Objectives: To determine the effect of prostate volume on the diagnostic yield of prostate biopsies. Materials and methods: 155 consecutive patients underwent 12-core transrectal ultrasound guided needle biopsies. Data were collected prospectively on age, serum PSA, digital rectal examination (DRE), previous prostate biopsies, prostate volume and pathologic result. Univariate and multivariate logistic regressions were undertaken to determine the effect of prostate volume on the risk for a positive biopsy. Results: 45 patients (29%) were diagnosed with cancer. The median patient age was 63 (range 48-82) years, the median PSA level was 6.7 ng/ml (0.5-156 ng/ml), and the median prostate volume was 57 ml (16-273 ml). 42 patients (27%) had an abnormal DRE and 51 (33%) had undergone previous prostate biopsies. Positive biopsy rates were 39%, 33%, and 14% for prostate volume below 46 ml, between 45 and 73 ml, and above 72 ml, respectively. Univariate analysis showed that age, serum PSA, DRE and prostate volume were all associated with a positive biopsy. Multivariate analysis adjusted for age, PSA and DRE showed a significant risk increase for a positive biopsy in smaller prostates. (OR = 5.6 95% CI 1.75-17.89; and 8.86 95% CI 2.72-28.82, for prostate volume between 45 and 72 ml and below 45 ml, respectively). Conclusion: The diagnostic yield of prostate biopsies is significantly lower in large prostates. As the result the standard 12-core biopsy may be insufficient for the diagnosis of cancer in large prostates. (C) 2013 Elsevier Inc. All rights reserved.

Objectives: To determine the proportion of benign testicular lesions among candidates for testicular sparing surgery (TSS) and to assess the safety and efficacy of this procedure.Methods and Materials: Sixteen patients underwent surgical exploration for testicular tumors with TSS intent in our center. Surgery was performed via an inguinal approach with temporary cord occlusion and frozen section (FS) analysis of the lesions. Benign findings allowed for TSS, whereas cancer prompted total orchiectomy.Results: The lesions measured 8-25 mm in the largest diameter. Eleven of the 16 lesions were benign (69%) and TSS was accomplished in these cases. Complete concordance was observed between the results of FS and permanent sections. Of the 5 patients with cancer, 3 had pure seminoma, and embryonal carcinoma and teratoma were found in I patient, each. Surveillance was applied in 4 of these patients, and chemotherapy was used in the patient with embryonal carcinoma. With an average follow-up duration of 48 months, all are alive and free of disease. All 11 patients in whom TSS was accomplished had an uneventful postoperative course, and with an average follow-up duration of 28 months, 9 have normal scrotal physical examination and ultrasound, whereas 2 patients were lost to follow-up.Conclusions: Sixty-nine percent of testicular lesions under 25 mm are benign. TSS is safe and effective in patients with small benign lesions. Cancer is reliably detected by FS, and testicular exploration is not associated with local or distant recurrence in any of our patients. (C) 2012 Elsevier Inc. All rights reserved.

OBJECTIVES:To evaluate the concordance between testicular tumor size and benign histology in order to identify a cut-off size, below which the rate of benign lesions would be highest. METHODS AND MATERIALS:During the years 1995-2008, we performed 131 consecutive testicular operations for testicular tumors. Ten of these were testicular preserving surgery, whereas the other 121 patients had radical orchiectomy. We searched for the rate of benign lesions in the following 3 groups of tumor diameter: 10 mm or less, 11-20 mm, and greater than 20 mm. ROC analysis was used to find the optimal size cut-off below which the rate of benign lesions would be highest. RESULTS:Benign lesions were found in 11 patients (8%), including epidermoid cyst (n = 4), Leydig cell tumor (n = 3), fibrosis (n = 1), adenomatoid tumor (n = 2), and 1 patient with a simple cyst. Small tumor size strongly correlated with benign histology. The mean diameter of benign vs. malignant lesions was 15 mm and 41 mm, respectively (P < 0.05). The rate of benign lesions in tumors with a diameter of 10 mm or less, 11-20 mm and greater than 20 mm was 50%, 17%, and 2%, respectively. Receiver Operating characteristic (ROC) analysis with 87% sensitivity and 83% specificity revealed a cut-off value of 18.5 mm tumor diameter below which the proportion of benign lesions was 38.5% compared with 2% above it (P < 0.05). CONCLUSIONS:While benign lesions comprise only 8% of all testicular tumors, their proportion among small lesions is much higher. With a size cut-off of 18.5 mm, 38.5% of smaller lesions are benign. These findings support consideration of testicular exploration for small testicular lesions aiming at preservation rather than predetermined radical orchiectomy.

You have accessJournal of Urology1 Apr 2009THE IMPACT OF PROSTATE VOLUME ON THE DIAGNOSTIC YIELD OF NEEDLE BIOPSIES: ARE 12 CORES ENOUGH IN LARGE PROSTATES? Dan Leibovici, Yaniv Shilo, Orit Raz, Kobi Stav, Amnon Zisman, Avraham Chahashvilli, Judith Sandbank, Michael Segal, and Arie Lindner Dan LeiboviciDan Leibovici More articles by this author , Yaniv ShiloYaniv Shilo More articles by this author , Orit RazOrit Raz More articles by this author , Kobi StavKobi Stav More articles by this author , Amnon ZismanAmnon Zisman More articles by this author , Avraham ChahashvilliAvraham Chahashvilli More articles by this author , Judith SandbankJudith Sandbank More articles by this author , Michael SegalMichael Segal More articles by this author , and Arie LindnerArie Lindner More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)62092-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "THE IMPACT OF PROSTATE VOLUME ON THE DIAGNOSTIC YIELD OF NEEDLE BIOPSIES: ARE 12 CORES ENOUGH IN LARGE PROSTATES?." The Journal of Urology, 181(4S), p. 750 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 750 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Dan Leibovici More articles by this author Yaniv Shilo More articles by this author Orit Raz More articles by this author Kobi Stav More articles by this author Amnon Zisman More articles by this author Avraham Chahashvilli More articles by this author Judith Sandbank More articles by this author Michael Segal More articles by this author Arie Lindner More articles by this author Expand All Advertisement PDF downloadLoading ...