Transesophageal Atrial Pacing in Anesthetized Patients with Coronary Artery Disease: Hemodynamic Benefits Versus Risk of Myocardial Ischemia

Background: Transesophageal atrial pacing (TEAP) provides prompt and precise control of heart rate and improves hemodynamics in anesthetized patients with bradycardia and hypotension. The authors' purpose in this study was to examine the hemodynamic benefits of TEAP versus the risk of myocardial ischemia in patients about to undergo coronary artery bypass surgery.

Methods: Hemodynamics, ventricular filling pressures, mixed venous oxygen saturation, and end-diastolic, end-systolic, and fractional area change of the left ventricle, determined by transesophageal echocardiography (TEE), were measured after anesthesia induction with 30 micro gram/kg fentanyl and at incremental TEAP rates of 65, 70, 80, and 90 beats/min (bpm) in 40 adult patients. Monitoring for myocardial ischemia was accomplished with 12-lead electrocardiograms and biplane TEE assessment of left ventricular regional wall motion. Hemodynamics, electrocardiograms, and TEE measurements at each TEAP rate were compared with baseline awake measurements (except TEE) and with measurements obtained after anesthesia induction before TEAP.

Results: Sinus bradycardia occurred in 15 patients after anesthesia induction and was associated with a hypotensive response and a decrease in cardiac output in 10 patients. In these patients, TEAP restored diastolic blood pressure and cardiac output to baseline values at TEAP rates of 65 and 80 bpm, respectively. Stroke volume was similar to baseline measurements after anesthesia induction and at TEAP rates of 65, 70, and 80 bpm, but was significantly reduced from baseline at TEAP 90 bpm. Myocardial ischemia was detected in 7 and 5 patients at a TEAP rate of 80 and 90 bpm, respectively.     

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.     

Transurethral ethanol ablation of the prostate (TEAP): an effective minimally invasive treatment alternative to traditional surgery for symptomatic benign prostatic hyperplasia (BPH) in high-risk comorbidity patients

Objective  To evaluate the efficacy and safety of transurethral ethanol ablation of the prostate (TEAP) for patients with symptomatic benign prostatic hyperplasia (BPH) and high-risk comorbidities. Materials and methods  Thirty-six patients (mean age 77.3 years) with symptomatic BPH or persistent urinary retention were assessed at baseline and at 3, 6, and 12 months after treatment. All patients were affected by comorbidities (cardiovascular, respiratory, hematologic, neoplastic, dysmetabolic diseases, or coagulation disorders). Baseline evaluation was achieved by the International Prostate Symptom Score (IPSS) and quality of life (QoL) score, prostate-specific antigen (PSA), prostate transrectal ultrasound (TRUS), and the maximum peak flow rate with evaluation of post-voiding residual urine volume (PVR). Treatment was performed by injecting dehydrated ethanol at a rate correlated to prostate volume into the prostate. The primary end-point for response was ≥80% improvement of the maximum peak flow rate and significant reduction of the PVR; secondary end-points included symptom improvement (≥40% reduction in IPSS and QoL scores). Statistical analysis was carried out with Pearson’s Chi-square test and the non-parametric Wilcoxon test with an assigned statistical significance at P < 0.05. Results  During the active follow-up period, we observed a statistically significant decrease of the baseline at the end of the study in the total IPSS score and in the QoL score. The mean peak flow rate improved from 6.0 ± 2.40 ml/min to 15.2 ± 0.14 ml/min (P < 0.001), while the PVR decreased from a baseline value of 290.6 ± 14.14 ml to 4.2 ± 14.10 ml (P < 0.001). Conclusion  We found that TEAP is a safe minimally invasive treatment, which significantly improves voiding dysfunctions in patients with symptomatic BPH.     

