Mean Prostate-specific Antigen Level Research Articles

Diagnosis of prostate cancer by trans rectal ultrasound guided prostate biopsy; an observational study

Introduction Digital rectal examination (DRE) coupled with the measurement of prostate specific antigen (PSA) is widely used for the early diagnosis and monitoring of prostate cancer. In the case of abnormal DRE and/or suspicious PSA value (over 4ng/ml), trans-rectal ultrasound guided prostate biopsy is adopted. Objective was to correlate the ultrasonic appearance with the biochemical markers and histological findings. Methodology This observational study was conducted at the Department of Radiology of Colombo North Teaching Hospital from August 2012 to January 2014. An interviewer administered questionnaire was used to collect data from all patients undergoing biopsy. Demographic data, biochemical markers, ultrasonic appearance and histological findings were recorded. An 18-gauge biopsy needle loaded in a spring-action automatic biopsy device was used to procure six 1.5cm prostate biopsy specimens from both lobes. Results Data from 194 patients were analyzed. Out of patients 30.9% (60) had cancer on biopsy; 33.5% (65) had benign adenomatous hyperplasia(BPH) and 34.5%(67) had chronic prostatitis. Mean (SD) age positive for malignancy was 72.2 (7.6) years. Men with prostate cancer had mean prostate volume of 39.8 ml and mean PSA level of 102.6/dl. 65% (39) of malignant patients had focal lesions. Men with non malignant histology had mean prostate volume of 44.7 ml and mean PSA level of 23.8ng/dl. Ultrasonically focal lesions were identified in 19.7% (26/132) non-malignant males. Presence of focal lesions on imaging was significantly associated with malignancy (p Conclusion Men with prostate cancer were older, had smaller prostate and had higher PSA levels than men with negative biopsies. There is a significant association between finding focal lesion on ultrasound and being diagnosed as malignancy in histology.

Clinical significance of single microscopic focus of adenocarcinoma atprostate biopsy.

ObjectiveProstate cancer (PC) is one of the most common cancer and an important reason of cancer specific death. The incidence of patients who diagnosed at low stage increased because of widespread using Prostate Specific Antigen (PSA) testing. We evaluated the patients who were diagnosed single microscopic focus of adenocarcinoma and treated radical prostatectomy at final pathology.MethodsThe patients who underwent transrectal ultrasound guided prostate biopsy between January 2004 and January 2012 were enrolled retrospectively. We extracted the patients who were diagnosed single microscopic focus of adenocarcinoma and treated with RP. Single microscopic adenocarcinoma was defined as one single focus measuring 3 mm or less, well differentiated (Gleason ≤6) adenocarcinoma. 37 patients were included at the study. Clinical data; including age, serum PSA levels, PSA density and prior biopsy and prostatectomy specimen results were recorded. In pathological examination; high molecular weight cytokeratin (HMW-CK), p63, and alpha-methylacyl-CoA racemase (AMACR) were used for differential diagnosis.ResultsThe patients' ages were between 42 and 77 with a mean age of 64.9 ± 7.57 years. Mean PSA levels and prostate volumes were 8.03 ± 5.21 ng/ml and 54 ± 25.51 cc. T0, T2a, T2c and T3a were reported in 2 patients, 17 patients, 17 patients and 1 patient after pathological evaluation. According to the Gleason grading system; 6 patients were 7 (3 + 4), one patient was 7 (4 + 3), one patient was 5 (3 + 2) and 27 patients were 6 (3 + 3).ConclusionSmall volume of cancer at prostate biopsy is not necessarily small cancer in radical prostatectomy. The treatment choice may be over or under treatment for some patients, so the patients must be informed when choosing the treatment.

Multiparametric magnetic resonance imaging-transrectal ultrasound fusion–assisted biopsy for the diagnosis of local recurrence after radical prostatectomy

