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Background: Infertility affects 8-12% of couples of reproductive age worldwide, with a significant prevalence in India, where primary infertility ranges from 3.9% to 16.8%. Male factors contribute to 40-50% of infertility cases. Proper diagnostic workup for male infertility is crucial to avoid unnecessary invasive procedures for the female partner. Traditional evaluation methods, including clinical assessment, semen analysis, and scrotal ultrasonography, have limitations in accurately identifying and classifying the underlying causes of male infertility. Methods: A prospective observational study was conducted from December 2022 to February 2024 at the Department of Radiodiagnosis, M.G.M. Medical College and M.Y. Hospital, Indore, India. A total of 100 male patients with infertility were recruited. The study involved a thorough ultrasonographic evaluation of the scrotum, including the testes, epididymis, and spermatic cord. Additionally, transrectal ultrasonography (TRUS) was performed to assess the bilateral seminal vesicles, prostate, ejaculatory ducts, and vas deferens to identify any obstructive etiologies. Methods: A prospective observational study was conducted from December 2022 to February 2024 at the Department of Radiodiagnosis, M.G.M. Medical College and M.Y. Hospital, Indore, India. A total of 100 male patients with infertility were recruited. The study involved a thorough ultrasonographic evaluation of the scrotum, including the testes, epididymis, and spermatic cord. Additionally, transrectal ultrasonography (TRUS) was performed to assess the bilateral seminal vesicles, prostate, ejaculatory ducts, and vas deferens to identify any obstructive etiologies. Conclusion: This study highlights the diagnostic value of combining scrotal and transrectal ultrasonography in evaluating male infertility. The combined approach provides a comprehensive assessment, distinguishing between obstructive and non-obstructive causes, and guiding appropriate treatment. The results suggest that clinical evaluation, semen analysis, and scrotal ultrasound alone are insufficient to evaluate the complex etiologies of male infertility and should be complemented by TRUS. [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Reddito is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Summa, Animali da Reddito is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recently diagnostic field in medicine was enriched by advances in ultrasonography (US) technology, which led to establishment of novel modalities, one of which is micro-ultrasound. Results demonstrated by early studies have been promising, simultaneously rising a question if those new modalities could become an alternative in diagnosis of prostatic carcinoma (PCa). To answer this question, several studies have been conducted where micro-ultrasound have been compared to standard diagnostic tools, such as conventional TRUS or mpMRI. Nevertheless, new technology presents with some limitations, which include inconsistent results, necessity for specialized equipment, need of training for investigators to understand the findings, and external validation. In this publication, we have identified studies that provided evaluation of the accuracy and efficiency of the micro-ultrasound technology. Additionally, analysis of the results provided a better understanding of the novel imaging tool when compared standard modalities in diagnosis of PCa. Increasing number of studies demonstrated that micro-ultrasound carries high detection rate of PCa and clinically significant prostatic cancer (csPCa), suggesting a similar performance to mpMRI and even showing superiority over conventional TRUS. Recent studies have also showed that micro-ultrasound takes active role in improving the detection of csPCa and guidance for prostate biopsy (PBx) as well as further treatment. Moreover, certain practical aspects such as lower costs, decreased waiting time, real-time imaging and application of the imaging tool for patients that are not suitable for mpMRI (contrast allergy, prosthetics etc.) are significant advantages. Analysis of the results still does not provide clear answer whether micro-ultrasound outperforms mpMRI. Further studies are necessary in order to completely understand the potential of this new technology. [ABSTRACT FROM AUTHOR]

Genital tumours are rare among cattle, largely due to their relatively short lifespans. Leio-myoma, a smooth muscle tumour being more prevalent in dogs, appears only at a rate of 1.00 - 2.00% in cattle, affecting reproductive efficiency in cases of complete uterine obstruction. This case report involves an 8-year-old cow with repeated insemination attempts unveiled 5.00 cm intra-luminal uterine mass, obstructing the right uterine horn. Transrectal sonography (TRUS) revealed a highly vascularized mass with normal ovarian function. Confirmation of clinical condition, i.e., uterine leiomyoma, via uterine biopsy concluded the presence of neoplastic smooth muscle cells arranged in interlacing bundles showing mild pleomorphism, and special staining using Masson's trichrome revealed an unappreciable amount of connective tissue; subsequently right flank celiotomy was performed to remove the benign tumour. Forty-five days after celiotomy, TRUS examination confirmed an unobstructed uterine horn, and bilateral oviduct patency was adjudged with 2.50% methylene blue. Following treatment for chronic endometritis, artificial insemination led to conception nearly 90 days post-procedure. The TRUS aids preliminary diagnosis, while definitive identification demands necropsy and surgical methods. This case underscores the diagnostic significance of TRUS, histopathology and celiotomy for identifying and managing uterine leiomyoma in cattle. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the relationship between resistive indices (RIs) and changes in prostate size after medical treatment in patients with benign prostatic hyperplasia (BPH). Methods: A total of 86 patients with BPH were included in the study, excluding 42 patients with a total prostate volume (TPV) of

Introduction and Background: Since it is the second most frequent cancer in males, and the second leading cause of cancer-related death, prostate cancer is a key focus of healthcare research and development. Traditional methods of assessing prostate cancer relied on digital rectal examinations and PSA levels because of the prostate's inconvenient position. Material and Methods: 20 patients with high PSA levels and aberrant DRE results who were sent to our clinic were analyzed. From December 2021 to November 2022, at Mahavir institute of Medical Sciences, Vikarabad, Telangana, researchers gathered data. All patients provided informed consent after having potential biopsy consequences outlined to them. Antibiotics were provided as a preventative measure before the operation. Results: In our prospective study, 20 patients with abnormal digital rectal examination and elevated PSA levels underwent transrectal real-time strain elastography, transrectal ultrasonography, a systematic 12-core biopsy, and additional targeted biopsies from abnormal areas found by transrectal real-time strain elastography and transrectal ultrasound. The interpretations from each of these techniques were contrasted with the histopathological diagnosis. Conclusion: This research shows that compared to ultrasonography, elastography is more sensitive to the presence of malignancies and has a strong negative predictive value, both of which aid in avoiding unnecessary biopsies. Elastography and ultrasonography together improve cancer detection by pinpointing malignant tumors and facilitating guided biopsies. [ABSTRACT FROM AUTHOR]

