共查询到20条相似文献，搜索用时 31 毫秒
1.
K.H. Tijani C.C. Anunobi A.O. Adeyomoye T.O. Alabi A.O. Lawal N.O. Akanmu R.W. Ojewola O.O. Soriyan 《The African Journal of Urology》2017,23(1):14-19
Introduction
In Western and Asian literature, the measurement of percentage free prostate specific antigen (%fPSA) has been known to enhance the predictive role of total prostate specific antigen (tPSA) in early prostate cancer (Ca-P) detection. Relationship between the tPSA and Ca-P are known to be influenced by race. To the best of our knowledge, the relationship between %fPSA and Ca-P has not been studied in sub-Saharan Africa using current established biopsy protocol.Objective
To evaluate the usefulness of %fPSA in indigenous West African men and determine the appropriate cut-off values that may be used as indication for prostate biopsy in men with tPSA of 4–10 ng/ml.Subjects and methods
A total 169 consecutive patients with tPSA of 4–10 ng/ml with non-suspicious findings on digital rectal examination (DRE) had a transrectal ultrasound (TRUS) guided 10-core prostate biopsy. The technique of PSA analysis was the Access hybritech assay technique using the Beckman's Access autoimmuno analyser. The rates of prostate cancer in different %fPSA ranges were evaluated. Receiver operating characteristic curve (ROC) was used to evaluate the efficiency of %fPSA in the diagnosis of prostate cancer.Results
A reduction %fPSA was associated with a higher detection rate of Ca-P. There was a 62% prevalence of Ca-P with %fPSA ≤ 10% while there was a zero prevalence in patients with fPSA above 20%. At a %fPSA cut off of 20% the sensitivity and specificity were 100% and 45%, respectively. Using the ROC curve, the area under the curve (AUC) was 0.76 while the ROC decision plot showed that a %fPSA cut off 15% was associated with the highest ability to discriminate between benign and malignant diseases.Conclusion
The %fPSA is an effective discriminating tool in determining the need for prostate biopsy in indigenous West African men with PSA 4–10 ng/ml. A cut off of 15% was associated with the highest performance. 相似文献2.
3.
Rita Faria Marta O. Soares Eldon Spackman Hashim U. Ahmed Louise C. Brown Richard Kaplan Mark Emberton Mark J. Sculpher 《European urology》2018,73(1):23-30
Background
The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI).Objective
To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer.Design, setting, and participants
Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS).Intervention
Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer.Outcome measurements and statistical analysis
Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs.Results and limitations
The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92–0.98] vs 0.91 [95% CI 0.86–0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer.Conclusions
An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines.Patient summary
We found that, under certain assumptions, the use of multiparametric magnetic resonance imaging first and then up to two transrectal ultrasound-guided biopsy is better than the current clinical standard and is good value for money. 相似文献4.
David Robinson Hans Garmo Ingela Franck Lissbrant Anders Widmark Andreas Pettersson Adalsteinn Gunnlaugsson Jan Adolfsson Ola Bratt Per Nilsson Pär Stattin 《European urology》2018,73(4):502-511
Background
There are no conclusive results from randomized trials on radiotherapy (RT) versus radical prostatectomy (RP) for prostate cancer. Numerous observational studies have suggested that RP is associated with a lower risk of prostate cancer death, but whether results have been biased due to limited adjustments for confounding factors is unknown.Objective
To compare the risk of prostate cancer death after RT versus RP.Design, setting, and participants
Nationwide population-based observational study of men in the Prostate Cancer data Base Sweden 3.0 who had undergone RT or RP between 1998 and 2012.Outcome measurements and statistical analysis
Prostate cancer deaths were compared. Hazard ratios (HRs) were calculated in Cox regression models, including clinical T stage, M stage, Gleason grade group, serum levels of prostate-specific antigen, proportion of biopsy cores with cancer, mode of detection, comorbidity, age, educational level, and civil status. Period analysis with left truncation was performed.Results and limitations
Primary treatment was RT or RP for 41 503 men. Treatment effect was associated with disease severity. In univariate analysis of RT versus RP, risk of prostate cancer death was higher after RT—low- and intermediate-risk cancer, HR 1.82 (95% confidence interval [CI]: 1.53–2.16), and high-risk cancer, HR 1.57 (95% CI: 1.33–1.85). After full adjustment in period analysis, this difference between the treatments was attenuated—low- and intermediate-risk cancer, HR 1.24 (95% CI: 0.97–1.58), and high-risk cancer, HR 1.03 (95% CI: 0.81–1.31). Confounding remained due to nonrandom allocation to treatment.Conclusions
In comparison with previous studies, the difference in prostate cancer mortality after RT and RP was much smaller.Patient summary
The difference in prostate cancer mortality after contemporary radiotherapy and radical prostatectomy was small in contrast to previous studies, indicating that potential side effects should be more emphasized when selecting treatment. 相似文献5.
