Third International Conference on Technical Sciences (ICST2020), 28 – 30 November 2020, Tripoli - Comparative study of the number of patients with prostate cancer in the cities in Libya attending to Misurata National cancer institute.

1,2 3,4 5 Mohamed. Ben Taher , K. Abufalgha , A. Alshara 1. Department of Radiology of Faculty of Medical Technology of . 2. Department of Radiology of National Cancer Institute of Misurata [email protected] 3. Department of Radiology of Faculty of Medical of University of Misurata 4. Department of Radiology of Medical Center of Misrata [email protected] 5. Department of Medical Equipment Engineering, Faculty of Medical Technology- Misurata. [email protected]

Abstract Prostate cancer is one of the most common cancers in Results. men. Though most types of prostate cancer are The current study shows that different ages growing slowly and may need minimal treatment, the from different cities in Libya. The highest other types are aggressive and may be spread quickly. However, prostate cancer, which detected in early- number of the patient had prostate cancer stage a better will has a chance of successful was (66 out of 202 patients) aged between treatment. 70 to 80 years old (25%). On the other Materials and methods. hand, the lowest number of the patient had This retrospective study included 202 prostate cancer in this study aged under 50 patients who were attending to the years old Oncology Hospital to exclude the prostate Conclusion. cancer. MRI was performed with a 1.5 T Health awareness and availability of system (Intera Achieva, Philips Medical medical imaging equipment such as CT Systems, The Misrata oncology centre). T2 scan and magnetic resonance imaging in TSE and DTI with ss-EPI were obtained in public health centres are of great each subject. This study divided in to two importance to maintain human safety groups. All cases underwent preoperative Keywords: MRI device; prostate cancer; MR imaging statistical; SPSS program.

659 ICTS32830112020-MD2030 Introduction Though these techniques have not been Prostate cancer is one of the most common performed cancers in men [1]. Though most types of broadly in daily clinical practice yet, they prostate cancer are growing slowly and are increasingly aforesaid as one of the may need minimal treatment, the other guidelines to detect prostate cancer [6]. types are aggressive and may be spread The European Society of Urogenital quickly. However, prostate cancer, which Radiology (ESUR) recommended in the detected in early-stage a better will has a latest diagnostic consensus statement to chance of successful treatment. Thus, use T2-weighted imaging combined with discovered of prostate cancer in an early at least two functional techniques: stage is paramount but remains diffusion-weighted imaging (DWI), challenging. Nowadays, used diagnostic optionally MR spectroscopy and dynamic tools are digital rectal examination, serum contrast-enhanced MRI (DCE-MRI) [2]. prostate-specific antigen (PSA), transrectal The important reasons MRI has not yet ultrasound (TRUS)–guided biopsy, rectal progressed as the first-line modality to examination, a nonspecific blood test; and detect the prostate cancer is that it requires a standardized but untargeted method [2]. fundamentally an expert radiologist to read In order of this unavailability these prostate MRI examinations and such this diagnostic tools, much effort is being put expertise is not widely available. into improving the accuracy of prostate Additionally, due to MRI is expensive, cancer discovering. In advances in MRI needs highly trained technicians. Addition, techniques show potential improvement in MRI produces a large number of 3-D detection the prostate cancer and accuracy images of the prostate which required a of MRI. A current multiparametric MRI long time to interpret the prostate MRI process that combines anatomical T2- images [7]. Also, the important thing in weighted imaging with practical data messing diagnostic of prostate cancer is appears to be one of the most important that in Libya MRI not the available at promising techniques for prostate cancer public centres in at the different Libyan detection [3, 4]. In Addition to functional cities. MRI techniques will provide display This study aims to compare the number altered cellularity, metabolic information and age of patients who have been and aid in the noninvasive characterization diagnosed with prostate cancer who of tissue and tumor vascularity [5]. underwent a medical examination at the National Cancer Institute. To compare 660 ICTS32830112020-MD2030 prostate cancer patients with the place of This study shows that (66 out of 202 residence. patients) had prostate cancer were aged between 70 to 80 years old (25%). On the Materials and methods other hand, this study illustrated that the This retrospective study included 202 lowest number of the patient had prostate patients who were attending to the cancer were aged under 50 years old Oncology Hospital to exclude the prostate (Figure 1). In addition, the largest number cancer (Table 1). This study divided in to of patients diagnosed with prostate cancer two groups. MRI was performed with a 1.5 lived in Misrata, while small numbers of T system (Intera Achieva, Philips Medical cases came from distant cities from Systems, The Misrata oncology centre). T2 Misurata such as from Derma, Nalut, Al TSE and DTI with ss-EPI were obtained in Bayda and Murzuq had prostate cancer in each subject. All cases underwent this study (Table 2). preoperative MR imaging and three- Table (1) shows the distribution of patients dimensional imaging in the prostate by years between 1th January 2015 and Number of Percentage Year th patients 31 Dismember 2018 at Misurata National 2015 41 20.3 Cancer Institute. Statistical analysis was 2016 55 27.2 2017 47 23.3 performed using IBM PSS, version 24 for 2018 59 29.2 PC. The Chi Square test was used in this Total 202 100.0 study to assess age differences for groups Discussion of patients and also to compare the MR imaging is continuously developing in incidence of patients in terms of the place detecting prostate cancer. It has adopted as of living of patients. a role for differentiation between patients

