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Prostate volume.pptx
- 1. Prostate volumetry Sukhdev, CMC Vellore
- 2. • Digital rectal examination • Palpatio per anum • Only diagnostic test for prostate cancer before 1920
- 3. How to do a DRE • Patient positioning • Patient instructions • Examination technique • Findings • limitations
- 5. • Positioning of patient ≠ increased diagnostic yield • Make the patient comfortable • Warm and reserved room, preferably with a restroom • Better to explain the steps of the procedure • Empty bladder before DRE – relieve the discomfort of fullness, false prostate enlargement • After exam, offer tissue for removing jelly and ask the patient if he wants to use the restroom
- 6. Technique • Spread the buttocks and examine the perineum • Fingertip of examiner placed at the entrance of anus for a few seconds, applying gentle pressure against anal sphincter reflex contraction. • After sphincter relaxes, and when patient is breathing out slowly, finger is inserted all the way into rectum • Entire circumference of rectum is examined
- 7. • Overestimation of small glands and underestimation of large glands • Isolated median lobe hypertrophy can have normal DRE
- 8. Consistency
- 9. Nodularity • Cancers arise in PZ and it is the zone which can be palpated rectally • Mean PPV of DRE for cancer is 34% (i.e. : 1 in 3 with nodular prostate have cancer) Hard prostate: • PZ calcifications • Granulomatous prostatitis • Midline prostatic cysts • Prostatic calculi • Prostatic infarction • Rectal phlebolith
- 11. Limitations of DRE • Until 1980, DRE was the most efficient test for diagnosis of cancer • DRE misses 23-45% of prostate cancers that are subsequently found with biopsies for ↑ PSA
- 12. Romero grading of BPE Upper limit reachability Lateral sulcus Median sulcus 20 g Grade I With ease 1 finger depth Not felt 30 g Grade I/II 40 g Grade II With effort >1 but <2 finger depth prominent 50 g Grade II/III 60 g Grade III With difficulty 2 finger depth Obliteration by rounded surface 80 g Grade IV Not reachable >2 finger depth Obliteration by rounded surface
- 13. USG grading of BPE Grade 1 <30 g Grade 2 30-50 g Grade 3 50-85 g Grade 4 >85 g Barnes grading of BPE Grade Protrusion into rectum Grade 1 1-2 cm Grade 2 >2 but ≤3 cm Grade 3 >3 but ≤4 cm Grade 4 >4 cm
- 14. Tsui et al grading of prostate Posterior surface area of prostate ml or g of prostate <2 FW <40 ≥2 but <3 FW 40-60 ≥3 FW >60
- 15. Prostate glandular volume – when do we need? • For BPE • PSA density • For brachytherapy – number of seeds to order
- 16. Determination of prostate volume by TRUS M K Terris et al, J Urol. 1991 May • 150 patients • 31 to 79 years old • Who underwent RP for CA prostate or RCP for TCC bladder • TRUS volumes were compared with specimen weights after removing SV and bladder
- 17. The dimensions
- 18. Step planimetry
- 19. The formulae
- 20. • Ellipsoid = ∏/6(TD*APD*CCD) • Spheroid = ∏/6(TD3) • Prolate spheroid = (TD2 * APD) • Step planimetry = sum of surface area of prostate in every 2 mm planes and adding the surface area and then multiplying by stepping interval(2 mm)
- 22. • Prolate ellipsoid formula>step section planimetry>ellipsoid • When glands>80g, spheroid formula is the best • Step section planimetry – cumbersome, time consuming for both patient and physician • Cephalocaudal dimension is the least reliable axis measurable – base and apex not distinct
- 23. Inter imaging accuracy of CT, MRI and TRUS in measuring prostate volume compared to anatomic prostate weight, Vaishnavi Narayanamurthy et al, Turk J Urol, 2020