Postpartum diseases of uterus represent a foremost predicament in cattle farms affecting reproductive efficiency. Postpartum (PP) uterine diseases include metritis, endometritis and subclinical endometritis (SCE). Barring SCE, all other diseases project the clinical signs. Diagnosis of SCE at the early stage of PP has been a challenging task for many veterinarians. The present study aimed to validate and correlate the proficiency of transitional changes in uterus and cervix assessed by transrectal ultrasonography (TRUS) and endometrial cytology (EC) in the diagnosis of SCE in PP cattle. The research was carried out in two phases i.e, 30th day postpartum (DPP) (n=74) and first exhibited oestrus after 45th DPP (n=24) (54.63 ± 1.13 d) to emphasise the proficiency of both the diagnostic modalities. Endometrial cytology could discriminate between cows positive and negative for SCE significantly at 30th DPP (20.54 ± 0.48 vs 5.55 ± 0.41). It was potent in diagnosing SCE after 45th DPP also, as a significant reduction in the per cent of PMN cells (20.54 ± 0.48 to 7.56 ± 0.32) was noticed. Uterine parameters assessed by TRUS like cervical and uterine diameter and endometrial thickness in both the phases of assessment did not correlate to the EC changes and also could not discriminate between SCE positive and negative animals. The results of the study signify that EC is efficacious in the diagnosis of SCE in cows, while TRUS is impractical as a sole diagnostic modality for SCE.

Abstract Background Anorectal malignant melanoma (ARMM) and low rectal adenocarcinoma (LRAC) have some similarities in clinical behaviors, histopathological characteristics and ultrasonographic findings, diagnostic errors are common. By comparing the transrectally ultrasonographic features between the two tumors, we propose to provide more possibilities in differentiating them. Methods The data of 9 ARMMs and 27 age- and gender-matched LRACs (the lower margin below the peritoneal reflection) in West China Hospital Sichuan University between April 2008 and July 2019 were retrospectively reviewed. The ultrasonic features between the two groups were compared. Results Transrectal ultrasonography (TRUS) showed that the length of ARMM was shorter than that of LRAC (28.22 ± 12.29 mm vs. 40.22 ± 15.16 mm), and ARMM had a lower position than that of LRAC (the distance to anal verge was 50.78 ± 11.70 vs. 63.81 ± 18.73 mm). Unlike LRAC, the majority of ARMM in our study was confined to the intestinal mucosa/submucosa (66.67/25.93%) (P

Background: To ensure reproducibility and representativeness of hypoechoic lesions in transrectal ultrasonography (TRUS), we used grayscale values and evaluated their usefulness in predicting prostate cancer (PCA). Methods: A total of 172 patients scheduled for prostate biopsy for suspected PCA between October 2016 and May 2018 were prospectively enrolled. Patients underwent 12 core target biopsies for hypoechoic lesions in 12 areas of the prostate and two additional target biopsy cores for two hypoechoic lesions. We estimated the grayscale value of the image using a red/green/blue scoring method through a function embedded in the picture archiving and communication system. Imaging data were analyzed using estimated grayscale values. Results: Of the 127 patients (median age = 68.5 years, median prostate-specific antigen level = 6.19 ng/mL), 67 (52.8%) had PCA. Of 1778 biopsy lesions, 327 (18.4%) were PCA lesions. No differences in the grayscale values were found between PCA and benign lesions; however, the grayscale value between 28.0 and 57.0 for hypoechoic lesions was identified as a significant factor for predicting PCA in multivariable analysis (p=0.008). Multivariable analysis indicated a grayscale value between 34.0 and 48.0 as a predicting factor for clinically significant PCA (cs-PCA: Gleason grade group ≥2) (p=0.001). The area under the curve (AUC) for predicting cs-PCA was higher for combined clinical and grayscale value parameters than for TRUS grayscale values (0.780 vs. 0.561, p

Introduction: Prostatic abscess is a serious urological problem that needs immediate attention due to its high morbidity and mortality in absence of appropriate treatment. The objective of our study is to evaluate the efficacy and safety of various modalities of management of prostatic abscess: medical management (MM), transrectal ultrasound-guided aspiration (TRUS-GA), and transurethral deroofing (TU-DR). Methods: This retrospective study was done in a tertiary care center after taking approval from the institutional review board. Conservative management was done by oral or parenteral medications. Transrectal ultrasound GAs were performed under local anesthesia with an 18-gauge two-part needle. Collapse of cavity was seen in “real time” on TRUS. TU-DR of the prostate was done by 26 French continuous irrigation monopolar resectoscopes. The aspirated pus was sent for microbiological investigation. Results: TRUS-guided aspiration was performed in 20 patients, TU-DR in five patients, and conservative management in 15 patients. The mean volume of abscess aspirated by TRUS guidance was 13 cc (range 8–50 cc) with single-time aspiration in 85% of cases. Re-aspiration was done in 3 patients. The mean volume of abscess was 33.2 cc (range: 25–40 cc) in TU-DR group and 1.2 cc (range 0.5–2.0 cc) in the MM group. The predominant organism isolated was Escherichia coli (48%). Clinical improvement was seen in 97.5% of cases. Conclusion: We suggest TRUS-GA for symptomatic patients with abscess size more than 2 cc and TU-DR if TRUS-GA fails or is contraindicated.

Background: Patient discomfort is often inevitable during transrectal ultrasonography (TRUS), a widely used modality for evaluating benign prostate hyperplasia/lower urinary tract symptoms. Music has been suggested as a method of pain relief during urologic procedures. In this study, we investigated the effect of music on pain relief during TRUS. Methods: In a pilot study conducted from March to June 2019, pain scores of 316 patients who underwent TRUS with or without music were quantified using the visual analog scale (VAS). One-to-one propensity score matching was performed by matching the subjects between the groups. Patients with hemorrhoids of grade ≥ III were excluded (n = 4). Results: Among the 312 patients included in the study (VAS score = 3.3 ± 2.4), 177 listened to music during the procedure. There were significant differences in age, prostate-specific antigen, prostate volume, International Prostate Symptom Score symptom/life score, and VAS score between the music (+) and music (−) groups. After adjusting for relevant variables, VAS scores were significantly lower in male patients aged ≥65.0 years who underwent music intervention than in those who did not (1.5 ± 1.4 vs. 3.0 ± 1.4, p = 0.002). Conclusion: Age was negatively associated with pain during TRUS, and music had a relieving effect on pain in patients aged ≥65.0 years. Our findings may help improve the quality of examinations in urologic outpatient offices.

