A higher PSA-density cut-off level in patients with intermediate PSA values for the early detection of prostate cancer

The use of PSA-density (PSAD) as an indicator for prostate biopsy at intermediate PSA values has generated controversy. There are investigators who consider that the determination of PSAD is futile, and that it is better to do a prostate biopsy based on PSA values alone, TRUS (Transrectal Ultrasound) findings and/or DRE examinations. Asian countries, especially in the Far East, are considered to have a low incidence of prostate cancer (PCa). However, based on western references, we still measure PSA-density with a cut-off level of 0.15 to promote prostate biopsy in patients with intermediate PSA values (4.1-10.0 ng/ml). Our study aims to evaluate the usefulness of PSAD as an indication for biopsy in patients with intermediate serum PSA values. To evaluate the usefulness of this indicator, we conducted a retrospective study of 132 uncatheterized (to minimize potential bias) BPH and PCa cases that were hospitalized in our department between 1995-1997 (3 years). This group comprised 127 BPH and 5 PCa patients. Mean age was 66.1 +/- 7.69 years; mean PSA was 7.92 +/- 9.289 ng/ml; mean prostate volume was 54.1 +/- 26.72 cc; mean PSAD was 0.15 +/- 0.185. More specifically, there were 49 patients with intermediate PSA values (47 BPH & 2 PCa). The receiver operator characteristic (ROC) curve revealed an optimum cut-off level of 0.19. At this level of PSA density, the measured sensitivity was 100% with a specificity of 79%. We concluded that, in our uncatheterized patients (without retention) series, the PSAD cut-off level for prostate biopsy (0.19) was higher than that in the western world (0.12 or 0.15).     

经直肠超声引导前列腺穿刺活检方案的合理选择

目的 分析经直肠超声(TRUS)和前列腺特异性抗原(PSA)及其相关参数在前列腺穿刺活检中的作用,探讨个体化前列腺穿刺方案的可行性。方法 回顾性分析195例患者的首次穿刺活检资料,所有患者均采用系统8点穿刺方案,并对可疑病灶增加1~2点。依据穿刺病理结果,分析前列腺癌(PCa)检出率与TRUS、PSA及其相关参数的关系。结果 195例患者中检出PCa 98例(50.3%),其中PSA 4~10 ng/mL组45例,检出PCa 16例(35.6%),其中TRUS(+)且PSATZ≥0.35 ng/mL² 210例均证实为PCa;PSA＞10 ng/mL组150例,检出PCa 82例(54.7%)。PSA 4~10 ng/mL与PSA＞10 ng/mL两组患者PCa检出率差异有统计学意义(P＜0.05),且两组中TRUS(+)与TRUS(-)患者相较PCa检出率差异均有统计学意义(P＜0.01)。结论 依据TRUS、PSA及其相关参数制定个体化前列腺穿刺方案是可行的。     

The clinical utility of measuring total PSA, PSA density, gamma-seminoprotein and gamma-seminoprotein/total PSA in prostate cancer prediction

BACKGROUND: To evaluate whether serum total prostate-specific antigen (PSA), PSA density (serum total PSA level divided by prostate volume), gamma-seminoprotein and gamma-seminoprotein/total PSA ratio could predict prostate cancer (PCa) prior to biopsy. METHODS: A total of 316 consecutive patients who had undergone transrectal prostate biopsy and/or transurethral resection were examined. The prostate volume was determined by transrectal ultrasonography (TRUS) and the ability of the above-mentioned four variables to distinguish PCa from benign prostatic hyperplasia (BPH) was evaluated. RESULTS: PCa was detected in 61 cases. Receiver-operating characteristic (ROC) analysis revealed that both the PSA density and serum total PSA were the most useful predictors of PCa among the four variables. For the patients with a serum total PSA level of 4.1-10.0 ng/ml, PSA density was significantly more accurate than total PSA (p < 0.005). An optimum PSA density value of 0.18 was chosen as a cutoff because it showed the highest sum of sensitivity and specificity, 92 and 54%, respectively. Using this PSA density cutoff, the number of biopsies could have been reduced to 57 from 63% when compared with a PSA density of 0.15. CONCLUSIONS: PSA density was significantly more accurate than other variables in predicting PCa. To avoid unnecessary biopsies, the PSA density cutoff value of 0.18 would be recommendable for determining a prostate biopsy for Japanese males with a serum total PSA level of 4.1-10.0 ng/ml.     

