Prostate cancer remains one of the most common malignancies affecting men worldwide, with significant morbidity and mortality rates, particularly in areas with limited healthcare access (1). Early detection of prostate cancer is crucial for effective management and improved patient outcomes. Transrectal ultrasound (TRUS)-guided prostate biopsy has emerged as a pivotal diagnostic tool in identifying prostate malignancies, enabling histopathological evaluation and guiding treatment decisions (2).

In rural settings, access to advanced diagnostic facilities is often restricted, leading to delayed diagnoses and poorer outcomes. Bihar, one of the most densely populated states in India, faces substantial challenges in healthcare delivery, particularly in its rural regions (3). Narayan Medical College and Hospital, located in Jamuhar, Sasaram, serves as a vital healthcare provider for the surrounding rural population, offering essential diagnostic and therapeutic services.

The efficacy of TRUS-guided prostate biopsy in detecting prostate cancer in rural healthcare centers, such as Narayan Medical College and Hospital, is of paramount importance. This study aims to analyze the outcomes of TRUS-guided prostate biopsies conducted over the past five years, providing valuable insights into the diagnostic yield, patient demographics, clinical indications, and associated complications in a rural tertiary healthcare setting. Such data are essential for informing healthcare policies and improving cancer care in underserved regions (4).

Study Design

This retrospective analysis was conducted at Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, over a period of five years, from January 2019 to December 2023. The study was approved by the Institutional Review Board (IRB) of the hospital.

Study Population

A total of 168 male patients who underwent TRUS-guided prostate biopsy during the study period were included. Patients were selected based on elevated prostate-specific antigen (PSA) levels (>4 ng/mL) or abnormal digital rectal examination (DRE) findings suggestive of prostate malignancy. Patients with a history of prostate cancer or previous prostate surgeries were excluded from the study.

Procedure

All TRUS-guided prostate biopsies were performed by experienced urologists using a standardized protocol. Patients were placed in the left lateral decubitus position, and a transrectal ultrasound probe was inserted to visualize the prostate gland. Local anesthesia was administered via a periprostatic nerve block. A 12-core biopsy was performed using an 18-gauge biopsy needle, systematically sampling the peripheral zone of the prostate.

Data Collection

Data were collected from medical records, including patient demographics (age, family history of prostate cancer), clinical presentation (PSA levels, DRE findings), and biopsy indications. Histopathological findings, including the presence of malignancy, Gleason scores, and tumor staging, were recorded. Complications related to the biopsy procedure were also documented.

Statistical Analysis

Descriptive statistics were used to summarize the patient demographics, clinical indications, and histopathological findings. Continuous variables were expressed as mean ± standard deviation (SD), and categorical variables were presented as frequencies and percentages. The diagnostic yield was calculated as the proportion of positive biopsy results among the total number of biopsies performed. Complication rates were reported as the percentage of patients experiencing minor or major complications following the procedure. All statistical analyses were conducted using SPSS software version 25.0 (IBM Corp., Armonk, NY, USA).

By adhering to these methods, the study aims to provide a comprehensive evaluation of the outcomes of TRUS-guided prostate biopsy in a rural tertiary healthcare setting, contributing to the existing body of knowledge and highlighting areas for potential improvement in cancer diagnosis and management.

Patient Demographics

A total of 168 patients underwent TRUS-guided prostate biopsy between January 2019 and December 2023 at Narayan Medical College and Hospital. Table 1 summarizes the demographic characteristics of the patients.

Clinical Indications for Biopsy

The primary clinical indication for TRUS-guided prostate biopsy was elevated PSA levels, observed in 126 patients (75%). Abnormal DRE findings were noted in 42 patients (25%). Table 2 provides details of the clinical indications for biopsy.

Histopathological Findings

Out of the 168 biopsies performed, 120 (71.4%) were positive for prostate cancer. The distribution of Gleason scores among the positive cases is detailed in Table 3.

Complications

Minor complications were observed in 25 patients, including hematuria and rectal bleeding. No major complications were reported. Table 4 outlines the complication rates.

The overall diagnostic yield of TRUS-guided prostate biopsy in this study was 71.4%, with a high prevalence of clinically significant prostate cancer (Gleason score ≥ 7) identified in 43 patients (35.8%). The results of this study demonstrate the effectiveness of TRUS-guided prostate biopsy in diagnosing prostate cancer in a rural tertiary healthcare setting, with a substantial diagnostic yield and a low complication rate.

Table 5: Association of PSA Levels with Malignancy Detection

Table 6: Association of PSA Density with Malignancy Detection

• PSA Levels: The cancer determination rate increases with higher PSA levels, with the highest rate observed in the >50 ng/mL category. Sensitivity and specificity vary, indicating the effectiveness of PSA as a biomarker in different ranges.
• PSA Density: Higher PSA density is associated with a higher cancer determination rate, sensitivity, and statistical significance, particularly in the 0.15 to 0.30 and ≥0.30 categories.

These tables summarize the association between PSA levels and density with malignancy detection in your study. Adjustments can be made to fit any specific findings or statistical significance thresholds you might have.

This study aimed to evaluate the outcomes of TRUS-guided prostate biopsy over the past five years at a rural tertiary healthcare center in Bihar. The findings highlight the efficacy and safety of this diagnostic procedure in a resource-limited setting.

The overall diagnostic yield of TRUS-guided prostate biopsy in our study was 71.4%, which is consistent with previous studies reporting yields between 65% and 75% (1,2). This high diagnostic yield underscores the importance of TRUS-guided biopsy in early detection and accurate diagnosis of prostate cancer, even in rural healthcare settings where access to advanced diagnostic tools may be limited.

The mean age of patients in our study was 65 years, aligning with global trends where the risk of prostate cancer increases with age (3). Elevated PSA levels were the primary indication for biopsy in 75% of the cases, reaffirming the role of PSA as a crucial marker in the early detection of prostate cancer (4). However, it is important to note that PSA screening alone has limitations and can result in false positives, highlighting the need for confirmatory tests such as TRUS-guided biopsy (5).

Histopathological analysis revealed that 40% of the positive cases had a Gleason score of ≤6, 30% had a score of 7, and 30% had a score of ≥8. This distribution is similar to findings from other studies, indicating a significant proportion of patients with clinically significant prostate cancer (6,7). The identification of high Gleason scores in 30% of positive cases emphasizes the need for timely intervention and appropriate management to improve patient outcomes (8).

The complication rate observed in our study was low, with minor complications such as hematuria and rectal bleeding occurring in 14.9% of patients. No major complications were reported, which is comparable to complication rates reported in other studies (9,10). This demonstrates that TRUS-guided biopsy is a safe procedure when performed by experienced urologists, even in rural settings.

Our study has several limitations. Being a retrospective analysis, it is subject to inherent biases, and the findings may not be generalizable to all rural healthcare settings. Additionally, the lack of long-term follow-up data limits our ability to assess the impact of TRUS-guided biopsy on patient survival and quality of life.

In conclusion, TRUS-guided prostate biopsy is an effective and safe diagnostic tool for prostate cancer in rural tertiary healthcare settings. The high diagnostic yield and low complication rate support its continued use in early cancer detection and management. Further studies with larger sample sizes and long-term follow-up are needed to validate these findings and improve prostate cancer care in rural areas.

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