Evaluation of the transurethral ethanol ablation of the prostate (TEAP) for symptomatic benign prostatic hyperplasia (BPH): a European multi-center evaluation

OBJECTIVE: We prospectively conducted a European multi-center study to assess the safety and efficacy of injecting dehydrated ethanol using a specialized injection system for the treatment of BPH. METHODS: Patients with symptomatic BPH were enrolled and evaluated to undergo transurethral ethanol ablation of the prostate for their BPH condition. Procedures were performed using the ProstaJect device. Treatment dosages were based on prostate volume, prostatic urethral length and median lobe involvement. Follow-up evaluations were done at four days and one, three, six and 12 months. RESULTS: One-hundred fifteen symptomatic patients underwent the transurethral ethanol ablation procedure and ninety-four patients have been followed and evaluated for the entire 12-month post-treatment period. The average prostate volume was 45.9 g, and average ethanol injected was 14 ml. Post-operatively, 98% of patients voided spontaneously four days following treatment. Significant reduction in reported lower urinary tract symptoms was evidenced at the one-month follow-up visit and maintained through 12 months follow-up, with International Prostate Symptom (IPSS) and Quality of Life (QoL) scores decreased by more than 50%. Peak flow rates (Q(max)) improved by 35% by the three-month evaluation and these results were sustained through to 12-months follow-up. The average prostate volume reduction was 16%. Adverse events included discomfort or irritative voiding symptoms in 26% of patients, hematuria in 16%, with retrograde ejaculation, and erectile dysfunction reported in less than 3% of patients. The majority of these events required no intervention. Two patients experienced serious adverse events (bladder necrosis) and underwent open surgery that included a urinary diversion and a ureteral implantataion. During the one year follow- up, 7% of patients required a trans-urethral resection of prostate (TURP). CONCLUSIONS: This preliminary multi-center data, representing the largest reported cohort to date, suggests that TEAP may be considered an effective minimally invasive treatment option for lower urinary tract symptoms secondary to BPH. Analyses of safety lead to a procedure modification for needle placement more distal from the bladder neck. Objective reduction in symptoms was not correlated in prostate volume reduction suggesting a non-purely mechanical effect.     

腔内手术治疗高危前列腺增生的临床研究

目的：探讨解除高危前列腺增生（BPH）患者膀胱出口梗阻（BOO）症状安全有效的手术方法。方法：采用经尿道前列腺气化电切上通道成形术、经尿道前列腺气化电切下通道成形术、经尿道前列腺乙醇注射消融术（TEAP）等腔内手术方法治疗BPH患者311例。结果：本组手术时间短，平均25.8min；术中出血不多，无死亡病例；近期排尿顺畅，18个月抽样随访，最大尿流率（Qmax)平均为14.8ml/s。结论：经尿道前列腺气化电切上、下通道成形术、TEAP是解除高危BPH患者BOO症状的一种腔内手术方法，其手术操作简易、微创，安全有效。     

Prophylaxis and treatment of a pulmonary artery thromboembolism

Experience of treatment of 103 patients with an acute thromboembolism (TE) of a. pulmonalis (AP) was analyzed. According to clinic, angiographical and hemodynamical investigations data the indications for performance of operative and conservative treatment depending on degree of the pulmonary blood flow disorder were substantiated. Comparative analysis of results of treatment of TEAP using different thromboembolic preparations was conducted. Efficacy of thrombolysis depends on time passed away from moment of lesion. In 69% patients thromboembolectomy is effective.     

Correlation between serum prostate specific antigen and prostate volume in Taiwanese men with biopsy proven benign prostatic hyperplasia

PURPOSE: We studied the correlation between serum prostate specific antigen and the volume of different zones of the prostate in Taiwanese men with biopsy proven benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 233 patients with a mean age of 71.4 years (range 42 to 89), serum prostate specific antigen less than 10 ng/ml and pathologically confirmed benign prostatic hyperplasia were enrolled in this study. Total prostate and transitional zone volumes were measured with transrectal ultrasonography. Peripheral zone volume was determined by subtracting transitional zone volume from total prostate volume. Correlations between patient age, total serum prostate specific antigen and the volume of each prostate zone were analyzed with the Pearson correlation coefficient. A linear regression model was used to determine the relationship between prostate specific antigen and prostate volume. The prostate specific antigen-prostate volume relationship in our patients was compared with published data on white and Japanese men. RESULTS: Age did not significantly correlate with serum prostate specific antigen and prostate volume. Serum prostate specific antigen significantly correlated with the volume of each prostate zone. After log transformation the Pearson correlation coefficient between total prostate specific antigen and the volume of the whole prostate gland, the transitional zone and the peripheral zone were 0.369, 0.377 and 0.272, respectively (p <0.001). Taiwanese men had lower prostate volume per unit prostate specific antigen comparing with white men, while the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men was similar. CONCLUSIONS: In Taiwanese men with biopsy proven benign prostatic hyperplasia the volume of each prostate zone has significantly correlates with serum prostate specific antigen. The prostate specific antigen-total prostate volume relationship in Taiwanese men is different from that in white men. However, the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men is similar.     

