Detection of prostate cancer and changes in prostate-specific antigen (PSA) six months after surgery for benign prostatic hyperplasia in patients with elevated PSA

OBJECTIVE: To evaluate early postoperative results of patients with elevated prostate-specific antigen (PSA) levels who underwent surgery due to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: 64 patients who had lower urinary tract symptoms (LUTS), normal digital rectal examinations (DRE), elevated PSA levels and prostate biopsies reported as being benign pathologically in specimens obtained by transrectal ultrasound (TRUS)-guided biopsies, were included in the study. Patients were assessed in accordance with PSA density, free/total PSA ratio and uroflowmetric studies. Patients had no cancer pre- and postoperatively (according to operative specimens). Six months postoperatively, 32 patients were accepted for re-evaluation for all PSA parameters, routine tests and prostatic biopsies. RESULTS: 64 patients with a mean age of 66.8 (SD 6.72) were included in the study. Total PSA average value was 14.38 (SD 7.49) ng/ml. Free PSA average value was 2.11 (SD 1.43) ng/ml. Average PSA density and free/total PSA ratio were 25.19 SD (14.12) ng/ml/cm(3) and 14.53% (SD 5.35%) respectively. 56 patients had BPH, 7 had chronic prostatitis and 1 had prostatic intraepithelial neoplasia (PIN) preoperatively with biopsies. Re-biopsy of the patient with PIN was reported as BPH. In pathologic examination with resected tissues postoperatively, 49 patients had BPH, 14 had chronic prostatitis and 1 had PIN. In the sixth month, average values of free/total PSA were 0.45 (SD 0.26) and 3.71 (SD 4.96) ng/ml respectively. Average PSA density and free/total PSA ratio were 12.41 (SD 13.8) ng/ml/cm(3) and 19.59% (SD 10.33%) respectively. There were significant decreases in PSA densities (p < 0.001) and increases in free/total PSA ratios (p = 0.004). Seven patients still had elevated PSA levels 6 months postoperatively. Three of 7 patients were reported as chronic prostatitis. One of them was indicated as prostatic carcinoma who was reported as PIN preoperatively. All other patients were stated as BPH at re-biopsies. CONCLUSION: If pretreatment biopsies are negative and operative specimens are also benign in patients with high PSA values, these patients can be followed up like usual BPH patients, but long-term follow-up is still unclear.     

Do all patients with high‐grade prostatic intraepithelial neoplasia on initial prostatic biopsy eventually progress to clinical prostate cancer?

OBJECTIVE: To assess the clinical outcome of patients with a diagnosis of high-grade prostatic intraepithelial neoplasia (PIN) on initial prostatic biopsy, with a minimum of 5 years of follow-up, as such patients are at greater risk of having prostate cancer on subsequent biopsy. PATIENTS AND METHODS: Between November 1992 and October 1998, 21 patients were identified as having PIN on their initial transrectal ultrasonography-guided prostate biopsy. None of these patients had a focus of cancer on the initial biopsy. Their medical data were reviewed retrospectively to determine the natural history of PIN in these patients. Patients who were not identified as having cancer were followed every 6-12 months with prostate-specific antigen (PSA) testing and digital rectal examinations (DRE). RESULTS: A mean (range) of 7 (2-8) cores were taken at initial biopsy; the mean age of the patients was 63 (53-77) years and mean PSA level 9.1 (4.9-17.6) ng/mL. Six patients had an abnormal DRE at presentation. A mean of 8 (7-10) cores were obtained on the second biopsy; six patients were diagnosed with cancer, with a mean Gleason score of 6 (5-7), while three were diagnosed with persistent PIN. These three patients had a third prostate biopsy which showed cancer of Gleason score 6 in one and benign prostatic hyperplasia in two. After a mean follow-up of 72.2 (60-84) months, none of the remaining 12 patients was diagnosed with clinically significant cancer. Five of these patients went on to a third prostate biopsy, with no evidence of cancer. One patient died from unrelated causes during this period. CONCLUSION: This study affirms our current practice of following patients with PIN conservatively if a second or third subsequent prostate biopsy is negative. Whether PIN is a premalignant lesion or merely a lesion associated with cancer needs to be addressed in multicentre studies with a follow-up of > 10 years.     