Predictive Value of the Platelet-To-Lymphocyte Ratio in Diagnosis of Prostate Cancer

Purpose: To predict prostatic carcinoma using a logistic regression model on prebiopsy peripheral bloodsamples. Materials and Methods: Data of a total of 873 patients who consulted Urology Outpatient Clinics of FatihSultan Mehmet Training and Research Hospital between February 2008 and April 2014 scheduled for prostatebiopsy were screened retrospectively. PSA levels, prostate volumes, prebiopsy whole blood cell counts, neutrophiland platelet counts, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), biopsy resultsand Gleason scores in patients who had established diagnosis of prostate cancer (PCa) were evaluated. Results:This study was performed on a total of 873 cases, with an age range 48-76 years, divided into three groups asfor biopsy results. with diagnoses of benign prostatic hyperplasia (BPH) (n=304, 34.8 %), PCa (n=265, 30.4 %)and histological prostatitis (n=304; 34.8 %). Intra- and intergroup comparative evaluations were performed.White blood cell and neutrophil counts in the histological prostatitis group were significantly higher than thoseof the BPH and PCa groups (p=0.001; p=0.004; p<0.01). A statistically significant intergroup difference wasfound for PLR (p=0.041; p<0.05) but not lymphocyte count (p>0.05). According to pairwise comparisons, PLRwere significantly higher in the PCa group relative to BPH group (p=0.018, p<0.05, respectively). Though notstatistically significant, higher PLR in cases with PCa in comparison with the prostatitis group was remarkable(p=0.067, and p>0.05, respectively). Conclusions: Meta-analyses showed that in patients with PSA levels over4 ng/ml, positive predictive value of PSA is only 25 percent. Therefore, novel markers which can both detectclinically significant prostate cancer, and also prevent unnecessary biopsies are needed. Relevant to this issuein addition to PSA density, velocity, and PCA3, various markers have been analyzed. In the present study, PLRw ere found to be the additional predictor of prostatic carcinoma.     

Prostate Specific Antigen,Mean Platelet Volume,and Platelet Distribution Width in Combination to Discriminate Prostate Cancer from Benign Prostate Hyperplasia

Background: Prostate cancer (PCa) represents the second most commonly diagnosed malignancy and the sixthleading cause for cancer related death among men worldwide. Although use of the prostate specific antigen (PSA) asa diagnostic marker has improved the detection and management of PCa, low specificity and sensitivity has limited itsclinical efficacy. Moreover, elevated PSA is frequently observed in benign prostate hyperplasia (BPH). Mean plateletvolume (MPV) and platelet distribution width (PDW) are commonly used indicators of platelet activation. The purposeof current study was to investigate the ability of PSA, MPV, and PDW individually or in combination, to differentiatePCa from BPH. Materials and Methods: This study included 100 patients with PCa and 108 patients with BPH. Wecollected all participants’ clinical and laboratory characteristics. The benefit of adding MPV and PDW to a modelwith only PSA was evaluated as an increased in the area under the curve (AUC) obtained by receiver operating curve(ROC). Results: PCa patients had reduced MPV and elevated PSA and PDW levels compared to BPH patients. Singlebiomarkers had AUC values ranging from 0.683 for PDW to 0.865 for PSA. Moreover, the combination of PSA, MPV,and PDW increased the AUC to 0.935 (0.892-0.964) (p<0.0001), significantly higher than those of any single marker.Conclusions: The combined use of PSA, MPV, and PDW may be clinically useful in distinguishing between PCa andBPH.     

PSAD和游离/总PSA比值在前列腺癌诊断中的意义

 目的　比较研究前列腺特异抗原(PSA)、PSA密度(PSAD)和游离/总PSA比值(F/TPSA)在前列腺癌诊断中的价值。方法　41例前列腺增生和22例前列腺癌患者,术前用放免法测定血清PSA和游离PSA。所有患者经直肠腔内B超测出前列腺体积,求得PSAD,用t检验比较分析。结果　前列腺癌组的PSA、PSAD均显著高于前列腺增生组(PSA：46.3±33.8μg/Lvs7.04±6.91μg/L,P=0.000021;PSAD：1.43±1.21μg。L-1。ml-1vs0.14±0.15ng。ml-1。ml-1,P=0.000055)。两组的F/TPSA比值无显著差异(0.18±0.11vs0.22±0.18,P=0.34)。结果　PSA和PSAD是鉴别前列腺癌的良好指标,对于PSA可疑者,PSAD有助于区分前列腺癌和前列腺增生,本组游离/总PSA比值不能帮助鉴别诊断。     