ObjectiveApproximately 15% of patients who undergo radical prostatectomy (RP) for prostate cancer develop local recurrence, which is heralded by a rise in serum prostate-specific antigen (PSA) levels. Early detection and treatment of recurrence improves the outcome of salvage treatment. We investigated the ability of multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion-guided biopsy (FGB) combined with “cognitive biopsy” to confirm local recurrence of prostate cancer after RP. Materials and methodsIn this retrospective study conducted between January 2010 and December 2014, patients with rising PSA levels after RP who had no known evidence of distant metastases underwent mpMRI including T2-weighted (T2W) imaging, diffusion-weighted imaging, dynamic contrast-enhanced (DCE) MRI at 3 Tesla, and subsequent MRI-ultrasound fusion biopsy with cognitive assistance. The detection rate of locally recurrent disease was determined. ResultsA total of 10 patients (mean age = 67y, mean PSA level = 3.44ng/ml) met the inclusion criteria. Of the 10 patients, all had positive findings suspicious for local recurrence on mpMRI per entrance criterion. The most important features on mpMRI were early enhancement on DCE MR images and hypointensity on T2W images. The average lesion diameter on mpMRI was 1.12cm (range: 0.40–2.20cm). All suspicious lesions (16/16, 100%) were positive on T2W MR images, 14 (89%) showed positive features on apparent diffusion coefficient maps of diffusion-weighted images, and 16 (100%) were positive on DCE MR images. MRI-TRUS FGBs were positive in 10/16 lesions (62.5%) and 8/10 (80%) patients. ConclusionMRI-TRUS FGB with cognitive assistance is able to detect and diagnose locally recurrent lesions after RP, even at low PSA levels. This may facilitate early detection of recurrent disease and improve salvage treatment outcomes.

What Burden of Prostate Cancer Can Radiologists Rule Out on Multiparametric Magnetic Resonance Imaging? A Sensitivity Analysis Based on Varying the Target Condition in Template Prostate Mapping Biopsies

To evaluate the minimum disease burden of prostate cancer at which multiparametric magnetic resonance imaging (MRI) optimally performs. Between 2006 and 2008, 64 men underwent multiparametric MRI imaging (index test) followed by template prostate mapping biopsy (reference test). Three radiologists independently reported each quadrant of every prostate on a scale of 1 to 5: highly likely benign, likely benign, equivocal, likely malignant, highly likely malignant (≥3 or ≥4 was considered positive). There were 256 prostate sectors; bootstrapping adjustment was used to account for nonindependence. The target condition indicating cancer on biopsies was varied by changing the maximum cancer core length (MCCL) and total cancer core length (TCCL) within each sector from 1 mm to 10 mm. The sensitivity, specificity, and positive (PPVs) and negative predictive values (PPVs) were calculated for each MCCL and TCCL. Gleason ≤3+3 and Gleason ≥3+4 cancers were analyzed separately. Mean age was 62 years (range, 40-76 years), and mean prostate-specific antigen level was 8.2 μg/L (range, 2.1-43 μg/L). Fifty percent of quadrants (127 of 256) had prostate cancer, of which 65% (83 of 127) were Gleason ≤3+3. For Gleason ≤3+3, multiparametric MRI had an NPV of ≥95% at an MCCL of ≥5 mm and at a TCCL of ≥7 mm (MRI score ≥3). For Gleason ≥3+4, an NPV of ≥95% was seen at an MCCL of ≥5 mm (MRI score ≥3) and TCCL ≥6 mm. Multiparametric MRI may allow areas of the prostate which test negative to avoid biopsy. Whether multiparametric MRI can be used as a "triage" test before the first biopsy requires results from ongoing prospective validating cohort studies.

Complicaciones infecciosas de la biopsia transrectal de próstata con preparación intestinal a base de levofloxacino y aceite mineral

IntroductionTransrectal prostate biopsy (TRPB) is considered the appropriate procedure for making prostate cancer diagnosis, but possible infectious complications include fever, orchiepididymitis, prostatitis, and sepsis. AimsThe aim of our study was to report the frequency of infectious complications following TRPB. Material and methodsA retrospective, analytic, cross-sectional study was conducted on patients that underwent TRPB within a 3-year time frame at a hospital in Mexico City. The data were obtained through telephone interviews. The descriptive statistics of means and percentages of the complications resulting from this procedure were carried out. ResultsThe study included 505 patients with a mean age of 65 years and a mean prostate-specific antigen level of 49.7ng/ml. There were 14 complications: 10 patients presented with fever, 2 with urosepsis, and 2 with prostatitis. DiscussionAntibiotic administration and bowel preparation are routinely used to reduce infectious complications and currently there is no criterion standard in this respect. Our results coincided with those reported in the medical literature. ConclusionsTRPB has a low frequency of infectious complications. Though definitely not free from them, the benefits of the procedure outweigh the risks. Bowel preparation based on levofloxacin and mineral oil is an option for reducing infectious complications resulting from TRPB.