经直肠超声引导下“10+X”点法前列腺穿刺活检术在PSA值介于4～20ng/ml之间患者前列腺癌诊断中的价值

目的 探讨经直肠超声引导下“10 +X”前列腺穿刺活检术在PSA值介于4 ～20ng/ml之间患者前列腺癌诊断中的价值。方法 回顾性分析226例血清PSA值介于4～20ng/ml之间疑似前列腺癌患者临床资料,所有患者均行经直肠超声引导下前列腺穿刺术活检。结果 前列腺癌47例,前列腺增生158例,前列腺炎11例,前列腺上...     

f/t PSA比值、PSA密度、PSA移行带密度在tPSA灰区前列腺偶发癌诊断中的意义

【摘要】 目的： 探讨血清f/t PSA比值、PSA密度、PSA移行带密度在tPSA位于灰区时前列腺癌诊断中的意义。方法： tPSA位于4～10ng/ml的前列腺增生患者112例,术前经前列腺穿刺活检均证实为前列腺增生,行TURP术后病理证实21例为前列腺偶发癌患者。回顾性分析该21例前列腺偶发癌患者和其余前列腺增生患者间的血清f/t PSA比值、PSA密度、PSA移行带密度,并进行统计学分析,以了解其在tPSA灰区前列腺偶发癌诊断中的意义。结果：前列腺偶发癌组和BPH组血清f/t PSA比值分别为0.13±0.03、0.21±0.04;PSAD分别为0.20±0.05 ng/ml2 、0.12±0.04 ng/ml2;PSATZ分别为0.38±0.06 ng/ml2 、 0.21±0.05 ng/ml2;两组在以上三个检测指标上差异具有显著性(P<0.05)。以0.15 ng/ml2为截断点则PSAD 灵敏性为76.115%,特异性为69.146%;以0.35 ng/ml2为截断点则PSATZ 灵敏性为60.642%,特异性为93.943%。结论：f/t PSA比值、PSAD、PSATZ对前列腺偶发癌的诊断具有重要价值,其中尤以PSATZ更具预测价值。     

Clinical usefulness of high sensitive PSA with endocrine treatment in the prostate cancer

PURPOSE: Prostate-specific antigen (PSA) is an important tool in the diagnosis of prostatic cancer and also is an essential marker for observing the therapeutic effect and clinical course. Though the conventional limit of PSA measurement was 0.1 ng/ml it recently became possible to determine PSA by means of a 3rd generation high sensitive PSA assay with the detectable sensitivity as highly as 0.003 ng/ml. The clinical utilities of this highly sensitive PSA was examined in this study. METHODS AND SUBJECT: In 51 patients with fresh untreated prostatic cancer diagnosed during the period from November 1996 to March 2001 and for whom endocrine therapy was selected. PSA (Tandem-R) and highly sensitive PSA (DPC Imrise 3rd generation kit) were determined at regular intervals. RESULTS: According to the nadir for highly sensitive PSA, the subjects were divided into 3 groups, Group, the nadir below 0.01 ng/ml, Group II, the nadir between 0.01 and 0.1 ng/ml and Group III, the nadir of 0.1 ng/ml or more. PSA failure was observed in none of Group I (0/10), 3 out of 19 cases in Group II and 10 out of 21 cases in Group III. Highly sensitive PSA failure was observed 3 out of 11 cases in Group I and 5 out of 19 cases in Group II. Furthermore highly sensitive PSA failure subsequently progressed to PSA failure in 3 cases. CONCLUSION: As for the clinical usefulness of highly sensitive PSA in patients with prostatic cancer during endocrine therapy. We propose that; (1) Nadir of highly sensitive PSA might be useful as an index for predicting the prognosis of prostatic cancer and (2) highly sensitive PSA failure could predict a possible recurrence of cancer relatively earlier than PSA failure.     

