OBJECTIVE: To compare the efficacy of periprostatic nerve block (PPNB) alone versus periprostatic nerve block plus oral Tramadol+Paracetamol Tablet for pain control during and after transrectal ultrasound-guided (TRUS) biopsy of the prostate gland. METHODS: This was a double-blind, placebo-controlled randomized clinical trial. The authors randomized 40 male patients each to either PPNB or PPNB plus oral tramadol and paracetamol (37.5mg/325mg) an hour prior to prostate biopsy. A ten-point visual analog scale was used to measure pain intensity and was recorded upon insertion of the ultrasound probe, during the biopsy, and one hour after the procedure. RESULTS: The two groups were similar in terms of baseline characteristics. Reductions in pain scores were statistically significantly different (p<.001) for each group when comparing pain from at point of insertion of the probe versus during biopsy and versus one-hour post-operatively. However, when comparing the two groups, the pain scores were not statistically significantly different upon insertion of the probe (p=.68), during the biopsy (p=.26) and one-hour post-operatively (p=.54). CONCLUSION Tramadol and paracetamol combination in addition to periprostatic nerve block produces pain relief similar to standard periprostatic nerve block alone.
Male ; Prostate ; Nerve Block ; Biopsy ; Ultrasonography

PURPOSE: To explore the effect of bi-parametric MRI-ultrasound (MR/US) fusion prostate biopsy on the detection of overall cancer and significant prostate cancer (sPCa). MATERIALS AND METHODS: We examined 140 patients with suspected prostate cancer lesions on MRI from August 2016 to March 2018. All patients had undergone 3T pre-biopsy bi-parametric (T2 weighted and diffusion-weighted) prostate MRI (bpMRI), and their MRI images were evaluated with Prostate Imaging Reporting and Data System (PI-RADS) version 2.0. MR/US fusion targeted prostate biopsy was performed for lesions with a PI-RADS score ≥3 before systemic biopsy. The results of targeted and systemic biopsy were evaluated in regards to detection rate according to PI-RADS score. RESULTS: Of the patients (mean age=67.2 years, mean prostate-specific antigen level=8.1 ng/mL), 66 (47.1%) and 37 (26.4%) patients were diagnosed with cancer and significant prostate cancer, respectively. The rate of positive targeted biopsy increased with higher PI-RADS score (3: 40.4%, 4: 56.7%, 5: 90.0%). The proportion of significant prostate cancer among positive target lesions was 65.3% (32/49). CONCLUSION: bpMRI is a feasible tool with which to identify sPCa. MR/US fusion biopsy, rather than systemic biopsy, can help identify sPCa. We recommend using supplemental tools to increase prostate cancer detection in patients with PI-RADS 3 lesions.
Biopsy ; Diffusion ; Humans ; Image-Guided Biopsy ; Information Systems ; Magnetic Resonance Imaging ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Ultrasonography

PURPOSE: To compare biopsy performance of 2 approaches for multiparametric magnetic resonance imaging (MRI) guided biopsy and transrectal ultrasonography (TRUS)-guided biopsy with 2nd and 3rd repeat biopsy patients in prostate cancer detection. MATERIALS AND METHODS: This retrospective study reviewed 2,868 patients who was performed prostate biopsy between September 2013 to March 2017 at Samsung Medical Center, Seoul, Korea with TRUS-guided random biopsy and MRI fusion, MRI cognitive, and MRI-guided biopsy as 2nd and 3rd repeat biopsy and propensity matching was applied to reduce bias. Detection rate of each study was compared with 1:1 matching. RESULTS: Among 265 patients who performed TRUS 2nd biopsy, positivity rate for prostate cancer (PCa) was 18.49% (n=49/265) while 54.72% (n=145/265) for MRI-guided biopsy. In 3rd biopsy, positivity rate for PCa of TRUS biopsy was 17.74% (n=11/62) while 56.45% (n=35/62) for MRI guided biopsy. There was no significant difference in the detection rate for the patient with Gleason score 8 or more. CONCLUSIONS: MRI-guided biopsy was associated with a higher detection rate of prostate cancer with especially in patients with prior negative biopsy.
Bias (Epidemiology) ; Biopsy ; Cohort Studies ; Humans ; Korea ; Magnetic Resonance Imaging ; Neoplasm Grading ; Passive Cutaneous Anaphylaxis ; Propensity Score ; Prostate ; Prostatic Neoplasms ; Retrospective Studies ; Seoul ; Ultrasonography