Adding gentamicin to fluoroquinolone-based antimicrobial prophylaxis reduces transrectal ultrasound-guided prostate biopsy-related infection rate

ObjectiveTransrectal ultrasound-guided prostate (TRUS) biopsy is the standard method for the diagnosis of prostate cancer. Quinolone-based prophylaxis before a TRUS biopsy of the prostate is the most common regimen worldwide. In this retrospective study, we evaluated the efficacy and cost effectiveness of adding gentamicin to a fluoroquinolone-based prophylaxis regimen. Materials and methodsIn total, our study included 263 patients classified into two groups. Group 1 consisted of 129 patients who received one oral dose of levofloxacin (500 mg) daily 2 days before the biopsy, on the day of the biopsy, and for 2 days after the biopsy. Group 2 consisted of 134 patients who received a single intramuscular (IM) gentamicin injection (80 mg) 30 minutes before the biopsy in addition to the same oral levofloxacin protocol as Group 1. We recorded and analyzed data including age, indication for a TRUS biopsy of the prostate, prostate volume, comorbidity, infectious complications, and blood and urine culture results. ResultsThe mean prostate-specific antigen level was 38.6 ng/mL ± 312.9 ng/mL (range, 4.4–2626 ng/mL) in Group 1, and 34.8 ng/mL ± 127.1 ng/mL (range, 2.11–1423 ng/mL) in Group 2. The groups were similar in terms of mean age, indication for a biopsy, prostate volume, number of biopsy cores taken, and comorbidities. Infection-related complications occurred in eight of 129 (6.2%) and in one of 134 (0.74%) patients in Groups 1 and 2, respectively (p = 0.02). ConclusionThe addition of IM gentamicin (80 mg) was beneficial in improving the efficacy of fluoroquinolone and reducing the post-TRUS biopsy infection rate. Gentamicin is relatively inexpensive and readily available in daily practice and has good compliance for patient use.

Combination of Tramadol and Lidocaine for Pain Control During Transrectal Ultrasound-guided Prostate Biopsy: A Randomized Double-blinded Study

To evaluate the efficacy of tramadol, lidocaine, and a combination of tramadol with lidocaine in pain relief using periprostatic nerve block technique by guidance of transrectal ultrasound (TRUS) before the prostate biopsy (PBx). For the indication of TRUS-PBx, the patients with a prostate-specific antigen (PSA) level >4.0 ng/mL or abnormal digital examination findings were selected. The patients were randomized through random method. Group 1: patients were administered 5 mL of 2% lidocaine; group 2: patients were administered 5 mL of 25-mg tramadol; and group 3: patients were administered 5 mL of 2% lidocaine + 25-mg tramadol. The procedures were completed in 10 minutes, and a visual pain scale was administered to the patients to question the pain severity. TRUS-guided PBx was performed in 60 patients with an age range of 57-77 years (mean age, 66.2 ± 7.49 years) and a PSA range of 1-1000 ng/mL. The mean PSA level of the groups was 28.5 (±7.5), 16.1 (±5.0), and 14.9 (±2.9) ng/mL, respectively. The postprocedural pain scores by visual pain scale were 4.6 ± 1.2, 5.4 ± 1.2, and 3.6 ± 0.9 in lidocaine, tramadol, and lidocaine + tramadol groups, respectively. Periprostatic nerve block is the current golden standard method owing to pain management and comfort provided, independent of the patient age and the number of core biopsies. We suggest that tramadol may also be used in this field to achieve better pain management by improving lidocaine's effect or as an alternative to lidocaine.

When to biopsy seminal vesicles

ObjectivesThe involvement of seminal vesicles in prostate cancer can affect the prognosis and determine the treatment. The objective of this study was to determine whether we could predict its infiltration at the time of the prostate biopsy to know when to indicate the biopsy of the seminal vesicles. Material and methodsObservational retrospective study of 466 patients who underwent seminal vesicle biopsy. The indication for this biopsy was a prostate-specific antigen (PSA) level greater than 10ng/ml or an asymmetric or obliterated prostatoseminal angle. The following variables were included in the analysis: PSA level, PSA density, prostate volume, number of cores biopsied, suspicious rectal examination, and preservation of the prostatoseminal angle, studying its relationship with the involvement of the seminal vesicles. ResultsForty-one patients (8.8%) had infiltrated seminal vesicles and 425 (91.2%) had no involvement. In the univariate analysis, the cases with infiltration had a higher mean PSA level (P<.01) and PSA density (P<.01), as well as a lower mean prostate volume (P<.01). A suspicious rectal examination (20.7% of the infiltrated vesicles) and the obliteration or asymmetry of the prostatoseminal angle (33.3% of the infiltrated vesicles) were significantly related to the involvement (P<.01). In the multivariate analysis, we concluded that the probability of having infiltrated seminal vesicles is 5.19 times higher if the prostatoseminal angle is not preserved (P<.01), 4.65 times higher for PSA levels >19.60ng/dL (P<.01) and 2.95 times higher if there is a suspicious rectal examination (P=.014). Furthermore, this probability increases by 1.04 times for each unit of prostate volume lower (P<.01). The ROC curves showed maximum sensitivity and specificity at 19.6ng/mL for PSA and 0.39 for PSA density. ConclusionsIn this series, greater involvement of seminal vesicles was associated with a PSA level ≥20ng/ml, a suspicious rectal examination and a lack of prostatoseminal angle preservation.

