UrologyDr.Nitin ShrivastavaProstate Cancer

Senior Urologist & Uro-Oncologist, Apollo Hospital Gurugram

Part 6 of 10 in Diagnosis and Management of Prostate Cancer

Biopsy Technique and Imaging: Transrectal vs Transperineal, CT vs MRI

July 7, 2024

Once biopsy is indicated, the two main approaches, transrectal and transperineal, are used across different settings. Asked directly about this given that transrectal remains the standard in most African countries and in most of India, Dr. Shrivastava was clear that the latest research shows no meaningful efficacy difference between the two: if a centre is set up for transrectal biopsy, it remains a perfectly reasonable choice.

The one non-negotiable precaution

Before any transrectal biopsy, a povidone-iodine cleansing of the rectum is a strong recommendation, reducing infection risk from the procedure itself.

Confirming diagnosis versus staging the disease

A related, practical question came from a doctor whose setting has more access to CT than MRI: can CT confirm prostate cancer? The answer is no, CT cannot diagnose prostate cancer; only MRI or biopsy can confirm it. But once a diagnosis is confirmed, CT is genuinely useful for staging, checking whether the disease has spread beyond the prostate, when MRI access is limited.

This article is based on a Jivo Masterclass session conducted by Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology, Artemis Hospital, Gurgaon (his affiliation at the time of this session). The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording

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This guide is based on a live Jivo Masterclass: Dr.Nitin Shrivastava taught doctors across Africa on July 7, 2024.

FROM THE LIVE Q&A

MO

Moderator

Apart from PSA, what other hormones should be monitored in case of prostate cancer?

NS

Dr.Nitin Shrivastava

None. PSA is the only one.

See all 14 questions from this masterclass →

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Frequently Asked Questions

What are the factors contributing to prostate cancer, and what are the staging parameters?

The most important contributing factor is genetics and family history. Researchers point to some role of obesity and possibly a non-vegetarian diet, but these risk factors are not firmly established.

What is a neobladder? What is an ileal conduit? How will treatment affect my quality of life?

Neobladder and ileal conduit are treatments for bladder cancer, not prostate cancer. A neobladder is an artificial bladder made from the patient's intestine, stitched together so the patient continues to pass urine through their natural passage. An ileal conduit instead diverts urine to exit through a different passage into a bag. On quality of life: what matters most in the long run is that the cancer comes out of the body completely; patients adjust well to either option over time.

Is there a limitation on the number of times TURP can be done on the same patient?

About 10 out of 100 patients will require another TURP within the following 10 years. There is no fixed limit, sometimes the prostate regrows fast and requires re-intervention, and sometimes it's done in stages. The more times TURP is repeated, the higher the chance of complications. Personally, the doctor has done it twice at most on the same patient.

CT scan is more accessible in our setup than MRI. Is there any place for CT to confirm prostate cancer?

CT scan cannot be used to confirm prostate cancer diagnosis, only MRI can do that. But if MRI isn't available, CT scan is very useful for staging: once a cancer diagnosis is confirmed by biopsy, CT can tell you if it has spread outside the prostate.

What is the value of PSA to consider dangerous: free PSA, total PSA, PSA ratio?

PSA density above 0.15 is suspicious for cancer. A PSA rise of more than 0.75 per year is also suspicious. These are used alongside the age-adjusted PSA cutoffs (2.5 / 3.5 / 4.5 / 6.5 for the 40s / 50s / 60s / 70s age bands) when a single reading is borderline.

Is transrectal or transperineal prostate biopsy better?

Latest research shows no meaningful efficacy difference between the two approaches; either is a reasonable choice depending on what a centre is set up to do.

Can a CT scan confirm prostate cancer if MRI isn't available?

No, CT cannot diagnose prostate cancer, only MRI or biopsy can. But CT is useful for staging (checking spread) once the diagnosis is already confirmed.

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