6.
Jibril O. Bello 《The African Journal of Urology》2018,24(1):79-82
Introduction
Children, adolescents and young adults in tropical Africa occasionally presents to the emergency department with testicular torsion. However, no estimates of the burden of the condition is available and there is also sparse evidence of a seasonal variation in incidence.Objective
To determine the incidence and seasonality of the condition in a Nigerian community.Subjects and methods
A retrospective review of incident cases of testicular torsion occurring in a typical tropical sub-Saharan African community between January 2011 and December 2016 was performed. Incidence rates were calculated and trend analysis performed to evaluate for seasonality.Results
Twenty-three patients were seen during the study period and the average annual incidence of testicular torsion among ‘at risk’ males (<40 years) was 2.7/100,000. Testicular salvage rate was 81%. Cases occurred 91% higher than average during the cold season (November to January). Trend analysis revealed a significant seasonal difference in the number of cases seen (p = 0.045) and Post Hoc tests (Tukey) further showed that this is attributable to the seasonal difference between the cold season and the warmer early rains period (p = 0.036).Conclusion
The burden of testicular torsion found in the studied tropical sub-Saharan community is comparable to other regions of the world and seasonal variation in incidence does occur with a significant increase in cases during the cold season. 相似文献7.
Sigrid Carlsson Melissa Assel David Ulmert Axel Gerdtsson Jonas Hugosson Andrew Vickers Hans Lilja 《European urology》2017,71(1):46-52
Background
Current prostate cancer screening guidelines conflict with respect to the age at which to initiate screening.Objective
To evaluate the effect of prostate-specific antigen (PSA) screening versus zero screening, starting at age 50–54 yr, on prostate cancer mortality.Design, setting, and participants
This is a population-based cohort study comparing 3479 men aged 50 yr through 54 yr randomized to PSA-screening in the Göteborg population-based prostate cancer screening trial, initiated in 1995, versus 4060 unscreened men aged 51–55 yr providing cryopreserved blood in the population-based Malmö Preventive Project in the pre-PSA era, during 1982–1985.Outcome measurements and statistical analysis
Cumulative incidence and incidence rate ratios of prostate cancer diagnosis, metastasis, and prostate cancer death.Results and limitations
At 17 yr, regular PSA-screening in Göteborg of men in their early 50s carried a more than two-fold higher risk of prostate cancer diagnosis compared with the unscreened men in Malmö (incidence rate ratio [IRR] 2.56, 95% confidence interval [CI] 2.18, 3.02), but resulted in a substantial decrease in the risk of metastases (IRR 0.43, 95% CI 0.22, 0.79) and prostate cancer death (IRR 0.29, 95% CI 0.11, 0.67). There were 57 fewer prostate cancer deaths per 10 000 men (95% CI 22, 92) in the screened group. At 17 yr, the number needed to invite to PSA-screening and the number needed to diagnose to prevent one prostate cancer death was 176 and 16, respectively. The study is limited by lack of treatment information and the comparison of the two different birth cohorts.Conclusions
PSA screening for prostate cancer can decrease prostate cancer mortality among men aged 50–54 yr, with the number needed to invite and number needed to detect to prevent one prostate cancer death comparable to those previously reported from the European Randomized Study of Screening for Prostate Cancer for men aged 55–69 yr, at a similar follow-up. Guideline groups could consider whether guidelines for PSA screening should recommend starting no later than at ages 50–54 yr.Patient summary
Guideline recommendations about the age to start prostate-specific antigen screening could be discussed. 相似文献8.
Brent K. Hollenbeck Samuel R. Kaufman Phyllis Yan Lindsey A. Herrel Tudor Borza Florian R. Schroeck Bruce L. Jacobs Ted A. Skolarus Vahakn B. Shahinian 《European urology》2018,73(4):491-498
Background
Prostate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment.Objective
To assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer.Design, setting, and participants
A retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free.Intervention
Urologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility.Outcome measurements and analysis
Use of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences.Results
Among men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p < 0.001). Patients managed in groups with IMRT ownership (n = 5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p < 0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p < 0.001) and overall treatment (53% vs 44%, p < 0.001) were more likely in groups with ownership than in those without, respectively.Conclusions
Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality.Patient summary
We assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient. 相似文献9.
