Prostatic Hyperplasia Research Articles

Rapidly Progressive Cognitive Decline and Varicella Zoster Blisters Associated With Teprotumumab in 2 Patients With Graves’ Orbitopathy

Introduction: Teprotumumab, an IGF-1R antagonist, was approved for treatment of Graves’ orbitopathy (GO) in 2020. Common side effects include nausea, diarrhea, muscle spasms, hearing impairment, dysgeusia, headache, dry skin, infusion reactions, and hyperglycemia. We report here 2 cases of unexpected adverse effects. Patient #1 is a 76-year-old man with Graves’ disease diagnosed in 2018, treated with methimazole 2.5mg every other day. His GO manifestations included diplopia, proptosis, and exposure keratopathy. Past history was significant for hypertension, hyperlipidemia, and prostate hyperplasia. He lived independently and walked several miles daily. Teprotumumab was initiated. Between the 4th and 5th doses, his family noted 6-weeks of rapidly progressive cognitive decline characterized by behavioral changes, confabulation, memory deficit, delirium/delusions/mania. He was admitted to neurology service and subsequent doses held. Lumbar puncture was unremarkable. TFT was normal before, during and after stopping teprotumumab. Thyroid antibodies were notable for elevated TSI but normal thyrotropin receptor Ab and TPO/TgAb. Other labs: IL2, IL6, ESR, CRP, heavy metals, IgG, IgM, SARS-CoV-2 IgM/IgGs, vitamins B1, B6, and B12 were all normal. His most recent repeat TPO Ab was 14 IU/mL (increased from <6), TgAb 18.4 IU/mL (increased from <1.0). EEG showed no epileptiform activity. Head MRI/MRA showed cerebral amyloid angiopathy without stenosis or aneurysms in the intracranial arterial vasculature. Symptoms progressed with IV glucocorticoids and IV Ig therapy. He subsequently underwent plasmapheresis with resolution of symptoms. Patient #2 is a 48-year-old man with Graves’ disease and GO diagnosed in 2018, initially treated with methimazole and subsequently underwent total thyroidectomy in 2019. Patient is euthyroid on levothyroxine. Ophthalmic signs and symptoms included significant proptosis and retrobulbar pain. He was started on teprotumumab infusions. After his 4th dose, he noted painful vesicles in a dermatomal distribution on his right posterior thigh. Direct fluorescent antibody stain was positive for varicella zoster, and rashes resolved with valacyclovir therapy. Discussion: Paraneoplastic/autoimmune encephalitis syndromes can be associated with antibodies to neuronal cell surfaces/synaptic proteins and may occur in the presence or absence of cancer. The incidence of varicella-zoster virus infection is associated with the immune status of the patient, disease-related immunocompromised, or iatrogenic immunosuppression, with age being the major risk factor for 90% of adult cases. This could be incidental, or related to other disorders, or perhaps teprotumumab may have activated auto-immunity. The exact mechanisms for rapidly progressive cognitive decline and shingles remains unclear.

Normal Basal Epithelial Cells Stimulate the Migration and Invasion of Prostate Cancer Cell RM-1 by TGF-β1/STAT3 Axis in vitro.

AimBasal epithelial cells are absent in distant prostate cancer. This study aimed to investigate whether basal epithelial cells could suppress migration and invasion of prostate cancer cells to become a new treatment strategy for prostate cancer.Main MethodsBasal epithelial cells were identified by immunofluorescence with anti-p63. Wound healing assays or transwell assays were used to explore the effects of basal epithelial cells, TGF-β1, SB431542 (inhibitor of TGF-β type I receptor) or stattic (inhibitor of phosphorylated STAT3) on migration or invasion of mouse prostate cancer cell (RM-1). Concentration of TGF-β1 was measured by ELISA assay. HE staining was used to investigate cell morphology. Immunocytochemistry with anti-p63 was used to identify basal epithelial cells. Levels of STAT3, p-STAT3 (Ser727) and proteins associated with EMT were measured with Western blot assay. Cell proliferation was measured with MTT or CCK8 assay.ResultsNormal basal epithelial cells acquired from mouse prostate were specific to anti-p63 and more than 90%. Basal epithelial cells and RM-1 could both secrete TGF-β1. Basal epithelial cells and TGF-β1 promoted the migration and invasion of RM-1 through changing the cell morphology and up-regulating expression of ZEB1, N-cadherin, vimentin, snail and p-STAT3 (Ser727), at the same time down-regulating E-cadherin of RM-1. SB431542 strongly suppressed migration, invasion as well as the expressions of EMT relevant proteins and p-STAT3 (Ser727) of co-cultured RM-1. In addition, stattic suppressed proliferation, migration and invasion of non-treated RM-1 and co-cultured RM-1.ConclusionOur study suggests that normal basal epithelial cells might stimulate the migration and invasion of RM-1 by TGF-β1/STAT3 axis which could be suppressed by inhibitor of TGF-β receptor and inhibitor of p-STAT3. So, basal epithelial cells might not become a treatment strategy for prostate cancer, but our results could provide some researching references for other diseases which include basal epithelial cells such as prostatic intraepithelial neoplasia, prostatic hyperplasia, cervical cancer, or urinary bladder cancer.