Progression of prostate cancer: diagnostic and prognostic utility of prostate-specific antigen, alpha2-macroglobulin, and their complexes

We previously reported cases of advanced prostate cancer (PCa) in which serum alpha2-macroglobulin (alpha2M) levels were markedly decreased to less than approximately 50 mg/dl whereas serum prostate-specific antigen (PSA) levels were remarkably increased. These cases were not complicated with disseminated intravascular coagulation (DIC). In this study, we measured serum PSA and alpha2M in 108 patients with either benign prostatic hyperplasia (BPH) or PCa to elucidate the relationship between PSA, i.e. the serum protease derived from the prostatic tissue, and alpha2M, i.e. the protease inhibitor that was the most abundantly contained in serum. alpha2M was determined by ELISA, total PSA and PSA-alpha1-antichymotrypsin (PSA-ACT) by EIA, and free-PSA by RIA in 44 patients with untreated BPH and 64 patients with untreated PCa. The ready association of alpha2M and PSA was assessed using Western blotting to identify complexes of the two. Levels of total serum PSA correlated positively with those of PSA-ACT in PCa (r = 0.99, p < 0.001), and both levels increased with advancing stage of disease. In contrast, the serum-free PSA/total PSA ratio (free/total PSA) and alpha2M levels decreased as the disease progressed. However, only the free/total PSA ratio attained significant difference for localized cancer in stage T1,2 versus BPH (p < 0.05). In stage M1b PCa, in which serum PSA levels were very high, there was a negative correlation between the total PSA and alpha2M values (r = -0.57, p < 0.05). In addition, serum alpha2M levels tended to decrease with progression of PCa. Serum total PSA levels correlated tightly with serum PSA-ACT levels. It is suggested that PSA is usually complexed with ACT in the serum. Free/total PSA was useful for differential diagnosis between early cancer and BPH. Levels of serum alpha2M of less than 50 mg/dl in PCa patients may indicate a possibility of bone metastases.     

Frequency of Unnecessarily Biopsies among Patients with Suspicion of Prostate Cancer in Syrian Men

Background: The prevalence of prostate cancer is considered high in many countries, and screening tests arevery important in order to detect prostate cancer in its early stages; however false positivity with these screeningtests means that a lot of patients undergo unnecessary biopsy, which is an invasive procedure, for the confirmatorytest. The purpose of this study was to estimate the frequency of unnecessary biopsy cases in patients referredfor prostate biopsy in one of the most important and overload cancer centers in Syria. Materials and Methods:Retrospective data for a period of four years between January 2009 and December 2012 were collected in Al-Bayrouni University Medical hospital in Damascus, Syria. The patients from whom data were collected werereferred to our histopathological department because of elevated prostate specific antigen (PSA) serum or anabnormal digital rectal examination (DRE). All patients underwent prostatic TRUS-guided biopsies. Diagnosisof prostate cancer (PCa) or benign prostatic hyperplasia (BPH) was based on histopathological examinationand prostate cancers cases were graded and scored according to the Gleason score system. Results: For the 406patients referred to biopsy, the mean±SD age was 58.4 ±23.3 years. The mean ± SD PSA level was 49.2±21.5 ng/ml. Of the total we found 237 patients diagnosed with PCa (58. 4%), 166 patients with BPH (40.9%) and 3 caseswere unable to be diagnosed (0.7%) because of biopsy collection errors. Conclusions: Our study shows that ahigh percentage of patients are undergoing unnecessary biopsy, which suggests that the performed screeningtests had a high level of false positive and may need re-evaluation.     

Serum soluble Fas level for detection and staging of prostate cancer

To evaluate the clinical usefulness of measuring serum soluble Fas (sFas) for differentiation between prostate cancer and benign prostate hyperplasia (BPH) and for staging of prostate cancer, serum sFas and PSA were determined in 38 and 20 men with prostate cancer and BPH, respectively, before treatment. In 17 patients, sFas and PSA were measured one hour after transrectal ultrasound-guided sextant biopsy in order to examine the leakage of sFas into the circulation after prostatic injury. Patients with prostate cancer had a significantly higher level of sFas than those with BPH. The serum sFas level was statistically elevated in patients with metastatic prostate cancer. There was a statistically significant correlation between sFas and PSA in patients with prostate cancer but not in those without cancer. The serum sFas did not change one hour after systematic prostatic biopsy although PSA levels were markedly elevated. sFas levels might be useful as a discriminator between prostate cancer and BPH while sFas might indicate the tumor burden in patients with prostate cancer.     

