Prostate Transition Zone Volume Research Articles

Ultrasound indicators of the prostate, urinary bladder and uroflowmetry parameters in the diagnosis of infravesical obstruction in men with benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common urologic diseases of males. In patients who failed drug therapy of lower urinary tract symptoms (LUTS) caused by BPH, the most important indication for surgery is the presence of infravesical obstruction (IVO). IVO is detected by pressure-flow studies and is characterized by high detrusor pressure with decreased urinary flow rate. The invasiveness and high cost of this investigation has stimulated a search for non-invasive techniques that could reliably characterize the presence of IVO secondary to BPH. To determine the value of ultrasound indicators of the prostate, urinary bladder and uroflowmetry parameters in the diagnosis of IVO in men with BPH. Seventy-six men with moderate and severe LUTS secondary to BPH underwent a comprehensive urological examination, including a clinical history, digital rectal examination, International Prostate Symptom Score (I-PSS), serum prostate-specific antigen (PSA), various ultrasound indicators of the prostate and urinary bladder, uroflowmetry and a pressure/flow study. Infravesical obstruction (IVO) was detected in 73.1% of men with BPH. IVO was found to have the strongest correlation with ultrasound signs of the intravesical prostatic protrusion (IPP, r = 0,667, p <0,05) compared with the prostate volume, prostate transition zone volume, prostate transition zone index, prostatic urethral angle, urethral length of the transition zone, estimated prostate circumference, prostate peripheral zone thickness, residual urine volume, weight of urinary bladder, the thickness of the detrusor, maximum and average urine flow rates and I-PSS score. The incidence of IVO increased in parallel with the increase of IPP. We established a cut-off value for IPP of 10 mm for the diagnosis of IVO with a sensitivity of 68.2%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 53.3%. The ultrasound findings of IPP measuring more than 10 mm strongly correlates with the IVO in men with LUTS and BPH as compared with other ultrasound parameters of the prostate, urinary bladder and urinary flow rates. The IPP is anatomical parameter that do not require urination, and is easily detected by both transabdominal and transrectal ultrasound. However, at the PPI values less than 10 mm, the main method for detecting IVO remains the pressure/ flow study.

A Study on the Correlations between Total Prostate Volume and Prostate Transition Zone Volume Assessed Using Blood and Ultrasound Tests: in the Healthy Korean Men in Thirties

A Study on the Correlations between Total Prostate Volume and Prostate Transition Zone Volume Assessed Using Blood and Ultrasound Tests: in the Healthy Korean Men in Thirties

MP39-20 ARE THERE ANY APPROPRIATE CRITERIA FOR RECOMMENDING PROSTATE BIOPSY IN PATIENTS OVER 75 YEARS OLD?

