OBJECTIVE: Image-guided targeted biopsy techniques have been proposed to address problems ofsystematic transrectal ultrasound guided prostate biopsies that lead to the suboptimal cancer detectionrate as well as inaccurate grading of the disease. This study aims to provide local data on the diagnosticaccuracy of multiparametric MRI (MP-MRI) and MP-MRI ultrasound cognitive fusion biopsy inidentifying areas of clinically significant malignancy of the prostate. MATERIALS AND METHODS: This is a validity study involving patients who underwent MP-MRI and MP-MRI ultrasound cognitive fusion biopsy, who eventually underwent robot-assisted laparoscopic radicalprostatectomy (RALRP). Outcome measures included sensitivity, specificity, positive and negativepredictive values of MP-MRI and MP-MRI ultrasound cognitive fusion biopsy. Reference standardused was the final histopathologic report obtained after RALRP. RESULTS: MP-MRI has a sensitivity of 35.5%, specificity of 95.2%, positive predictive value of 97.1%,and negative predictive value of 25%. MP-MRI ultrasound fusion biopsy had similar results, withsensitivity of 34.4%, specificity of 81.0%, positive predictive value of 88.9%, and negative predictivevalue of 21.8%. CONCLUSION The high specificity and positive predictive value of MP-MRI (95.2% and 97.1%respectively) indicates the necessity for a prostate biopsy and supports the utility of a targeted MP-MRI guided ultrasound cognitive fusion biopsy. However, the low sensitivity and negative predictivevalue (25% and 35% respectively) of 35.5% indicates that MP-MRI guidance does not limit thenumber of biopsy samples only to visible MP-MRI lesions, since negative areas on MP-MRI stillcontains tumors in 75% of cases.

Objective: Transrectal ultrasound guided biopy is the diagnostic of choice in detecting carcinoma of the prostate. The biopsy can be painful and many would refuse the procedure again without adequate analgesia.he combination of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids work synergistically in relieving pain. The investigators determined that the premedication of celecoxib and tramadol with 10ml intrarectal 2% lidocaine gel would significantly decrease the pain score of patients undergoing prostate biopsy compared to lidocaine gel alone.Methods: Thirty one patients who underwent 12-core prostate biopsy were randomly assigned into two groups. The control received 10ml 2% intrarectal lidocaine gel alone the experimental group was given celecoxib 400mg and tramadol 59mg 2 hours before biopsy plus intrarectal lidocaine gel. Immediately after biopsy, patients were asked to rate the pain score using visual analog scale (VAS).Results: A total of 15 patients assigned for cotrol group and 16 patients for the experimental group, showed similar characteristics in terms of age, prostate volume and prostate specific antigen (PSA) value. The overall mean pain score using visual analog pain scale was 4.1+/-1.7 in the experimental group compares to 5.5+/-1.9 in the control group with signifcant P value of 0.034 using chi-square test. There was a mean pain score decrease of 1.5 from the scale of 1 to 10 in the experimantal group compared to the cotrol.Conclusion: The addition of oral administration of celecoxib 400mg and tramadol 59mg 2 hours before intrarectal 10ml 2% lidocaine gel significantly reduced the pain exprienced by patients during ultrasound guided prostate biopsy as compared to lidocaine gel alone
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