Impact of laparoscopic radical prostatectomy on clinical T3 prostate cancer: experience of a single centre with long‐term follow‐up

To investigate the oncological safety and effectiveness of laparoscopic radical prostatectomy (LRP) for patients with clinical T3 (cT3) prostate cancer compared with patients with cT1 and cT2 prostate cancer. In all, 2375 consecutive LRPs were evaluated between 1999 and 2013. Of the 1751 patients enrolled with complete follow-up data (>24 months), patients were divided into three groups according to clinical stage of prostate cancer using Tumour-Node-Metastasis (TNM) classification. Group 1 consisted of patients with cT1 stage prostate cancer, group 2 those with cT2, and group 3 those with cT3. Demographic, postoperative, and long-term data of patients were recorded and statistical analyses were performed. The mean (SD) age was 63.6 (6.2) years. The mean (SD) follow-up was 104 (28.4) months. There were 417 patients in group 1, 842 patients in group 2, and 492 patients in group 3. The mean prostate-specific antigen level, biopsy Gleason score, tumour volume, body mass index, and age, were all higher in group 3 (P < 0.001). Nerve-sparing techniques were used more in group 1 than in the other groups (P < 0.001). Extracapsular extension, seminal vesicle invasion, Gleason score, positive surgical margin (PSM), and rate of adjuvant hormone and radiotherapies were highest in group 3. However, urinary continence was similar in all groups. Group 1 contained the most patients with an erection sufficient for intercourse. Group 1 had the best cancer-specific survival rate, whereas overall survival (OS) rates and complications were similar in all groups. LRP seems effective and safe for patients with cT3 prostate cancer with similar OS rates as for those with cT1 and cT2; however, additional therapies may have contributed to these rates. LRP can be considered for the treatment of patients with cT3 prostate cancer.

Transition zone prostate specific antigen density improves prostate cancer detection in Iranian men.

Background:Prostate specific antigen (PSA) as a tumor marker has extensively changed the diagnosis of prostate cancer (PCa). With the advent of PSA, the majority of patients are diagnosed with nonpalpable early stage PCa. However, PSA lacks specificity and many patients undergo unnecessary biopsies due to an elevated serum PSA level.Objectives:This study aimed to assess the sensitivity and specificity of transition zone PSA density (TZPSAD) in detection of PCa.Patients and Methods:This study was performed on 1712 men underwent trans-rectal ultrasound guided prostate biopsy in our institution between March 2008 and March 2013. A total of 1120 men with PSA < 20 ng/mL and normal digital rectal exam were selected for evaluation. Transition zone PSA density was calculated in all patients and the receiver operating characteristic (ROC) curve was used to analyze the accuracy of TZPSAD for the diagnosis of PCa.Results:Among 1120 men who were eligible for enrolment, prostate cancer was detected in 265 patients. Mean serum PSA levels were 9.7 ± 4.3 ng/mL and 8.5 ± 3.7 ng/mL in patients with and without PCa, respectively (P < 0.001). Mean value for TZPSAD was 1.18 ± 1.19 ng/mL/mL in patients with PCa, whereas it was 0.55 ± 0.84 ng/mL in men without cancer (P < 0.001). Optimal cut-off value for TZPSAD was 0.32 ng/mL. At this cut-off value, the sensitivity and specificity values for TZPSAD were 85% and 45%, respectively. Applying the TZPSAD for PCa screening decreased 50% of unnecessary biopsies.Conclusions:Using TZPSAD as an adjunct to PSA may improve the specificity of PSA in the diagnosis of PCa and decrease the number of unnecessary prostatic biopsies in Iranian men with serum PSA level < 20 ng/mL.

A prospective, observational grouped analysis to evaluate the effect of triptorelin on lower urinary tract symptoms in patients with advanced prostate cancer.