CLINICAL ANALYSIS OF 95 CASES OF PERCUTANEOUS CYSTOSTOMY

(Introduction) Percutaneous cystostomy is a standard urological procedure; however, very few reports have focused on the many cases of this procedure performed in Japan. We analyzed the background of the procedure and its approach as well as the incidence of its complications at our institution. (Material and methods) We examined 95 patients who underwent percutaneous cystostomy between April 2010 and March 2019. A comparative analysis was conducted for each type of procedure performed. Furthermore, cases that experienced accidental catheter extraction before the first catheter replacement were analyzed, and the three patient groups were compared based on the type of procedure performed and cases that needed another operation. (Result) The indications for cystostomy were urethral stricture (56.3%), neuropathic bladder (13.5%), and prostatic hyperplasia (11.5%). The complications included hemorrhage, peritoneal injury, urinary tract infection, and catheter damage caused by a puncture needle. The overall complication rate was 10.5%. Based on type of the procedure performed, the incidence of hemorrhage was found to be as high as 25% in patients who underwent the procedure using a cannula puncture needle. Accidental catheter extraction before the first catheter replacement occurred most frequently in patients treated with Seldinger technique (17.0%). The rate of complications including accidental catheter extraction ranged from 25.0% to 25.4% among the three groups. (Conclusion) We prefer the Seldinger technique for the first placement of the cystostomy catheter because of its low rate of hemorrhage, but a cannula puncture needle may also be used by using exploratory puncture if vascular damage and accidental catheter extraction are avoided.

A Pilot Study of18F-DCFPyL PET/CT or PET/MRI and Ultrasound Fusion Targeted Prostate Biopsy for Intra-Prostatic PET-Positive Lesions.

ObjectivesThe purpose of this study was to evaluate the feasibility and diagnostic performance of prostate-specific membrane antigen (PSMA) based 18F-DCFPyL PET/CT-ultrasound (PET/CT-US) or PET/MRI-ultrasound (PET/MRI-US) fusion targeted biopsy for intra-prostatic PET-positive lesions.MethodsFrom April 2018 to November 2019, we prospectively enrolled 55 candidates to perform PET/CT-US or PET/MRI-US fusion targeted biopsies for solitary PET-positive prostate lesions (two to four cores/lesion). The positive rates of prostate cancer based on patients and biopsy cores were calculated respectively. With reference to the pathological results of biopsy cores, the MR signal characteristics in the area of the PET-positive lesion were analyzed for the patients who underwent PET/MRI.ResultsA total of 178 biopsy cores were taken on the 55 patients. One hundred forty-six biopsy cores (82.0%, 146/178) from 51 (92.7%, 51/55) patients were positive for prostate cancer; 47 (85.5%, 47/55) were clinically significant prostate cancer. It is noteworthy that nine patients underwent both 18F-DCFPyL PET/CT and PET/MRI examinations; the seven patients with prostate cancer showed abnormal MR signal in the area of the PET-positive lesion while the other two patients with prostatic hyperplasia and prostatitis showed normal MR signal in the area of the PET-positive lesion.ConclusionThis study indicated that 18F-DCFPyL PET/CT-US or PET/MRI-US fusion targeted prostate biopsies may be valuable for prostate cancer diagnosis and have a high detection rate of clinically significant prostate cancer for PET-positive lesions. PET/MR can rule out some false PET-positive lesions, which may potentially reduce unnecessary prostate biopsies.

