptomatic enlarged prostate underwent transrectal ultrasound guided true cut needle biopsy of the prostate were studied in (GHRDS) in the period from June2006 to June2009.                    

Results: The majority 188 (63.3%) of patients were between 50-70 years of age. Abnormal digital rectal examination (DRE) like obliteration of the median sulcus, and fixed mucosa revealed higher incidence of carcinoma prostate (CaP) with a significant value (p= 0.0000). PSA level showed significant relation (p= 0.0001) with the diagnosis of carcinoma prostate. Transrectal U/S findings well correlated to the histopathological results, where abnormal findings (like hypo-echoic lesions or calcifications and cysts) showed higher incidence of malignancy in 46 patients constitute 52.8% of the abnormal U/S findings.

Conclusions and recommendations: PSA level is highly sensitive but less specific in detection of prostate cancer. Normal DRE doesn’t exclude prostate cancer, fixed mucosa and obliterated median sulcus has the highest predictors of cancer prostate in DRE. Presence of calcifications and cyst on trans-rectal ultrasound has the highest liability for cancer prostate in compare to the other ultrasonic findings.                 

Key words: Prostate cancer, DRE, PSA level, TRUS/ BX (Transrectal ultra sound biopsy), sextant biopsy.

[1] D. M. Parkin, F. I. Bray, and S. S. Devesa, “Cancer burden in the year 2000 the global picture,” Eur J Cancer, vol. 37, 8, pp. 4–66, 2001.

[2] D. Abuidris, E. Mohammed Imam, and O. E. Mustafa, “Elgaylani Ahmed Elhag, The Impact of TRUS in detection of prostate cancer in Gezira, Sudan,” GJHS, vol. 6, no. 1, pp. 35–42, 2010.

[3] R. R. John, J. H. Elhan, and G. G. Leonard, “Ultrasonographic and biopsy of the prostate,” in In: Wein: Campbell, Walsh, Urology, 2007, 9th ed, 2007, Saunders.

[4] J. A. Eastham, R. May, J. L. Robertson, O. Sartor, and M. W. Kattan, “Development of a nomogram that predicts the probability of a positive prostate biopsy in men with an abnormal digital rectal examination and a prostate-specific antigen between 0 and 4 ng/ml,” Urology, vol. 54, no. 4, pp. 709–713, 1999.

[5] W. J. Catalona, D. S. Smith, T. L. Ratliff, and J. W. Basler, “Detection of organ-confined prostate cancer is increased through prostate-specific antigen-based screening,” Journal of the American Medical Association, vol. 270, no. 8, pp. 948–954, 1993.

[6] J. S. Krumholtz, G. F. Carvalhal, C. G. Ramos et al., “Prostate-specific antigen cutoff of 2.6 ng/mL for prostate cancer screening is associated with favorable pathologic tumor features,” Urology, vol. 60, no. 3, pp. 469–473, 2002.

[7] American Urological Association, “Prostate-specific antigen (PSA): Best practice policy,” Oncology, vol. 14, p. 267, 2000.

[8] I. H. Derweesh, J. C. Rabets, and A. Patel, “Prostate biopsy: Evolving indications and techniques,” Contemp Urol, vol. 16, pp. 28–44, 2004.

[9] W. J. Catalona, A. W. Partin, K. M. Slawin et al., “Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial,” Journal of the American Medical Association, vol. 279, no. 19, pp. 1542–1547, 1998.

[10] B. Djavan, A. Zlotta, M. Remzi et al., “Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men,” Journal of Urology, vol. 163, no. 4, pp. 1144–1149, 2000.

[11] K. K. Hodge, J. E. McNeal, and T. A. Stamey, “Ultrasound guided transrectal core biopsies of the palpably abnormal prostate,” Journal of Urology, vol. 142, no. 1, pp. 66–70, 1989.

[12] K. K. Hodge, J. E. McNeal, M. K. Terris, and T. A. Stamey, “Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate,” Journal of Urology, vol. 142, no. 1, pp. 71–75, 1989.

[13] J. E. McNeal, E. A. Redwine, F. S. Freiha, and T. A. Stamey, “Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread,” The American Journal of Surgical Pathology, vol. 12, no. 12, pp. 897–906, 1988.

[14] L. A. Eskew, R. L. Bare, D. L. McCullough, and T. A. Stamey, “Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate,” Journal of Urology, vol. 157, no. 1, pp. 199–203, 1997.

[15] W. J. Ellis, M. P. Chetner, S. D. Preston, and M. K. Brawer, “Diagnosis of prostatic carcinoma: The yield of serum prostate specific antigen, digital rectal examination and transrectal ultrasonography,” Journal of Urology, vol. 152, no. 5 I, pp. 1520–1525, 1994.

[16] C. Mettlin, G. P. Murphy, R. J. Babaian et al., “The results of a five-year early prostate cancer detection intervention,” Cancer, vol. 77, no. 1, pp. 150–159, 1996.

[17] W. T. Jones and M. I. Resnick, “Prostate Ultrasound in screening, diagnosis and staging of prostate cancer,” Probl Urol, vol. 4, pp. 343–357, 1990.