Prostate volume as an independent predictor of prostate cancer in men with PSA of 10–50?ng ml?1

Prostate volume (PV) has been shown to be associated with prostate cancer (PCa) detection rates in men with a prostate-specific antigen (PSA) in the ‘grey zone'' (2.0–10.0 ng ml⁻¹). However, the PSA ‘grey zone'' in Asian men should be higher because the incidence of PCa in Asian men is relatively low. Therefore, we evaluated the association between PV and PCa detection rates in men with PSAs measuring 10–50 ng ml⁻¹. Men who underwent a 13-core prostatic biopsy with PV documentation participated in the study. A multivariate stepwise regression was used to evaluate whether the PV at time of prostate biopsy could predict the risk of PCa. The rates of PCa among men in different PSA ranges, stratified by PV medians (<60 and ≥60 ml), were calculated. There were 261 men included in the final analysis. PV was the strongest predictor of PCa risk (odds ratio, 0.02; P<0.001) compared to other variables. The PCa rates in men with PVs measuring <60 and ≥60 ml in the 10–19.9 ng ml⁻¹ PSA group were 40.6% and 15.1%, respectively, while the rates for men with PSAs measuring 20–50 ng ml⁻¹ were 65.1% and 26.8%. PV is an independent predictor of PCa in men with PSA measuring 10–50 ng ml⁻¹. In clinical practice, particularly for those countries with lower incidences of PCa, PV should be considered when counselling patients with PSAs measuring 10–50 ng ml⁻¹ regarding their PCa risks.     

Prostate cancer vaccines in combination with additional treatment modalities

Immunologic Research - Immunotherapy has been investigated in both preclinical studies and clinical trials as a new therapy for prostate cancer. Vaccines, including those that utilize dendritic...     

A nomogram based on age,prostate-specific antigen level,prostate volume and digital rectal examination for predicting risk of prostate cancer

Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) status, % free PSA and transrectal ultrasound (TRUS) findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% (223/535). The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.     

Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men

Study Type – Prognostic (cohort)
Level of Evidence 2b What’s known on the subject? and What does the study add? Currently, the U.S. Preventive Services Task Force (USPSTF) recommends against PSA screening for prostate cancer in men aged ≥75 years as it concluded that “the harm of screening for prostate cancer in men age ≥75 years may outweigh the potential benefits”. Our findings suggest that elderly men with a PSA velocity of ≥0.45 ng/ml/year have higher risk of death from prostate cancer. Continuing PSA testing may be beneficial for these men.

OBJECTIVE

? To evaluate weather prostate‐specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk.

PATIENTS AND METHODS

? The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa. ? The rates of death from PCa after diagnosis in different PSA velocity groups were calculated. Kaplan‐Meier and log rank test were used to assess the significant difference in death from PCa after diagnosis, stratified by PSA velocity cutoff.

RESULTS

? On multivariate analysis, men with a PSA velocity of PSA velocity ≥0.45 ng/mL/year had a 4.8‐fold higher risk of death from PCa as compared to men with a PSA velocity of <0.45 ng/mL/year (p value = 0.013). After a median 6.5 (up to 16.9) years of follow‐up from diagnosis, 1.4% of the men with a PSA velocity <0.45 ng/mL/year had died of PCa as compared to 8.7% of those with a PSA velocity ≥0.45 ng/mL/year. ? The cumulative rate of death from PCa after diagnosis, stratified by a PSA velocity of 0.45 ng/mL/year, was statistically different (log rank test, P < 0.001).

CONCLUSION

? Men age ≥ 75 years old with a PSA velocity of <0.45 ng/mL/year are unlikely to die of PCa. It may be safe to discontinue PSA screening in these men.     

Immunohistochemical study of chondroitin-6-sulphate and tenascin in the larynx: a loss of chondroitin-6-sulphate expression accompanies squamous cell carcinoma invasion

Chondroitin 6-sulphate is a glycosaminoglycan component of both cell membrane and basement membrane proteoglycans. In vitro it can inhibit tenascin, a molecule critical for epithelial cell migration during development and in wound healing. The immunohistochemical expression of chondroitin-6-sulphate and tenascin has been examined in 143 laryngeal biopsies from 38 patients, with particular attention to changes occurring with squamous cell carcinoma invasion. All tissues were formalin-fixed and paraffin-embedded. An avidin-biotin complex immunoperoxidase technique was used. Immunostaining for chondroitin-6-sulphate was seen in the basement membrane and/or cell membranes of basal and suprabasal cells of the laryngeal epithelium. Immunostaining of cell or basement membrane was seen at least focally in 67 of 71 (94 per cent) biopsies with no atypia, in 39 of 45 (87 per cent) biopsies with mild/moderate atypia, and in 16 of 16 (100 per cent) biopsies with severe dysplasia or carcinoma in situ (CIS); but in only 2 of 18 biopsies with invasion, although in neither of these was chondroitin-6-sulphate immunostaining seen at the actual site of invasion. Tenascin immunostaining was seen along the basement membrane in all biopsies. Those with CIS or invasion showed, in addition, strong tenascin staining of the adjacent stroma. The loss of chondroitin-6-sulphate immunostaining concurrent with squamous cell carcinoma invasion in the larynx suggests that loss of a chondroitin-6-sulphate-containing proteoglycan, or a change in proteoglycan side-chain composition, is a critical step in laryngeal epithelial tumour invasion.     

Potassium load from blood transfusion in dialysis patients

When a transfusion of packed red blood cells is given, the net potassium load results from lysis of some cells and absorption of potassium by surviving cells. Potassium load was calculated which results from administration of 1 unit (200 cc.) of packed RBC and also that resulting from administration of sufficient packed cells to yield 200 cc. of surviving RBC. Although the acute load of potassium due to cell lysis increases as blood is stored for longer periods, the absorption of potassium by surviving cells also increases. Thus, net potassium load may be least if blood is stored for about one week. Hence the acute potassium load and the net potassium burden a patient receives from a transfusion can be considered when transfusion therapy is selected.     

Novel Use of AngioVac System to Prevent Pulmonary Embolism during Radical Nephrectomy with Inferior Vena Cava Thrombectomy

Venous tumor thrombus occurs in 5-10% of patients with renal cell carcinoma. Surgical excision offers the best chance for survival, but is technically difficult. Risk of pulmonary embolism from venous thrombus or tumor thrombus is high, especially with tumors located higher in the inferior vena cava. Cardiopulmonary bypass may be used when a tumor extends above the diaphragm, but carries significant risk. We present an 86-year-old woman with a 7 cm renal mass extending into the inferior vena cava just below the confluence of the hepatic vessels. Prior to surgery she was found to have increasing pulmonary embolisms despite appropriate anticoagulation. Intraoperatively, the AngioVac aspiration system was utilized to prevent further pulmonary embolism. This is the first reported case of the use of this system during radical nephrectomy.Key Words: Nephrectomy, Venous thrombus, Pulmonary embolism, Vena cava