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INTRODUCTION
Prostate cancer is the 2nd most common cancer and the 5th most
common death rate for men worldwide. The definitive diagnosis should
be based on digital rectal examination (DRE), serum PSA, prostate
biopsy results. Biopsy plays a decisive role in diagnosis of prostate
cancer, however biopsy results depend on biopsy methods and
techniques. At Viet Duc Hospital, Trans-rectal ultrasound guided
(TRUS) biopsy has been done since 2008, the 6-core and 10-core
prostate biopsy in the 2008-2011 period resulted in the positive cancer
rate of 59/104 (56.7%). But in this study, the vast majority of prostate
cancer patients were discovered at a later stage. In recent years, thanks
to improved prostate biopsy techniques, especially increasing the
number of biopsy pieces, has helped increase the early diagnosis rate of
prostate cancer. The early diagnosis of prostate cancer has helped to
monitor and treat it more actively, reducing the mortality rate of this
pathology. Based on that fact, we have implemented the project titled
“Studying the application of 12-core prostate biopsy by transrectal
ultrasound guidance for diagnosis of prostate cancer” to achieve the
following objectives:
1. Developing the indications and procedures of 12-core prostate
biopsy under transrectal ultrasound guidance.
2. Evaluating the results and giving the comments on relevant
factors of 12-core prostate biopsy under transrectal
ultrasound guidance.
The urgency of the thesis
Prostate biopsy is crucial in diagnosis of prostate cancer, stage of
the tumor and its treatment. However, the biopsy results depend on the
biopsy method and technique.
Curative treatment of prostate cancer (removal of the entire
prostate gland and seminal vesicles) depends on the stage of the disease
when the tumor is localized in the gland, stage T1, T2 and the age of the
patient is < 70 years old and has period expect to live for more than 10
years, but the symptoms of prostate cancer are poor, mainly diagnosed
based on serum PSA (Serum Prostate Specific antigen) and DRE detect
abnormal mass. In fact, patients come to health facilities with
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complications of prostate hyperplasia and signs of metastatic prostate
cancer such as urinary retention, urinary tract infections, kidney failure,
bone pain, urinary retention, secretive defecation ..., including young
people under 60.
Vietnam is considered a country that is not in the focus area of
prostate cancer, but according to the research results at two large
medical centers of Viet Duc University Hospital and Cho Ray Hospital,
most patients are treated for prostate cancer at a late stage. From 2011-
2015), in Cho Ray Hospital, among 222 patients with prostate cancer,
most of the cancer was in the stage of metastasis and local progression,
accounting for 70.7% and 16.2% respectively and local-stage cancer
only accounted for 12.1%. According to the research by Vu Nguyen
Khai Ca (2012), for two years (2010-2011), the Urology Department of
Viet Duc Hospital treated 119 patients with prostate cancer, only 8
patients at the early stages T1 and T2 (6.7%). To increase the rate and
the ability to identify the early prostate cancer by prostate biopsy under
the guidance of transrectal ultrasound at Viet Duc University Hospital
from which to give curative treatment indications for patients we
choose topic.
New contributions of the thesis
- Successfully applying 12-core transrectal prostate biopsy, the
study showed signs or combination of clinical and subclinical
examinations, analyzing the results, thereby proposing indications of
prostate biopsy for diagnosis to identity the prostate cancer, especially
the cases of early-stage cancer.
- The first domestic study analyzed prostate biopsy values at the
levels of 6 cores; 10 cores and 12 cores on the same patient.
- Replicating the prostate biopsy procedure to provincial hospitals
for early diagnosis and effective treatment of prostate cancer patients.
Layout of the thesis
The thesis has 126 pages, including parts: Introduction (2
pages), Literature overview (44 pages), Research subjects and methods
(16 pages), Results (23 pages), Discussion (39 pages), Conclusion (2
pages). The thesis has 34 tables, 15 figures, 3 charts, 150 references
(133 ones in English and 17 ones in Vietnamese).
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Chapter 1
LITERATURE OVERVIEW
1.1. The situation of prostate cancer in the world and in Vietnam
1.1.1. The situation of prostate cancer in the world
Prostate cancer is the 2nd most common cancer and the 5th most
common death rate for men worldwide. In 2013, over 3 million prostate
cancer patients were alive worldwide, while in the United States,
238,590 patients and 29,720 patients died.