Utility of Digital Rectal Examination,Serum Prostate Specific Antigen,and Transrectal Ultrasound in the Detection of Prostate Cancer: A Developing Country Perspective

Purpose: To determine the utility of digital rectal examination (DRE), serum total prostate specific antigen(tPSA) estimation, and transrectal ultrasound (TRUS) for the detection of prostate cancer (PCa) in men withlower urinary tract symptoms (LUTS). Materials and Methods: All patients with abnormal DRE, TRUS, or serumtPSA >4ng/ml, in any combination, underwent TRUS-guided needle biopsy. Eight cores of prostatic tissue wereobtained from different areas of the peripheral prostate and examined histopathologically for the nature of thepathology. Results: PCa was detected in 151 (50.3%) patients, remaining 149 (49.7%) showed benign changeswith or without active prostatitis. PCa was detected in 13 (56.5%), 9 (19.1%), 26 (28.3%), and 103 (74.6%) ofpatients with tPSA <4 ng/ml, 4-10 ng/ml, 10-20 ng/ml and >20 ng/ml respectively. Only 13 patients with PCahad abnormal DRE and TRUS with serum PSA <4 ng/ml. The detection rate was highest in patients with tPSA>20 ng/ml. The association between tPSA level and cancer detection was statistically significant (p<0.01). Among209 patients with abnormal DRE and raised serum PSA, PCa was detected in 128 (61.2%). Conclusions: Theincidence of PCa increases with increasing serum level of tPSA. The overall screening and detection rate can befurther improved by using DRE, TRUS and TRUS-guided prostate needle biopsies.     

The pursuit of prostate cancer in patients with a rising prostate-specific antigen and multiple negative transrectal ultrasound-guided prostate biopsies

To determine if patients with persistently elevated prostate-specific antigen (PSA) levels who have had transrectal ultrasound (TRUS)-guided prostate biopsies negative for carcinoma will benefit from additional saturation (> or =14 cores) TRUS biopsies with or without transurethral (TUR) biopsies. A retrospective review of 35 men between ages 51-74 with PSA values between 4.5-46 ng/mL, normal digital rectal examinations, and > or =2 previously negative sextant TRUS biopsies. Seventeen patients had TUR biopsies in addition to saturation TRUS biopsies. Eighteen patients had saturation TRUS biopsies only (median 20 cores). Seven patients who had no cancer detected with the combined TRUS/TUR biopsies had an additional saturation biopsy performed (median 20 cores). Seven (20%) of the 35 patients who had a saturation biopsy had cancer detected, and one (5.9%) cancer was detected in the 17 men that had a TUR biopsy. Five (71.4%) of the seven patients who had an additional TRUS biopsy had cancer detected (total core range 45-60). The overall yield of prostate cancer was therefore 37.1%, with 1-9 cores positive (median 5 cores). For patients with a rising PSA and > or =2 negative sextant TRUS biopsies, the cancer yield of the initial saturation TRUS biopsies was 20%. Furthermore, a significant proportion of patients with negative initial saturation biopsies had cancer detected on repeat TRUS biopsy. The cancer yield of adding TUR biopsies in this same group of patients is < 6.     

Transrectal ultrasound guided biopsy for detecting early prostate cancer: An Indian experience