Few studies have assessed the effect of gonadotropin-releasing hormone (GnRH) agonists, such as triptorelin, on lower urinary tract symptoms (LUTS) in patients with advanced prostate cancer. Therefore, multiple, national observational, noninterventional studies were initiated to assess the effectiveness of triptorelin in reducing moderate or severe LUTS [International Prostate Symptom Score (IPSS) >7] in men with prostate cancer starting triptorelin therapy in clinical practice. Prospective, noninterventional, multicentre studies of LUTS located in Algeria, Belgium, China, Hungary, Romania and South Korea, in patients who were scheduled to receive triptorelin (3-month extended release or 1-month formulation) in clinical practice. The primary effectiveness endpoint was the proportion of patients with moderate or severe LUTS after 48 weeks as assessed by IPSS. Secondary endpoints included the distribution of IPSS categories, total IPSS and prostate-specific antigen (PSA) levels at baseline, 24 and 48 weeks. In total, 2461 patients were recruited in the studies; 1282 patients had moderate or severe LUTS at baseline (IPSS > 7), received triptorelin and had follow-up IPSS. Mean total IPSS was reduced from 18.2 [95% confidence interval (CI) 17.8-18.5] at baseline to 11.9 (95% CI 11.5-12.3; p < 0.001) and 10.6 (95% CI 10.2-11.0; p < 0.001) at weeks 24 and 48, respectively. Mean PSA levels were reduced from 117.9 ng/ml (95% CI 93.8-141.9) at baseline to 8.5 ng/ml (95% CI 5.2-11.7) and 16.6 ng/ml (95% CI 7.4-25.8) at weeks 24 and 48, respectively. There was a significant correlation between total IPSS change from baseline and PSA change from baseline at weeks 24 and 48 (ρ = 0.3 and 0.2, p < 0.001). The improvement in LUTS in men with locally advanced or metastatic prostate cancer after 24-48 weeks suggests that triptorelin is effective in improving LUTS in this subgroup of patients.

Use of serial multiparametric magnetic resonance imaging in the management of patients with prostate cancer on active surveillance

IntroductionWe evaluated the performance of multiparametric prostate magnetic resonance imaging (mp-MRI) and MRI/transrectal ultrasound (TRUS) fusion–guided biopsy (FB) for monitoring patients with prostate cancer on active surveillance (AS). Materials and methodsPatients undergoing mp-MRI and FB of target lesions identified on mp-MRI between August 2007 and August 2014 were reviewed. Patients meeting AS criteria (Clinical stage T1c, Gleason grade≤6, prostate-specific antigen density≤0.15, tumor involving≤2 cores, and≤50% involvement of any single core) based on extended sextant 12-core TRUS biopsy (systematic biopsy [SB]) were included. They were followed with subsequent 12-core biopsy as well as mp-MRI and MRI/TRUS fusion biopsy at follow-up visits until Gleason score progression (Gleason≥7 in either 12-core or MRI/TRUS fusion biopsy). We evaluated whether progression seen on mp-MRI (defined as an increase in suspicion level, largest lesion diameter, or number of lesions) was predictive of Gleason score progression. ResultsOf 152 patients meeting AS criteria on initial SB (mean age of 61.4 years and mean prostate-specific antigen level of 5.26ng/ml), 34 (22.4%) had Gleason score≥7 on confirmatory SB/FB. Of the 118 remaining patients, 58 chose AS and had at least 1 subsequent mp-MRI with SB/FB (median follow-up = 16.1 months). Gleason progression was subsequently documented in 17 (29%) of these men, in all cases to Gleason 3+4. The positive predictive value and negative predictive value of mp-MRI for Gleason progression was 53% (95% CI: 28%–77%) and 80% (95% CI: 65%–91%), respectively. The sensitivity and specificity of mp-MRI for increase in Gleason were also 53% and 80%, respectively. The number needed to biopsy to detect 1 Gleason progression was 8.74 for SB vs. 2.9 for FB. ConclusionsStable findings on mp-MRI are associated with Gleason score stability. mp-MRI appears promising as a useful aid for reducing the number of biopsies in the management of patients on AS. A prospective evaluation of mp-MRI as a screen to reduce biopsies in the follow-up of men on AS appears warranted.

