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TRUS Biopsy Yield in Indian Population: A Retrospective Analysis
Sunil Raghunath Patil1, Prakash Wamanrao Pawar2, Ajit Somaji Sawant3
1Senior Registrar, Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital , Mumbai, Maharashtra, India .
Journal of Clinical and Diagnostic Research : JCDR
|April 8, 2017
Summary
The cancer detection rate of Trans-Rectal Ultrasonography (TRUS) biopsies in India is low, necessitating higher Prostate-Specific Antigen (PSA) and PSA Density (PSAD) cutoffs. Current thresholds lead to unnecessary biopsies, indicating a need for revised guidelines for the Indian population.
Area of Science:
- Urology
- Oncology
Background:
- Trans-Rectal Ultrasonography (TRUS) biopsy yield is approximately 30% in Western countries but significantly lower in India.
- This disparity results in a higher number of unnecessary biopsies for Indian patients.
Purpose of the Study:
- To determine the cancer detection rate of TRUS biopsy in the Indian population.
- To evaluate the positive predictive values of serum Prostate-Specific Antigen (PSA) and PSA Density (PSAD) at various cutoff levels, alongside Digital Rectal Examination (DRE) findings.
Main Methods:
- A retrospective study of 235 symptomatic patients with elevated PSA (>4 ng/ml) or suspicious DRE findings undergoing TRUS biopsy from January 2012 to December 2014.
- Statistical analyses included Chi-square test, Mann-Whitney U-test, Spearman's rank correlation, and ROC curve analysis.
Main Results:
- The overall cancer detection rate was 25.53% (60 out of 235 patients).
- Cancer detection rates were low for PSA ranges of 4-10 ng/ml (5.95%) and 10-20 ng/ml (13.16%), and PSA density up to 0.25 ng/ml/cm³ (10%).
- Higher PSA levels (>50 ng/ml) showed a 100% detection rate, with AUC for PSA and PSAD at 0.876 and 0.884, respectively. Post-biopsy complication rate was low (0.43%).
Conclusions:
- Current serum PSA (4 ng/ml) and PSAD (0.15 ng/ml/cm³) cutoff levels require upward revision for the Indian population to enhance positive predictive value.
- Prospective studies are needed to validate these findings.