Aims: Transvaginal sonography (TVS) is not applicable for evaluating the endometrium in some cases with abnormal uterine bleeding (AUB) such as virgin women. The aim of the present study was to investigate the diagnostic value of transrectal sonography (TRS), as a non-invasive alternative for TVS, among women with AUB. Methods: In this cross-sectional study, 40 women over 40 years of age with AUB first underwent TRS and then TVS. Endometrial biopsy was also performed as a gold standard method to evaluate endometrial pathologies. The findings of the two endometrial ultrasound methods were compared with the biopsy results. Also, the findings of the two methods were compared in terms of the agreement on other uterine markers and adnexal findings. Results: There was a high agreement between the findings of TVS and TRS for uterine size, endometrial thickness and homogeneity, endomyometrial junction, myometrial homogeneity, uterine lesions, uterine lesions size, ovarian size and ovarian echogenicity. When comparing the results of these two methods with biopsy findings, sensitivity, specificity as well as positive and negative predictive values of both methods were similar (82%, 100%, 100%, and 0%, respectively). Conclusion: When it is not possible to use TVS in women with AUB, TRS is a suitable, non-invasive and inexpensive alternative method for evaluating the endometrium and other genital organs. [ABSTRACT FROM AUTHOR]

Context The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing. Aims We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer. Settings and Design This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019. Methods and Material We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS. Statistical Analysis Used The statistical analysis for this study was performed using SPSS v20.0 software. Results Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion (p

Introduction and purpose of the study: Prostate cancer is one of the most common malignancies in the human population worldwide. The continuous development of imaging methods allows for its increased recognition. Conclusions have been drawn that MRI-TRUS (magnetic resonance imaging - transrectal ultrasonography) fusion biopsy is superior to other diagnostic methods. The aim of this study is to review the available studies and publications and determine which method of diagnosing prostate cancer is most effective. Materials and Evidence: We reviewed the literature available on PubMed and Google Scholar using the words "fusion biopsy"; "prostate diagnosis"; "prostate cancer"; "transrectal ultrasonography". Results: The diagnosis of prostate cancer is made possible by a range of tests such as transrectal palpation, measurement of prostate specific antigen, transrectal ultrasonography, needle biopsy and MRI. The combination of biopsy, MRI and transrectal ultrasonography has led to the development of fusion biopsy. It combines the high-resolution features of MRI and the real-time images provided by ultrasound. Conclusions: The higher cost of the test and the need for specialised equipment together with the advanced software required for fusion biopsy ultimately provides a statistically significant higher success rate for the diagnosis of prostate cancer. Mentioned the effects of this method, further development and dissemination is expected.

Background: For diagnosis of prostate cancer, prostate biopsy accompanied by TRUS is the current method applied today. Aim: The aim of this study was to compare targeted antibiotic prophylaxis, chosen according to rectal swab results before the procedure, with routinely administered prophylaxis and to investigate the effect on infective complications. Methods: The study included 140 patients with 12-quadrant prostate biopsy accompanied by TRUS in our hospital from 2018 to 2020. The first group had antibiotherapy prophylaxis administered according to the results of rectal swabs before the procedure. The second group had routine ciprofloxacin prophylaxis administered. Patients were followed prospectively for 1 month after the procedure. Results: When the mean age, systemic diseases and distribution in both groups are examined, there was no significant difference observed. Fever (> 38.5 °C) was observed in 3 patients in the rectal swab group (4.3%), while it was identified in 10 people in the control group (14.1%) (p = 0.047). Major complications were observed in 3 people in the rectal swab group (4.3%) and in 7 people in the control group (9.9%) (p = 0.012). Conclusions: The results of the study identified that routine administration of targeted antibiotic prophylaxis may be more effective in preventing infective complications compared to standard prophylaxis. Targeted prophylaxis is recommended for risky patients in the guidelines. However, the lack of difference between the groups in terms of age and comorbidities supports the need to administer targeted prophylaxis not just to risky patients but as well as routine practice. [ABSTRACT FROM AUTHOR]

Introduction A prostatic utricle is a congenital saccular indentation in the prostatic urethra and frequently enlarged in hypospadias patients. We present a case of urinary retention associated with a mildly enlarged utricle. Case presentation A 20‐year‐old male, who underwent multiple repair procedures for hypospadias during childhood, was referred to us for dysuria. Retrograde urethrogram, voiding cystourethrogram, and cystoscopy results revealed only a mildly enlarged prostatic utricle, with no apparent lower urinary tract obstruction or urethral valves. A meatotomy was performed under suspicion of meatal stenosis, though urinary retention occurred following that procedure. Transrectal ultrasonography revealed flapping of the prostatic urethra floor over the utricle. Transurethral unroofing of the utricle relieved the dysuria. Conclusion A mildly enlarged prostatic utricle can cause dysuria. To the best of our knowledge, no case similar to the present has been previously reported.

Background: Anorectal malignant melanoma (ARMM) and low rectal adenocarcinoma (LRAC) have some similarities in clinical behaviors, histopathological characteristics and ultrasonographic findings, diagnostic errors are common. By comparing the transrectally ultrasonographic features between the two tumors, we propose to provide more possibilities in differentiating them.Methods: The data of 9 ARMMs and 27 age- and gender-matched LRACs (the lower margin below the peritoneal reflection) in West China Hospital Sichuan University between April 2008 and July 2019 were retrospectively reviewed. The ultrasonic features between the two groups were compared.Results: Transrectal ultrasonography (TRUS) showed that the length of ARMM was shorter than that of LRAC (28.22 ± 12.29 mm vs. 40.22 ± 15.16 mm), and ARMM had a lower position than that of LRAC (the distance to anal verge was 50.78 ± 11.70 vs. 63.81 ± 18.73 mm). Unlike LRAC, the majority of ARMM in our study was confined to the intestinal mucosa/submucosa (66.67/25.93%) (P < 0.05).Conclusions: Based on the data of our study, several ultrasonographic findings (length, invasion depth, and position) of ARMM were significantly different from LRAC. Accordingly, more attention should be paid to masses at anorectal junction with lower position, shorter length, and shallower infiltration depth. Instead of the most common tumor, LRAC, ARMM should be taken into account to avoid a misdiagnosis, which will result in a poorer prognosis. [ABSTRACT FROM AUTHOR]