BACKGROUND: With the advent of prostate specific antigen the number of patients undergoing prostate biopsy has dramatically increased. The sextant biopsy technique has been conventionally used for the diagnosis of prostate cancer. Recently, concern has arisen that the original sextant method may not include an adequate sample of the prostate, hence it may result in high false negative rates. We conducted a prospective study to determine whether the 5-region prostate biopsy technique significantly increases the chance of prostate cancer detection as compared to the sextant biopsy technique. AIMS: To evaluate the efficacy of TRUS guided sextant and 5-region biopsy techniques in detecting carcinoma prostate in patients with PSA between 4 and 10 ng/ml and normal digital rectal examination. METHODS AND MATERIAL: Between December 2001 and August 2003 one forty-two men, aged 49-82 years, who presented with LUTS, normal digital rectal examination (DRE) and PSA between 4 and 10 ng/ml underwent TRUS guided sextant prostate biopsy. Serum PSA was reassessed after 3 months in patients whose biopsies were negative for cancer. If PSA was still raised, the patients underwent extensive 5-region biopsy. RESULTS: Mean patient age was 64 years and median PSA was 6.9 ng/ml. TRUS guided sextant biopsy revealed adenocarcinoma prostate in 34 men (24%). Median Gleason score was 7. Seven men (4.9%) had cellular atypia and 3(2.1%) had prostatic intraepithelial neoplasia (high grade). On repeat PSA estimation after 3 months, 48 patients showed stagnant or rising trend for which they underwent TRUS guided 13-core biopsy. Five (10.4%) patients were detected to have adenocarcinoma on repeat biopsy. Biopsy negative patients are on regular follow up with yearly PSA estimation. Complications included transient mild haematuria in14 patients (9.82%) and haematospermia in 4 (2.8%). Urinary retention developed in one patient and required an indwelling catheter for 4 days. CONCLUSION: Transrectal ultrasound guided sextant biopsy has shown a false negative rate of approximately 11%. A repeat 5- region (13-core) biopsy strategy can decrease the false negative rate of conventional sextant biopsy in patients with previously negative biopsies but persistently high PSA levels, high grade PIN or cellular atypia.     

Editorial comments

Ninety-nine of 105 consecutive men who underwent transrectal prostatic ultrasound (TRUS) at Highland Park Hospital had the results correlated with digital rectal examination (DRE), serum prostate specific antigen (PSA), and biopsy results. Ninety-six cases had evaluable ultrasound studies. Thirty-two of the 99 who underwent biopsy had primary carcinoma of the prostate. Prostate volume, predicted PSA, a ratio of observed/predicted PSA, and Gleason score were examined. There was no correlation between age and prostate volume, volume and the presence of carcinoma, or PSA and Gleason score. Thirty-one point six percent of the abnormal DREs, 36.6% of the abnormal TRUSs, and 40.6% of the elevated PSAs occurred in men with prostatic carcinoma (PCa). If PSA was normal (less than or equal to 4.0 ng/ml) and either DRE or TRUS was abnormal, then the risk of carcinoma was 2.9%. If PSA was elevated, regardless of the other two tests, the risk of finding PCa was at least 38%. If all three tests were abnormal, the risk of carcinoma was 38% in our series and 68% in a meta-analysis. Many men with PSA values between 4 and 10 ng/ml have benign biopsies. However, close future follow-up with consideration of repeat biopsy should be strongly considered. © 1994 Wiley-Liss, Inc.     

Detection of prostatic carcinoma: the role of TRUS, TRUS guided biopsy, digital rectal examination, PSA and PSA density

The purpose of this study was to evaluate the efficacy of various diagnostic tests including transrectal ultrasound (TRUS), TRUS guided biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), and prostate specific antigen density (PSAD) in detecting prostatic carcinomas. One hundred and thirty-four men underwent TRUS guided random, or directed and random sonographic biopsies of the prostate. The mean age was 64.67 (range, 31- 88) years. Indications for biopsy were abnormal findings suggesting prostatic carcinoma on DRE or increased levels of PSA, defined as 4.0 ng/ml or greater in a monoclonal antibody assay. PSAD was calculated by dividing the serum PSA in ng/ml to the volume of the entire prostate in cm3. The biopsy results were grouped as benign, malign and, prostatitis. The patients were also divided into three groups according to their PSA values. Of the 134 patients evaluated, 31 (23.1%) had prostate adenocarcinoma, 89 (66.4%) had benign prostatic tissue, hyperplasia or prostatic intraepithelial neoplasia, and 14 (10.4%) had prostatitis. The mean PSA and PSAD of the carcinoma group were significantly higher than those of the noncancer group. In the group of patients with PSA levels between 4 and 10 ng/ml, abnormal TRUS or DRE increased cancer detection rate, where neither PSA nor PSAD was capable of discriminating the patients with and without cancer. PSAD did not prove to be superior to the other diagnostic tests in this study. We recommend biopsy when either TRUS or DRE is abnormal in patients with PSA levels between 4 and 10 ng/ml. In the patients with PSA levels greater than 10 ng/ml, biopsy is indicated whatever the findings on TRUS or DRE are, since cancer detection rate is high.     