Performance of prostate‐specific antigen mass in estimation of prostate volume in Japanese men with benign prostate hyperplasia

Objectives: Obese men with benign prostate hyperplasia might have lower serum prostate‐specific antigen because of hemodilution, resulting in underestimation of total prostate volume by serum prostate‐specific antigen. The aim of this study was to compare the performance of prostate‐specific antigen mass as the absolute amount of prostate‐specific antigen protein secreted into circulation with that of serum prostate‐specific antigen in the prediction of total prostate volume. Methods: A total of 1517 men with serum prostate‐specific antigen up to 10 ng/mL, including 1425 with biopsy‐proven benign prostate hyperplasia, were enrolled in this study. Height and weight were used to estimate body mass index, body surface area and plasma volume. Prostate‐specific antigen mass was calculated as serum prostate‐specific antigen multiplied by plasma volume. The association between serum prostate‐specific antigen or prostate‐specific antigen mass and transrectal ultrasound‐measured total prostate volume were evaluated by Pearson's correlation coefficient (Υ), linear regression analyses and receiver operating characteristic curves. Results: Serum prostate‐specific antigen had an inverse relationship with plasma volume, decreasing as plasma volume increased, after adjustment of total prostate volume. Larger total prostate volume per serum prostate‐specific antigen was found in men with higher body mass index or plasma volume. Among all participants, the correlation (Υ = 0.456) between prostate‐specific antigen mass and total prostate volume was apparently stronger than that (Υ = 0.442) between serum prostate‐specific antigen and total prostate volume. Prostate‐specific antigen mass outperformed serum prostate‐specific antigen at estimating total prostate volume cut‐off values of 30 and 40 mL. These findings were more significant in men aged ≥60 years. Conclusions: Prostate‐specific antigen mass performs better than serum prostate‐specific antigen in estimating TPV, especially in men aged ≥60 years.     

Influence of prostate volume and percent free prostate specific antigen on prostate cancer detection in men with a total prostate specific antigen of 2.6 to 10.0 ng/ml

PURPOSE: Percent free prostate specific antigen and prostate specific antigen density have been independently shown to increase the specificity of prostate cancer screening in men with prostate specific antigen levels between 4.1 and 10.0 ng/ml. Recent data suggest the total prostate specific antigen cutoff for performing a biopsy should be 2.6 ng/ml. We assessed the influence of percent free prostate specific antigen and prostate volume on cancer detection in men with a prostate specific antigen between 2.6 and 10.0 ng/ml. MATERIALS AND METHODS: From 1991 to 2005 all transrectal ultrasound guided prostate biopsies (5,587) for abnormal digital rectal examination and/or increased age specific prostate specific antigen were evaluated. A total of 1,072 patients with a prostate specific antigen between 2.6 and 10.0 ng/ml and any percent free prostate specific antigen were included in study. The cancer detection rate was calculated for each percent free prostate specific antigen/volume stratum. RESULTS: Prostate cancer was detected in 296 patients (27.6%). The mean age and prostate specific antigen of the patients with benign pathology and prostate cancer were similar. Mean percent free prostate specific antigen was 17.5% and 14.1% (p>0.05), and the mean volume was 62.0 and 46.0 cc (p=0.001), respectively. The strongest risk factors for a positive biopsy were percent free prostate specific antigen (odds ratio 0.004, p<0.001), volume (OR 0.977, p<0.001) and digital rectal examination (OR 1.765, p=0.007), but not total prostate specific antigen (p=0.303). When stratified by volume and percent free prostate specific antigen, distinct risk groups were identified. The probability of detecting cancer inversely correlated with prostate volume and percent free prostate specific antigen. CONCLUSIONS: In men with prostate specific antigen levels between 2.6 and 10.0 ng/ml, the probability of detecting cancer was inversely proportional to prostate volume and percent free prostate specific antigen. This table may assist in predicting patient risk for harboring prostate cancer.     