Simple Summary: The number of growing antral follicles visualised by ultrasound generates an antral follicle count (AFC), which can predict the number of female gametes remaining in an animal's ovary. However, important information on ovarian biology with regard to the ovarian interrelationship with the main number of antral follicle populations (mAFC) is scarce; therefore, it is important to uncover additional information on ovarian biology that can be helpful in predicting the ovarian response after hormonal stimulation in mono-ovulatory animal species. Thus, mono-ovulatory Bos indicus beef cows with low numbers of AFC were induced using a hormonal programme in an effort to increase the understanding of the interrelationship with unilateral mAFC (main number of antral follicle populations appearing on only one side of the ovary). Based on the odds ratio, our results emphasise that the likelihood of an ovarian response was higher in cows with unilateral mAFC relationships on the day of exogenous hormonal stimulation. The antral follicle count (AFC) is a test in which the number of oocyte-containing follicles that are developing in both ovaries are visually counted. The count of these follicles strongly relates to the population of the growing follicle reserve on the ovaries. However, the importance of the main number of antral follicle populations (mAFC) in mono-ovulatory animal species has yet to be completely elucidated. Moreover, the investigation of the ovarian interrelationship with unilateral mAFC (main number of antral follicle populations appearing on only one side of the ovary) and bilateral mAFC (main number of antral follicle populations appearing in equivalent numbers on both sides of the ovary) and how understanding this interrelationship can offer possible indicators of ovarian response to hormonal induction have not yet been investigated in mono-ovulatory Bos indicus beef cows. The aim of this study is to investigate the different ovarian interrelationships of mAFC (unilateral and bilateral mAFC) at the time of exogenous hormonal stimulation on the total number of AFC (left and right ovaries) at the beginning of the hormonal protocol for ovarian stimulation and ovarian response at the completion of exogenous hormonal stimulation as well as their usefulness as possible biomarkers of successful hormonal stimulation in Bos indicus beef cattle. Beef cows (n = 104) with low total numbers of AFC (4.7 ± 2.4 follicles) were stimulated with a gonadotropin-releasing hormone-progesterone-prostaglandin F2α-based protocol. At the beginning of the hormonal protocol, ovarian ultrasound scans were performed to evaluate AFC from both ovaries of cows. Beef cows were divided into two groups, unilateral (n = 74) and bilateral mAFC (n = 30), according to the ovarian interrelationship. At the completion of the hormonal stimulation, ovarian ultrasound scans were performed to evaluate the dominant follicle (DF) and cows with DF > 8.5 mm in diameter emerging on their ovaries were defined as having experienced a response to hormonal stimuli. There was a difference of 19.1% between Bos indicus cows bearing unilateral mAFC that produced an increase in ovarian response (odds ratio = 2.717, p < 0.05) compared to the responsive rate of cows displaying bilateral mAFC (82.4% vs. 63.3%). In unilateral mAFC, cows bearing mAFC ipsilateral to the ovary of dominant follicle (DF) had a higher responsive rate than cows bearing mAFC contralateral to the DF ovary (50.0% vs. 32.4%, p < 0.05). In mAFC ipsilateral to the DF ovary, pregnancy rates were greatest in cows bearing mAFC and DF on the right ovary compared with cows bearing mAFC and DF on the left ovary (25.0% vs. 9.1%, p < 0.05). In primiparous and multiparous cows, unilateral mAFC occurs with a greater (p < 0.05) frequency than bilateral mAFC (69.0% and 72.0% vs. 31.0% and 28.0%, respectively). In unilateral mAFC, primiparous cows bearing mAFC ipsilateral to the DF ovary had a greater responsive rate than primiparous cows bearing mAFC contralateral to the DF ovary (55.0% vs. 20.0%, p < 0.05). In mAFC ipsilateral to the DF ovary, responsive and pregnancy rates were greatest (p < 0.05) in multiparous cows bearing mAFC and DF on the right ovary compared with multiparous cows bearing mAFC and DF on the left ovary (58.1% and 22.6% vs. 25.8% and 3.2%, respectively). Furthermore, there was a positive correlation between the mean diameter of AFC at the time of the exogenous hormonal trigger and the mean diameter of DF at the completion of hormonal synchronisation (p < 0.05). Our findings emphasise that the ovarian interrelationship with unilateral mAFC at the time of the hormonal trigger might be a promising biomarker for predicting success in ovarian response to hormonal stimulation of mono-ovulatory Bos indicus beef cows with low AFCs. [ABSTRACT FROM AUTHOR]

Introduction: Prostatic abscess is a serious urological problem that needs immediate attention due to its high morbidity and mortality in absence of appropriate treatment. The objective of our study is to evaluate the efficacy and safety of various modalities of management of prostatic abscess: medical management (MM), transrectal ultrasound-guided aspiration (TRUS-GA), and transurethral deroofing (TU-DR). Methods: This retrospective study was done in a tertiary care center after taking approval from the institutional review board. Conservative management was done by oral or parenteral medications. Transrectal ultrasound GAs were performed under local anesthesia with an 18-gauge two-part needle. Collapse of cavity was seen in "real time" on TRUS. TU-DR of the prostate was done by 26 French continuous irrigation monopolar resectoscopes. The aspirated pus was sent for microbiological investigation. Results: TRUS-guided aspiration was performed in 20 patients, TU-DR in five patients, and conservative management in 15 patients. The mean volume of abscess aspirated by TRUS guidance was 13 cc (range 8–50 cc) with single-time aspiration in 85% of cases. Re-aspiration was done in 3 patients. The mean volume of abscess was 33.2 cc (range: 25–40 cc) in TU-DR group and 1.2 cc (range 0.5–2.0 cc) in the MM group. The predominant organism isolated was Escherichia coli (48%). Clinical improvement was seen in 97.5% of cases. Conclusion: We suggest TRUS-GA for symptomatic patients with abscess size more than 2 cc and TU-DR if TRUS-GA fails or is contraindicated. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the best- performing of three risk calculators (RCs) for the Turkish population in predicting cancer- free status and high- risk prostate cancer (PCa) in patients undergoing transrectal ultrasound- guided prostate biopsy. The electronic medical records of 527 patients who underwent prostate biopsy for the first time due to PSA of 0.3-- 50 ng/dl and/or cancer suspicion at digital rectal examination (DRE) between January 2017 and December 2020 were retrieved retrospectively. The predictive power of the RCs in the biopsy and the surgical cohort was calculated by two urologists using European Randomised Study of Screening for Prostate Cancer (ERSPC) RC, the North American Prostate Cancer Prevention Trial- RC (PCPT- RC), and the Prostate Biopsy Collaborative Group (PBCG)- RC. All three RCs were successful in predicting PCa and high- risk disease at ROC analysis (p < 0.0001). Of these three nomograms, PBCG- RC outperformed PCPT- RC 2.0 and ERSPC- RH in predicting benign pathology outcomes at biopsy. A better performance of PBCG- RC was also observed in terms of prediction of high- risk disease at biopsy. Using any of the available RCs prior to biopsy is of greater assistance to prostate- specific antigen and DRE than examination alone. The study results show that PBCG- RC performed before biopsy has a higher predictive power than the other two RCs. [ABSTRACT FROM AUTHOR]

When compared to other solid organ malignancies, the diagnosis of prostate cancer is not reliant on imaging findings alone. Men found to have abnormal digital rectal examination findings, raised serum prostate-specific antigen levels, or both are subjected to prostate biopsy to arrive at a diagnosis. Since its introduction in the 1970s, Transrectal ultrasonography (TRUS) plays a vital role in the diagnostic pathway to guide prostatic biopsy. However, many men are subjected to unnecessary biopsies, leading to a diagnosis of clinically-indolent cancer or occasionally missing a focus of clinically significant disease. Currently, TRUS-guided prostate biopsy performed under local anesthesia is in widespread use for the diagnosis of prostate cancer. The peripheral zone of the prostate showing a hypoechoic lesion is the most common finding consistent with prostate cancer. In this review, we aim to highlight the ultrasonographic anatomy of prostate, the technique, and associated complications along with a brief note on the recent advances in imaging technology for the diagnosis of prostate cancer.

