Abstract 1.1 Introduction The over-diagnosis and over-treatment of prostate cancer is a major public health concern, and in 2012 the United States Preventive Services Taskforce (USPSTF) recommended against prostate cancer screening. Prostate cancer is usually detected by performing a prostate biopsy. Previously, many men received a biopsy at the first sign of an elevated cancer risk identified by screening. Currently, physicians have more tools are their disposal to select men for biopsy who are likely to have clinically significant cancers, including repeat prostate specific antigen (PSA) testing, PSA density, PSA velocity, PSA free/total ratio, and age-specific cutoffs. These tests allow physicians to reduce the number of unnecessary biopsies performed on lower risk patients. One would expect that the use of these tests, in addition to more selective screening, would decrease the incidence of prostate biopsies in the population. I hypothesized that in the last 10 years in Ontario: 1) the incidence of prostate biopsy has decreased, 2) the proportion of biopsies that are malignant has increased, and 3) patients receiving biopsies are healthier. 1.2 Methods I performed a secondary analysis of population-based administrative databases. I validated the prostate biopsy procedure code in the Ontario Health Insurance Plan (OHIP) then used this code to create a cohort of Ontario men who received their first prostate biopsy between 1992 and 2012. Crude and age standardized incidence rates of prostate biopsy were determined for each study year. Era-specific inter-censal population estimates from Statistics Canada were used to establish the number of men at risk of biopsy each year. Changes over time in prostate biopsy incidence were examined using negative binomial regression by comparing the biopsy incidence of each year to a referent year expressed as incident density ratios. Similar analyses were performed to examine changes over time in the proportion of biopsies that are malignant and the health status of patients receiving biopsy. Health status was determined by calculating the Aggregated Diagnosis Group (ADG) score for each patient. 1.3 Results The sensitivity of the OHIP prostate biopsy code improved during the study period and was approximately 90% in recent years. The specificity for identifying the first prostate biopsy a patient received was estimated to exceed 95%. The crude and age standardized incidence of prostate biopsy in Ontario gradually increased between 1992 and 2007 and then dropped sharply in 2008 and 2012. Overall, 39% of biopsies were malignant but this proportion increased during the study period. The health status of patients receiving biopsy, as measured by the ADG score, improved over the study period. 1.4 Conclusions This is the first study to report crude and age standardized prostate biopsy incidence in a population. We found that previously rising biopsy rates decreased significantly in 2008 and 2012 in conjunction with changes to the perceived utility of prostate cancer screening. More years of follow up are required to determine if these changes were transient or the start of broad practice changes.

Made available in DSpace on 2014-06-11T19:29:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-05-29Bitstream added on 2014-06-13T19:17:15Z : No. of bitstreams: 1 tsuji_fh_me_botfm.pdf: 318361 bytes, checksum: 56cacc8c355b93b78d68153c4f245f6f (MD5) / Universidade Estadual Paulista (UNESP) / O câncer de próstata, excluindo os tumores de pele, é a neoplasia mais comum no homem e, representando globalmente 9,7% dos tumores, é a segunda causa de óbito, precedido apenas pelo câncer de pulmão1. Sua incidência vem aumentando nas últimas décadas. O diagnóstico de certeza é realizado em fragmentos obtidos por meio de biópsia prostática guiada por ultrassom transretal. Com o aumento do número de biópsias e fragmentos por procedimento e com a possibilidade, cada vez mais frequente, de novos procedimentos realizados para um mesmo paciente, ficou clara a importância de se realizar algum tipo de analgesia para sua realização. Neste contexto, o estudo de novas formas de analgesia, visando à efetividade, segurança e comodidade para o médico e paciente é extremamente atual, principalmente por não haver consenso sobre qual seja o melhor método de analgesia para esse procedimento. Avaliar a intensidade da dor e o grau de satisfação dos pacientes submetidos à biopsia prostática transretal guiada por ultrassom com uso de sedação e analgesia endovenosa com midazolam e citrato de fentanila. É um estudo prospectivo descritivo transversal, realizado em uma amostra