Comparación de los valores de antígeno prostático específico en pacientes con y sin obesidad abdominal del servicio de urología de una unidad médica de tercer nivel de atención

BackgroundThere is evidence of the relation between obesity and an increase in prostate-specific antigen, albeit some is contradictory. AimsOur aim was to compare prostate-specific antigen values in patients with and without abdominal obesity that were seen at the urology service of a tertiary care medical unit, and to analyze the results. Material and methodsA cross-sectional analytic study was conducted within the time frame of June to October 2014. It included first-time urology consultation patients that were referred due to presenting with prostate disease and that had not received medication modifying prostate-specific antigen values. Waist circumference and serum prostate-specific antigen levels were measured. The Student's t test was used for the independent samples and the Pearson and Spearman correlations and the Mann-Whitney U test were used to evaluate the correlation between waist circumference and prostate-specific antigen levels. ResultsA total of 110 patients were included that were first-time referrals to the urology service due to prostate pathology. Calculated as means, patient age was 62.6±7.5 years (range: 48-79), waist circumference was 104.5±10.6cm (range: 57-130), and prostate-specific antigen level was 3.4±2.5ng/dl (range: 0.46-21). The mean prostate-specific antigen level was 1.2±6.3ng/dl (range: 0.46-10.0) for the patients with obesity and 0.4±1.9ng/dl (range: 1.21-21) for the patients without obesity. ConclusionThere was no statistically significant difference in prostate-specific antigen values in the comparison of the populations presenting with and without obesity.

Population-based analysis of salvage radical prostatectomy with examination of factors associated with adverse perioperative outcomes

IntroductionSalvage radical prostatectomy (SRP) is a potentially curative operation performed for recurrent prostate cancer after radiation therapy (RT). The purpose of this study was to examine perioperative and pathologic outcomes of SRP in a national cohort. Materials and methodsThe National Cancer Database from 1998 to 2011 was used to identify 408 patients who underwent SRP. We evaluated the demographic data, clinical variables, and pathologic and perioperative outcomes. Primary outcomes of interest were length of stay (LOS) and positive surgical margins (PSM). A multivariable logistic regression model was employed to identify preoperative predictors of LOS ≥3 days and PSM following SRP. ResultsAmong patients undergoing SRP, the mean age was 62.5±6.8 years, mean prostate-specific antigen (PSA) level was 12.6±15.6ng/ml, and 64% were categorized as clinical stage T1. External beam RT (89%), followed by brachytherapy (11%), was the most common modalities for primary RT. Most SRPs were performed at high-volume centers (57%) in metropolitan locations (83%). Most patients underwent a lymph node dissection (75%) and the mean node count was 15.0±30.1. On final pathology, 73% had intermediate- or high-grade disease (Gleason score 7 in 43% and Gleason score 8–10 in 30%), 49% had pT3 or pT4 disease, 6.2% had positive lymph nodes, and 34% had PSM. The mean LOS was 3.5±9.9 days, and 43% of patients had a LOS≥3 days. The 30-day readmission rate was 6.5% after SRP, and 30- and 90-day postoperative mortality rates were extremely low at 0.4% (n = 1). On multivariable analysis of the entire cohort, PSA level>20ng/ml was an independent predictor of PSM (OR = 3.68, 95% CI: 1.2–10.9, P = 0.018). PSA level>20ng/ml (OR = 4.37, 95% CI: 1.2–16.2, P = 0.027) and cT2 or greater disease (OR = 2.52, 95% CI: 1.0–6.2, P = 0.046) were associated with prolonged LOS (LOS≥3d), whereas surgery at an academic facility (OR = 0.30, 95% CI: 0.1–0.8, P = 0.02) reduced the odds of LOS≥3 days. ConclusionsIn select patients derived from a population-based cohort, SRP results in effective local cancer control with acceptable perioperative outcomes. PSA level>20ng/ml is independently associated with PSM and prolonged LOS after SRP. Clinical stage T2 or greater disease is also associated with prolonged LOS, whereas surgery at an academic facility reduced this risk.