PURPOSE: The aim of this study was to evaluate the applicability of machine learning methods that combine data on age and prostate-specific antigen (PSA) levels for predicting prostate cancer. MATERIALS AND METHODS: We analyzed 943 patients who underwent transrectal ultrasonography (TRUS)-guided prostate biopsy at Chungnam National University Hospital between 2014 and 2018 because of elevated PSA levels and/or abnormal digital rectal examination and/or TRUS findings. We retrospectively reviewed the patients’ medical records, analyzed the prediction rate of prostate cancer, and identified 20 feature importances that could be compared with biopsy results using 5 different algorithms, viz., logistic regression (LR), support vector machine, random forest (RF), extreme gradient boosting, and light gradient boosting machine. RESULTS: Overall, the cancer detection rate was 41.8%. In patients younger than 75 years and with a PSA level less than 20 ng/mL, the best prediction model for prostate cancer detection was RF among the machine learning methods based on LR analysis. The PSA density was the highest scored feature importances in the same patient group. CONCLUSIONS: These results suggest that the prediction rate of prostate cancer using machine learning methods not inferior to that using LR and that these methods may increase the detection rate for prostate cancer and reduce unnecessary prostate biopsy, as they take into consideration feature importances affecting the prediction rate for prostate cancer.
Biopsy ; Chungcheongnam-do ; Digital Rectal Examination ; Forests ; Humans ; Logistic Models ; Machine Learning ; Medical Records ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies ; Support Vector Machine ; Ultrasonography

PURPOSE: This study aimed to develop a multi-channel near-infrared spectroscopy (NIRS) and ultrasonography (USG) fusion imaging system for imaging prostate cancer and to verify its diagnostic capability by applying the hybrid imaging system to a prostate cancer phantom. METHODS: A multi-channel NIRS system using the near-infrared 785-nm wavelength with 12 channels and four detectors was developed. After arranging the optical fibers around a USG transducer, we performed NIRS imaging and grayscale USG imaging simultaneously. Fusion imaging was obtained by processing incoming signals and the spatial reconstruction of NIRS, which corresponded with grayscale USG acquired at the same time. The NIRS-USG hybrid system was applied to a silicone-based optical phantom of the prostate gland containing prostate cancer to verify its diagnostic capability qualitatively. RESULTS: The NIRS-USG hybrid imaging system for prostate cancer imaging simultaneously provided anatomical and optical information with 2-dimensional registration. The hybrid imaging system showed more NIR attenuation over the prostate cancer model than over the model of normal prostate tissue. Its diagnostic capability to discriminate a focal area mimicking the optical properties of prostate cancer from the surrounding background mimicking the optical properties of normal prostate tissue was verified by applying the hybrid system to a silicone-based optical phantom of prostate cancer. CONCLUSION: This study successfully demonstrated that the NIRS-USG hybrid system may serve as a new imaging method for improving the diagnostic accuracy of prostate cancer, with potential utility for future clinical applications.
Diagnosis ; Methods ; Optical Fibers ; Prostate ; Prostatic Neoplasms ; Spectroscopy, Near-Infrared ; Transducers ; Ultrasonography

BACKGROUND: Insufficient physical activity is well known to increase benign prostate hyperplasia (BPH). However, only few studies have been conducted on the relationship between occupational physical activity and BPH. This study aimed to investigate the relationship between occupational physical activities and BPH in South Korea.METHODS: The study subjects included 4,102 workers who visited the health promotion center at Ulsan University Hospital and underwent transrectal ultrasonography between January 2016 and December 2017. The subjects were divided into two groups according to occupational physical activity (manual or non-manual workers). BPH was defined as a prostate volume of >25 mL. We performed a multivariate regression analysis to investigate the associations between the occupational groups and BPH. In addition, we divided the subgroups according to age and body mass index and analyzed the relationship between occupational physical activities and BPH in each subgroup.RESULTS: The risk of BPH was significantly higher in the non-manual workers than in the manual workers. This result was consistent after adjusting for other risk factors of BPH (odds ratio, 1.26; 95% confidence interval, 1.05–1.51). Likewise, in the subgroup analysis according to age and body mass index, the non-manual workers had higher BPH risk than the manual workers.CONCLUSION: The risk of BPH was significantly higher in the non-manual workers than in the manual workers. To prevent BPH, more attention should be paid to the physical activities and education of non-manual workers.
Body Mass Index ; Education ; Health Promotion ; Humans ; Hyperplasia ; Korea ; Motor Activity ; Occupational Groups ; Prostate ; Prostatic Hyperplasia ; Risk Factors ; Ulsan ; Ultrasonography

PURPOSE: The purpose of this study was to compare the diagnostic yield of five systematic randomized protocols using 12–20 biopsy cores with variably-sized phantoms. METHODS: A total of 100 prostate phantom models were produced by casting liquid devil's tongue jelly using silicone molds. Sets of 20 phantoms were created with the following volumes: 20 mL, 40 mL, 60 mL, 80 mL, and 100 mL. Three focal lesions were created by injecting 0.5 mL of warm agar solution stained with red, blue, and green ink into each phantom model. The focal lesions were verified by ultrasonography. The systematic randomized biopsy protocols consisted of 12, 14, 16, 18, and 20 biopsy cores. The diagnostic yield of the multiple systematic biopsy protocols was compared. RESULTS: The overall detection rates of each model set were 93.3% for 20 mL, 88.3% for 40 mL, 71.7% for 60 mL, 43.3% for 80 mL, and 30.0% for 100 mL. Statistically significant differences in the detection rate were found between 40 mL and 60 mL and between 60 mL and 80 mL. No statistically significant increase in the detection rate was observed within a given volume set even when the number of core biopsies increased from 12 to 20. CONCLUSION: The diagnostic yield of systematic randomized biopsies is inversely proportional to the phantom volume.
Agar ; Amorphophallus ; Biopsy* ; Fungi ; Ink ; Prostate* ; Silicon ; Silicones ; Tongue* ; Ultrasonography