The interpretation of serum prostate specific antigen in men receiving 5alpha-reductase inhibitors: a review and clinical recommendations

PURPOSE: We reviewed the effects of 5alpha-reductase inhibitors on prostate specific antigen and clarified the adjustments that should be made to compensate for these effects to ensure that the usefulness of prostate specific antigen for detecting prostate cancer is maintained. MATERIALS AND METHODS: We reviewed articles published in the scientific literature with relevance to the effects of 5alpha-reductase inhibitors on the usefulness of prostate specific antigen for detecting prostate cancer. RESULTS: A total serum prostate specific antigen of 4.0 ng/ml has traditionally been used as the threshold for triggering prostate biopsy. However, clinical trials of finasteride and dutasteride have shown that 5alpha-reductase inhibitors decrease serum prostate specific antigen in patients with and without prostate cancer. To compensate, the doubling rule has been applied in clinical trials and clinical practice. However, doubling serum prostate specific antigen may overestimate actual prostate specific antigen in some patients receiving 5alpha-reductase inhibitors for up to 6 to 9 months, accurately estimate prostate specific antigen from 1 to 3 years and underestimate it thereafter. An increase in prostate specific antigen of 0.3 ng/ml from nadir as a trigger for biopsy maintains 71% sensitivity for prostate cancer in men receiving dutasteride with 60% specificity, similar to the 4.0 ng/ml prostate specific antigen cutoff using placebo. CONCLUSIONS: We propose that a prostate specific antigen increase from nadir of 0.3 ng/ml or greater could represent an alternative to the doubling rule for monitoring prostate specific antigen in patients on 5alpha-reductase inhibitors. The prostate specific antigen increase from nadir appears to be a more accurate cancer indicator than a doubled value in some patients.     

Impact of familial and hereditary prostate cancer on cancer specific survival after radical retropubic prostatectomy

PURPOSE: Men with a family history of prostate cancer are at higher risk for prostate cancer. There are conflicting data regarding the impact of hereditary forms of prostate cancer on long-term outcomes after radical prostatectomy. We examined the impact of familial and hereditary prostate cancer treatment in the prostate specific antigen era. MATERIALS AND METHODS: Patients who underwent radical prostatectomy for prostate cancer from 1987 to 1997 were surveyed (3,560 responders) to determine the family history of prostate cancer. Patients were categorized as having familial prostate cancer if they had at least 1 first-degree relative with prostate cancer. Hereditary prostate cancer was defined as nuclear families with 3 cases of prostate cancer, families with prostate cancer in each of 3 generations and families with 2 men diagnosed before age 55 years. Sporadic prostate cancer was defined as patients with no family history. Clinical and pathological features, and long-term outcome measures, including biochemical recurrence-free, systemic progression-free and cancer specific survival, were compared among patients with familial, hereditary and sporadic prostate cancer. RESULTS: A total of 865 and 133 patients were categorized as having familial prostate cancer and hereditary prostate cancer, respectively. Preoperatively prostate specific antigen was higher in patients with hereditary prostate cancer than in the other 2 groups (p = 0.04). Ten-year biochemical progression-free, systemic progression-free and cancer specific survival were equivalent. CONCLUSIONS: Except for preoperative prostate specific antigen, clinicopathological features and long-term oncological outcomes are equivalent after radical prostatectomy in patients with familial, hereditary and sporadic prostate cancer.     