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2016MP39-20 ARE THERE ANY APPROPRIATE CRITERIA FOR RECOMMENDING PROSTATE BIOPSY IN PATIENTS OVER 75 YEARS OLD? Yu Teranishi, Takeo Kosaka, Kazuhiro Matsumoto, Shinya Morita, Kazunobu Shinoda, Ryuichi Mizuno, Toshiaki Shinojima, Eiji Kikuchi, Hiroshi Asanuma, Akira Miyajima, and Mototsugu Oya Yu TeranishiYu Teranishi More articles by this author , Takeo KosakaTakeo Kosaka More articles by this author , Kazuhiro MatsumotoKazuhiro Matsumoto More articles by this author , Shinya MoritaShinya Morita More articles by this author , Kazunobu ShinodaKazunobu Shinoda More articles by this author , Ryuichi MizunoRyuichi Mizuno More articles by this author , Toshiaki ShinojimaToshiaki Shinojima More articles by this author , Eiji KikuchiEiji Kikuchi More articles by this author , Hiroshi AsanumaHiroshi Asanuma More articles by this author , Akira MiyajimaAkira Miyajima More articles by this author , and Mototsugu OyaMototsugu Oya More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.145AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Appropriate criteria for recommending prostate biopsy are controversial, especially in elderly men. In this study, we investigated the diagnostic value of prostate-specific antigen (PSA) and its multiple factors in men over 75 years of age to avoid overdiagnosis and reduce unnecessary biopsy procedures. METHODS A total of 2498 men underwent a transrectal prostate biopsy between 2004 and 2011 at Keio University Hospital in Tokyo. We retrospectively reviewed the records of 458 men who were over 75 years old. Patients with PSA levels between 4.0 and 10.0 ng/ml were divided into two groups: one with a negative biopsy and Gleason score of 6 or less, the other with a Gleason score of 7 or more. The clinical values of age, prostate volume (P vol), prostate transition zone volume (Tz vol), prostate-specific antigen density (PSAD), and prostate-specific antigen density of the transition zone (PSATzD) for the detection of prostate cancer were compared using receiver operating characteristic (ROC) curves and by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. The same was conducted for PSA levels between 10.0 and 20.0 ng/ml and over 20.0 ng/ml. RESULTS Among the patients with PSA levels between 4.0 and 10.0 ng/ml, the mean (± SD) age, PSA, P vol, Tz vol, PSAD, and PSATzD were 77.7 ± 2.5 years, 6.7 ± 1.6 ng/ml, 38.2 ± 21.5 cm3,19.0 ± 14.9 cm3, 0.22 ± 0.12, and 0.54 ± 0.39, respectively, in men with positive biopsy. There were significant differences in PSA (P=0.001), P vol (P<0.001), Tz vol (P<0.001), PSAD (P<0.001), and PSATzD (P<0.001). A total of 153 men had a negative biopsy and Gleason score 6 or less, and 92 a Gleason score 7 or more. Statistical analysis to compare these 153 men and 92 men revealed a significant difference in PSAD only (P<0.001). The area under the curve of ROC of PSAD was 0.711. The sensitivity, specificity, positive predictive value, and negative predictive value were 76.1%, 52.69%, 49.3%, and 78.6%, respectively, by setting the cut-off value to PSAD 0.15. Among the patients with PSA levels between 10.0 and 20.0 ng/ml and with PSA levels over 20.0 ng/ml, there was no difference in PSAD. CONCLUSIONS Patients 75 or older with a PSA level between 4.0 and 10.0 ng/ml and PSAD less than 0.15 are unlikely to have prostate cancer and therefore it may be possible to avoid overdiagnosis, thereby reducing unnecessary biopsies. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e549 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yu Teranishi More articles by this author Takeo Kosaka More articles by this author Kazuhiro Matsumoto More articles by this author Shinya Morita More articles by this author Kazunobu Shinoda More articles by this author Ryuichi Mizuno More articles by this author Toshiaki Shinojima More articles by this author Eiji Kikuchi More articles by this author Hiroshi Asanuma More articles by this author Akira Miyajima More articles by this author Mototsugu Oya More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Individualized prostate-specific antigen threshold values to avoid overdiagnosis of prostate cancer and reduce unnecessary biopsy in elderly men.

To individualize prostate-specific antigen threshold values to avoid overdiagnosis of prostate cancer and reduce unnecessary biopsy in elderly men. A total of 406 men aged over 70 years old with prostate-specific antigen levels between 4.0 and 20.0 ng/ml, normal digital rectal examination results and diagnosed by transrectal needle biopsy were retrospectively analyzed. The patients were divided into a no/favorable-risk cancer group or an unfavorable-risk cancer group based on their Gleason score and the number of positive cores. Prostate-specific antigen levels, percent free prostate-specific antigen level, prostate transition zone volume and the number of previous biopsies were used to discriminate between the two groups. The optimal individualized prostate-specific antigen threshold values based on the other variables that gave a sensitivity of 95% for the detection of unfavorable-risk cancer were calculated using a boosting method for maximizing the area under the receiver operating characteristic curve. A total of 66 men had favorable-risk cancer, and 139 had unfavorable-risk cancer. The area under the receiver operating characteristic curve of the combination model determined by the boosting method for maximizing the area under the receiver operating characteristic curve was 0.852. The sensitivity and specificity of the threshold values for the detection of unfavorable-risk cancer were 95 and 36%, respectively. By using the threshold values, 100 (25%) of the subjects with no/favorable-risk cancer could have avoided undergoing biopsies, with a <5% risk of missing the detection of unfavorable-risk cancer. These individualized prostate-specific antigen threshold values may be useful for determining an indication of prostate biopsy for elderly men to avoid overdiagnosis of prostate cancer and reduce unnecessary biopsy.

Effect of the Ratio of Resected Tissue in Comparison With the Prostate Transitional Zone Volume on Voiding Function Improvement After Transurethral Resection of Prostate

Few studies exist correlating the extent of tissue resected with symptom improvement after transurethral resection of prostate (TURP). This study evaluated the effect of the ratio of resected tissue in comparison with the transitional zone volume (TZV) on improvement of voiding symptoms and flow rate. A total of 263 patients who underwent TURP from January 2001 to June 2008 were included in this retrospective study. TURP efficacy was assessed at 6 months using International Prostate Symptom Score (IPSS) and uroflowmetry. Patients were then stratified into 2 subgroups according to resection ratio (volume of resected tissue/TZV); individuals with resection ratio<50% (group A) and ≥50% (group B). The 2 groups were compared with regard to prostate volume, TZV, preoperative and postoperative IPSS, quality of life (QoL), peak flow rate (Qmax), and postvoid residual (PVR). Similar analyses were performed according to prostate volume (small [<40 g] vs large [≥40 g]). Of these individuals, 85 (32.3%) met the criteria for group A, and 178 (67.7%) for group B. There were no statistically significant differences in age, prostate volume, TZV, preoperative IPSS, QoL score, Qmax, and PVR. After TURP, there was no significant difference of IPSS, QoL score, Qmax, and PVR between the 2 groups. After stratification according to prostate size, the differences in clinical variables were not significant according to resection ratio. Resection ratio had no effect on post-TURP clinical improvement. These results suggest that complete prostate adenoma resection may not be essential.