Background. The only radical curative treatment for rectal fistulae is surgery. The choice of surgery requires precise characterisation of the fistulous tract. The most common instrumental methods for rectal fistula diagnosis are transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI).Objectives. Comparative assessment of the diagnostic power of 3D TRUS and MRI techniques in revealing cryptogenic anal fistulae with respect to intraoperative examination.Methods. The study enrolled 92 patients with rectal fistulae aged 27 to 66 years. Fistulous opening was external in 47 (51.1%) and obliterated in 45 (48.9%) patients. The average patient age was 42.7 ± 15.9 years. Surgery for acute paraproctitis 14 to 32 days prior to examination was in history of 58 (63.1%) patients. All patients had preoperative subsequent 3D TRUS and MRI compared with intraoperative examination results.Results. The rate of correct fistulous tract type diagnosis verified with intraoperative revision was 96.7% (89/92) with 3D TRUS and 82.6% (76/92) with MRI (p = 0.0027). The error rate of 3D TRUS estimation of external sphincter involvement was 1.1% (1/92), sensitivity 96.6%, specificity 93.5%, overall accuracy 94.5%. The MRI error rate was 21.7% (20/92), with a statistically significant difference for sensitivity and overall accuracy (p < 0.0001). The rate of correct estimation of internal fistulous localisation in “anorectal clock” was 97.8% (90/92) with 3D TRUS and 90% (81/90) with MRI (p = 0.0342). Internal fistula was not detected with MRI in 2/92 (2.2%) cases, which explains the deviation. Intraoperative revision identified total 113 abscesses. The rate or correct abscess estimation was 97.3% (110/113) with 3D TRUS and 74.7% (71/95) with MRI. MRI failed to detect abscess in 18/113 (15.9%) cases (p < 0.0001).Conclusion. 3D transrectal ultrasonography is statistically superior over magnetic resonance imaging in estimating internal fistula localisation in “anorectal clock”, fistulous type, as well as the fistulous tract location relative to external sphincteric tissue in patients with transsphincteric anal fistulae. Estimation of pararectal and intramural abscesses was also significantly different.

Background Determination of isolated prostate-specific antigen (PSA) in asymptomatic individuals has not demonstrated sufficient sensitivity and specificity to be useful in the routine evaluation of prostate disease. To enhance the accuracy of serum PSA we have used a proportion of serum PSA and prostate volume, which we refer to as prostate-specific antigen density (PSAD). Prostate volume in this study was calculated using transrectal ultrasonography (TRUS). Materials and Methods A total of 106 patients with prostatic disease clinically confined to the prostate glands were evaluated. Results and Observation The mean PSAD for prostate cancer was 0.15 ± 0.01 while that for benign hypertrophy of the prostate (BPH) was 0.11 ± 0.02 (p < 0.05). Significant difference (p < 0.05) was noted in the prostate volume in these two groups with the mean prostate volume measured by TRUS in the BPH to be 53.85 ± 9.71 mL compared with 58.14 ± 7.48 mL in the carcinoma. PSA density of 0.13 ng/mL can be used as a cutoff for the individual in our set-up who should go for prostate biopsy with sensitivity and specificity of over 90%. Conclusion These results suggest that PSAD may be useful in distinguishing BPH and prostate cancer.

Objective: To identify the role of povidone iodine-soaked gauze following transrectal digital guided prostate biopsy in the prevention of infectious complications. Methodology: This prospective comparative study was conducted in the urology department of Lady Reading Hospital including 201 patients. Patients who had indications for prostate biopsy, including an elevated prostate- specific antigen (PSA) or abnormal prostatic nodule on digital rectal findings were included. Patients were distributed into two groups by the closed envelop method. Group, I (n=101) received a povidone-iodine-soaked gauze intrarectally along with xylocaine lubricant for 5 minutes just before biopsy, while group 2 (n=100) did not receive povidone-soaked gauze. The transrectal digital guided prostate biopsy guided method was used in this study. The rectal swab was taken before using povidone-soaked gauze and after doing biopsy in both groups The bacterial colonies were counted in swabs before using povidone-soaked gauze and after biopsy using biopsy Mueller-Hinton agar medium. Results: The mean age of group 1 was 64 years (range, 39--80) and group 2 was 61.7 years (range, 35--82). The average PSA values were 7.3 ng/ml and 8.34 ng/ml in groups 1 and 2, respectively. The rate of infectious complications in group1 was 0.9% (n=1) whereas in group 2 was 10% (n=10). A single-use of povidone-soaked rectal gauze significantly lowered the risk of infectious complications P<0.05. There was a 99.9% decrease in the mean number of colony-forming units after rectal preparation. Conclusion: Findings concluded that using povidone iodine-soaked gauze before doing digital guided prostate biopsy is a significant method to minimize complications. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the value of changing the number of biopsy cores in proportion to the size of the prostate in patients who had initial transperineal prostate biopsies. Materials and methods: This study included 470 patients who underwent an initial transperineal prostate biopsy. The number of biopsy cores was changed according to the value of the product of the vertical and horizontal diameters of the largest horizontal section of the prostate on transrectal ultrasonography (TRUS). Biopsies were classified into five groups: 12 cores, 14 cores, 18 cores, 20 cores, and 24 cores. Predictive factors for positive biopsy were studied with logistic regression analyses. Results: Variables that were significantly associated with positive biopsy were age, prostate-specific antigen density (PSAD), prostate volume (Pvol), and number of biopsy cores in univariate analysis. Age, PSAD, and Pvol were independent predictors in multivariate analysis. There was no significant difference in the number of biopsy cores, and it was not an independent predictor. Conclusions: Changing the number of biopsy cores according to the area of the largest horizontal section of the prostate on TRUS had no significant impact in detecting prostate cancer. However, further research is required to confirm this conclusion. Level of evidence: Level 2b. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of intraprostatic injection of prophylactic antibiotics for the prevention of infections following transrectal ultrasonography‐guided prostate biopsy. Methods: In this prospective interventional study, patients aged between 40 and 70 years with clinical indications for transrectal ultrasonography‐guided prostate biopsy were enrolled. Consecutive patients who received intraprostatic injection of amikacin coupled with oral ciprofloxacin were compared with historical controls receiving only prophylactic oral fluoroquinolones prior to biopsy. Patients were followed for 7 days after biopsy for signs and symptoms of infection. Results: A total of 210 patients were included in this study (mean age 65.7 ± 7.8 years). Among patients without intraprostatic injection, nine (8.6%) developed infectious complications (lower urinary tract infection in seven patients, and prostatitis in two), which led to hospitalization in six patients (5.7%). None of the patients who received intraprostatic antibiotic injection developed infectious complications. The difference in the incidence of post‐transrectal ultrasonography‐guided biopsy infections between the two groups was statistically significant (P = 0.003). Conclusion: Local intraprostatic antibiotic injection during transrectal ultrasonography‐guided prostate biopsy adjuvant to oral fluoroquinolones can significantly reduce the rate of post‐biopsy infectious complications. [ABSTRACT FROM AUTHOR]