The association between total prostate specific antigen concentration and prostate specific antigen velocity

PURPOSE: It has been previously demonstrated that a prostate specific antigen velocity greater than 2 ng/ml per year is associated with reduced cancer specific survival following radical prostatectomy or external beam radiation. However, men with different initial prostate specific antigen levels may be more or less likely to reach this prostate specific antigen velocity threshold. Because prostate specific antigen and prostate specific antigen velocity contain much of the same predictive information, our objective was to further examine the relationship between them. MATERIALS AND METHODS: From a large prostate cancer screening study, serial prostate specific antigen measurements were available for 13,276 men, including 1,851 with a negative digital rectal examination who underwent biopsy and 894 who were diagnosed with prostate cancer. Prostate specific antigen velocity was calculated using simple linear regression of the prostate specific antigen values from the year before diagnosis. ANOVA and the Kruskal-Wallis test were used to compare the mean and median prostate specific antigen velocity of men in different total prostate specific antigen ranges. In addition, chi-square analysis was used to compare the number of men in each total prostate specific antigen range who presented with high risk prostate specific antigen velocity greater than 2 ng/ml per year. RESULTS: In the total prostate specific antigen ranges of 2.5 ng/ml or less, 2.6 to 4.0, 4.1 to 10.0 and more than 10.0 ng/ml, the proportion of screened men with a prostate specific antigen velocity of more than 2 ng/ml per year was 1%, 14%, 31% and 74%, respectively (p <0.0001). Mean and median prostate specific antigen velocity were also significantly higher as the total prostate specific antigen level increased. CONCLUSIONS: Prostate specific antigen velocity varies directly with total prostate specific antigen. Men with high initial prostate specific antigen levels are significantly more likely to present with a prostate specific antigen velocity of more than 2 ng/ml per year that is more frequently associated with prostate cancer specific mortality.     

Prostate specific antigen velocity threshold for predicting prostate cancer in young men

PURPOSE: Longitudinal changes in prostate specific antigen are increasingly used to guide the recommendation for biopsy. Prostate specific antigen velocity 0.75 ng/ml yearly has been proposed to distinguish prostate cancer from benign prostate conditions. However, this threshold might be too high in young men with lower total prostate specific antigen. MATERIALS AND METHODS: In a large prostate cancer screening study 6,844 men were 60 years or younger at study entry and prostate specific antigen velocity calculation was possible. Of these men 346 (5%) were subsequently diagnosed with prostate cancer and various prostate specific antigen velocity thresholds were examined for prediction of prostate cancer risk. Multivariate analysis was performed to determine whether prostate specific antigen velocity is an independent predictor of prostate cancer in men younger than 60 years. RESULTS: Median prostate specific antigen velocity was significantly higher in men who were later diagnosed with prostate cancer than in those who were not (0.840 vs 0.094 ng/ml yearly, p<0.0001). On multivariate analysis prostate specific antigen velocity greater than 0.4 ng/ml yearly was more predictive of prostate cancer than age, total prostate specific antigen, family history or race. Multivariate analysis in the subgroup of men with total prostate specific antigen less than 2.5 ng/ml had similar results. Overall a cutoff of 0.4 ng/ml yearly was associated with 67.3% sensitivity, 81.2% specificity, 16% positive predictive value and 98% negative predictive value for prostate cancer detection in young men. CONCLUSIONS: The traditional prostate specific antigen velocity threshold of 0.75 ng/ml yearly is too high for men younger than 60 years and it misses 48% of prostate cancers. Young men with prostate specific antigen velocity greater than 0.4 ng/ml yearly are at significantly greater risk for prostate cancer and close followup is warranted.     

