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Prostate biopsy, PSA test, prostatectomy--Urology textbook

Of all sources of medical information, textbooks rank first.  Campbell-Walsh is the best for the field of Urology. 


Campbell-Walsh, Urology, 9th ed., 2007

Prostate biopsy

Digital (DRE) and PSA yield a confirmation on biopsy of carcinoma 55-63%, with 20% with high grade; PSA alone 22%. 


Prostate weighs 20-25 gms until 59 years.  800,000 biopsies annually.  Cystic prostate lesions are common. 


All hypoechic lesions should be included.  The lack of hypoechoic focus does not preclude biopsy because 39% of all cancers are isochoric.  Other causes for hypoechoic focus include granulomatous, prostatitis, Prostatic infaret, and lymphoma. 


Hypoechoic lesions is malignant in 17-57% of cases.  TAUS findings correlate poorly with pathologic findings and outcome


LHRH causes 30% (10-60% depending on size) of prostate volume.


Cleansing enema and antibiotics one-day prior are recommended.


Prostatic block using 2% lidocaine, 5 mL. 


Label location of biopsy samples.


The vast majority of adenocarcimomas arise in posteral PZ.

6 cores were standard, now 8 with a 96% detection rate (with large prostates more samples yield a + 15% detection).  A second biopsy yield about 5% rate.


Fine-needle aspiration biopsy is used in many countries outside the US. 


Color Doppler is not sufficient accurate (misses 45%) to permit skipping biopsy; however, it improves biopsy detection. 


2% of those who have a biopsy require hospitalization for infection. 



Based on PSA screening, carcinoma rate of 22-34%.

Among the genes common to prostate cancer are AMCACR on chromosome 5; P19GSTP1) for glathione S-transferase and ras associated domain family protein isoform A (RASSSFIA0; …. {chart in book on genes}


There are three proteins that bind PSA.  With prostate cancer the ACT binding percentage is higher and thus a lower percentage of free total PSA.


BPH, prostatitis, and prostate cancers are the most important factors affecting serum PSA levels.


Deferred treatment is traditional reserved for men with a life expectancy of less than 10 years and a low-grade prostate cancer.


The section below explains why the excision of the cancerous tissue is preferred when aggressive treatment is advisable. 



The main advantage to radical prostatectomy is that if it is skillfully performed, it offers the possibility of cure with minimal collateral damage to surrounding tissue.  Further, it provides more accurate tumor staging by pathologic examination of the surgical specimen.  Also, treatment failure is more readily identified and the postoperative course is much more readily identified and postoperative course is much smoother than in the past.  Hospital stay is 1-3 days.  Moreover, radical prostatectomy significantly reduces local progression and distant metastases and improves cancer-specific and overall survival rates compared with watch and waiting.  Erectile dysfunction and rectal complications are less likely with nerve-sparing surgery than with radiotherapy.  Other common side effects include inguinal hernia and urethral stricture. 


Approximately half of patients develop erectile dysfunction after radiotherapy for prostate cancer.  This is caused by injury to the vasculature of the cavernous nerves and to the corpora cavernosa of the penis, usually beginning about 1 year after the completion of treatment.  (p. 2939) Comparisons of radical prostatectomy to radiation therapy are misleading because of different endpoints—surgery having the longer endpoint.   



For more on the prostate http://healthfully.org/cvt/id2.html


Prostate cancer http://healthfully.org/cvt/id3.html