Patients who have a previously negative biopsy in the setting of clinical suspicion of prostate cancer still have a high risk of harboring significant undiagnosed disease. Various markers such as prostate-specific antigen (PSA) velocity, PSA density, PCA3, and newer markers may aid in repeat biopsy selection. Repeating the same biopsy procedure in such patients does not yield high cancer detection rates. More anteriorly directed transrectal or transperineal biopsies are indicated. Multiparametric magnetic resonance imaging can detect abnormal areas, and lesion-targeted biopsies can improve the cancer detection rate.

Multiparametric magnetic resonance imaging (MRI) has provided a method for visualizing prostate cancer. MRI-ultrasonography fusion allows prostate biopsy to be performed quickly, on an outpatient basis, using the transrectal technique. Targeted biopsies are more sensitive for detection of prostate cancer than nontargeted, systematic biopsies and detect more significant prostate cancers and fewer insignificant cancers than conventional biopsies. A negative MRI scan should not defer biopsy. Two groups who will especially benefit from targeted prostate biopsy are men with low-risk lesions in active surveillance and men with increased prostate-specific antigen levels and previous negative conventional biopsies.

When compared to other solid organ malignancies, the diagnosis of prostate cancer is not reliant on imaging findings alone. Men found to have abnormal digital rectal examination findings, raised serum prostate-specific antigen levels, or both are subjected to prostate biopsy to arrive at a diagnosis. Since its introduction in the 1970s, Transrectal ultrasonography (TRUS) plays a vital role in the diagnostic pathway to guide prostatic biopsy. However, many men are subjected to unnecessary biopsies, leading to a diagnosis of clinically-indolent cancer or occasionally missing a focus of clinically significant disease. Currently, TRUS-guided prostate biopsy performed under local anesthesia is in widespread use for the diagnosis of prostate cancer. The peripheral zone of the prostate showing a hypoechoic lesion is the most common finding consistent with prostate cancer. In this review, we aim to highlight the ultrasonographic anatomy of prostate, the technique, and associated complications along with a brief note on the recent advances in imaging technology for the diagnosis of prostate cancer. [ABSTRACT FROM AUTHOR]

The antral follicle count (AFC) is a test in which the number of oocyte-containing follicles that are developing in both ovaries are visually counted. The count of these follicles strongly relates to the population of the growing follicle reserve on the ovaries. However, the importance of the main number of antral follicle populations (mAFC) in mono-ovulatory animal species has yet to be completely elucidated. Moreover, the investigation of the ovarian interrelationship with unilateral mAFC (main number of antral follicle populations appearing on only one side of the ovary) and bilateral mAFC (main number of antral follicle populations appearing in equivalent numbers on both sides of the ovary) and how understanding this interrelationship can offer possible indicators of ovarian response to hormonal induction have not yet been investigated in mono-ovulatory Bos indicus beef cows. The aim of this study is to investigate the different ovarian interrelationships of mAFC (unilateral and bilateral mAFC) at the time of exogenous hormonal stimulation on the total number of AFC (left and right ovaries) at the beginning of the hormonal protocol for ovarian stimulation and ovarian response at the completion of exogenous hormonal stimulation as well as their usefulness as possible biomarkers of successful hormonal stimulation in Bos indicus beef cattle. Beef cows (n = 104) with low total numbers of AFC (4.7 ± 2.4 follicles) were stimulated with a gonadotropin-releasing hormone-progesterone-prostaglandin F2α-based protocol. At the beginning of the hormonal protocol, ovarian ultrasound scans were performed to evaluate AFC from both ovaries of cows. Beef cows were divided into two groups, unilateral (n = 74) and bilateral mAFC (n = 30), according to the ovarian interrelationship. At the completion of the hormonal stimulation, ovarian ultrasound scans were performed to evaluate the dominant follicle (DF) and cows with DF > 8.5 mm in diameter emerging on their ovaries were defined as having experienced a response to hormonal stimuli. There was a difference of 19.1% between Bos indicus cows bearing unilateral mAFC that produced an increase in ovarian response (odds ratio = 2.717, p < 0.05) compared to the responsive rate of cows displaying bilateral mAFC (82.4% vs. 63.3%). In unilateral mAFC, cows bearing mAFC ipsilateral to the ovary of dominant follicle (DF) had a higher responsive rate than cows bearing mAFC contralateral to the DF ovary (50.0% vs. 32.4%, p < 0.05). In mAFC ipsilateral to the DF ovary, pregnancy rates were greatest in cows bearing mAFC and DF on the right ovary compared with cows bearing mAFC and DF on the left ovary (25.0% vs. 9.1%, p < 0.05). In primiparous and multiparous cows, unilateral mAFC occurs with a greater (p < 0.05) frequency than bilateral mAFC (69.0% and 72.0% vs. 31.0% and 28.0%, respectively). In unilateral mAFC, primiparous cows bearing mAFC ipsilateral to the DF ovary had a greater responsive rate than primiparous cows bearing mAFC contralateral to the DF ovary (55.0% vs. 20.0%, p < 0.05). In mAFC ipsilateral to the DF ovary, responsive and pregnancy rates were greatest (p < 0.05) in multiparous cows bearing mAFC and DF on the right ovary compared with multiparous cows bearing mAFC and DF on the left ovary (58.1% and 22.6% vs. 25.8% and 3.2%, respectively). Furthermore, there was a positive correlation between the mean diameter of AFC at the time of the exogenous hormonal trigger and the mean diameter of DF at the completion of hormonal synchronisation (p < 0.05). Our findings emphasise that the ovarian interrelationship with unilateral mAFC at the time of the hormonal trigger might be a promising biomarker for predicting success in ovarian response to hormonal stimulation of mono-ovulatory Bos indicus beef cows with low AFCs.