The patients less than 50 years: is there a need to lower the PSA cutoff point?

The aim of this study was to study the incidence and possibility of prostate cancer detection in patients <50 years with prostate-specific antigen (PSA) <4 ng ml(-1). Between January 2006 and January 2008, 355 men were subjected to radical cystoprostatectomy for bladder cancer. Among 162 cases without pathological prostatic invasion, random selection of two groups with serum PSA <4 ng ml(-1) was carried out. According to the age, 56 pairs in group A (< or =50 years) and group B (>50 years) were selected randomly. The resected prostate glands of each group were examined pathologically for evidence of prostatic adenocarcinoma. Correlation of the age groups with pathological findings, PSA, digital rectal examination (DRE) and body mass index (BMI) was carried out. The mean age of the groups (A and B) was 46.17+/-4.3 and 58.42+/-4.4 years, respectively. Mean PSA was 1.9+/-1.6 ng ml(-1) in group A and 2+/-1.6 ng ml(-1) in group B. Prostatic adenocarcinoma was detected in 1.8 and 10.7% in groups A and B, respectively (P=0.051). High-grade prostatic intraepithelial neoplasia (PIN) was higher in group A than in group B, 11 cases versus 4 (P=0.079). DRE was not significantly associated with pathological findings in those groups of patients. BMI was directly correlated with PSA in patients of group A (mean: 27.8+/-4.4, CC: 0.5, P=0.015), but not with that of group B (mean: 27.5+/-4.8, CC: 0.16, P=0.239). A new PSA cut-off point for younger patients (<50 years) is warranted. Serum PSA 2 ng ml(-1) is recommended as a cut-off point to screen and biopsy advice for nonsymptomatic patients <50 years. High-grade PIN was higher among the younger patients with low serum PSA, which indeed needs a meticulous follow-up.     

Clinical management of prostatic intraepithelial neoplasia as diagnosed by extended needle biopsies

OBJECTIVE: To examine the results of the clinical management of patients with high-grade prostatic intraepithelial neoplasia (PIN), as diagnosed by extended needle biopsies. PATIENTS AND METHODS: The clinical data were reviewed from a cohort of 387 men who underwent > or = 10 core prostate needle biopsies between 1 January 1996 and 31 December 1997 by one urologist (W.C.D.). Two study groups were identified; the first comprised 47 patients with only high-grade PIN and the second was a control group of 137 patients with only benign findings on their biopsies. Those patients with cancer, atypia or a prostatic biopsy with fewer than 10 cores were excluded. The clinical and histological data were evaluated. The criteria for re-biopsy were two successive increases in prostate specific antigen (PSA) level or any change in the findings on digital rectal examination (DRE). All patients were monitored at 6-12 month intervals. RESULTS: Of the 387 patients, 46% had normal findings, 5.2% had atypia, 12.6% had PIN alone, 15 (3.9%) had PIN plus atypia, 6.7% had PIN plus cancer and 32.3% had cancer. There was no significant difference between the PIN and control groups in age, DRE, PSA level, prostate size (by ultrasonography), free testosterone level, number of the cores and time of follow-up (median 34.8 and 36.6 months for the PIN and control groups, respectively). Of the PIN and control groups, 21 (45%) and 43 (31%) respectively had at least one re-biopsy. Five patients (24%) in the PIN and one (2.3%) in the control group developed cancer (P = 0.0124). All these patients had organ-confined disease and were found to have either Gleason scores 3 + 3 or 3 + 4 on surgical specimens. There was no correlation between the original location of PIN and the location of subsequent malignancy. CONCLUSIONS: Patients with one set of extended needle biopsies with high-grade PIN should be followed clinically every 6-12 months, and it may be safe to reserve repeat biopsy for those with changes in PSA level and/or in the DRE.     