Introduction
Prostate cancer is one of the commonest, malignancies affecting elderly males. Prostatic basal cell carcinoma, (PBCC) accounts for less than 0.01% of all prostate cancers.Observation
A 32-year-old man presented with hematuria and lower urinary tract symptoms. Clinical examination showed hard, nodular enlarged prostate with multiple penile hard nodules. His prostate-specific antigen (PSA) level was 0.91 ng/mL. Histopathological examination of the fingerguided prostate biopsy revealed a malignancy with features of basal cell carcinoma. Further imaging studies were performed and metastases were found in both lungs, penis, pelvic lymph nodes and right ischium.Conclusion
The current case highlights PBCC as a diagnostic pitfall which presented in a young adult with a normal PSA level. 相似文献10.
11.
Daniel D. Sjoberg Andrew J. Vickers Melissa Assel Anders Dahlin Bing Ying Poon David Ulmert Hans Lilja 《European urology》2018,73(6):941-948
Background
Prostate-specific antigen (PSA) screening reduces prostate cancer deaths but leads to harm from overdiagnosis and overtreatment.Objective
To determine the long-term risk of prostate cancer mortality using kallikrein blood markers measured at baseline in a large population of healthy men to identify men with low risk for prostate cancer death.Design, setting, participants
Study based on the Malmö Diet and Cancer cohort enrolling 11 506 unscreened men aged 45–73 yr during 1991–1996, providing cryopreserved blood at enrollment and followed without PSA screening to December 31, 2014. We measured four kallikrein markers in the blood of 1223 prostate cancer cases and 3028 controls.Outcome measurements and statistical analysis
Prostate cancer death (n = 317) by PSA and a prespecified statistical model based on the levels of four kallikrein markers.Results and limitations
Baseline PSA predicted prostate cancer death with a concordance index of 0.86. In men with elevated PSA (≥2.0 ng/ml), predictive accuracy was enhanced by the four-kallikrein panel compared with PSA (0.80 vs 0.73; improvement 0.07; 95% confidence interval 0.04, 0.10). Nearly half of men aged 60+ yr with elevated PSA had a four-kallikrein panel score of <7.5%, translating into 1.7% risk of prostate cancer death at 15 yr—a similar estimate to that of a man with a PSA of 1.6 ng/ml. Men with a four-kallikrein panel score of ≥7.5% had a 13% risk of prostate cancer death at 15 yr.Conclusions
A prespecified statistical model based on four kallikrein markers (commercially available as the 4Kscore) reclassified many men with modestly elevated PSA, to have a low long-term risk of prostate cancer death. Men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy.Patient summary
Men with elevated prostate-specific antigen (PSA) are often referred for prostate biopsy. However, men with elevated PSA but low scores from the four-kallikrein panel can be monitored rather than being subject to biopsy. 相似文献12.
Introduction
Late recurrence of renal cell carcinoma is rare and mostly of clear cell histology. The objective of our study was to report our case of late recurrence of papillary RCC.Observation
Seventy year old female patient was presented to our department, more than 7 years post radical nephrectomy for moderate risk RCC. The presentation was persistent localized abdominal pain and proved by immunohistochemistry to be a metastatic papillary RCC.Conclusion
Any symptomatic patient, with history of previous radical nephrectomy, should have recurrent cancer considered in his differential diagnosis. 相似文献13.
Introduction
Perivascular epithelioid cell tumors (PEComas) of the bladder are infrequent localisation of this mesenchymal cancer with uncertain malignant behavior.Case report
We report the case of a 74?years old women who was diagnosed a malignant PEComa of the bladder. She necessited radical cystectomy with orthotopic ileocaecal pouch reconstruction. Histology and immunohistochemistry confirmed the diagnosis of a malignant PEComa of the bladder. We evaluate the literature cases to adjust the prognosis criteria.Conclusion
Evolution and prognosis evaluation remain hard and could necessitate a radical surgery. Prognosis criteria for the bladder PEComas have to be clarified. 相似文献14.
