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Biomedical subjects

B Djavan

Publications and source records attributed to B Djavan.

6 recordsLinked to original sources
PubMed1997

Prostate specific antigen density of the transition zone: a new effective parameter for prostate cancer prediction.

PURPOSE: Use of prostate specific antigen (PSA) density to enhance the predictive value of detecting prostate cancer at intermediate PSA levels has been limited due to contradictory results in large scale studies. Most PSA leakage from the benign prostate into the serum comes from the transition zone. Therefore, in patients with benign prostatic hyperplasia (BPH) and prostate cancer with a serum PSA of less than 10 ng/ml. we studied and compared the values of PSA density of the total prostate and the transition zone. We examined the ability of PSA density of the transition zone to enhance prostate cancer detection in patients with intermediate PSA levels. MATERIALS AND METHODS: The volumes of the entire prostate and of the transition zone were determined by transrectal ultrasound. PSA density for both regions was calculated in 88 patients with histologically confirmed prostate cancer (radical prostatectomy), and 74 with BPH and histologically proved benign disease. RESULTS: Average total prostate PSA density plus or minus standard deviation was 0.12 +/- 0.07 and 0.22 +/- 0.12 ng./ml./cc in patients with BPH and prostate cancer, respectively, while average PSA density of the transition zone was 0.21 +/- 0.13 and 1.02 +/- 0.70 ng./ml./cc, respectively (p < 0.0001). If a total prostate PSA density of 0.15 had been chosen, the cancer would have been missed in 34% of the patients compared to 10% if a cutoff value of 0.35 for PSA density of the transition zone had been chosen (p < 0.001). Overall, in patients with a PSA of 0.25 to 10.0 ng./ml. the sensitivity and specificity of PSA density of the transition zone for predicting prostate cancer at a 0.35 cutoff value were 90 and 93%, respectively, compared to 94 and 89%, respectively, for those with a PSA of 4 to 10 ng./ml. CONCLUSIONS: In our study PSA density of the transition zone was much more accurate in predicting prostate cancer than was total prostate PSA density for PSA levels of less than 10 ng./ml. With respect to the high sensitivity and specificity, if confirmed in large prospective studies, including patients seen for early diagnosis, PSA density of the transition zone could become a routine tool for urologists in the prediction of prostate cancer in men with a PSA of 4 to 10 ng./ml.

Aged↗
PubMed1996

[The effect of 5-alpha-reductase inhibitors on benign prostatic hyperplasia].

The prevalence of BPH is high in elderly men with more than 60% of patients over the age of 60 experiencing some form of prostatism. Balancing the superior benefit of TUR/P are the small but significant risks and complications of surgery and the high cost of the procedure. The WHO guidelines recommend finasteride or alpha-blockers as treatment options for men with bothersome symptoms. Finasteride therapy reduces the volume of the hyperplastic prostate gland by more than 20%, improves the urinary flow rate and the symptoms associated with bladder outlet obstruction. Although statistically significant, results obtained with finasteride are just slightly better than placebo and TUR/P still offers the greatest improvement of symptoms. Finasteride is well tolerated and adverse events are rare. However, it decreases serum PSA (prostate specific antigen) by 50%, suggesting careful monitoring and exclusion of prostate cancer before initiation and during therapy. Current research is focusing on developing new 5-alpha-reductase inhibitors (type I and II) using polyunsaturated fatty acids and nonsteroidal inhibitors. Given the multifactorial nature of BPH, further clinical trials combining 5-alpha-reductors inhibitors and 5-alpha-receptor blockers are still needed.

5-alpha Reductase Inhibitors↗
PubMed1995

Radical retropubic prostatectomy for localized carcinoma of the prostate in a large metropolitan hospital: changing trends over a 10-year period (1984-1994). Dallas Outcomes Research Group for Urological Disorders.

OBJECTIVES: To analyze changing trends in the surgical treatment for localized carcinoma of the prostate in a large metropolitan community hospital over a 10-year period from 1984 to 1994. METHODS: The records of all 428 patients who underwent radical prostatectomy for localized carcinoma of the prostate from January 1, 1984, to January 1, 1994, at a large metropolitan community hospital (Baylor University Medical Center, Dallas, Tex) were retrieved and data abstracted in a predefined computerized database by a urology resident who was not part of the patient's surgical team. The abstracted data included attending surgeon, date of surgery, patient's age, clinical stage at presentation and pathologic stage, prostate-specific antigen (PSA), perioperative events, such as duration of surgery, blood loss, transfusion, duration of hospital stay, comorbidities according to the Charlson comorbidity index, and others. The data were analyzed in regard to changes over the 10-year period and stratified by a variety of parameters. RESULTS: The number of radical prostatectomies performed increased by fourfold from 1984 to 1993. The distribution of clinical stage and the incidence of pathologic upstaging noted in the 428 cases were similar to other series reported in the literature. The average age of patients decreased from 67 to 63 years over the 10 years (average calculated in increments of 15 cases in ascending order). Similarly, over time the average duration of surgery, average blood loss, average use of transfusion, and the average duration of hospital stay decreased. When the cases were grouped by individual attending surgeon, whose numerical surgical experience during that time period ranged from 1 to 76 cases, no correlation was noted between the numerical experience and these outcomes. CONCLUSIONS: As opposed to the national Medicare experience recently reported by the Prostate Patients Outcome Research Team, the increase in the number of cases performed was mostly due to patients under the age of 70 years, considered reasonable candidates for radical prostatectomy. Independent of numerical experience of individual attending surgeons, duration of surgery, blood loss, transfusion rates, and duration of hospital stay decreased during this period. This might indicate a learning effect due to continuing education, exchange of ideas, published technical improvements in the surgical procedure, and other factors, ultimately benefiting the patient by improving outcomes.

Adult↗
PubMed1995

False-positive serum prostate-specific antigen values in a patient with non-Hodgkin lymphoma of the kidney.

Prostate-specific antigen (PSA) is the clinically most useful tumor marker for prostate cancer. Although false-positive elevations have been reported due to disease processes outside the prostate gland with the use of the polyclonal assay, such false-positive test results have been exceedingly rare with the use of the monoclonal assay. We report the case of a patient diagnosed with a B-cell lymphoma of the kidney and a significant elevation of serum PSA levels by monoclonal assay in the absence of either inflammatory or malignant prostate disease. PSA returned to normal during lymphoma-specific chemotherapy with a cyclophosphamide, mechlorethamine, vincristine, procarbazine, prednisone regimen. Possible explanations and clinical implications are discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Mucinous adenocarcinoma in defunctionalized bladders.

Primary adenocarcinoma of the bladder accounts for less than 2% of all bladder cancers. There is no report of such a case in a defunctionalized bladder. All reported cases of carcinoma in defunctionalized bladders were either squamous cell, signet ring cell, or transitional cell carcinoma, detected within an average of 5 years after urinary diversion, and all have been associated with chronic inflammation of the bladder. We report on 2 cases of adenocarcinoma that developed in defunctionalized bladders 30 and 8 years after ileal loop diversion for prune belly syndrome and neurogenic bladder, respectively.

Adenocarcinoma, Mucinous↗