Control Performance Evaluation of Serial Urology Manipulator by Virtual Prototyping

Prostatic hyperplasia and tumor are common diseases, and the minimally invasive surgery inserting the instruments through the urethra into the prostate is commonly conducted. Taking the robotic manipulator for such surgery into consideration, this paper analyses the workspace of the end effector, and proposes the distribution error of the fixed point and the tracking error of manipulator end effector on the cone bottom surface of the workspace as the basis for control implementation of the manipulator. The D-H coordinate system of the manipulator is established and the trajectory planning of the end effector in the Cartesian space is carried out. The digital model was established, and dynamics simulation was performed in Solidworks and Matlab/Simulink environment to guide the manipulator design. Trajectory mapping and synchronization control between virtual model and the actual manipulator are realized based on digital twin technique. The virtual manipulator can reflect the real-time state of the manipulator with data interaction by comparing the dynamics simulation results with the motor current values obtained by experiment. Experiment was carried out with PD feedback control and Newton–Euler dynamics based feedforward control to get the trajectory tracking characteristic of each motor, errors of the fixed point and tracking performance of the end effector of the manipulator. The results show that compared with PD feedback control, feed forward control implementation can achieve a reduction of 30.0% in the average error of the fixed point of the manipulator and a reduction of 33.3% in the maximum error.

Improvement in Near Vision Following Silodosin Treatment in Patients With Lower Urinary Tract Symptoms.

PurposeThe objective of this study was to investigate the change in near visual function after the administration of oral silodosin to patients with lower urinary tract symptoms (LUTS).MethodsThis prospective study included treatment-naive patients who were scheduled to start treatment with silodosin for LUTS. A comprehensive ophthalmological evaluation including the near vision and the automated pupillometry was performed at baseline and after 3 months of silodosin treatment. For subjective assessment of near visual ability and satisfaction, a Near Activity Visual Questionnaire-10 (NAVQ-10) was also used at the same time (higher scores indicating worse quality).ResultsOf 23 patients enrolled in this study, 15 continued with silodosin (8 mg once daily) treatment for 3 months and completed a follow-up evaluation. The mean age of participants was 60.4±8.4 years. Distant visual acuity and spherical error were unchanged after silodosin treatment. However, near vision acuity (logMAR) was improved after treatment (right, 0.47±0.36 vs. 0.38±0.39, P=0.018; left, 0.41±0.37 vs. 0.31±0.34, P=0.068; both, 0.27±0.26 vs. 0.21±0.27, P=0.043). Pupil size under room light decreased significantly in both eyes (right, 3.77±0.60 vs. 3.16±0.58, P=0.001; left, 3.72±0.80 vs. 3.21±0.75, P=0.002). The Rasch scale at NAVQ-10 improved from 54.7±9.9 to 48.5±11.2 (P=0.004).ConclusionsThis preliminary study demonstrated that highly selective alpha-1A adrenergic receptor antagonists such as silodosin improve near visual acuity and quality in patients with LUTS/benign prostatic hyperplasia. Decrease in pupil size caused by inhibition of adrenergic alpha 1 mediated contraction of iris dilator muscle is a possible mechanism underlying improved near vision.

Periodontitis Exacerbates Benign Prostatic Hyperplasia through Regulation of Oxidative Stress and Inflammation.