Factors Affecting the Improvement of the Initial Peak Urinary Flow Rate after Transurethral Resection of the Prostate or Photoselective Vaporization of the Prostate for Treating Benign Prostatic Hyperplasia

PurposeWe evaluated the factors that affect the improvement of the initial peak flow rate after transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) patients by using noninvasive tools.MethodsOne hundred and twenty seven BPH patients who had undergone TURP or PVP between January 2005 and May 2009 were evaluated. They were divided into 2 groups: the postoperative initial peak urinary flow rate (Qmax) was less than 10 mL/sec (Group 1; n=37, TURP=11, PVP=26) and more than 10 mL/sec (Group 2; n=90, TURP=41, PVP=49). We confirmed the patients' preoperative check lists. The check list were the international prostate symptom score (IPSS), the quality of life score, a past history of acute urinary retention (AUR), body mass index and/or pyuria, the serum prostate-specific antigen (PSA) level and the prostate volume, the prostate transitional zone volume and prostatic calcification. The initial Qmax was measured at the outpatient clinic one week after discharge.ResultsThe improvement rate was not significant difference between the TURP group (78.8%) and the PVP group (65.3%). The efficacy parameters were the IPSS-storage symptom score, the prostate volume, the PSA level and a past history of AUR. The IPSS-storage symptom scores of Group 1 (12.3±3.3) was higher than those of Group 2 (10.5±1.7). The prostate volume of Group 2 (42.3±16.6 g) was bigger than that of Group 1 (36.6±7.8 g). The PSA level of Group 2 (3.8±2.6 ng/mL) was higher than that of Group 1 (2.6±2.6 ng/mL). A past history of AUR in Group 1 (35.1%) was more prevalent than that of Group 2 (15.6%).ConclusionsThe non-invasive factors affecting the initial Qmax after TURP or PVP were the IPSS-storage symptom score, the prostate volume and a past history of AUR. Accordingly, in patients who have a higher IPSS-storage symptom score, a smaller prostate volume and a history of AUR, there might be a detrimental effect on the initial Qmax after TURP or PVP. These factors might also be used as long-term prognostic factors.

Initial Biopsy Outcome Prediction in Korean Patients-Comparison of a Noble Web-based Korean Prostate Cancer Risk Calculator versus Prostate-specific Antigen Testing

We developed and validated a novel Korean prostate cancer risk calculator (KPCRC) for predicting the probability of a positive initial prostate biopsy in a Korean population. Data were collected from 602 Koreans who underwent initial prostate biopsies due to an increased level of prostate-specific antigen (PSA), a palpable nodule upon digital rectal examination (DRE), or a hypoechoic lesion upon transrectal ultrasound (TRUS). The clinical and laboratory variables were analyzed by simple and multiple logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was computed to compare its performance to PSA testing alone. Prostate cancer was detected in 172 (28.6%) men. Independent predictors included age, DRE findings, PSA level, and prostate transitional zone volume. We developed the KPCRC using these variables. The AUC for the selected model was 0.91, and that of PSA testing alone was 0.83 (P < 0.001). The AUC for the selected model with an additional dataset was 0.79, and that of PSA testing alone was 0.73 (P = 0.004). The calculator is available on the website: http://pcrc.korea.ac.kr. The KPCRC improved the performance of PSA testing alone in predicting the risk of prostate cancer in a Korean population. This calculator would be a practical tool for physicians and patients.

Prostatic volume and volume-adjusted prostate-specific antigen as predictive parameters for prostate cancer patients with intermediate PSA levels