consecutiva de conveniência de pacientes com diferentes indicações para biópsia prostática que foram submetidos ao procedimento com uso de 5 mg de midazolam e 50 mcg de citrato de fentanila endovenoso três minutos antes do procedimento. Após a biópsia a dor foi avaliada, por meio da Escala Visual Analógica (VAS), em três momentos: 1 – Durante a introdução do transdutor no canal anal, 2 – Durante a penetração da agulha no tecido prostático e 3 – Na semana seguinte ao exame. A intensidade da dor nesses diferentes momentos, foi comparada com a estratificação de idade, raça, escolaridade, volume prostático, rebiópsia e ansiedade pré biópsia... / of tumors, being the second cause of death among cancers. Its incidence has increased in recent decades. Its diagnosis is obtained from prostate biopsy guided by transrectal ultrasound. The growing number of biopsies and fragments per procedure as well as its possible repetition clearly shows the importance of performing some kind of analgesia for prostate biopsy. In this context, there are many studies on new forms of analgesia aiming at effectiveness, safety and convenience for the physician and patient, once there is no consensus on the best method of anesthesia for this procedure. To assess the pain intensity of patients undergoing transrectal prostate biopsy guided by ultrasound, using intravenous sedation and analgesia with midazolam and fentanyl citrate. It is a prospective cross-sectional study, conducted with a convenience sample of patients with different indications for prostate biopsy who underwent the procedure using 5 mg of midazolam and 50 mcg of fentanyl citrate intravenously three minutes prior to the procedure. After the biopsy, pain was assessed by Visual Analogue Scale (VAS) in three stages: 1 - Introduction of the probe in the anal canal, 2 - Penetration of the needle into the prostate tissue and 3 – One week following the exam. Pain intensity in these different times was tested with the stratification of age, race, education, prostate volume, rebiopsy and anxiety before biopsy. The pain was ranked according to score: 0 (no pain), 1-3 (mild pain), 3.01-7 (moderate pain) and 7.01-10 (severe pain). Statistical analysis was performed using Kruskal Wallis and Wilcoxon two-tailed with a significance of 5%. Factors such as age, race, education level, prostate volume, presence of rebiopsy, pre biopsy anxiety, did not influence the pain intensity regarding the method used. The mean pain VAS 1 score was... (Complete abstract click electronic access below)

Orientador: Carlos Márcio Nóbrega de Jesus / Banca: Marcos Tobias Machado / Banca: Aparecido Donizete Agostinho / Resumo: O câncer de próstata, excluindo os tumores de pele, é a neoplasia mais comum no homem e, representando globalmente 9,7% dos tumores, é a segunda causa de óbito, precedido apenas pelo câncer de pulmão1. Sua incidência vem aumentando nas últimas décadas. O diagnóstico de certeza é realizado em fragmentos obtidos por meio de biópsia prostática guiada por ultrassom transretal. Com o aumento do número de biópsias e fragmentos por procedimento e com a possibilidade, cada vez mais frequente, de novos procedimentos realizados para um mesmo paciente, ficou clara a importância de se realizar algum tipo de analgesia para sua realização. Neste contexto, o estudo de novas formas de analgesia, visando à efetividade, segurança e comodidade para o médico e paciente é extremamente atual, principalmente por não haver consenso sobre qual seja o melhor método de analgesia para esse procedimento. Avaliar a intensidade da dor e o grau de satisfação dos pacientes submetidos à biopsia prostática transretal guiada por ultrassom com uso de sedação e analgesia endovenosa com midazolam e citrato de fentanila. É um estudo prospectivo descritivo transversal, realizado em uma amostra consecutiva de conveniência de pacientes com diferentes indicações para biópsia prostática que foram submetidos ao procedimento com uso de 5 mg de midazolam e 50 mcg de citrato de fentanila endovenoso três minutos antes do procedimento. Após a biópsia a dor foi avaliada, por meio da Escala Visual Analógica (VAS), em três momentos: 1 - Durante a introdução do transdutor no canal anal, 2 - Durante a penetração da agulha no tecido prostático e 3 - Na semana seguinte ao exame. A intensidade da dor nesses diferentes momentos, foi comparada com a estratificação de idade, raça, escolaridade, volume prostático, rebiópsia e ansiedade pré biópsia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: of tumors, being the second cause of death among cancers. Its incidence has increased in recent decades. Its diagnosis