1.1.2. The situation of prostate cancer in Vietnam
In Vietnam, prostate cancer incidence and adjusted death rate by
age are 3.4 and 2.5 respectively per 100,000 people. The disease is the
10th most common cancer in both sexes with 1275 new cases and 872
estimated annual deaths nationwide.
In 2012, the authors of the Binh Dan Hospital reported the results
of prostate cancer screening at Binh Dan Hospital. Among 1098 men
aged ≥ 50 who participated in the study, 222 cases were biopsied, 33
cancer were detected, accounting for 3%.
1.2. Prostate surgery
According to Mc Neal S. H. Selman, prostate parenchyma is divided
into 5 zones.
Figure 1.1: External appearance of prostate (rear view).
- Anterior zone: Fibromy muscle structure has no glandular
structure.
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- Central zone: Accounting for 25% of gland volume,
- Transitional zone: Occupying 5-10% of prostate volume, this is
the area where benign prostatic hyperplasia develops, and also
about 25% of prostate cancer is produced.
- Peripheral zone: Accounting for 70% of the gland volume, which
forms the lower part of the gland and produces about 67% of
prostate carcinoma
- The zone around the urethra gland.
1.3. Anatomy of prostate cancer
1.3.1. Some precancerous lesions
- Prostate Intraepithelial Neoplasia - PIN
Lesions including 2 types: High grade PIN and Low grade PIN.
1.3.2. Adenocarcinoma
- Most prostate cancer is adenocarcinoma adenocarcinoma> 95%.
- Other types very rare:
1.3.3. Gleason grading system
Most commonly used based on cell structure with degree of
malignancy. Gleason divides 5 grades of differentiation from a very
differentiated structure (grade 1) to a non-differentiated structure
(grade 5).
1.4. Prostate biopsy
1.4.1. History of transrectal prostate biopsy under the guidance of
ultrasound.
Transrectal prostate biopsy was first performed by Astraldi in
1937. In 1989, prostate biopsy under the guidance of 6-core transectal
ultrasound was first introduced by Hodge et al. standardized to
transrectal prostate biopsy and today this method is popular all over the
world.
1.4.2. Study on prostate biopsy in Vietnam.
From June 2004 to May 2005, Do Anh Toan reported the results of
116 cases of prostate biopsy of 6 samples through the perineum at
Medic Medical Diagnostic Center. The findings of prostate cancer
accounted for 14.7 %.
In 2005, Le Ngoc Bang reported conducting a study of 53 patients
receiving biopsy transrectal prostate under the orientation of abdominal
ultrasound and index finger at Viet Duc University Hospital, the results
of 21/53 (39.6%) of patients have prostate cancer results.
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In 2010, some authors reported the results of transrectal prostate
biopsy research under ultrasound guidance using 6 standard samples
and the results of prostate cancer detection, Vu Van Ty 20.5%, Nguyen
Tuan Vinh 11.5% and Vu Le Chuyen in 2012 were 14.8%.
From March 2008 to March 2011 at Viet Duc University Hospital,
rectal prostate cancer was conducted under ultrasound guidance for 104
patients, resulting in 56.7% prostate cancer.
From December 2013 to June 2016 at Hanoi Cancer Hospital,
prostate biopsy under the guidance of transrectal ultrasound was
performed for 83 patients, of which 73.8% of patients had 10 biopsies,
resulting in Result of 52 patients with prostate cancer. The positive
biopsy rate of the method is 61.9%
For the 12-core biopsy method, the two authors, Phan Van Hoang
and Le Quang Trung, reported cancer detection rates of 17.07% and
26% of prostate cancer patients..
CHAPTER 2
RESEARCH SUBJECTS AND METHODS
2.1. Research subjects
Including all patients who visited Viet Duc University Hospital or
Friendship Hospital and had 12-core prostate biopsy from October 2015
to April 2017.
2.1.2. Criteria for selecting patients
Patients with one or more of the following signs are indicated for
prostate biopsy:
- Patients with PSA>10 ng/ml or
- Prostate rectal probe suspected prostate cancer or
- CT scanner or magnetic resonance imaging of prostate with
images of suspected prostate cancer
- Patient had 12 biopsy samples by rectal ultrasound.
2.2. Research Methods
2.2.1. Sample size
Calculate sample size based on formula
n =
−
−2
)1(
2
2
1
pp
Z