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Abstrak :
Tujuan: Mengevaluasi secara prospektif keamanan dan efektifitas penyuntikan lidokain 1% periprostat pada biopsi prostat transrektal dengan bimbingan USG transrektal. Materi dan Metoda: sari 60 pasien yang dibiopsi prostat, dipilih secara random masing-masing 30 orang disuntikan lidokain 1% atau plasebo secara double-blind. Disuntikan 5 cc lidokain 1% atau Na CI 0,9% menggunakan jarum 22 dengan bantuan probe USG transrektal ke kumpulan syaraf dikedua sisi prostat. Nyeri yang dirasakan waktu biopsi dinilai dengan menggunakan skala nyeri "Visual Analogue Scale" (VAS) dan komplikasi yang terjadi setelah biopsi pada kedua grup. Skala nyeri dianalisa statistik menggunakan Student -T Test. Hasil: Skala nyeri waktu biopsi antara yang disuntikan lidokain 1% dibandingkan NaCl 0,9% berbeda secara bermakna dengan VAS (2,1 ± 1,3 dan 5,7 ± 1,7 p<0,05). Komplikasi setelah biopsi seperti nyeri, hematuri, hematochezia dan demam pada kedua perlakuan tidak memberikan perbedaan yang bermakna. Kesimpulan: Penyuntikan lidokain 1% periprostat merupakan metode mudah, aman dan efektif untuk mengurangi nyeri pada biopsi prostat.

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Purpose : We prospectively evaluated the safety and efficacy of periprostatic 1 % lidocaine injection during transrectal prostate biopsy with transrectal ultrasound guided. Materials and Methods: A total of 60 consecutive patients undergoing prostate biopsy were randomized into 1% lidocaine and placebo groups using 0,9% sodium chloride of 30 each in double-blind fashion. A 2,5 ml dose of 1% lidocaine or 0,9% sodium chloride was injected via 22 gauge needle inserted through and guided by the transrectal ultrasound probe at the prostatic neurovasculer bundle on each side. Pain during biopsy was assessed using a 0 to 10 point linear visual analog pain scale and other complications (pain after biopsy, hematuria, hematochezia and fever) were recorded to determine whether there was a difference between those two groups. Statistical analysis of pain score was performed by using Student T-Test. Results : Pain scores were significantly lower in the periprostatic 1% lidocaine injection group compared to the placebo group (2.1 ± 1.3 versus 5.7 ±1.7 , p < 0.05 ). There was no significant difference in pain after biopsy, hematuria, hematochezia and fever rate among these two groups. Conclusions : Per iprostatic 1% lidocaine injection is a simple, safe and efficacious method of providing satisfactory anesthesia to reduce pain in men undergoing transrectal prostate biopsy.

Abstrak :
This book covers all the practical issues related to the interpretation of prostatic biopsies in day-to-day practice, including: biopsy sampling and processing; the diagnosis of limited cancer; differentiation of prostate cancers from benign lesions and recognition of histologic variants; the recognition and clinical significance of “atypical” diagnoses and HGPIN; the identification of recently described entities; the contemporary approach to Gleason grading; the utility of immunohistochemical markers and emerging molecular markers; and the reporting of prostate biopsies. Algorithms, flow charts, and tables are used throughout to simulate the thought and decision-making process upon encountering common clinical scenarios during sign-out of prostate biopsy.

Abstrak :
ABSTRAK
Untuk mengidentifikasi faktor prediktor seperti PSA, usia, volume prostat, dan densitas PSA (PSAD) sebagai indikasi untuk melakukan biopsi prostat yang dipandu dengan TRUS dalam mengurangi biopsi yang tidak perlu dan meningkatkan tingkat deteksi. Sebanyak 1232 sampel didapatkan dari rekam medis pasie yang dilakukan biopsiprostat dari Januari 2008 sampai Desember 2013 di Rumah Sakit Cipto Mangunkusumo. Diantara 1232 pasien, 33,5% memiliki hasil biopsi yang positif. Nilai median dari usia dan PSA (68 tahun dan 57,45 ng/ml) pada grup dengan biopsi positif lebih tinggi dari grup biopsi negative (65 tahun dan 11,69 ng/ml), p< 0,001. PSAD pada pasien dengan PSA 4-10 ng/ml, 10-20 ng/ml, dan 20 ng/ml (0.20, 0.35, 2.05) pada grup positif lebih tinggi dari grup negative (0.14, 0.24, 0.53), p < 0,001. Hasil pada grup dengan hasil biopsi positif memiliki volume prostat yang lebih rendah (42 ml), dibandingkan pada grup biopsi yang negative (55,4 ml), p < 0,001. Pada kurva ROC, PSAD memiliki sensitivitas dan spesifisitas yang paling tinggi (81.4% dan 82.0%) dengan cut-off point 0,43, p < 0,001. Insidensi PCa meningkat dengan nilai PSA yang lebih tinggi, usia yang lebih tua, dan volume prostat yang lebih kecil. Penggunaan PSAD 0,17 ng/ml sebagai cut-off point pada pasien dengan tingkat PSA antara 4-10 ng/ml direkomendasikan untuk meningkatkan deteksi PCa pada laki-laki di Indonesia

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ABSTRACT
To identify the predictor factors such as PSA, age, prostate volume (PV), and PSA Density (PSAD) as indications to perform TRUS guided prostate biopsy in reducing unnecessary biopsies and improving detection rate. 1232 samples were obtained from the medical records of patients underwent prostate biopsy from January 2008 to December 2013 in Cipto Mangunkusumo Hospital Jakarta. Statistical analysis was performed with Mann-Whitney test and unpaired t test for the quantitative variables. Chi-square test was used for qualitative variables. This study also conducted Receiver Operating Characteristic (ROC) curve to determine the cut-off point and the optimum specificity and sensitivity for each variable. Among 1232 patients, 33.5% had positive biopsy result. The median age and PSA (68 years and 57.45 ng/ml) in positive biopsy group was higher than negative group (65 years and 11.69 ng/ml), p < 0.001. PSAD in patients with PSA 4-10 ng/ml, 10-20 ng/ml, and 20 ng/ml (0.20, 0.35, 2.05) in positive group was higher than negative group (0.14, 0.24, 0.53), p < 0.001. Positive biopsy result has lower PV (42 ml) compared to negative biopsy (55.4 ml), p < 0.001. In ROC curve, PSAD had the highest sensitivity and specificity (81.4% and 82.0%) with cut-off point 0.43, p <0.001. The Incidence of PCa increased with higher PSA level, older age and lower PV. Utilization of PSAD 0.17 ng/ml/ml as cut-off point in patients with PSA level between 4 -10 ng/ml is recommended to improve PCa detection in Indonesian men.