CLINICOPATHOLOGICAL STUDY OF PROSTATE BIOPSY IN PATIENTS RECEIVING DUTASTERIDE FOR BENIGN PROSTATIC HYPERPLASIA

Dutasteride is a 5-alpha reductase inhibitor used to treat benign prostatic hyperplasia. Dutasteride lowers prostate-specific antigen (PSA) levels, which may lead to delays in the diagnosis and treatment of prostate cancer (PCa). This study investigated patients who underwent prostate biopsy (PBx) while receiving dutasteride to investigate whether this agent affects the diagnosis and treatment of PCa. PBx was performed on six patients receiving dutasteride for > 3 months at our medical institutions between January 2010 and June 2013. No patients underwent PBx before dutasteride administration. We performed PBx both for patients with high initial PSA levels and for those with elevated PSA levels with or without initial PSA decline after dutasteride administration. We also investigated clinicopathological findings. Mean age at the start of administration was 69.5 ± 5.9 years (range, 59-77 years), mean duration of administration was 14.1 ± 7.4 months (range, 4.0-23.5 months), mean prostate volume at the start of administration was 70.4 ± 30.7 ml (range, 18.8-104.6 ml), and mean PSA level at the start of administration was 7.7 ± 3.3 ng/ml (range, 4.9-14.2 ng/ml). PSA density was 0.098 ± 0.045 ng/ml/cm3 (range, 0.042-0.181 ng/ml/cm3), and PSA level at PBx was 5.4 ± 2.7 ng/ml (range, 2.5-10.7 ng/ml). We detected three PCa patients, and clinical stage in each case was cT1cN0M0. Radical retropubic prostatectomy was performed in two cases, and androgen-deprivation therapy was performed in one case. All PCa were detected in the early clinical stage. No delays in detection or treatment of PCa were seen in any cases. Careful observation of PSA levels is simple and useful for detecting PCa in patients under dutasteride administration.

The Practicality of Targeted Prostate Biopsy Procedures on the Dominant Side of the Tumor Determined by Magnetic Resonance Imaging in Elderly Patients with High Serum Levels of Prostate-Specific Antigen.

PurposeTo examine the possibility of reducing the number of cores per prostate biopsy in elderly patients with high levels of prostate-specific antigen (PSA) without significantly lowering the detection rate of prostate cancer.Materials and MethodsTwo hundreds sixteen men with PSA levels >20 ng/mL who underwent prostate biopsies from May 2009 to April 2013 were retrospectively reviewed. With the help of magnetic resonance imaging (MRI), the laterality of the dominant tumor burden in patients was determined. The results of targeted biopsies were compared with those of conventional biopsy procedures.ResultsThe mean age and PSA level were 79.5 years and 81.3 ng/mL, respectively, and the overall diagnostic rate of sextant biopsies was 81.9% (177/216). MRI was able to show the tumor burden in 189 of the 216 patients. The detection rate of transrectal ultrasonography (TRUS)-guided targeted biopsies was 87.3% (165/189). Detection rates were comparable with conventional biopsies (81.9% [177/216]) (p=0.23). Of the 177 men in whom the results of the sextant biopsy were positive, 12 men (6.8%) with PSA levels <29 ng/mL did not have any cancer cells according to targeted biopsies. However, all other patients were diagnosed with prostate cancer using the abovementioned techniques.ConclusionsWe believe that TRUS-guided targeted biopsies of the prostate in elderly men with high PSA levels could reduce the number of unnecessary cores per biopsy. However, a risk of detection loss remains. Therefore, we recommend that at least a sextant biopsy should be performed, even in elderly patients, in order to detect prostate cancer.

The role of transurethral resection of the prostate for patients with an elevated prostate-specific antigen.

PurposeThe aim of this study was to define the clinical significance of transurethral resection of the prostate (TURP) in patients with benign prostate hyperplasia (BPH) and an elevated prostate-specific antigen (PSA) level.MethodsWe retrospectively evaluated patients with BPH, lower urinary tract symptoms (LUTS; International Prostate Symptom Score [IPSS]≥8), an elevated serum PSA level (≥4 ng/mL), and previous negative transrectal ultrasonography (TRUS) guided prostate biopsy. The PSA level after TURP was monitored by long-term follow-up. The tumor detection rate on resected prostate tissue, IPSS, maximal urinary flow rate (Qmax), and postvoid residual urine (PVR) were analyzed.ResultsOne-hundred and eighty-six patients were enrolled. Histological examination of resected tissue by TURP revealed prostate cancer in 12 of these patients (6.5%). Among 174 patients without prostate cancer, the mean PSA level and the PSA normalization rate in 112 patients followed up at postoperative day (POD) 3 months were 1.26±0.13 ng/mL and 94.6%, respectively. The mean PSA level and the PSA normalization rate were 1.28±1.01 ng/mL and 95.7% in 47 patients at 1st year, 1.17±0.82 ng/mL and 97.1% in 34 patients at second years, and 1.34±1.44 ng/mL and 97.2% in 36 patients at third years of TURP. One patient showed a dramatic increase in the PSA level was diagnosed with prostate cancer at 7 years after TURP. IPSS, quality of life, Qmax, and PVR were improved significantly at POD 3 months compared to baseline (P<0.05), respectively.ConclusionsTURP significantly reduced the serum PSA level, which was maintained for at least 3 years. This could be helpful to screen the prostate cancer using PSA value in the patient with previous negative biopsy and elevated PSA. In addition, TURP improves IPSS, Qmax, and PVR in patients with BPH, moderate LUTS, and an elevated PSA level.