Effect of inflammation and benign prostatic enlargement on total and percent free serum prostatic specific antigen

OBJECTIVE: To analyze the influence of inflammation and benign prostatic enlargement on total and percent free serum prostatic specific antigen (PSA). PATIENTS AND METHODS: Total and free PSA serum levels were determined in 284 patients with no evidence of cancer in the sextant ultrasound-guided biopsy. Double antibody immunoradiometric assay Tandem and Tandem free PSA were used. Benign tissue without inflammation was found in 23.2% of the patients (group 1), while in 68.3%, it was associated with chronic prostatitis (group 2) and with acute prostatitis in 8.4% (group 3). RESULTS: Median serum PSA was 7.8 ng/ml in group 1, 6.7 ng/ml in group 2 and 6.4 ng/ml in group 3, p>0.05. Median percent free PSA was 14.1, 15.6 and 16.4%, respectively, p>0.05. Multiple linear regression analysis showed that prostatic size was the only significant contributor to serum PSA concentration. Moreover, total PSA and prostatic size contributed significantly to the percent free serum PSA. Inflammation had no significant influence on total or percent free serum PSA. CONCLUSION: Inflammation has an important prevalence in cancer-free prostatic biopsy specimens. It seems to have no significant influence on total and percent free serum PSA. However, prostatic size seems to be the major contributor.     

HGPIN患者血清PSA特征及首次穿刺活检HGPIN阳性针数对再次活检PCa检出率的影响

目的 考察高级别前列腺上皮内瘤(HGPIN)患者血清前列腺特异抗原(PSA)特征和首次穿刺活检HGPIN阳性针数对再次活检前列腺癌(PCa)检出率的影响.方法 使用穿刺活检法对551例疑似为PCa患者进行诊断.依据诊断结果比较各组间血清PSA水平以及首次穿刺活检HGHN阳性针数组间再次活检PCa检出率.结果 活检结果显示37.0％(204/551)患者为PCa患者,43.6％(240/551)患者为良性前列腺增生(BPH),10.7％ (59/551)患者为低级别前列腺上皮内瘤(LGPIN),48例患者为HGPIN,其中阳性针数为1针者28例、2针者13例、3针及以上者7例.PCa、阳性针数为2针以上患者PSA水平显著高于BPH患者(P＜0.05).BHP患者复诊PCa检出率12.8％(6/47)、LGPIN患者10.3％ (3/29)、单灶HGPIN患者10.7％ (3/28)、双灶HGHN患者23.1％ (3/13)、三灶及以上HGPIN患者57.1％ (4/7).结论 单灶型HGPIN血清PSA水平较低,多灶型HGPIN血清PSA水平升高,且多灶型HGPIN再次活检时PCa检出率增加.     

An evaluation of the immunochemical measurement of prostatic acid phosphatase and prostatic specific antigen in carcinoma of the prostate

Serum prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) were evaluated with double monoclonal radioimmunoassays. In 250 patients with prostatic cancer the normal limits were as follows: PSA 0.1-2.7 ng/ml, and PAP 1.09 +/- 0.45 ng/ml (mean +/- SD). In 91 untreated patients with non-metastatic tumours, 42.8% had PSA greater than 10 ng/ml and 18.6% had PAP greater than 2 ng/ml. In 60 untreated patients with metastatic disease PSA was greater than 10 ng/ml in 91.7%; PAP was greater than 2 ng/ml in 65%. In prolonged remission PSA was generally less than 5 ng/ml and PAP less than 2 ng/ml. Longitudinal studies of 2-4 years showed the independence of these markers and a higher correlation of changes in the PSA level and clinical status than given by parallel PAP measurements. In non-metastatic disease, PSA greater than 10 ng/ml at presentation, with or without a coincidentally raised PAP, carried an increased risk of progression within 2 years.     

