1 Department of Urology, University Hospital “St.Anna”, Ferrara, Italy
Purpose: We evaluated the correlation between prostate calculi and hematospermia in patients undergoing prostate biopsy, and its impact on sexual activity of patients.
Materials and Methods: A single-center prospective randomized study of 212 patients referred for transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed. All patients were divided into two groups: Group A (GA), 106 patients with moderate/ marked presence of prostatic calculi visualized by TRUS; Group B (GB), 106 patients with absence/scarce of prostatic calcifications. Patients were handed questionnaires to obtain a validated data on the duration and impact of hematospermia on sexual activity. The anxiety scores were recorded using a visual analogue scale.
Results: No significant difference was noted between the two groups when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for digital rectal examination (DRE) findings. Post-biopsy results of patients included in GA revealed that the complication of hematospermia was present in 65.1%, while in GB was present in 39.7% (p<0.001).
On multivariate analysis for identifying significant preoperative predictors of hematospermia, which included variables of age, PSA, prostate volume, and prostate cancer were not shown to be significant predictors of hematospermia, except DRE and prostate calculi (p<0.001).
Curvature of the erect penis from elements of internal fibrosis has been recognized for centuries (first described in 1743), yet our understanding still seems limited. Guidelines exist in both the United States and Europe, with most based on low level evidence and opinion (1, 2). Men afflicted by this situation are typically lumped together and labeled with the singular descriptor of Peyronie’s disease. The level of evidence for the pathophysiology and natural history of this affliction is poor, as is the awareness of data surrounding treatment modalities. This is evidenced by the fact that one of the most commonly provided interventions is Vitamin E, which has not been shown to provide benefit and is not recommended by existing guidelines. In medical practice, it is dangerous to equate shared assumptions with fact, as this may limit pursuit of additional knowledge. Additionally, in the absence of evidence, logic should prevail.
Keywords: Magnetic Resonance Imaging; Prostatic Neoplasms; Diagnosis; Watchful Waiting
Magnetic resonance imaging (MRI) has been used for staging prostate cancer (PCa) since the 1990’s, more precisely after the advent of the endorectal coil, which enabled significant improvement in the quality of the examination. Also, the standardization of prostate MRI with multiparametric sequences (including high resolution T2-weighted, diffusion and dynamic contrast-enhanced or perfusion images), together with the progressive learning curve by uro-radiologists, contributed to include the method definitively in the list of available procedures for staging prostate cancer (1).
The accuracy of multiparametric MRI (mpMRI) is greater than that of other isolated clinical, laboratory and imaging methods available, with specificities around 85% for detection of extracapsular extension and seminal vesicle invasion (2). Moreover, the incremental value of MRI has been validated around a decade ago in three articles by the interdisciplinary group of Memorial Sloan Kettering Cancer Center, demonstrating that the addition of MRI to the commonly used clinical nomograms significantly increases the accuracy for prediction of organ-confined disease, extracapsular extension and seminal vesicle invasion (3-5).
One of the basic principles of medical care is that a diagnostic test should inform a clinical decision. If the test is uninformative, it is not useful; if no decision is to be made then a diagnostic test is not necessary. Indeed, performing a diagnostic test when it adds nothing to the decision-making process is not only a waste of healthcare resources, it is potentially harmful, leading to incorrect conclusions or more unnecessary testing. From this perspective, how could mp-MRI potentially inform the initial management of localized prostate cancer?
Men who are candidates for active surveillance based on low-risk prostate cancer (cT1c, PSA<10, Grade Group 1 (Gleason 3+3=6)) may be harboring a higher grade tumor that eluded the initial biopsy, particularly if it is anteriorly placed. mp-MRI has the promise of detecting this potentially more serious cancer and avoiding the risk of inappropriate observation.
Some have argued men with low-risk prostate cancer with a “normal” mp-MRI (PI-RADS 1) have very little risk of cancer progression. The promise of mp-MRI to provide a better risk assessment in men considering active surveillance is alluring.