Evaluation of free-to-total prostate specific antigen ratio in the diagnosis of prostate cancer

It'sreportedthatfreetototalprostatespecificantigenration(f/tPSA)canprovidemorebenefitthanthesingleuseofprostatespecificantigen(PSA)inthediagnosisofprostatecancer(PCa).WemeasuredserumPSAandfPSAlevelsin62casesofbenignprostatichyperplasia(BPH)and40casesofPCausingradioimmunoassay,withpatients'agerange59y-89y.RESULTSPSA,fPSAandf/tPSAareshowninTable1.BoththesetwogroupsshowslinearcorrelationbetweenPSAandfPSA,correlationcoefficientofBPHis0.55(P<0.01),ofPCais0.44(P<0.01).Twoslopesha…     

Negative Biopsy Histology in Men With PI-RADS Score 5 in Daily Clinical Practice: Incidence of Granulomatous Prostatitis

IntroductionThe purpose of this study was to evaluate the biopsy histology of men who underwent transperineal multi-parametric magnetic resonance imaging (mpMRI)/transrectal ultrasound fusion biopsy for Prostate Imaging Reporting and Data System (PI-RADS) score 5 lesions.Patients and MethodsFrom January 2016 to June 2019, 105 men with PI-RADS score 5 underwent mpMRI/transrectal ultrasound fusion biopsy combined with systematic prostate biopsy. All the patients underwent a 3.0 Tesla pelvic mpMRI for the first time before prostate biopsy. In detail, the detection rate for clinically significant prostate cancer (PCa) and the follow-up of the patients without proven diagnosis of PCa has been reported.ResultsIn 91 (86.7%) of 105 patients, a stage T1c PCa was diagnosed, and 89 (84.5%) of 105 of them were classified as clinically significant PCa. Among the 16 (15.5%) of 105 patients with absence of cancer, 5 (31.5%) of 16 had an aspecific granulomatous prostatitis, 1 (6.2%) of 16 had a specific granulomatous prostatitis secondary to prostatic Mycobacterium Tubercolosis, and 10 (62.3%) of 16 had a diagnosis of normal parenchyma. The 6 patients with granulomatous prostatitis underwent specific antibiotic therapy followed by laboratory (ie, semen and urine cultures) and clinical evaluation. Six months from prostate biopsy, none of the 16 patients underwent repeat prostate biopsy because prostate-specific antigen (PSA) (15/16 cases) plus PSA density significantly decreased; in addition, in all the cases the initial PI-RADS score 5 was downgraded at mpMRI revaluation to PI-RADS score ≤ 3.ConclusionThe reduction of PSA plus PSA density values and the downgrading of PI-RADS score to ≤ 3 allow avoiding a repeated prostate biopsy in men with initial mpMRI PI-RADS score 5 lesion and negative biopsy histology.     

Differential blood-based diagnosis between benign prostatic hyperplasia and prostate cancer: miRNA as source for biomarkers independent of PSA level,Gleason score,or TNM status

Since the benefit of prostate-specific antigen (PSA) screening remains controversial, new non-invasive biomarkers for prostate carcinoma (PCa) are still required. There is evidence that microRNAs (miRNAs) in whole peripheral blood can separate patients with localized prostate cancer from healthy individuals. However, the potential of blood-based miRNAs for the differential diagnosis of PCa and benign prostatic hyperplasia (BPH) has not been tested. We compared the miRNome from blood of PCa and BPH patients and further investigated the influence of the tumor volume, tumor-node-metastasis (TNM) classification, Gleason score, pretreatment risk status, and the pretreatment PSA value on the miRNA pattern. By microarray approach, we identified seven miRNAs that were significantly deregulated in PCa patients compared to BPH patients. Using quantitative real time PCR (qRT-PCR), we confirmed downregulation of hsa-miR-221* (now hsa-miR-221-5p) and hsa-miR-708* (now hsa-miR-708-3p) in PCa compared to BPH. Clinical parameters like PSA level, Gleason score, or TNM status seem to have only limited impact on the overall abundance of miRNAs in patients’ blood, suggesting a no influence of these factors on the expression of deregulated miRNAs.     