Epidemiological studies demonstrate that men with periodontitis are also susceptible to benign prostatic hyperplasia (BPH) and that periodontal treatment can improve the prostatic symptom. However, molecular links of this relationship are largely unknown. The goal of the current study was to elucidate the effects of experimental periodontitis on the hyperplasia of prostate and whether oxidative stress and inflammation participated in this process. For this purpose, ligature-induced periodontitis, testosterone-induced BPH, and the composite models in rats were established. Four weeks later, all the rats were sacrificed and the following items were measured: alveolar bone loss and histological examination of periodontal tissues were taken to assess the establishment of periodontitis model, prostate index and histological examination of prostate tissues were taken to test the establishment of the BPH model, inflammatory cytokines in plasma were assessed, and Bax/Bcl-2 proteins related to cell apoptosis were analyzed via western blot analysis. To further investigate whether oxidative stress participates in the aggravation of BPH, in vitro models were also conducted to measure the production of intracellular reactive oxygen species (ROS) and hydrogen peroxide (H2O2) concentration. We found that simultaneous periodontitis and BPH synergistically aggravated prostate histological changes, significantly increased Ki67 proliferation, and reduced apoptosis in rat prostate tissues. Also, our results showed that periodontal ligation induced increased Bcl-2 protein expression, whereas Bax expression was decreased in BPH rats than in normal rats. Compared with the control group, periodontitis and BPH both significantly enhanced inflammatory cytokine levels of TNF-α, IL-6, IL-1β, and CRP. Furthermore, Porphyromonas gingivalis lipopolysaccharide induced enhanced generation of intracellular expression of ROS and H2O2 in BPH-1 cells. Our experimental evidence demonstrated that periodontitis might promote BPH development through regulation of oxidative stress and inflammatory process, thus providing new strategies for prevention and treatment of BPH.

Study on the Expression and Mechanism of Tumour-Derived IgG in Prostate Cancer

ABSTRACT The lack of effective treatment for CRPC is the leading cause of death in prostate cancer patients. However, CRPC exhibits high immunoglobulin (Ig) expression. Ig, one of the most important immune molecules, is a unique product of B lymphocytes and plays an important role in immune defence. The expression of IgG in malignant tumour tissues is positively correlated with the degree of tumour malignancy, and IgG promotes the proliferation and metastasis of tumour cells. A retrospective analysis of immunohistochemical pathological tissue sections collected from 50 patients with prostate cancer (PC) and 40 patients with prostatic hyperplasia from Yichun City People’s Hospital between May 2010 and May 2014 was conducted. The experimental group had an average age of 70.8 ± 2.7 years (58˜86 years old) and included 12 patients with low Ig expression and 38 with high Ig expression. The survival time of the former group was significantly longer than that of the latter group. In vitro, the expression of IgG protein and mRNA in PC3 cells was detected by Western blotting and RT-PCR. IgG expression was knocked down via small interfering RNA (siRNA), and the migration and invasion abilities of PC3 cells were assessed using a Transwell assay. Positive expression of tumour-derived IgG in prostate cancer can indicate poor prognosis of patients with prostate cancer, and high IgG expression promotes the invasion and metastasis of prostate cancer. Thus, IgG may become a therapeutic target in prostate cancer.

A clinical study on surgical causes of Hematuria.

Introduction:Hematuria is a clinical sign and symptom that every individual would have a worst nightmare and invokes a physician to carefully evaluate possible causes of hematuria. It may be medical or surgical causes. A thorough examination is required to exact the primary pathology. As such, a study on hematuria in North east India is not sufficiently researched or published.Material & methods:Here we present an observational study in our institution on that very topic. A study was done purely on surgical causes of hematuria on symptomatic patients. It was done on the inpatient and outpatient basis in Assam Medical College, Dibrugarh during the period of 2016–2019. Total 43 patients were evaluated, who came with symptomatic hematuria.Results:Out of 43 cases of symptomatic hematuria, 34 were male and 9 were females patients. Carcinoma urinary bladder was the commonest cause of hematuria, followed by BPH, urolithiasis, carcinoma prostrate, carcinoma upper urinary tract, etc.Conclusion:Benign prostatic hyperplasia was found to be the most common benign cause and carcinoma bladder was the commonest malignant cause of hematuria.

Highly compact sized circular microstrip patch antenna with partial ground for biomedical applications

Miniaturized patch antenna is mostly preferable for biomedical applications like stroke imaging, tumor detection in breast cancer to characterize malignant, benign, and normal breast tissues etc. In this paper highly compact sized circular microstrip patch antenna with partial ground is being developed on FR4 substrate with 13 × 12 × 1.6 mm3 dimensions of compact and simple structure. The simulated results of the proposed antenna show, that the antenna can be used for the biomedical applications. The proposed antenna obtained good results with a high bandwidth of 11.2 GHz and with a moderate directivity and gain of 3.2 dBi and 1.2 dBi each. This antenna can also be used for therapeutic applications based on local heating: prostate hyperplasia, heart and other tissue ablation, angioplasty which come under Ultra-wideband microwave radar techniques. The design is verified using CST Studio for simulation.