Melissa Assel Anders Dahlin David Ulmert Anders Bergh Pär Stattin Hans Lilja Andrew J. Vickers 《European urology》2018,73(6):961-967
Background
Lead time (LT) is of key importance in early detection of cancer, but cannot be directly measured. We have previously provided LT estimates for prostate cancer (PCa) using archived blood samples from cohorts followed for many years without screening.Objective
To determine the association between LT and PCa grade at diagnosis to provide an insight into whether grade progresses or is stable over time.Design, setting, and participants
The setting was three long-term epidemiologic studies in Sweden including men not subject to prostate-specific antigen (PSA) screening. The cohort included 1041 men with PSA of 3–10 ng/ml at blood draw and subsequently diagnosed with PCa with grade data available.Outcome measurements and statistical analysis
Multivariable logistic regression was used to predict high-grade (Gleason grade group ≥2 or World Health Organization grade 3) versus low-grade PCa at diagnosis in terms of LT, defined as the time between the date of elevated PSA and the date of PCa diagnosis with adjustment for cohort and age.Results and limitations
The probability that PCa would be high grade at diagnosis increased with LT. Among all men combined, the risk of high-grade disease increased with LT (odds ratio 1.13, 95% confidence interval [CI] 1.10–1.16; p < 0.0001), with no evidence of differences in effect by age group or cohort. Higher PSA predicted shorter LT by 0.46 yr (95% CI 0.28–0.64; p < 0.0001) per 1 ng/ml increase in PSA. However, there was no interaction between PSA and grade, suggesting that the longer LT for high-grade tumors is not simply related to age. Limitations include the assumption that men with elevated PSA and subsequently diagnosed with PCa would have had biopsy-detectable PCa at the time of PSA elevation.Conclusions
Our data support grade progression, whereby following a prostate over time would reveal transitions from benign to low-grade and then high-grade PCa.Patient summary
Men with a longer lead time between elevated prostate-specific antigen and subsequent prostate cancer diagnosis were more likely to have high-grade cancers at diagnosis. 相似文献15.
Ahmed Adam Frederik Claassen Ashraf Coovadia Tim de Maayer Margaret Fockema Joy Fredericks Errol Gottlich Lizelle Grindell Mohamed Haffejee John Lazarus Cecil Levy Kgomotso Mathabe Mignon McCulloch Glenda Moonsamy Evelyn Moshokoa Shingai Mutambirwa Haroun Patel André van der Merwe Piet Hoebeke 《The African Journal of Urology》2018,24(1):1-13
Introduction
Enuresis (or Nocturnal Enuresis) is defined as discreet episodes of urinary incontinence during sleep in children over 5 years of age in the absence of congenital or acquired neurological disorders.Recommendations
Suggestions and recommendations are made on the various therapeutic options available within a South African context. These therapeutic options include; behavioural modification, pharmaceutical therapy [Desmospressin (DDAVP), Anticholinergic (ACh) Agents, Mirabegron (β3-adrenoreceptor agonists), and Tricyclic Antidepressants (TCA)], alternative treatments, complementary therapies, urotherapy, alarm therapy, psychological therapy and biofeedback. The role of the Bladder Diary, additional investigations and Mobile Phone Applications (Apps) in enuresis is also explored. Standardised definitions are also outlined within this document.Conclusion
An independent, unbiased, national evaluation and treatment guideline based on the pathophysiological subcategory is proposed using an updated, evidence based approach. This Guideline has received endorsement from the South African Urological Association, Enuresis Academy of South Africa and further input from international experts within the field. 相似文献16.
Introduction
Emphysematous pyelonephritis is a life threatening infection of the kidney and peri-renal tissues. We present an interesting and rare presentation of this condition which is the first such case to be reported in literature.Observation
A 52-year-old diabetic presented with a right groin swelling. On evaluation and imaging he had right emphysematous pyelonephritis with a peri-renal collection tracking down till the scrotum, mimicking a groin swelling. Management involved broad spectrum antibiotics and aggressive drainage and debridement.Conclusion
Emphysematous pyelonephritis is a rare but important differential diagnosis for a groin swelling where early diagnosis and aggressive management is necessary. 相似文献17.
18.
P.O. Areo A.E. Omonisi P.T. Adegun J.A. Omotayo S.A. Dada J.O. Esho T.V. Asowo 《The African Journal of Urology》2017,23(2):139-143
Introduction
Advanced prostate cancer usually presents with lower urinary tract symptoms associated with features of malignancy on digital rectal examination. The bones, the liver, and the lungs are the common sites of metastasis for advanced prostate cancer.Observation
We report an atypical case of a 56- year old Nigerian male who had bowel obstruction, multiple peripheral and intra-abdominal lymphadenopathies. The patient had a normal initial urological evaluation but his diagnostic conundrum was resolved to be prostate cancer by immuno-histochemistry of the cervical lymph node biopsy and he did well after antiandrogen monotherapy. 相似文献19.
Introduction
Pelvi uretric junction obstruction (PUJO) is the most common cause of hydronephrosis in the neonatal period and is also the commonest cause of a palpable abdominal mass in a child. Giant hydronephrosis (GH) in a neonate is rare.Observation
We are reporting a unique case of neonatal giant hydronephrosis which was managed successfully.Conclusion
Establishing the correct diagnosis of GH is necessary to plan appropriate surgical intervention. 相似文献20.
Martijn G. Schouten Marloes van der Leest Morgan Pokorny Martijn Hoogenboom Jelle O. Barentsz Les C. Thompson Jurgen J. Fütterer 《European urology》2017,71(6):896-903