Feasibility of constructing tissue microarrays from diagnostic prostate biopsies

OBJECTIVES: The ability to construct prostate tissue microarrays (TMAs) using prostate needle biopsies could allow high throughput molecular profiling to search for prostate cancer prognostic biomarkers. MATERIALS AND METHODS: Diagnostic prostate biopsies from 13 patients (diagnosed 1996-2000) were obtained from the University of North Carolina (UNC) to construct one prostate TMA under uniform conditions. A second prostate TMA was attempted using diagnostic prostate biopsies from 45 patients (diagnosed 2004) obtained from the North Carolina-Louisiana Prostate Cancer Project (PCaP). RESULTS: Eleven men had sufficient prostate cancer in their diagnostic prostate biopsy blocks to construct a UNC TMA that yielded six-micron sections that provided an average of 76% of cores (maximum 99%) to a depth of 360 microm. Diagnostic prostate biopsy blocks from 35 PCaP research subjects were unsuitable for TMA construction as a result of no remaining prostate cancer in 4, insufficient prostate cancer in 9, and insufficient prostate tissue in 22. The PCaP TMA constructed from 10 men yielded an average of 37%, and a maximum of 45%, of cores when sectioned to a depth of 360 microm. CONCLUSIONS: TMAs may be constructed from diagnostic prostate biopsies obtained at an academic center under uniform conditions. However, excessive facing of blocks and the large number of re-cuts ordered by many community pathology laboratories deplete diagnostic prostate biopsy tissue. The experience of a population-based study of men with newly diagnosed prostate cancer in Louisiana and North Carolina suggests that TMAs may not be constructed using diagnostic prostate biopsies from men diagnosed with prostate cancer throughout the United States.     

Establishing normal reference ranges for prostate volume change with age in the population-based Krimpen-study: prediction of future prostate volume in individual men

BACKGROUND: We aim to establish the normal pattern of prostate volume change with age to provide a baseline from which accelerated prostate growth might be identified in patients with lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH). METHODS: In a community-based study, prostate volume was determined at baseline and after 2.1 and 4.2 years in men without prostate cancer. A bivariate multilevel growth curve model was used to estimate the pattern of change of prostate volume with age. RESULTS: The average percentage increase of total prostate volume and transition zone volume per year of follow-up was 2.2% and 3.5%, respectively. The final model showed that prostate volume was related to age only. The future prostate volume of an individual can be predicted based on his age and known history of prostate volume. The model was also used to calculate time needed for the prostate volume to increase with a certain percentage, for men with different baseline prostate volume values at different ages. CONCLUSIONS: This method establishes normal prostate volume values by age using prostate volume history in men without prostate cancer. The model provides baseline data from which disease progression might be detected.     

The necessity of a second prostate biopsy cannot be predicted by PSA or PSA derivatives (density or free:total ratio) in men with prior negative prostatic biopsies

Serum prostate specific antigen, prostate specific antigen density and free:total prostate specific antigen are known to be useful for determining the risk of prostate cancer in patients undergoing prostate cancer screening. The patient with a positive biopsy presents no future prostate specific antigen dilemma. Those with negative biopsies often go on to numerous repeat biopsies. Our goal was to establish criteria that could be used to identify patients who will require repeat prostate biopsies (possibly false negative initial biopsy), while not exposing the low risk population (probable true negative initial biopsy) to additional invasive procedures. Between March 1991 and March 1998, 148 patients who had a biopsy for an elevated prostate specific antigen value (4.1-10.0) or an altered digital rectal examination, had no cancer found in the specimen. From these, 51 (34.4%) had repeated biopsies, while the others persisted on close follow-up. We examined their serum prostate specific antigen, prostate specific antigen density and free:total prostate specific antigen value, as well as their age and histology results of the initial and repeat biopsy, to determine if any predictor of the need for a repeat biopsy could be identified. Eight (15.7%) from 51 men who had repeat biopsy had prostate cancer detected. Forty three (84.3%) patients persisted with a negative biopsy, despite filling the criteria for re-biopsy. Multivariate analysis failed to identify any significant predictors of prostate cancer in the repeat biopsy group. Despite initial success, the prostate specific antigen derivatives and free:total prostate specific antigen have not safely limited the number of biopsies performed for an abnormal prostate specific antigen (4.1-10.0). Neither prostate specific antigen density nor free:total prostate specific antigen predicted the need for repeat biopsy in this specific group. The results of this ongoing study demonstrate that to date, prostate specific antigen and prostate specific antigen derivatives can not be utilized to determine which patients will be at high risk for requiring repeat prostate biopsy. All patients must be closely monitored for evidence of a change in status from benign to malignant disease, and new markers for this purpose are urgently needed.     