Pregnancy rates of Holstein cows showed a substantial decline in the past years, which caused intensive TAI programs for nonpregnant cows to shorten the period between unsuccessful insemination and the next attempt on the same cow. Although many studies examined the improvement in pregnancy rates following TAI, only a few examined the economic impact of such programs. In this study, we look at the feasibility of reproductive programs that included early pregnancy diagnosis performed by transrectal ultrasonography 25 days after artificial insemination (AI) and TAI of nonpregnant cows. This resulted in the following two TAI programs: a modified OvSynch program with a second PGF2α treatment at 24 h interval (GPPG, n = 100) and a modified OvSynch program with an intravaginal progesterone-release device inserted between days 0–7 (PRID + GPPG, n = 100). Cows included in the TAI programs recorded an improvement in the cumulative pregnancy rate (67% vs. 53%; 69% vs. 53%) compared to those in which this strategy was not applied (p < 0.05). An economic analysis was performed using a decision-support tool to estimate the net present value (NPV; USD/cow/year). The analysis revealed a difference in NPV of 89.6 USD/cow/year between the programs (rebreeding the nonpregnant cows following the TAI program vs. AI at detected estrus). In summary, rebreeding the nonpregnant cows after early negative pregnancy diagnosis (25 days after AI) using this strategy can improve the cumulative pregnancy rate and profitability of dairy farms.

Introduction: Differences in Gleason grade in transrectal ultrasonography (TRUS) biopsies and radical prostatectomy (RP) specimens are well documented in literature. Keeping in view the limitations of Gleason grading system, Epstein JI grade group system was introduced. Various other parameters also have a significant role in predicting the pathological stage, extraprostatic extension, status of surgical margins and metastatic disease in regional lymph nodes. RP is performed at limited centres in Pakistan. Till date, no comparison of the histopathological findings in 12-core TRUS and RP specimens had been performed at the national level. Our study is aimed at generating local data in this context. Materials and Methods: This was a crosssectional study and non-probability consecutive sampling was performed. It was conducted at Histopathology Department, Shifa International Hospital, Islamabad, from January 2008 to December 2014. Gleason scores of 20 RP specimens were compared to Gleason scores of TRUS biopsies of same patients. Concordance in Gleason score and grade groups with laterality, perineural invasion was also studied. Results: Out of 20 RP cases, 40% (n = 8) had a Gleason score of 6, 30% (n = 6) had score 7, 20% (n = 4) had score 8 and 15% (n = 3) had score 9. Compared to the TRUS biopsy, RP Gleason score was concordant in 11 cases (55%), higher in 7 cases (35%) and lower in 2 cases (10%). TRUS involvement was unilateral in 10 cases (50%) and bilateral in 10 cases (50%). However, bilateral involvement of RP specimen was seen in 14 cases (70%) and unilateral in 6 cases (30%). Thus, better tumour yield was observed in RP specimens i.e., bilateral involvement in RP specimens was found in additional 5 cases (25%). Perineural involvement was higher in RP specimen i.e., 12 cases (60%), compared to 5 cases (25%) in TRUS biopsies. Its concordance was significantly higher in those with Gleason score of equal to or more than 7 (83%) and low in score less than score 7 (17%). Conclusion: When comparing RP to initial TRUS biopsies, Gleason score was upgraded in 35% and downgraded in 10% of cases. Bilateral involvement in 25% of cases of RP specimens was underestimated as unilateral involvement in TRUS biopsies. Perineural involvement with high Gleason score was also seen.

Prostate cancer (PC) is the commonest malignancy in men that causes significant morbidity and mortality. The incidence has quadrupled in the last three decades. This is predominantly due to its increased detection by excellent newer techniques like Prostate-specific antigen (PSA) evaluation, Transrectal ultrasonography (TRUS), Transrectal ultrasound-guided biopsy, Contrast enhanced ultra sound studies, Multiparametric (Mp) MRI (MpMRI) and Nuclear medicine. Its incidence shows a rise in India. With the availability of PSA and trans-rectal biopsy, nowadays the majority of prostate cancers (PC) are diagnosed at an asymptomatic early stage (T1). Most PC are adenocarcinomas while a small percentage are ductal carcinomas, mucinous carcinomas, signet ring cell carcinomas and small cell carcinomas. These variants have poor prognosis. The anatomy of prostate will help us to further understand the basis of TRUS studies. The whole prostate can be divided into Transition Zone (TZ),Central Zone (CZ) and Peripheral Zone (PZ). This zonal anatomy of prostate is vital to understand the PC, since PC is predominantly seen as follows: TZ – 20%; CZ – 10%; and PZ – 70%. PSA is an extremely valuable tool in the evaluation of PC. It is exclusively produced by the prostate and to a lesser extent by the seminal vesicles. It is present in all post-pubertal men and absent in women and men following radical prostatectomy. Though the PSA is a vital parameter to detect PC, it can also be elevated in: i) Benign prostrate hypertrophy; ii) Prostate inflammation; iii) Prostatic infarct; iv) Post-digital rectal examination; and v) Sexual activity. The normal value of PSA is 0-4 ng/mL. The two techniques that are available to assess PSA levels are polyclonal assay or monoclonal assay. The monoclonal assay is the most commonly used method the world over. The accepted PSA values are: 10 ng/mL (abnormal). Other than normal PSA values, there are other PSA parameters which are often useful in confirming the diagnosis of PC. These are: i) PSA density; ii) PSA velocity; iii) PSA doubling time; iv) Other markers like PCA3; and v) PC is associated with more protein bound PSA (less free PSA) than in BPH. Free PSA (FPSA) can enhance the specificity of the total PSA value for detection of the PC while reducing the number of unnecessary biopsies. Another new finding is that of levels of insulin like growth factor binding protein-2 (IGFBP-2) appear to be directly associated with the presence of PC. Prostate Biopsy: Ultrasound guided biopsy of the prostate still remains the most important technique for the diagnosis of PC. Different biopsies which are used for diagnosis of PC are: Saturation Biopsy, MRI Guided Biopsy and Fusion Biopsy. Use of Gleason Score for grading the PC: Gleason score is the grading system used to determine the aggressiveness of PC. This grading system can be used to choose appropriate treatment options. The tumour grades provide important information regarding how fast the cancer is likely to be growing and the likelihood of the cancer spreading to other parts of the body such as lymph nodes or bones. The pathologist assigns the grade of the tumour when he or she looks at the malignant cells under the microscope. The higher the Gleason grade, the more aggressive is the tumour. Histopathology: Variants of usual acinar adenocarcinoma defined in 2004 by the WHO, include atrophic, pseudohyperplastic, foamy, colloid, signet ring, etc. Recently, variants not included in the 2004 WHO classification are microcysticadeno carcinoma, prostatic intraepithelial neoplasia – adenocarcinoma, large cell neuro endocrine carcinoma and pleomorphic giant cell carcinoma. Other diagnostic modalities for PC are Colour Flow Imaging, Elastography, Contrast Enhanced Ultrasound (CEUS), MR Imaging of Prostate Malignancies. The MR Imaging consisting of the following: Prostate Imaging Reporting and Data System (PIRADS) refers to a structured reporting scheme for evaluating the prostate for PC. T1-weighted images are not helpful in differentiating different zones or detecting the lesion. However, invasion of neurovascular bundle, haemorrhage within the gland and loco-regional lymphadenopathy is better visualized on this sequence. DWI imaging plays an important role in determining PIRADS score, predominantly in peripheral zone neoplasm. It utilizes proton diffusion properties in water to produce image contrast. Thus prostate malignancy appears bright (hyperintense) on DWI with corresponding low values on ADC map (darkhypo intense).Of all functional MR imaging techniques, DW imaging is the most practical and simple in its use. Dynamic Contrast Scan is considered positive if a suspected lesion/ nodule on T2-W or DWI image reveals earlier than normal or more than normal enhancement (hyper enhancement), as routinely seen in lesions with malignant etiology. MR Spectroscopy reflects resonance frequencies that are unique for protons in different metabolites present at the sampled location. A change in the ratios of concentrations of these metabolites suggests abnormality within the tissue. Normal PZ has high concentration of citrate and polyamines and low concentration of choline and creatinine. A reversal of these, i.e. decrease in citrate peak due to altered metabolism and increase in choline and creatinine peaks in a suspected nodule on T2-W image may suggest malignancy. Recent studies reveal that MR spectroscopy is more specific and less sensitive that anatomic T2-W scan. Current Modalities of Prostate Cancer Treatments There are a wide variety of treatments available for the management of prostate cancer. Radical prostatectomy, external beam radiation and radioactive prostate seed implant are potential cures for the prostate cancer. Hormone therapy may force the cancer into a prolonged remission but does not provide a cure unless it is combined with other treatments. The most commonly used treatments include the following: • Watchful Waiting (Active surveillance) • Radical Prostatectomy (Robot assisted radical prostatectomy; Laparoscopic prostatectomy) • Radiation Therapy (External beam radiation; Radioactive prostate seed implants) • Hormone Therapy • Combination of Therapies • High Intensity Focused Ultrasound (HIFU) or Magnetic Resonance-guided Focussed Ultrasound Surgery (MRgFUS) • Others (Cryotherapy; Photodynamic therapy) • Metastatic Disease 1. Hormonal therapy (orchidectomy) 2. Anti androgens 3. Luteinizing Hormone-releasing Hormone (LHRH) Agonists (Leuprolide; Goserelin; Triptorelin; Histrelin) – monthly to annual depot injection S.C. implants Metastatic PC responds to androgen- ablation/deprivation therapy, which heralded the beginning of a new era PC therapy.