Longitudinal PSA changes in men with and without prostate cancer: assessment of prostate cancer risk

BACKGROUND: To determine longitudinal PSA changes over a period of 10 years in patients with and without prostate cancer. METHODS: Serial PSA measurements performed over 10 years were evaluated in 353 men who eventually developed prostate cancer and in 2.462 participants of a screening program without prostatic malignancy. RESULTS: In men with cancer, mean tPSA increased from 2.28 ng/ml at 10 years before diagnosis to 6.37 ng/ml at the time of postive biopsy (PSA velocity: 0.409 ng/ml/year). PSA velocity was significantly associated with Gleason scores and pathologic stage. In the benign group (n=2.462), mean tPSA increased from 1.18 to 1.49 ng/ml over a period of 10 years (PSA velocity of 0.03 ng/ml/year). Of the subjects with tPSA levels of 2 ng/ml or less, 2 years prior to cancer diagnosis, 11.4% had tPSA values of more than 4 ng/ml at the time of biopsy. Of the 972 men with tPSA below 1 ng/ml 2 years before the most recent measurement was obtained, 966 (99.4%) had no evidence of prostate cancer 2 years later, while six were found to have malignancies (0.6%). CONCLUSIONS: Longitudinal PSA changes in men with and without prostate cancer are significantly different. Annual testing may not be required in men with baseline tPSA levels of 1 ng/ml or below, whereas in patients with levels higher than 1 ng/ml, it seems to be indicated because of the significant percentage of men presenting with tPSA levels of more than 4 ng/ml two years later.     

Prostatic cancer developing after transurethral resection of the prostate for benign prostatic hyperplasia

From January 1993 to June 1998, 319 cases were histopathologically diagnosed as prostatic cancer. In 7 of the 319 cases (2.2%) transurethral resection of the prostate (TUR-P) had been performed and a diagnosis of benign prostatic hyperplasia had been made with the resected specimens. The interval between TUR-P and the diagnosis of prostatic cancer ranged from 22 months to 15 years. All the cases showed an elevation of the prostate specific antigen (PSA) value (6.4-399 ng/ml, Tandem-R: RIA) at the time of cancer diagnosis. In 2 cases, PSA was measured in cancer screening. The clinical stage was stage B1 in 2 cases, stage B2 in 2 and D2 in 3. Only one case had been regularly followed-up after TUR-P, in which cancer was diagnosed by needle biopsy 22 months after TUR-P, because of the sustained high PSA values. Since most of such patients have an advanced stage of prostate cancer, it is of importance to have periodical follow-up examinations after TUR-P. The measurement of PSA appears the most reliable means in this way.     

冷冻治疗单病灶前列腺癌12例临床分析

目的 评价冷冻疗法治疗局限性单病灶前列腺癌的近期疗效及安全性。 方法 局限性单病灶前列腺癌患者12例,均经穿刺活检证实。术前PSA 4.2～14.9 ng/ml,平均9.7 ng/ml。Gleason评分5分3例,6分5例,7分4例。临床分期T1c期8例、T2a期4例。均行超声引导下经会阴前列腺局灶冷冻治疗。术后1年内每3个月、以后每6个月复查PSA。PSA最低值≥1.0 ng/ml或PSA达最低值后上升＞2.0 ng/ml者再次行前列腺穿刺活检排除肿瘤复发。 结果 12例手术顺利,手术时间( 82±26) min,均未输血。术后住院(5±2)d。拔除尿管后,12例控尿均满意。术前有勃起功能者10例,术后仍保持勃起功能者8例。12例随访12 ～ 30个月,平均23个月。术后PSA最低值0.1～6.8 ng/ml,平均2.2 ng/ml,其中＜1.0 ng/ml者9例。术后PSA异常行前列腺穿刺活检4例,阴性3例,冷冻对侧腺体活检阳性1例。 结论 超声引导下经会阴前列腺局灶冷冻治疗安全有效、并发症少,可用于局限性单病灶前列腺癌患者,远期疗效尚需进一步观察。     

