Prostatic biopsies: experience of the urology department of CHU HASSAN II of Fez about 200 cases

Early detection of CaP prostate cancer relies on identification of risk factors, digital rectal examination, and PSA testing. The recognized risk factors for CaP are age (constant increase in risk), ethnicity and family history of prostate and breast cancer. Rozet F et al (2) report an average age at diagnosis of 70 years, which is consistent with our study.

Far from taking the place of pathological examination, RT is a valuable aid in the diagnosis of BPH or prostate cancer. Most cancers develop in the posterior peripheral zone of the prostate and can therefore be accessed by DRE. A normal DRE does not rule out cancer, 23-45% of cancers do not result in palpable changes. In our series, the prostate was suspicious in 123 cases (72.8%). Cross found 61% of cases and Barthelemy 67% of cases.

Approximately 70% of total serum PSA circulates as bound to blood proteins and 30% as free form. The free form increases in benign prostatic hypertrophy (BPH). The bound form increases in the case of cancer. The free/total PSA ratio decreases in the case of cancer: a low ratio < 15% is correlated with the presence of cancer. PSA levels are correlated with the evolution of the tumor mass. ( 3,4,5) .

The most commonly used PSA cut-off value for cancer diagnosis is 4 ng/mL. When the PSA is between 4 and 10 ng/mL, 70% of diagnosed cancers are localized. A PSA of more than 30 ng/mL is a sign of locally advanced prostate cancer with a high probability of local lymph node metastasis. A PSA level above 100 ng/mL is a marker of locally and distantly advanced prostate cancer with a high probability of bone metastases.

We can say that our results concerning the PSA level in patients with positive prostate biopsies were identical to the literature.

Cancer was detected in 73 of 332 men (22%) with PSA levels between 2.6 and 4.0 ng/ml. Smith et al reported an overall cancer detection rate of 27% in men with PSA levels between 2.6 and 4.0 ng/ml . In contrast to these results, Carter et al. found a minimal difference (2% to 4%) in the probability of detecting curable cancer at PSA levels between 2.5 and 6.0 ng/ml for all age groups .

Biopsy is generally well tolerated, with a low risk of major complications. However, minor complications such as pain and bleeding are common. In the European Rotterdam Study (ERSPC), a randomized prostate cancer screening study, hematuria greater than 3 d was observed in 22.6% of men and correlated with prostate (r = 0.096; p <0.001) and transition zone volumes (r = 0.076; p <0.001) .(7) Others have also found an increase in hematuria with greater prostate volume . The reported rate of hematospermia varied considerably among studies (1.1 to 93%). This variation may reflect cultural issues, social stigma, or differing perceptions of importance, as well as differences in data collection between studies . The rate of rectal bleeding varied between 1.3% and 45% across studies. Fewer rectal bleeds were reported in the ERSPC study (1.3%) and there was no correlation with other recorded parameters(7). Rosario et al. suggested that rectal bleeding was more common than previously reported (36.8%), but only 2.5% found it to be a major or moderate problem.(8) Infection is a well-established risk of transrectal ultrasound-guided biopsy, and in the United Kingdom, out of 72,500 biopsies, 2.15 to 3.6% were readmitted with infectious complications.