Comparison of Amino Acid Metabolisms in Normal Prostate (PNT-1A) and Cancer Cells (PC-3)

Prostate cancer is the second most common cancer in men. Prostate-specific antigen (PSA) levels, commonly used in the diagnosis of prostate cancer, are increased in both malign and benign conditions, such as prostate hyperplasia (BPH) and prostatitis. Thus, more specific markers are urgently needed to discriminate between prostate cancer and benign diseases of the prostate. The purpose of this study is to examine both the intracellular and extracellular free amino acid profiles of metastatic prostate cancer cells (PC-3), normal prostate cells (PNT-1A), and metabolic changes (e.g., pH). In this study, cancer and normal cells were incubated in the appropriate medium. Then, the cells were collected and lysed in a cold medium. Finally, intracellular and extracellular free amino acid profiles were analyzed using the liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Extracellular metabolites were analyzed via blood gas measurements, including pH, CO₂, and O₂. We determined that intracellular prostate cancer cells include high amounts of glutamic acid, aspartic acid, glutamine, alpha aminobutyric acid, glycine, and proline, while cancer cells mostly use hydroxyproline, serine, alpha aminobutyric acid, ethanolamine, and valine from the extracellular medium. It was also determined that the extracellular pH of cancer cells is more acidic than that of normal cells, and normal cells have higher levels of Ca⁺, Cl^-, and Glu. In this study, we found that group amino acids have significant potential in prostate cancer pathogenesis; therefore, they have potential usefulness as a biomarker in the diagnosis of prostate cancer.

АНАЛИЗ ХРОНИЧЕСКОЙ ЗАБОЛЕВАЕМОСТИ ПИЛОТОВ ГРАЖДАНСКОЙ АВИАЦИИ

Retrospective health analysis was performed having the data from 211 airline pilots and 168 flight mechanics with symptoms of chronic neurosensorybradyacusia gathered in the period from 2015 to 2020. There were 2 control groups. One group consisted of bus drivers comparable to pilots in terms of acoustic environment and work intensity. The other group included power station operators working in standard acoustic environments and doing intensive work. The investigation revealed a statistical difference between the pilots and control groups in the rates of cardiovascular diseases (22.45 vs. 7.08 and 71.19 in the control groups), respiratory diseases (0.18 vs. 0.07 and 0.44), digestive diseases (17.13 vs. 1.90 and 154.21), musculoskeletal (15.44 vs. 15.44 and 254.97), neural, urogenital diseases (11.49 vs. 0.79 and 167.61). In comparison with the control groups, pilots were at a higher risk of cerebral atherosclerosis (13.79 vs. 2.81 and 67.58), essential hypertension (14.25 vs. 1.01 and 200.78), spinal osteochondrosis (3.00 vs. 0.39 and 22.95), prostate hyperplasia (2.29 vs. 0.11 and 48.82) and chronic prostatitis (3.43 vs. 0.20 and 57.65). Also stated was a statistical difference in the medium of chronic diseases at the retirement age in pilots and flight mechanics in comparison with the control members: (6 (4–8) pilots, 6 (4.5–8.0) flight mechanics, 3 (1–5) drivers, 2 (1–3) operators; р&lt; 0.05).

Clinical implications of using questionnaires in elderly men with urinary disorders

