Utility of Histoscanning™ prior to prostate biopsy for the diagnosis of prostate adenocarcinoma

Abstract

Objectives

HistoScanning™ (HS) is a method of ecographic diagnosis of prostate cancer. We analyze the effectiveness of the HS realization prior to the biopsys for the prostate adenocarcinoma diagnosis.

Materials and methods

From August to October 2012 we have carried out a study with HS prior to the biopsys in 32 patients. In all cases sextants transrectalbiopsys have been realized (two cores in each sextant) in the periphery zone. In those sextants in which there were suspicious areas with HS, the biopsys were addressed to those areas. Transperinealbiopsys were added to those zones placed in the half-front or apical prostatic zone. The medium age was 63.7 years (range 40–82) with a medium PSA of 8.0 ng/ml (range 3.5–36.2) and a medium prostatic volume of 46.6 cc (range 18.2–103.2). In eight cases it was the first biopsy, in 14 cases they were repetition biopsys and 10 patients had a previous diagnosis of prostate adenocarcinoma (8 in a program of active surveillance and 2 T1a in RTU of previous prostate).

Results

In the 32 patients a medium of 7.5 zones were biopsed (range 6–9) with a total of 239 zones studied. There were identified a medium of 3.2 zones with suspictious areas (ZS) with HS (range 2–5) with a total of 103 ZS. In 72 zones of 25 patients it was found adenocarcinoma or PIN (2 PIN, 11 score Gleason 6, 7 score Gleason 7, 3 score Gleason 8 and 2 score Gleason 9). There were 35 positive falses zones in 20 patients (11 normal parenquima and 9 cronic inflammation). False negatives were produced in 5 zones in 5 patients (2 PIN, 2 score Gleason 6 and 1 score Gleason 7) although in all 5 cases adenocarcinoma was encountered (0 discovered) in other zones. The HS presented a sensibility of a 93.5% with a specificity of 79.5%. The positive predictive value was of the 67.35% with a negative predictive value of 96.5%.

Conclusions

In spite of being a selected series, with a high rate of patients with adenocarcinoma, the exploration with HS has presented a great sensibility and a high negative predictive value. These data, although they must be confirmed in less selected series, state that the prior exploration with HS can help both in the diagnosis in the biopsies and in the follow-up of programs of active surveillance.

Resumen

Objetivos

HistoScanning™ (HS) es un método de diagnóstico ecográfico del cáncer de próstata. Analizamos la eficacia de la realización de HS previo a las biopsias para el diagnóstico de adenocarcinoma de próstata.

Material y métodos

Entre agosto y octubre de 2012 hemos realizado estudio con HS previo a las biopsias en 32 pacientes. En todos los casos se realizaron biopsias transrectales por sextantes (2 tomas en cada sextante) de la zona periférica. En aquellos sextantes en los que hubo áreas sospechosas con HS las biopsias se dirigieron a dichas áreas. Se añadieron biopsias transperineales en aquellas áreas situadas en la zona media-anterior o apical prostática. La edad media fue de 63.7 años (rango: 40–82), con un PSA medio de 8,0 ng/ml (rango: 3,5–36,2) y un volumen prostático medio de 46,6 cc (rango: 18,2–103,2). En 8 casos se trataba de primera biopsia, en 14 de biopsias de repetición y 10 pacientes tenían diagnóstico previo de adenocarcinoma de próstata (8 en programa de vigilancia activa y 2 T1a en RTU de próstata previa).

Resultados

En los 32 pacientes se biopsiaron una media de 7,5 zonas (rango: 6–9) con un total de 239 zonas estudiadas. Se identificaron una media de 3,2 zonas con áreas sospechosas (ZS) con HS (rango: 2–5), con un total de 103 ZS. Se encontró adenocarcinoma o PIN en 72 zonas de 25 pacientes (2 PIN, 11 score Gleason 6, 7 score Gleason 7, 3 score Gleason 8 y 2 score Gleason 9). Hubo 35 zonas falsos positivos en 20 pacientes (11 parénquima normal y 9 inflamación crónica). Se produjeron falsos negativos en 5 zonas en 5 pacientes (2 PIN, 2 score Gleason 6 y un score Gleason 7), aunque en los 5 casos se descubrió adenocarcinoma en otras zonas. El HS presentó una sensibilidad del 93,5% con una especificidad del 79,5%. El valor predictivo positivo fue del 67,35% con un valor predictivo negativo del 96,5%.

Conclusiones

A pesar de tratarse de una serie seleccionada, con alta tasa de pacientes con adenocarcinoma, la exploración con HS ha presentado una gran sensibilidad y un elevado valor predictivo negativo. Estos datos, aunque deben ser confirmados en series menos seleccionadas, indican que la exploración previa con HS puede ayudar tanto al diagnóstico en las biopsias como en el seguimiento en programas de vigilancia activa.