Prostate specific antigen measurements after minimally invasive surgery of the prostate in men with benign prostatic hypertrophy

There is a trend of minimally invasive surgery in the treatment of benign prostatic hypertrophy (BPH). Studies have examined levels of prostate specific antigen (PSA) in patients after open prostatectomy or transurethral resection of prostate (TURP) and noted reset of PSA to lower values after surgery. We reviewed PSA levels in patients after minimally invasive procedures to determine if levels were reset. There were 120 patients (age 45-70) enrolled in the study. Fifty patients underwent laser ablation, 20 patients had electrovaporization (TVP) and 50 patients underwent TURP. PSA measurements were obtained prior to and after surgical procedures in a three-year follow-up. Mean pre-operative PSA was 2.8 (+/-0.34) ng/ml for laser cohort, 3.2 (+/-0.31) ng/ml for the TURP group and 2.3 (+/-0.42) ng/ml for TVP patients (P=0.33). At 1 y follow-up, mean PSA decreased 32% for laser patients, 46% for the TURP cohort and 8% for TVP group. The largest mean decrease in PSA velocity was-1.5 (+/-0.31) ng/ml per y for TURP followed by 0.9 (+/-0.29) ng/ml per y for laser patients and-0.1 (s.d.+/-1.2) ng/ml per y for TVP group in y 1. The TURP group maintained the largest decrease in PSA velocity in y 2,-0.6 (+/-0.26) ng/ml per y. Three patients (2-TURP, 1-TVP) were diagnosed with prostate cancer during follow-up. In conclusion, serum PSA levels were reset at lower levels following different surgical interventions. This lower level of PSA remained decreased for 2 y post-procedure. Urologists should be cognizant of this reset level and monitor PSA levels for possible increases to screen for prostate cancer in this patient population. Prostate Cancer and Prostatic Diseases (2000) 3, 200-202     

Extended sector biopsy for detection of carcinoma of the prostate

Purpose: To determine whether an extended sector biopsy of the prostate will increase the detection of prostate cancer, without causing an increase in morbidity. Materials and Methods: A total of 74 men with a mean age of 62.3 years (46-98 years) who either had an elevated PSA or an abnormal digital rectal exam underwent a transrectal ultrasound guided needle biopsy. Beginning on 7/1/98, an extended sector biopsy technique was performed on 74 patients by one urologist (RRB). Each transrectal ultrasound guided needle biopsy included 12 total cores (normal sextant biopsy, 2 in each peripheral zone, and 2 in the transition zone). We retrospectively reviewed the biopsy results for the location of cancer. PSA data and morbidity of the procedures were reviewed. Results: Of 74 total patients, 40 (54.1%) were positive for adenocarcinoma of the prostate. There were 10 positive results detected only in the additional zones. If one looks at the total number of cancers detected (40), then 10/40 (25%) of the cancers detected were found in the additional regions only or in 13.5% of all patients biopsied. Of the 10 patients with sector only prostate cancer, 8 were detected in the peripheral zone, 1 in the transition zone and 1 in both zones. All 10 patients had a Gleason pattern score 3+3=6 or 4+3=7. There were no atypical or PIN cores found in the sector zones only. PSA ranged from 1.2-142 (median 6.0 ng/ml). The median PSA was 6.2 ng/ml in all patients found to have cancer, and 6.0 ng/ml in the cancers detected only in the additional zones. There was 1 (1.4%) complication of urinary retention and fever. Conclusion: Our study suggests that an extensive sector biopsy may increase the detection of prostate cancer by 13.5% over a routine sextant biopsy, without demonstrable serious morbidity.     