Introduction. The frequency of lower urinary tract symptoms (LUTS) progression associated with prostatic hyperplasia in elderly men is increasing despite improvements in early diagnosis methods and the emergence of new drugs. Questionnaires are used to assess the patient's condition on primary admission and to monitor the effectiveness of medical procedures to diagnose the severity of LUTS in clinical practice.Purpose of the study. To compare the effectiveness of LUTS diagnosis in elderly men using different scales: the International Prostate Symptom Index (IPSS) and the Visual Prostate Symptom Scale (VPSS) for differential analysis of the cognitive impairment degree.Materials and methods. The study included 56 men, residents of the Trans-Baikal Territory, over the age of 50 with LUTS of varying severity. All patients completed the VPSS and IPSS questionnaires (IPSS1) independently. Subsequently, the IPSS questionnaire (IPSS2) was completed in cooperation with the urologist. Additionally, respondents were questioned using the Montreal Cognitive Assessment Scale (MoCa-test) to determine the degree of dementia and other cognitive impairments.Results. All patients were divided into 3 groups after analyzing the results of the MoCa test: I — patients with signs of dementia, II — with cognitive impairments, III — no cognitive impairments. The predicted differences were obtained when comparing the results of IPSS1 / IPSS2: the greatest differences were in the patients of the first group (76.47%; p &lt; 0.05), the smallest in the third group (12.5%; p &gt; 0.05); there was an increase in the severity of LUTS with self-completion of questionnaires (IPSS1). When evaluating a similar indicator on the VPSS questionnaire, compared with a more objective response with the participation of a physician (IPSS2), statistically significant differences were not obtained in all groups of participants.Conclusion. The dependence of the objectivity of filling out the questionnaires for the diagnosis of LUTS on the severity of cognitive impairments and the age of the respondents was revealed. A reliable correlation of VPSS indicators with the indices of the validated IPSS scale was established. The new questionnaire may be in demand in the clinical practice of a urologist to assess the degree of LUTS in elderly men, as an alternative to the generally accepted IPSS scale, especially in patients with age-related dementia and other cognitive impairments.

Therapeutic effects of losartan on prostatic hyperplasia in spontaneously hypertensive rats

AimsWe investigated the therapeutic effects of losartan, an angiotensin II type 1 receptor blocker, on prostatic hyperplasia in spontaneously hypertensive rats (SHRs). Main methodsMale SHRs (age, 36 weeks) were perorally treated with losartan (3 or 10 mg·kg−1) or vehicle once daily for 18 weeks. Age-matched Wistar Kyoto rats (WKYs) were used as vehicle-treated controls (n = 8). The effects of losartan were evaluated by analyzing prostate weight, blood pressure, and prostatic blood flow. The tissue malondialdehyde (MDA), interleukin-6 (IL-6), and basic fibroblast growth factor (bFGF) levels were measured. Histological analysis for the ventral prostate involved hematoxylin and eosin staining and TdT-mediated dUTP nick-end labeling (TUNEL) assay. Key findingsCompared to the vehicle-treated WKYs, the vehicle-treated SHRs had significantly higher prostate weight, prostate weight/body weight ratio (PBR), blood pressure, glandular epithelial area, and tissue MDA, IL-6, and bFGF levels in the ventral prostate and lower prostatic blood flow. Treatment with losartan caused significant recovery of blood flow and decreased PBR and glandular epithelial area as well as tissue MDA, IL-6, and bFGF levels in the SHR ventral prostate without affecting blood pressure. High-dose losartan significantly decreased blood pressure and increased TUNEL-positive cells in the ventral prostate in SHRs. SignificanceChronic losartan treatment could ameliorate prostatic hyperplasia via recovery of reduced prostatic blood flow and induction of apoptosis in the ventral prostate in SHRs. Losartan might have therapeutic effects on not only hypertension but also prostatic hyperplasia in humans.

MiR-96-5p, miR-134-5p, miR-181b-5p and miR-200b-3p heterogenous expression in sites of prostate cancer versus benign prostate hyperplasia\u2014archival samples study

MicroRNAs are involved in various pathologies including cancer. The aim of the study was to assess the level of expression of miR-96-5p, -134-5p, -181b-5p, -200b-3p in FFPE samples of prostate cancer, adjacent cancer-free tissue, and benign prostatic hyperplasia. Samples of 23 FFPE prostate cancer and 22 benign prostatic hyperplasias were dissected and HE stained. Compartments of tumor tissue and adjacent healthy glandular tissue were isolated from each sample using Laser Capture Microdissection. Total RNA was isolated from dissected tissues. Expression of miR-96-5p, miR-134-5p, 181b-5p, and miR-200b-3p was determined by real-time RT-qPCR method. The expression of miR-200b-3p was significantly higher in cancerous prostate: both in adenocarcinomatous glands and in the adjacent, apparently unaffected glands compared to BPH samples. The expression of miR-181b-5p was lower in in both prostate cancer tissues and adjacent tissue compared to BPH samples. Expression of miR-96-5p and miR-134-5p was lower in prostate cancer tissues compared to BPH. Levels of miR-96-5p, miR-134-5p, and 181b-5p negatively correlated with the Gleason score. Given further studies, miR-96-5p, miR-134-5p and especially miR-200b-3p and miR-181b-5p may differentiate BPH and PC.