with organ-confined cancer and those with Results. As our knowledge, the National cancer extracapsular tumor extension [8]. This institute receiving a significant number of study evaluated the number of patients people from different Libyan cities to diagnosed with prostate cancer from th make medical examinations or to take the different cities from Libya between 1 th different cancers' medications. The current January 2015 and 31 Dismember 2018. study shows the different ages of patients This study showed that a substantial from different cities in Libya. number of people had prostate cancer who

661 ICTS32830112020-MD2030 had an MRI examination to evaluate of these cases 66 were from Misurata and prostate cancer. 26 cases from Al khums city, and the rest To discover the cancers in the early stages of the cases from various cities of Libya. the government should make educational This may be due to the Hospital in seminars to increase the people Misurata also Al khums not far from this knowledgeable about the cancers. All Oncology Centre. cases in this study have done MRI

Less to 50 examination to evaluate the prostate cancer From 50 years From up to < 60 From 60 ,[القيمة] and the number was 202 patients. All cases to 80, years year to 70 70 النسبة From] year ,[القيمة] ,[القيمة] [to 80المئوية in this study have done MRI examination ,[القيمة] النسبة ] النسبة ] years النسبة ] [المئوية [المئوية ,[القيمة] to evaluate the prostate cancer and the [المئوية النسبة ] [المئوية number was 202 patients. In addition, most Number of City Percentages patients Al khums 26 12.9 Msallata 4 2.0 Figure (1): Shows the percentages of age Misurata 66 32.7 Zliten 17 8.4 groups of cases who have prostate cancer. jakhira 4 2.0 Tripoli 17 8.4 Table. (2) shows the distribution of Sabha 9 4.5 patients by city. 13 6.4 Ghat 3 1.5 The ability to accurately detect prostate Derna 1 .5 cancers with MR imaging can be useful in 7 3.5 Tarhuna 5 2.5 patients for whom systematic biopsy has Bani Walid 8 4.0 failed despite rising PSA values and Nalut 1 .5 Kaser Al 1 .5 continued suspicion of cancer. Eventually, Akiar AL MR imaging may be performed before the 2 1.0 GARABOLE first biopsy to more precisely guide the Zamzam 1 .5 Al Orban 1 .5 biopsy needle into the tumour. MRI better Qatrun 1 .5 to categorize the risk of malignancy in Murzuq 1 .5 Brak 3 1.5 prostate and localize the suspected lesions 3 1.5 Ubari to be targeted by transrectal US biopsy that 1 .5 Houn 2 1.0 it may more accurately stage tumours in Tajura 1 .5 the pre-treatment stage. Potentially this Waddan 2 1.0 1 .5 technology will be useful in image-guided, Al Bayda 1 .5 focal therapy as well as whole gland Total 202 100.0