The criteria for avoiding unnecessary computerized tomography and bone scan in staging patients with newly diagnosed prostate cancer: retrospective study of patients at Matsusaka Chuo General Hospital

PURPOSE: Staging for prostate cancer often includes computed tomography (CT) and bone scan in Japan. We examined the criteria of avoiding unnecessary CT and bone scan for the prostate cancer patients at Matsusaka Chuo General Hospital. SUBJECTS AND METHODS: 211 patients were newly diagnosed at our institution between 1998 September and 2004 April. We reviewed data from 208 patients who had a staging CT and bone scan. The data was analysed using Gleason score, clinical T-stage and serum prostatic specific antigen (PSA) level. RESULTS: CT detected lymphadenopathy in 19 patients (9.1%), Bone scan detected bone metastasis in 31 patients (14.9%). However there was no lymphadenopathy detected by CT in the patients with 20 ng/ml or less. In the analysis using PSA and Gleason score, there was no bone metastasis detected by bone scan in the patients with PSA level of 20 ng/ml or less and Gleason sum 7 or less. In the analysis using PSA and clinical local stage there was no bone metastasis detected by bone scan in the patients with PSA level of 20 ng/ml or less and localized lesion (cT1-2). CONCLUSION: In a new proatate cancer patient CT and bone scan can be avoidable by PSA level of 20 ng/ml or less and cT1-2 or less and Gleason sum 7 or less.     

Early detection of prostate cancer in the ESRD population

BACKGROUND: There are currently no prostate cancer screening guidelines specific to the end-stage renal disease (ESRD) population. With this in mind, we evaluated the clinical usefulness of digital rectal examination (DRE), serum total prostate-specific antigen (PSA), prostate-specific antigen density (PSAD) and transrectal ultrasound (TRUS) in predicting prostate cancer in men with ESRD. METHODS: Fifty male ESRD patients age 40 years and older with no prior history of prostate cancer were enrolled in the study. All patients underwent PSA measurement and a DRE followed by a TRUS. PSAD was calculated as the total PSA divided by the prostate volume. Ultrasound-guided prostate biopsies were performed on any patient with 1 or more of the following abnormal findings: a nodule detected on DRE; an abnormal TRUS; PSA > 4.0 ng/ml, or a PSAD > 0.15 ng/ml/cm3. RESULTS: Abnormal findings were detected in 19 patients. Two (4%) had an abnormal DRE, 3 (6%) had PSA > 4.0 ng/ml, 3 (6%) had PSAD > 0.15 ng/ml/cm3 and 16 (32%) had abnormal findings on TRUS. Three patients had 2 abnormal findings and 1 had 3. Of the 15 prostate biopsies performed, 4 (27%) revealed prostate cancer and 3 (20%) high-grade prostatic intraepithelial neoplasm (HGPIN) comprising 8% and 6%, respectively, of the studied population. Of the 4 patients diagnosed with prostate cancer, none had abnormal DRE, 2 (50%) had PSA > 4.0 ng/ml (sensitivity = 66.7% and PPV = 50% (p = 0.236)), 3 (75%) had PSAD > 0.15 ng/ml/cm3 (sensitivity = 100% and PPV = 75% (p < 0.018)), and 3 (75%) had abnormal findings on TRUS (sensitivity = 30% and PPV = 75% (p = 1.000)). CONCLUSION: Routine screening with PSA and DRE does not seem sensitive enough to predict the presence of the disease. Although TRUS detected abnormalities in 16 patients (32%), sensitivity was very low (30%). In our patients, PSAD increased the sensitivity and positive predictive value (PPV) of detecting prostate cancers compared to PSA alone.     