Prostate cancer is commonly diagnosed by using a transrectal ultrasound (TRUS)-guided biopsy. Although this procedure is usually well tolerated, rarely it may be complicated by massive rectal bleeding. We report a case of a 77-year-old male who underwent a TRUS biopsy and subsequently developed recurrent episodes of rectal bleeding with syncope and anemia requiring the transfusion of multiple units of blood. A sigmoidoscopy revealed the source of the bleeding: a large hemorrhoid on the anterior wall of the rectum with an overlying ulceration. We successfully applied a band to ligate the hemorrhoid, and the patient's condition improved. To our knowledge, this case represents the first report of a successful band ligation to treat massive bleeding from a hemorrhoid that had been punctured in the course of the TRUS biopsy procedure.
Aged ; Anemia ; Biopsy ; Hemorrhage ; Hemorrhoids ; Humans ; Ligation ; Male ; Prostate ; Prostatic Neoplasms ; Rectum ; Sigmoidoscopy ; Syncope ; Ulcer ; Ultrasonography

For the several decades, the treatment of clinically localized prostate cancers has been largely represented by surgery, radiotherapy, and observation. Until recently, this has not changed much. In particular, curative treatment through surgery or radiotherapy is considered to be of no great benefit in elderly patients with low-risk groups. Thus, these strategies are recommended only in moderate or high-risk patients with a life expectancy of 10 years or more. In general, surgery and radiotherapy have been reported to be similar in terms of oncologic outcomes, but the level 1 evidence was lacking to support this to date. Recent advances in imaging modalities have led to the introduction of treatments for the concept of focal therapy, such as high-intensity frequency ultrasound or cryotherapy. Subsequently, positive results have been reported in terms of functional outcomes. However, the level of evidence is not high due to the short follow-up period and the absence of large-scale prospective studies. For the reasons described above, counseling and decision-making were not straightforward. Consequently, the treatment strategy for each individual patient was determined mainly on the risk of incontinence, erectile dysfunction, or other adverse effects of radiotherapy. To overcome these limitations, substantial studies have been reported evaluating survival outcomes and complications following treatments of localized prostate cancer for the past several years. In this review, we aimed to summarize recent literatures on surgery, radiotherapy, and expectant management, which have been the mainstays of treatment for localized prostate cancer; and introduce several treatments for the concept of focal therapy.
Aged ; Counseling ; Cryotherapy ; Erectile Dysfunction ; Follow-Up Studies ; Humans ; Life Expectancy ; Male ; Prospective Studies ; Prostate ; Prostatic Neoplasms ; Radiotherapy ; Ultrasonography

PURPOSE: We aimed to study clinicopathological parameters and complications of patients who underwent magnetic resonance imaging-transrectal ultrasonography fusion guided prostate biopsy (MRI-TRUS FGB). MATERIALS AND METHODS: We investigated 576 patients who underwent MRI-TRUS FGB of prostate from May 2003 to December 2017 retrospectively. The clinicopathological features and complications were presented, using the modified Clavien-Dindo classification system. RESULTS: Fourteen patients (2.4%) readmitted within 30 days after MRI-TRUS FGB due to complications, and 85.7% (12 of 14) of them complained mild to moderate complications, the Clavien-Dindo classification grades I and II. The most common complication was hematuria (n=5, 0.9%), followed by acute urinary retention (n=3, 0.5%), dysuria (n=2, 0.3%), fever (n=1, 0.2%), hematochezia (n=1, 0.2%). According to multivariate analysis, only age was the significant risk factor of overall complications and bleeding related complications. Two hundred thirteen patients were diagnosed as prostate cancer after MRI-TRUS FGB. When the Likert suspicious scale of prostate cancer on apparent diffusion coefficient (ADC) was ≤4, 27.8% (137 of 493) were diagnosed as prostate cancer, of whom 56.2% (77 of 137) were confirmed as prostate cancer only at randomized 12 cores. When the ADC suspicious level was grade 5, 91.6% (76 of 83) were diagnosed as prostate cancer, of whom 11.8% (7 of 76) were confirmed as prostate cancer only at randomized 12 cores. CONCLUSIONS: The present study demonstrates the safety of MRI-TRUS FGB in terms of complications. When ADC suspicious level is grade 5, MRI-TRUS FGB alone could be a reasonable measure to diagnose prostate cancer, but randomized 12-core prostate biopsy would be recommended additionally when ADC suspicious level is ≤4.
Biopsy ; Classification ; Diffusion ; Dysuria ; Fever ; Gastrointestinal Hemorrhage ; Hematuria ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Pathology ; Prostate ; Prostatic Neoplasms ; Retrospective Studies ; Risk Factors ; Ultrasonography ; Urinary Retention