is obtained from prostate biopsy guided by transrectal ultrasound. The growing number of biopsies and fragments per procedure as well as its possible repetition clearly shows the importance of performing some kind of analgesia for prostate biopsy. In this context, there are many studies on new forms of analgesia aiming at effectiveness, safety and convenience for the physician and patient, once there is no consensus on the best method of anesthesia for this procedure. To assess the pain intensity of patients undergoing transrectal prostate biopsy guided by ultrasound, using intravenous sedation and analgesia with midazolam and fentanyl citrate. It is a prospective cross-sectional study, conducted with a convenience sample of patients with different indications for prostate biopsy who underwent the procedure using 5 mg of midazolam and 50 mcg of fentanyl citrate intravenously three minutes prior to the procedure. After the biopsy, pain was assessed by Visual Analogue Scale (VAS) in three stages: 1 - Introduction of the probe in the anal canal, 2 - Penetration of the needle into the prostate tissue and 3 - One week following the exam. Pain intensity in these different times was tested with the stratification of age, race, education, prostate volume, rebiopsy and anxiety before biopsy. The pain was ranked according to score: 0 (no pain), 1-3 (mild pain), 3.01-7 (moderate pain) and 7.01-10 (severe pain). Statistical analysis was performed using Kruskal Wallis and Wilcoxon two-tailed with a significance of 5%. Factors such as age, race, education level, prostate volume, presence of rebiopsy, pre biopsy anxiety, did not influence the pain intensity regarding the method used. The mean pain VAS 1 score was... (Complete abstract click electronic access below) / Mestre

Background: Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective. Aim: To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events. Results: When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days. Conclusions: The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated.

Prostate cancer is a worldwide health concern for men. Needle biopsy is the most definitive form of cancer diagnosis. Target-specific biopsies can be performed under magnetic resonance imaging (MRI) guidance. However, needle placements are often inaccurate due to intra-operative prostate motion and the lack of motion compensation techniques. As a result, malignant tumors can be missed, which in turn will lead to an increased number of repeated biopsies and delaying of treatment. To increase the needle targeting accuracy, intra-operative prostate motion and deformation need to be studied so that motion compensation techniques can be developed accordingly. This thesis intends to make three main contributions: 1. A comprehensive survey of the state-of-art in image-guided prostate needle placement interventions. 2. Retrospective clinical accuracy validation of a MRI-guided robotic prostate biopsy system that was used in the U.S. National Cancer Institute for over 6 years. A 3D-3D registration algorithm consists of an initial two-step rigid alignment followed by a B-spline deformable transform was developed to align the pre- and post-needle insertion images. A total of 90 biopsies from 24 patients were studied. The mean target displacement, needle placement error, and clinical biopsy error were 5.2, 2.5, and 4.3 mm, respectively. 3. Development of a multi-slice-to-volume registration for intra-operative target localization. The algorithm aligns the planning volume with three orthogonal image slices of the prostate acquired immediately before needle insertion. It consists of a rigid registration followed by a deformable step using only the prostate region. The algorithm was validated on 14 clinical images sets from Brigham and Women's Hospital in Boston, Massachusetts. All registration errors were well below the radius of a clinically significant tumour (5 mm), and are considered clinically acceptable. The results show that there was a substantial amount of biopsy error caused by prostate motion and deformation during MRI-guided biopsy. This error can be reduced by using quantitative imaging techniques for prostate registration and motion compensation. In particular, the multi-slice-to-volume registration algorithm demonstrated the feasibility of intra-operative target localization and motion compensation; which in turn may improve the quality of MRI-guided prostate interventions. / Thesis (Ph.D, Computing) -- Queen's University, 2014-03-01 11:45:55.8

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, 2007. / Bibliyografya var.