662 ICTS32830112020-MD2030 therapy such as surgery or radiation. Our discover a lesion as being present or absent data indicates that multi-parametric MRI [11]. of prostate at 1.5T enables accurate tumor The mechanism by which DWI adds detection with reasonable sensitivity and diagnostic accuracy to T2 imaging is specificity values. Among MRI sequences, uncertain. T2 signal loss in the external ADC maps of weighted magnetic zone might be related to a number of resonance imaging (DW MRI) and causes, including inflammation, cancer, Dynamic contrast-enhanced (DCE MRI) fibrosis, hemorrhage and inflammation were the two most helpful for tumor [12]. In addition, H Miao et al (2007) detection in the central gland, where a pointed that to detect the prostate cancer significant overlap between tumors and using DW imaging better than that of T2W benign prostatic hyperplastic changes imaging [13]. usually occurs. A combination of DW The current study shows that different ages MRI and DCE MRI demonstrated the most from different cities in Libya, but the promising sensitivity for anterior zone highest number of the patient had prostate prostate (PZ) and Central gland (CG) cancer was between 70 to 80 years old and tumors. Traditionally, systemic TRUS the patient who aged under 50 years old guided biopsy under samples the CG and was the lowest number. This due to MRI is the anterior PZ [9]. Ikonen et al (2001) not always available in public hospitals in evaluated the accuracy of MR imaging to Libya, and healthcare is paid for by the differ prostate cancer from other prostatic individual. Also, it might be expected that diseases, such as benign prostatic in Libya caution over the cost of MRI hyperplasia, chronic bacterial or acute would be a concern. Baade et al. (2009) bacterial prostatitis and chronic bacterial mention that decreasing mortality rates are prostatitis. In their study, the accuracy of becoming widespread among more the diagnosis of cancer was high, but the developed countries, though it is not clear differentiation of bacterial prostatitis from whether this is because earlier observing cancer was difficult because the former (PSA testing) or improved treatment [14]. showed some features similar to that of the Despite the debate over if PSA testing is latter [10]. The accuracy of beneficial in reducing disease-lead to Multiparametric magnetic resonance mortality. It has been widely used imaging (mpMRI) at identifying clinically worldwide. However, in Libya, it is not considerable prostate cancer various with regularly used due to the lack of public the mpMRI threshold that was used to awareness and/or the cost of the 663 ICTS32830112020-MD2030 investigation. In order that might References 1. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer contribute to an increase in the mortality statistics, 2010. CA Cancer J Clin 60:277–300 related to prostate cancer. Also, genetic 2. Barentsz JO, Richenberg J, Clements R, et al (2012) ESUR prostate MR guidelines 2012. Eur Radiol may one of the risk factors lead to prostate 22:746–757 cancer. Parkin et al. (2012) environmental 3. Sciarra A, Panebianco V, Salciccia S, et al (2011) Modern role of magnetic resonance and spectroscopy and Genetic factors may play a role in the in the imaging of prostate cancer. In: Urologic persistent geographical incidence Oncology: Seminars and Original Investigations. Elsevier, pp 12–20 differences over the course of the last three 4. Sciarra A, Barentsz J, Bjartell A, et al (2011) decades in spite of different levels of PSA Advances in magnetic resonance imaging: how they are changing the management of prostate cancer. Eur testing [15]. Urol 59:962–977 5. Pinto F, Totaro A, Calarco A, et al (2011) Imaging in prostate cancer diagnosis: present role and future Limitations of this study perspectives. Urol Int 86:373–382 6. Heidenreich A, Bastian PJ, Bellmunt J (2012) A large-scale prospective study needs to Guidelines on prostate cancer. Arnhem: European Association of Urology, 2013 be performed to truly establish the 7. Karssemeijer N, Otten JDM, Rijken H, Holland R accuracy of evaluation of prostate cancer (2006) Computer aided detection of masses in mammograms as decision support. Br J Radiol in Libya and make full protocol including 79:S123–S126 to all medical examinations and all 8. Yu KK, Hricak H, Alagappan R, et al (1997) Detection of extracapsular extension of prostate investigations which required to detect and carcinoma with endorectal and phased-array coil MR evaluated the tumors. Also, the experience imaging: multivariate feature analysis. Radiology 202:697–702 of readers of MRI images is very 9. Scheidler J, Hricak H, Vigneron DB, et al (1999) important for providing useful reports. Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging—clinicopathologic

study. Radiology 213:473–480 Conclusion 10. Ikonen S, Kivisaari L, Tervahartiala P, et al (2001) Prostatic MR imaging: accuracy in differentiating Health awareness and availability of cancer from other prostatic disorders. Acta radiol medical imaging equipment such as 42:348–354 magnetic resonance imaging and Position 11. Abd-Alazeez M, Kirkham A, Ahmed HU, et al (2014) Performance of multiparametric MRI in men at risk of Emission Tomography in public health prostate cancer before the first biopsy: a paired centres are of great importance to maintain validating cohort study using template prostate mapping biopsies as the reference standard. Prostate human safety. This may increase the Cancer Prostatic Dis 17:40 knowledge of the people also simplicity to 12. Shukla-Dave A, Hricak H, Eberhardt SC, et al (2004) Chronic prostatitis: MR imaging and 1H MR attend to make medical examination will spectroscopic imaging findings—initial observations. help to discover these cancers in early Radiology 231:717–724 stages. 13. Miao H, Fukatsu H, Ishigaki T (2007) Prostate cancer detection with 3-T MRI: comparison of diffusion-

664 ICTS32830112020-MD2030 weighted and T2-weighted imaging. Eur J Radiol Food Res 53:171–184 61:297–302 15. Parkin DM, Bray F, Ferlay J, Jemal A (2014) Cancer 14. Baade PD, Youlden DR, Krnjacki LJ (2009) in africa 2012. Cancer Epidemiol Prev Biomarkers International epidemiology of prostate cancer: 23:953–966 geographical distribution and secular trends. Mol Nutr

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