超声引导下经会阴穿刺活检在前列腺癌诊断中的价值

目的：探讨超声引导下经会阴道前列腺穿刺活检诊断前列腺癌的价值。方法：对376例临床怀疑前列腺癌患者行直肠腔内超声引导下经会阴前列腺穿刺活检。分3组。A组：184例,为指检前列腺触及结节或前列腺增大、质硬怀疑前列腺癌者;B组：84例,为因前列腺增生行直肠腔内超声检查发现有异常回声区域者;C组：108例,为指检未及明显硬节而血中PSA＞10ng/ml者。结果：3组穿刺活检阳性率分别为44．5％（82／184）,29．8％（25／84）,57．4％（62／108）。结论：直肠腔内超声引导下经会阴穿刺活检取材准确,能清楚显示穿刺针的径路和深度,避免损伤邻近脏器,可重复操作,明显提高穿刺活检的阳性率。     

Characteristics of patients with stage T1b incidental prostate cancer

OBJECTIVE: To study the characteristics of patients with incidental prostate cancer. MATERIAL AND METHODS: The proportion of incidentally diagnosed prostate cancer was investigated in patients who underwent transurethral resection of the prostate (TURP) at our clinic over a 5-year period. "True" incidental prostate cancer was defined as cases where the preoperative digital rectal examination (DRE) and the prostate-specific antigen (PSA) value were normal. Patients with known malignancy of the prostate were excluded, together with those with PSA >4 ng/ml and/or a positive DRE. The characteristics of these patients were compared to those of benign prostatic hyperplasia patients and the group as a whole. RESULTS: Of the 786 patients operated on between 1999 and 2003, 34 (4.3%) had a positive pathology report for "true" incidental prostate cancer. An increased frequency of poorly differentiated tumors (32.3%) was noted. Of the 34 patients, 17 were stage T1a and 17 T1b; 11 patients had a Gleason sum of 7-10, all of them in the T1b group. In the T1b group the mean age was 74 years, the mean PSA level 2.9 ng/ml and the mean weight of tissue resected 11.1 g. Corresponding values in the T1a patients were 70.1 years, 3.32 ng/ml and 18.2 g. CONCLUSIONS: Compared to previous studies, we noticed a low incidence of "true" incidental prostatic carcinoma but a high ratio of poorly differentiated tumors (all stage T1b). Compared to the group as a whole, patients with incidental prostate cancer were older and had smaller prostate and transition zone volumes. Further research is needed to identify parameters that may aid in the earlier identification of incidental prostate cancer, as patients may benefit from curative treatment.     

Elevated prostate specific antigen serum levels after intravesical instillation of bacillus Calmette-Guerin

PURPOSE: We determined whether intravesical bacillus Calmette-Guerin (BCG) instillation is associated with elevated prostate specific antigen (PSA). MATERIALS AND METHODS: We treated 36 consecutive patients with bladder cancer with a 6-week course of BCG, followed by cystoscopy at 6 weeks. Blood samples for PSA determination were obtained before each BCG instillation and at cystoscopy with each patient also serving as a control. PSA elevation was defined as 2-fold the baseline level in at least 2 specimens and any PSA level greater than 4 ng./ml. was considered clinically significant. Digital rectal examination was done to identify firm nodules and prostate size. The prostate was examined histologically by transrectal ultrasound guided biopsy or after radical cystectomy. RESULTS: We observed elevated PSA in 27 men (75%) during BCG treatment, of whom 15 (41.6%) had a clinically significant elevation. Overall average PSA increased from 1.3 ng./ml. before BCG instillation to 3.8 during treatment (range 0.1 to 21.5, p <0.0001). In those with a clinically significant elevation average PSA increased from 2.31 ng./ml. at baseline to 6.97 during treatment (p <0.0001) and returned to 3.86 ng./ml. 3 months after treatment. Palpation demonstrated prostatic findings in 10 patients, including firm nodules in 7, while there was significantly elevated PSA in 5 with firm nodules and 2 with diffuse prostatic enlargement. Histological examination of the prostate in 10 patients was diagnostic for granulomatous prostatitis, nonspecific inflammation and benign prostatic hyperplasia in 3, 3 and 4, respectively, of whom none had prostate cancer. CONCLUSIONS: Intravesical BCG therapy is associated with significantly elevated PSA in up to 40% of cases. This effect is self-limited and PSA reverts to normal in 3 months. Therefore, we suggest that prostate biopsy be withheld in such patients and PSA monitored.