PURPOSE: To determine the accuracy of prostate biopsy Gleason score (GS) compared to prostatectomy GS. To determine whether a biopsy is a satisfactory diagnostic procedure to offer active surveillance for patients with low-grade prostate cancer. METHODS: This study was conducted in Tuft Medical Center as retrospective cohort study over the period from 2007-2010. The study included 83 patients for whom biopsy and prostatectomy GS were available. MEASUREMENTS: Gleason scores of 6, 7, and 8-10 were assigned to low, moderate, and high-grades, respectively. The kappa statistic was calculated to assess the degree of agreement between biopsy and prostatectomy. The ROC curve was used to evaluate the sensitivity and specificity of prostate biopsy for different Gleason grades. Also, compared whether the use of specific criteria for active surveillance (Johns Hopkins and UCSF) may decrease the level of up-grading in patient with low-grade prostate cancer using Chi-square test. RESULTS: The distribution of low, moderate, and high-grade cancer in biopsy (52%, 32%, 16%) and prostatectomy specimen (33%, 55%, 12%) showed fair agreement with weighted kappa 0.35. The prostate biopsy accurately predicted GS in 46%, up-graded in 38%, and down-graded in 16%. The patients with low-grade cancer and potentially eligible for active surveillance showed up-grading in 50% of cases. This up-grading reduced to 40% with the use of Johns Hopkins criteria and to 41% with the use of UCSF criteria. CONCLUSIONS: The accuracy of biopsy GS in predicting prostatectomy GS is severely limited and therefore biopsy is not enough diagnostic procedure to offer active surveillance.

Den vanligaste cancerformen hos män är prostatacancer, med 10 000 nya dödsfall årligen. Vid prostatacancerdiagnostik utförs prostata biopsi. För att minska risken för komplikationer i samband med biopsi ges i Sverige en singeldos av antibiotikapreparatet Ciprofloxacin. Andelen bakterier som är resistenta mot ciprofloxacin har ökat. För detektion av genmutationer som orsakar antibiotikaresistens kan droplet digital PCR (ddPCR) användas. Det är en metod som ger en absolut kvantifiering av antalet DNA-sekvenser. Den är baserad på vatten olja-emulsionsdroppsystem.  Syftet med denna studie var att optimera och validera en digital droplet PCR för att detektera och kvantifiera mutationen S83L i gyrA genen från faecesprover, samt att jämföra digital droplet resultat från studieprover med odlingsresultat från resistensbestämning och ration mellan S83L allelen och vildtyps allelen i prover tagna före och efter biopsi. För att optimera och validera metoden användes prover tagna före och efter biopsi från nio patienter som genomgått en transrektal prostatabiopsi och fått en dos antibiotika profylax i samband med ingreppet.  Den optimala annealingtemperaturen bedömdes vara 60°C och den optimala  primer- och probekoncentrationen bestämdes till 1,2 µM respektive 0,4µM. Dessa koncentrationer gav lägst antal falskt positiva droppar. Den minsta detektionsnivån för S83L gyrA (EC40) var 160 kopior/ml och för vildtyps gyrA (EC108) var det 78 kopior/ml. Resultatet från valideringen visade att både vildtyps gyrA och S83L gyrA kunde detekteras och kvantifieras i rektalprover från samtliga patienter. / The most common form of cancer in men is prostate cancer, with 10,000 new deaths annually. In prostate cancer diagnosis, prostate biopsy is performed. To reduce the risk of complications in connection with biopsy, a single dose of the antibiotic drug Ciprofloxacin is given in Sweden. The proportion of bacteria that are resistant to ciprofloxacin has increased. For the detection of gene mutations that cause antibiotic resistance, droplet digital PCR (ddPCR) can be used. It is a method that provides an absolute quantification of a DNA sequence in a sample. It is based on water oil emulsion drop system.  The purpose of this study was to optimize and validate a digital droplet PCR to detect and quantify the S83L mutation in the gyrA gene from faecal samples and to compare digital droplet results from study samples with culture results from resistance determination and the ration between the S83L allele and the wild-type allele in samples taken before and after biopsy. To validate the method, samples taken before and after biopsy were used from nine patients who had undergone a transrectal prostate biopsy and received a dose of ciprofloxacin or trimethoprim in connection with the procedure.  The optimal annealing temperature was determined to be 60 °C and the optimal primer and probe concentrations were determined to be 1.2 µM and 0.4µM, respectively. These concentrations gave the lowest number of false positive droplets. The minimum detection level for S83L gyrA (EC40) was 160 copies/ml and for wild-type gyrA (EC108) it was 78 copies/ml. The results showed that both wild-type gyrA and S83L gyrA could be detected and quantified in rectal samples from all nine patients.

