Profile and outcome of patients undergoing finger guided Tru-cut biopsy of the prostate at Muhimbili National Hospital.

Abstract

ABSTRACT

Background Finger guided prostate biopsy is a common minor procedure done to patients with suspicious Digital rectal examination (DRE) and or raised Prostate specific antigen (PSA) to diagnose prostate cancer. Though outdated and crude it is the only available option at resource constraints hospitals. The procedure is done at outpatient setting with minimal or no preparation and anaesthesia. The outcome of the specimen obtained and associated complications have not been well studied.This study aimed toassessprofile and outcome of finger guided prostate biopsyat Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Objectives The study aimed at determining the profile of patients and outcome of finger guided Tru-cut biopsy of the prostate at MNH Materials and methods The study was descriptive cross-sectional conducted for a period of ten months. Data were collected using patient clinical files, structured questionnaires, Visual Analog Scale for pain, laboratory results of PSA and biopsy. Participants were followed for 1 week.Data were analyzed using SPSSstatistical software version 20

Results The mean age of the study participants was 71.1± 9.5(41-95)years, majority between 60 to 79 years 118(68.6%).Clinical presentations were LUTS 172 (100%), back pain 118(68.6%), lower limb swelling 38(22.1%), macroscopic blood in urine 31(18%) andlower limb paralysis 30(17%). Biopsy revealed mostly adenocarcinoma 95(55.2%), BPH 48(27.9%) and Inadequate sample 28(16.3%). Poorly differentiated adenocarcinoma 59(62.1%) was the most common. Adenocarcinoma detection rate was 70.9% in participants with suspicious DRE and PSA ≥ 4ng/dl. Factors associated with the positive rate of adenocarcinoma were back pain 81(68.6%, P<0.05), Paraplegia 24(80.0%, P<0.05), lower limb swelling 3(81.7%, P<0.05) and Macroscopic blood in urine 21(67.7%, P=0.122). Severe pain (VAS of 7 to 10) 53(30.8%), rectal bleeding 19(11%), hematuria 11(6.4%) were the common complications.

Conclusion • Prostate cancer is a disease of elderly mostly seen in their 6th decade of life and above. • Inadequate biopsy samples were significantly high and most patients had poorly differentiated prostate cancers • There was a late presentation of patients to hospital as many patients presented with symptoms and signs of advanced prostate cancer on their initial visit

Recommendation • There is a need to have a guideline on Tru-cut biopsy procedure of the prostate at MNH. • The hospital should think of buying TRUS to facilitate TRUS guided prostate biopsy rather than the old type, digit guided prostate biopsy to avoid missing the target tissue. • Proper training for registrars and residents on prostate biopsy is needed • Community education on prostate cancer awareness is needed