前列腺特异性抗原在前列腺癌中的表达和意义

目的为了提高对前列腺癌的诊断和鉴别诊断水平。方法用免疫组织化学染色方法对199例前列腺癌与良性前列腺增生组织作了前列腺特异性抗原(PSA)标记,间接了解组织腺体基底细胞层的完整与否。结果对PSA染色,大多数前列腺癌表达低,少数分化好的癌组织呈阳性,而良性前列腺增生组织标本中PSA高表达。结论本研究表明应用间接了解前列腺组织基底细胞层完整性与否的PSA标记在前列腺癌与增生性病变的诊断和鉴别诊断中以及对肿瘤恶性程度的判断均有很好的应用价值。     

Hereditary prostate cancer: clinical characteristics and survival

PURPOSE: Hereditary prostate cancer accounts for 5% to 10% of all prostate cancer cases. We assessed clinical characteristics and survival in patients with hereditary prostate cancer MATERIALS AND METHODS: The study comprised 201 patients from 62 Swedish hereditary prostate cancer families and 402 controls with prostate cancer who were matched for age and calendar year at diagnosis, and the hospital where the diagnosis was made. Clinical data were obtained from the National Cancer Registry, Causes of Death Registry and medical records. RESULTS: Median age at the diagnosis of hereditary prostate cancer was 68 years, which was 6 years less than in patients with prostate cancer in the general population in Sweden. Distributions of tumor grade, symptoms at diagnosis and initial therapy were similar in hereditary prostate cancer cases and controls. More controls were classified with localized disease but it may have been due to methodological problems. Overall and cancer specific survival was similar in patients with hereditary prostate cancer and controls as well as in subgroup analyses including those with early onset and those diagnosed before 1990. Prostate cancer was the cause of death in 75% of patients with hereditary prostate cancer, in contrast to 55% with prostate cancer in the Swedish population. This difference was completely explained by the earlier age at the diagnosis of hereditary prostate cancer. CONCLUSIONS: Hereditary prostate cancer has an earlier onset than sporadic prostate cancer but this study did not indicate any other important difference in clinical characteristics or survival in patients with hereditary prostate cancer and those with sporadic prostate cancer. However, it cannot be excluded that individual hereditary prostate cancer genes may have specific biological characteristics.     

Clinical use of prostate specific antigen in patients with prostate cancer

The clinical use of prostate specific antigen as a screening test for prostate cancer, as a preoperative determinant for staging of prostate cancer and to monitor response to therapy in prostatic cancer patients was evaluated in 168 men with benign prostatic hyperplasia and 231 men with prostate cancer. Only 3% of the men with benign prostatic hyperplasia had prostate specific antigen levels greater than 10 ng. per ml. compared to 44% of the men with proved prostate cancer. Preoperative prostate specific antigen levels increased with higher clinical stages of prostate cancer but there was substantial overlap among stages. Among patients with stage A1 prostate cancer who were followed expectantly none had an elevated prostate specific antigen value or metastatic disease during a followup of 15 to 120 months. After radical prostatectomy serum prostate specific antigen values decreased to undetectable levels (less than 0.6 ng. per ml.) in 89% of the patients with organ-confined disease, in 87% of those with microscopically positive margins only but in only 34% with seminal vesicles or lymph node involvement. Failure of the prostate specific antigen levels to decrease to the undetectable range after radical prostatectomy was associated with a greater likelihood of subsequent tumor recurrence. Only 3 of 18 patients (17%) treated with definitive radiation therapy had post-irradiation prostate specific antigen values of less than 0.6 ng. per ml., while in 39% the prostate specific antigens values remained greater than 4 ng. per ml. and in 4 of 18 (22%) the values were greater than 10 ng. per ml. Of patients with previously untreated stage D2 prostate cancer the mean pre-treatment prostate specific antigen value was 63.7 ng. per ml. compared to a post-hormonal therapy mean value of 31.1 ng. per ml. Of 32 patients treated with hormonal therapy 14 had stable disease, including 13 with prostate specific antigen levels of less than 10 ng. per ml. In contrast, 18 patients had progressive disease, of whom 16 had prostate specific antigen levels of more than 10 ng. per ml. We conclude that the serum prostate specific antigen assay is most useful clinically to monitor the response to therapy of prostate cancer patients.