Prostatos vėžys yra dažniausia vyrų onkologinė liga JAV, Vakarų Europoje bei Lietuvoje. Dėl senstančios visuomenės ateityje bus nustatoma dar daugiau naujų prostatos vėžio atvejų. Lietuvos vėžio registro duomenimis 1995 – 2005 metais vidutinis metinis prostatos vėžio sergamumo didėjimas - 14,5 proc. per metus. Vyrų sergamumas prostatos vėžiu Lietuvoje 2005 metais siekė 125,9/100000 atvejų, o mirtingumas nuo šios ligos siekė 31/100000 atvejų. Vyrų mirtingumas nuo prostatos vėžio antras pagal dažnį po plaučių vėžio su vėžiu susijusio mirtingumo grupėje. Todėl daugelis tyrėjų pabrėžia, kad norint mažinti mirtingumą, reikia ankstinti prostatos vėžio nustatymo laiką. Pradėta Lietuvos vyrų ankstyvosios prostatos vėžio diagnostikos programa ir dažnas prostatos specifinio antigeno nustatymas lėmė padidėjusį apsilankymų pas urologus skaičių ir padidino prostatos biopsijų kiekį. Norint efektyviai ir optimaliai ištirti šiuos pacientus, reikia daug materialinių išteklių ir laiko.Šio darbo tikslas buvo optimizuoti pacientų su padidėjusia prostatos vėžio rizika ištyrimą ir stebėjimą bei nustatyti ryšį tarp prostatos vėžio rizikos veiksnių ir prostatos vėžio diagnozavimo padidėjusios rizikos grupėje. Darbo uždaviniai: 1. Išanalizuoti prostatos vėžio nustatymo dažnį pirmąja ir kartotinėmis lateralinėmis sekstantinėmis prostatos biopsijomis ir įvertinti jų efektyvumą. 2. Nustatyti amžiaus, rūkymo, alkoholio vartojimo, prostatos vėžio šeiminės anamnezės, viršsvorio ir padidėjusio cholesterolio... [toliau žr. visą tekstą] / Prostate cancer is the most frequent malignant disease in men in United States, Western Europe and in Lithuania. Due to ageing population incidence of prostate cancer will rise even more in the future. Since the year 2003 prostate cancer became the most common form of cancer diagnosed in men in Lithuania (more than 1500 new prostate cancer cases a year). There were 2005 of new prostate cancer cases diagnosed in the year 2005. According to Lithuanian Cancer Registry data during the years 1995-2005 the prevalence of prostate cancer was increasing 14.5 percent annually. Prostate cancer was detected in 24.3 percent of all cancer cases in men in the year 2005 in Lithuania and in 48.3 percent of them disease was detected in the stages I and II. In the year 2005 the prevalence of prostate cancer in Lithuanian men was 125.9 per 100000 population and mortality was 31 per 100000 population. Prostate cancer is a second common form of death after lung cancer in cancer-associated mortality group in Lithuania. Prostate cancer mortality ranged between 19 and 55 per 100000 in Europe and it was 23.2 per 100000 populations in the year 2006 in European Union. Many authors stress that it is important to diagnose prostate cancer in the early stages in order to reduce prostate cancer mortality rate. The aim of the study was to optimize investigation and follow-up of the high prostate cancer risk patients, and to define the relation between prostate cancer risk factors and prostate cancer... [to full text]