PROSPECTIVE STUDY OF TRUCUT BIOPSY VS FINE NEEDLE ASPIRATION CYTOLOGY OF PROSTATE IN PATIENT WITH PROSTATE SPECIFIC ANTIGEN &gt; 4NG/ML.

It is often difficult for the examining finger in the rectum to decide whether the enlargement is due to benign or malignant or inflammatory conditions of the prostate such as chronic inflammation, both specific and nonspecific prostatic abscess, calculi, benign hyperplasia and carcinoma of prostate. Prostatic obstruction must be diagnosed as early as possible so that definite treatment can be instituted prevent the sequele of the obstruction. Determination of histological nature of lesion is the only positive method of establishing a definitive diagnosis. A suitable and simple technique of obtaining biopsy material and aspirational material from prostate for definitive diagnosis is essential. Aim of this study was Comparision between Trucut biopsy and FNAC in lesions of prostate gland. A prospective comparative study of Trucut biopsy vs FNAC of prostate in patient with prostate specific antigen &gt; 4 ng/ml, was conducted among 50 patient. Patients were chosen for the study on the basis of clinical history and DRE. Patient with LUTS symptoms and enlarged Prostate on DRE were further subjected to PSA screening through blood examination at pathology lab and ultrasound for measuring prostatic volume at Radiology Department. Following consent, patients are subjected for FNAC and Trucut biopsy under local anaesthesia. Out of 50 patients, by Trucut biopsy diagnosed case of BPH are 30,Ca.Prostate are 5 and chronic prostitis are 5, while by FNAC diagnosed case of BPH are 15 , Ca.prostate are 3 and chronic prostitis are 2. In developing countries like India FNAC is more preferable due to its simplicity ,very low cost and least invasiveness and very less or no complication. Overall present studies suggest that Trucut biopsy is superior to FNAC in diagnosis and management of prostate diseases.&#x0D; Keywords: FNAC, Trucut biopsy, Lesions of prostate gland.

Interpretation of Prostatic Biopsy at a tertiary care centre

Introduction: Worldwide prostatic carcinoma is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. Prostate-specific antigen (PSA), digital rectal examination, and transrectal ultrasound are the tools most commonly used to screen for prostate cancer. Prostatic biopsy is most often preceded by abnormalities found on digital rectal examination (DRE) or serum prostate specific antigen (S.PSA) elevation. This study was planned to know proportion of malignant and benign lesions in histopathologic examination for prostatic lesions in patient who attend OPD/IPD and to analyze the usefulness of serum PSA & ultrasound examination by histopathological confirmation. Methods: Patients visited to urology department with urinary incontinence and other complaints were evaluated which includes clinical history, signs and symptoms. Rectal examination of patients was done. Serum PSA level and prostatic biopsy were sent of those who were suspected for prostatic disease. Prostate biopsy was obtained by using any one of the following method 1.Transurethral resection biopsy 2. Transrectal biopsy Trucut biopsy. Results: Out of 300 cases of prostatic biopsy 265 (88.33%) are benign and 35 (11.66%) cases are malignant lesions. Out of 300 cases, 191 (63.66%) are pure benign prostatic hyperplasia, 48(16%) are BPH with chronic prostatitis and 11(3.66%) are BPH with severe prostatitis. Out of 35 cases of prostatic carcinoma 33 (94.28%) cases are adenocarcinoma and 2 cases (5.71%) are transitional cell carcinoma. Out of 262 cases with clinically benign lesions, 258 cases proved benign histopathologically but 4 cases (1.52%) are diagnose malignant. 151 patients have S.PSA less than 4 ng/ml, out of 151, 149 turned to be benign on histopathological examination. 52 patient have S.PSA above 10 ng/ml, out of these 52 cases, 29 have malignancy in HPE examination. Out of 278 cases diagnosed as benign isoechoic by ultra sonography 262 cases have benign lesion on histologic diagnosis and 16 have malignant lesion. Out of 22 cases diagnosed as malignant (hypoechoic asymmetrical) by ultrasonographicaly 19 proved malignant histologically. Conclusion: The results of this study indicate that transrectal ultrasound, serum prostate specific antigen and digital rectal examination were good tool to differentiate between malignant and benign lesions of prostate. Proportion of malignancies are quiet significant in prostatic lesions and increased with age. Key words: Prostae, Malignancy, Biopsy, PSA, DRE