The object of the study was to examine the usefulness of volume-adjusted prostate-specific antigen (PSA) parameters for prediction of prostate cancer in the patients with intermediate PSA levels. The subjects were 235 patients with intermediate PSA levels (range: 4.1-10.0 ng/ml) whose prostate volume (PV) and prostate transition zone volume (TZV) were evaluated between August 1996 and April 2004. PSA, PV, TZV, PSA density (PSAD) (PSA/PV) and PSA transition zone density (PSATZD) (PSA/TZV) were assessed with the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Simple and multivariate logistic regression analyses were used to analyze the odds ratios of age, PSA, PSAD, PSATZD, PV, TZV, digital rectal examination (DRE) and transrectal ultrasonography (TRUS) findings. Fifty-five patients (23.4%) of 235 patients had biopsy-proven prostate cancer. The univariate analysis revealed significant differences in the mean values of age, PSAD, PSATZD, PV, TZV and DRE between the patients with cancer and the non-cancer patients. The ROC curve analysis revealed that PV, TZV, PSAD and PSATZD had significant predictive values as compared with that of PSA. However, there was no difference in AUC between them. The stepwise logistic regression analysis showed that the age, PV, PSATZD and DRE had significant predictive values, and that PSATZD had the most predictive power. In conclusion, both PSAD and PSATZD had significant predictive values in discriminating prostate cancer. Furthermore, the stepwise logistic regression analysis showed that PSATZD had the strongest predictive value.

AUTONOMIC NERVOUS SYSTEM OVERACTIVITY IN MEN WITH LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA

The relationship of lower urinary tract symptoms (LUTS) to objective measures of benign prostatic hyperplasia (BPH), such as prostatic size and urodynamic parameters, has proved difficult to evaluate. Studies in animal models of BPH suggest that autonomic nervous system (ANS) activity is an important determinant of prostatic growth. We investigated the relationship of ANS activity to LUTS as well as to objective measures of BPH in men with BPH. This study was done in 3,047 men with LUTS secondary to BPH during screening for enrolment at 1 center in a large, multicenter, double-blind, placebo controlled trial designed to assess the long-term effects of medical therapy on BPH progression. A total of 38 men with an American Urological Association (AUA) symptom score of 8 or greater and a maximum urinary flow rate of 4 to less than 15 ml per second had ANS activity assessed based on heart rate, blood pressure, the response to circulatory stress via tilt table, and plasma and urinary catecholamine. These ANS related variables were compared with subjective measures of LUTS (AUA symptom score, quality of life score and BPH impact index), overall health measures (RAND 36-Item Health Survey) and objective clinical measures of BPH (prostate size, post-void residual volume and maximum urinary flow rate). Pearson correlation coefficients were calculated for each ANS variable vs each LUTS and BPH variable. These correlations were further assessed using stepwise multiple regression analysis to determine which BPH and LUTS variables were independently related to the ANS variable. Relationships that were identified as significant then underwent final multiple regression analysis together with control variables to exclude known extraneous and confounding influences on ANS activity. After adjusting for extrinsic influences on ANS activity AUA symptom score (p <0.01), BPH impact index score (p <0.001) and quality of life score (p <0.05) were independently associated with the change in systolic and diastolic blood pressure 1 and 5 minutes after tilt. Additionally, prostate transition zone volume (p <0.001) and the RAND 36-Item Health Survey mental subscale score (p <0.001) were independently associated with the plasma norepinephrine response to tilt. ANS hyperactivity is significantly associated with the most commonly used measures of LUTS, namely AUA symptom score and BPH impact index score. Also, the magnitude of the serum norepinephrine increase after tilt predicts prostate size. These relationships persist after controlling for extrinsic influences on ANS activity. The current findings may have important implications concerning the pathophysiological mechanisms underlying or influencing LUTS as well as its optimal treatment in men with BPH.

An Artificial Neural Network for Prostate Cancer Staging when Serum Prostate Specific Antigen is 10 NG./ML. or Less

An artificial neural network was developed to improve the prediction of pathological stage before radical prostatectomy based on variables available at biopsy and clinical parameters. We used the prospectively accrued European prostate cancer detection data base to train an artificial neural network to predict pathological stage in 200 men with serum prostate specific antigen (PSA) 10 ng./ml. or less who underwent radical prostatectomy. Variables included in the artificial neural network were patient age, serum PSA, free-to-total PSA ratio, PSA velocity, transrectal ultrasound calculated total and transition zone volumes with their associated PSA parameters (transition zone PSA density and PSA density), digital rectal examination and Gleason score on biopsy. Two multilayer perceptron neural networks were trained on the remaining variables. Data on the 200 patients were divided randomly into a training set, a test set and a validation or prospective set. Overall classification accuracy of the artificial neural network was 92.7% and 84.2% for organ confined and advanced prostate cancer staging, respectively. For preoperatively predicting local versus advanced stage the area under the ROC curve for the artificial neural network was significantly larger (0.91) compared with logistic regression analysis (0.83), Gleason score (0.69), PSA density (0.68), prostate transition zone volume (0.63) and serum PSA (0.62) (all p <0.01). The artificial neural network outperformed logistic regression analysis and correctly predicted pathological stage in more than 90% of the validation patients with serum PSA 10 ng./ml. or less based on clinical, biochemical and biopsy data. In the future artificial neural networks may represent a significant step for improved staging of prostate cancer when counseling patients referred for radical prostatectomy or other curative treatments.