Prostate-specific Antigen Velocity (PSAV) and PSAV per Initial Volume (PSAVD) for Early Detection of Prostate Cancer in Chinese Men

Aim: To investigate the utility of prostate-specific antigen velocity (PSAV) and PSAV per initial volume(PSAVD) for early detection of prostate cancer (PCa) in Chinese men. Methods: Between January 2009 andJune 2012, a total of 193 men (aged 49–84 years, median 67 years) with at least 2 transrectal ultrasonography(TRUS) procedures and concurrent serum PSA measurements underwent prostate biopsy because of suspicionof PCa. The total group were classified into PCa and non-PCa groups, and the variables of the two groups werecompared. Univariate and multivariate analyses were used to investigate which variables were predictove. Thediagnostic values of PSAV, PSAVD and prostate-specific antigen density (PSAD) were compared using receiveroperating characteristic (ROC) analysis. Results: Prostate cancer was diagnosed in 44 (22.8%) of the 193 men.There were significant differences between the groups in last and initial prostate volumes determined by TRUS,initial age, last serum PSA levels, PSAV, PSAD and PSAVD. After adjusting for confounding factors, the oddsratios of PCa across the quartile of PSAVD were 1, 4.06, 10.6, and 18.9 (P for trend <0.001).The area under theROC curves (AUCs) of PSAD (0.779) and PSAVD (0.776) were similar and both significantly greater than thatof PSA (AUC 0.667). PSAVD was a significantly better indicator of PCa than PSAV (AUC 0.736). There was nostatistical significant difference between the AUC of PSAV and that of last serum PSA level. The sensitivity andspecificity of PSAVD at a cutoff of 0.023ng in participants with last serum PSA levels of 4.0ng/mL-10.0ng was73.7% and 70.7%, respectively. Conclusions: The results of this study demonstrated PSAVD may be a usefultool in PCa detection, especially in those undergoing previous TRUS examination.     

Molecular forms of prostate‐specific antigen in serum with concentrations of total prostate‐specific antigen <4 μg/L: Are they useful tools for early detection and screening of prostate cancer?

Molecular forms of prostate-specific antigen (PSA) improve the differentiation between benign prostatic hyperplasia (BPH) and prostate cancer (PCa) in men with total PSA concentrations between 4 and 10 microg/l. To evaluate the diagnostic utility of free PSA (fPSA) and complexed PSA forms for identification of men with PCa in the low PSA range of <4 microg/l, total PSA (tPSA), alpha(1)-antichymotrypsin complexed PSA (PSA-ACT) and fPSA (Roche Elecsys [ES] system) as well as tPSA and complexed PSA (cPSA) (Bayer Immuno 1 system) were measured in archival serum samples from 31 untreated patients with PCa, 66 patients with BPH, and 90 men without prostatic disease. The median ratios of fPSA/tPSA, PSA-ACT/tPSA and cPSA/tPSA were significantly different between patients with BPH and PCa (27.2 vs. 19.4%, 64 vs. 88%, 77.2 vs. 88.2%, p < 0.05). No associations between PSA forms and tumor stage and grade were found. Analysis of the receiver operating characteristic curves showed that these ratios could discriminate better between BPH and PCa patients than determination of the analytes tPSA, fPSA, cPSA and PSA-ACT alone. The use of one of the ratios would have eliminated roughly half of the unnecessary biopsies in this study. The ratios should be considered as potential tools to increase the selectivity of PCa detection at low PSA concentration. The ratios fPSA/tPSA and cPSA/tPSA can be determined using commercially available assays so that one of these ratios could be preferred instead of PSA-ACT determination. The ratios could be useful in assessing the risk of PCa in the individual and therefore in deciding on prostate biopsy for final diagnosis.     

直肠超声引导经会阴途径穿刺活检诊断前列腺癌

目的:通过总结经直肠超声(TRUS)引导下经会阴途径前列腺癌(PCa)穿刺活检患者的临床表现、相关检查及病理特征,提高对PCa穿刺活检的病理诊断水平.方法:选择2014年7月至2016年12月期间于我院行TRUS引导下经会阴途径PCa穿刺活检患者101例,对这些患者的临床表现、血清PSA检查、影像学检查及病理检查进行总结.结果:PCa患者年龄多大于60岁,多伴有泌尿系统症状与直肠指检异常、血清PSA常超出上限;影像学表现为病变区域图像改变与血流信号异常;镜检特征主要表现在细胞异型、结构异型和浸润性生长,镜下特征性结构与免疫组化检查有助于PCa的诊断.结论:前列腺穿刺活检病理检查是诊断PCa的金标准,在熟练掌握其病理特征与免疫组化表达的同时,注意结合PCa临床表现与临床相关检查的特点,对提高病理诊断准确性具有重要的临床意义.