Ultrasound prostate parameters as predictors of successful trial without catheter after acute urinary retention in patients ongoing medical treatment for benign prostatic hyperplasia: a prospective multicenter study.

BACKGROUND Alpha-blockers (ABs) are considered the standard treatment after initial management of acute urinary retention (AUR). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients previously on treatment with ABs and 5alpha reductase inhibitors (5ARI). Aim of our study was to investigate prostate ultrasound parameters as predictors of TWOC outcome. METHODS A consecutive series of patients, on treatment with ABs alone or in combination with 5ARI, experiencing AUR were prospectively enrolled. Clinical data (i.e.age, body mass index (BMI) and IPSS), urinary ultrasound features including hydronephrosis, prostate volume-TRUS, bladder wall thickness (BWT), intravesical prostatic protrusion more than 10mm (IPP≥10) were related to TWOC outcome performed seven days after AUR. A binary logistic regression analysis was computed to detect predictors of successful TWOC. RESULTS Overall,143 patients with a median age of 72 years (IQR 64-77) were enrolled. Seventy-mine patients (54%) with smaller prostate volume (59(IQR 52-74) Vs 99 (IQR 74-125) ml, p=0.008) and a thinner BWT (5(IQR 4.8-5.2) Vs 5.2 (4.7-5.5) mm p=0.001) recovered voiding at TWOC. IPP≥10 was less common in patients with successful TWOC 11(14%) vs 33(52%), p=0.001. On multivariate analysis, IPP<10mm (OR 6.10 (95%CI 2.61-14.20), p=0.001), lower IPSS (OR 0.95 (95%CI 0.89-0.99), p= 0.045), smaller TRUS (OR 0.96 (95%CI 0.95-0.97), p=0.001), thinner BWT OR 1.23 (95%CI 0.73-0,92) p=0.001were the independent predictors of voiding recovery. CONCLUSIONS Patients receiving medical treatment for BPH and experiencing AUR still present a 54% probability of a successful TWOC. Ultrasound may help to identify patients with successful TWOC.

Prostatic Urethral Lift for Benign Prostatic Hyperplasia

Prostatic urethral lift (PUL) is an increasingly popular, minimally invasive, outpatient procedure for patients with benign prostatic hyperplasia. PUL

Tissue Expression of HSP27 in Prostate Cancer Is Correlated with the Aggressivity of Cancer in the Algerien Population

Background: Prostate Cancer (CaP) is the second most common cancer in men and a major public health problem. Clinical outcomes at diagnosis are heterogeneous and difficult to predict, so predictive and diagnostic markers are needed. Heat shock proteins (HSPs) such as HSP27 are highly regulated in several malignant tumors. Basal HSP27 levels in most human tissues are low compared to high levels in tumors. Methods: In this work, we evaluated, in subjects with CaP, the levels of expression of the HSP27 antigen in tumor tissues and its association with tumor aggressiveness. The Immunohistochemical (IHC) method was used to determine the expression of HSP27 in 58 prostate cancer tissues and 4 prostate hyperplasia (BPH). Results: Tissue levels of HSP27 were significantly higher in patients with CaP than in BPH (QSM = 153.43±0; P&lt;0.0001). In the case of aggressive cancer (Gleason score &gt; 7), we found a very significant increase in HSP27 protein (QSM = 169.73±84.26; P&lt;0.0001) compared to non-aggressive cancer (Gleason score ≤ 7) (QSM = 123.92± 91.36; P&lt;0.001). Conclusion: Overexpression of HSP27 in the tissues of patients with CaP compared to patients with BPH may be of diagnostic and/or prognostic interest and maybe a therapeutic target in patients with prostate cancer.