Diffusion-weighted imaging to evaluate for changes from androgen deprivation therapy in prostate cancer.

The objective of our study was to investigate the usefulness of apparent diffusion coefficient (ADC) values in evaluating for therapeutic changes from androgen deprivation therapy (ADT) in prostate cancer patients. Forty-eight patients with prostate cancer treated with ADT were enrolled in this retrospective study. Diffusion-weighted imaging (DWI) at 3 T was performed before and after ADT. Before and after treatment, ADC values were measured in the tumors and in the benign tissues of the prostate, and serum prostate-specific antigen (PSA) levels and prostate volumes were also assessed. Statistical analysis was performed using a paired Student t test, Wilcoxon signed rank test, and Spearman rank correlation. In 48 patients, 55 tumors were identified. After treatment, the mean ADC value of the tumors (1.06×10(-3) mm2/s) was significantly increased as compared with the pretreatment value (0.78×10(-3) mm2/s) (p<0.001), whereas the ADC values of the benign tissues after treatment were significantly decreased compared with the pretreatment values (p<0.001). The mean prostate volume and mean PSA level were significantly reduced from 42.8 cm3 and 153.60 ng/mL before treatment to 21.4 cm3 and 9.51 ng/mL, respectively, after treatment (p<0.001). Changes in tumor ADC values showed a weak negative correlation with changes in PSA levels after treatment (correlation coefficient, ρ=-0.320; p=0.028). DWI may have potential as a noninvasive tool for monitoring changes in response to ADT in prostate cancer patients.

Racial and Ethnic Differences in the Association of Metabolic Syndrome with Prostate-Specific Antigen Levels in U.S. Men: NHANES 2001–2006

Abstract Background: The interplay between metabolic syndrome (MetS) and race/ethnicity on prostate specific antigen (PSA) still remains unclear. The three major definitions of MetS (National Cholesterol Education Program [ATP III], International Diabetes Federation [IDF], and World Health Organization [WHO]) differ in number and type of components, which are linked to race/ethnicity. We proposed to investigate the associations of three major definitions of metabolic syndrome with PSA levels, and to determine whether these associations vary by race and ethnicity. Methods: We used measurements of serum PSA levels (ng/mL) in 3528 adult men >40 years from the National Health and Nutrition Examination Survey 2001–2006. MetS was defined using ATP III, IDF, and WHO criteria. Racial/ethnic groups included non-Hispanic blacks (NHBs), non-Hispanic whites (NHWs), and Mexican Americans (MAs). We computed geometric mean PSA levels from weighted multiple linear regression models. Results: Men classified with MetS-ATP ...

¿Cuándo biopsiar las vesículas seminales?

ObjectivesThe involvement of seminal vesicles in prostate cancer can affect the prognosis and determine the treatment. The objective of this study was to determine whether we could predict its infiltration at the time of the prostate biopsy to know when to indicate the biopsy of the seminal vesicles. Material and methodsobservational retrospective study of 466 patients who underwent seminal vesicle biopsy. The indication for this biopsy was a prostate-specific antigen (PSA) level greater than 10ng/ml or an asymmetric or obliterated prostatoseminal angle. The following variables were included in the analysis: PSA level, PSA density, prostate volume, number of cores biopsied, suspicious rectal examination, and preservation of the prostatoseminal angle, studying its relationship with the involvement of the seminal vesicles. ResultsForty-one patients (8.8%) had infiltrated seminal vesicles and 425 (91.2%) had no involvement. In the univariate analysis, the cases with infiltration had a higher mean PSA level (P<.01) and PSA density (P<.01), as well as a lower mean prostate volume (P<.01). A suspicious rectal examination (20.7% of the infiltrated vesicles) and the obliteration or asymmetry of the prostatoseminal angle (33.3% of the infiltrated vesicles) were significantly related to the involvement (P<.01). In the multivariate analysis, we concluded that the probability of having infiltrated seminal vesicles is 5.19 times higher if the prostatoseminal angle is not preserved (P<.01), 4.65 times higher for PSA levels >19.60ng/dL (P<.01) and 2.95 times higher if there is a suspicious rectal examination (P=.014). Furthermore, this probability increases by 1.04 times for each unit of prostate volume lower (P<.01). The ROC curves showed maximum sensitivity and specificity at 19.6ng/mL for PSA and 0.39 for PSA density. ConclusionsIn this series, greater involvement of seminal vesicles was associated with a PSA level ≥20ng/ml, a suspicious rectal examination and a lack of prostatoseminal angle preservation.