With view to study the luteal growth and regression pattern, ultrasonographic studies were carried out in 10 apparently healthy crossbred dairy cattle at 24 hour interval from the day of ovulation to next oestrus. In all the animals the span of corpus luteum (CL) was completed in three phases like growth, stationary and regression phase. First appearance of CL by transrectal ultrasonography (TRUS) was detected on third day of ovulation and was imaged as poorly defined, uneven, greyishblack structure with echogenic spots within the ovary. An increased growth rate of CL was noticed up to day 8 post ovulation, formed the growth phase. Mean maximum diameter of CL was observed on day11.From day 8 to day 16 of ovulation the luteal growth rate is in a stationary phase and the luteal regression observed from day 16 or 17 post ovulation.

Objective: To evaluate the effects of three different local anesthetic agents in patients who underwent Transrectal ultrasoun guided prostate needle biopsy. Materials and Methods: One hundred and sixty patients who were admitted to our clinic between January 2012 and May 2012 for prostate biopsy were divided into 4 groups: no anesthesia-administered group (group 1), lidocaine-administered group (group 2), levobupivacaine-administered group (group 3) and bupivacaine-administered group (group 4). Pain intensity was evaluated in each group using the visual analog scale (VAS): during administration of local anesthetic (VAS 1), during the biopsy (VAS 2), just after the biopsy (VAS 3) and one hour after the biopsy (VAS 4). Results: There was not any significant difference among the groups in terms of VAS 1 (p=0.152). Pain scores were significantly lower during biopsy (VAS 2) in groups 1, 2 and 3 compared to that in group 1 (p=0.001, p=0.005 and p=0.007, respectively). VAS 3 scores were significantly lower in group 2 and group 3 compared to group 1 while no difference was found in group 4 (p=0.003, p=0.032, and p=0.136, respectively). VAS 4 scores were significantly lower only in group 3 compared to group 1 (p=0.001). Conclusions: It was observed that all the three local anesthetics effectively diminished pain during prostate biopsy. However, we found that levobupivacaine, which improved pain scores in all steps of pain evaluation compared to the control group, was relatively superior for pain management in the transrectal biopsy setting.

Introduction Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings. Methods Prospective study was done in 66 males of age >40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA >4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings. Results Twenty three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%. Conclusion TRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer. [ABSTRACT FROM AUTHOR]

Background  Determination of isolated prostate-specific antigen (PSA) in asymptomatic individuals has not demonstrated sufficient sensitivity and specificity to be useful in the routine evaluation of prostate disease. To enhance the accuracy of serum PSA we have used a proportion of serum PSA and prostate volume, which we refer to as prostate-specific antigen density (PSAD). Prostate volume in this study was calculated using transrectal ultrasonography (TRUS). Materials and Methods  A total of 106 patients with prostatic disease clinically confined to the prostate glands were evaluated. Results and Observation  The mean PSAD for prostate cancer was 0.15 ± 0.01 while that for benign hypertrophy of the prostate (BPH) was 0.11 ± 0.02 (p < 0.05). Significant difference (p < 0.05) was noted in the prostate volume in these two groups with the mean prostate volume measured by TRUS in the BPH to be 53.85 ± 9.71 mL compared with 58.14 ± 7.48 mL in the carcinoma. PSA density of 0.13 ng/mL can be used as a cutoff for the individual in our set-up who should go for prostate biopsy with sensitivity and specificity of over 90%. Conclusion  These results suggest that PSAD may be useful in distinguishing BPH and prostate cancer. [ABSTRACT FROM AUTHOR]

Screening for cancer has become extremely common. The evidence supporting screening for breast, colon, and cervix cancer is strong, but it is unclear for skin cancer, problematic for prostate cancer, and ineffective for lung cancer. Despite the problems associated with many screening approaches for cancer, enthusiasm by the medical profession and the public remains high. The objective analysis for the major tumor types is presented in this review, but the ultimate decision on whether to be screened lies in the personal and societal arena of values.