Biomedical subjects

F Leal Hernández

Publications and source records attributed to F Leal Hernández.

15 recordsLinked to original sources

PubMed2000

[Usefulness of free PSA/total PSA ratio in the diagnosis of prostatic cancer in symptomatic patients with PSA levels ranging from 2.5 to 20 ng/ml].

OBJECTIVE: To evaluate the value of free PSA/total PSA ratio (fPSA/tPSA) to boost total PSA (tPSA) specificity in the diagnosis of prostate cancer in a series of symptomatic patients. MATERIAL AND METHOD: Prospective study on 334 patients presenting symptoms compatible with PBH and tPSA (ProStatus, Wallace Oy, Turku, Finland) between 2.5 and 20 ng/ml, and mean age 67.2 +/- 7 (49-87). Patients were divided into 3 groups: Group I (normal DRE and tPSA between 2.5 and 10 ng/ml)--189 patients. Group II (normal DRE and tPSA between 10 and 20 ng/ml)--78 patients. Group III (suspicion DRE and sPSA between 2.5 and 20 ng/ml)--67 patients. For each group, the sensitivity, specificity and ROC curves were calculated for several cut-off values of the lPSA/tPSA ratio. RESULTS: Group I--Prostate cancer was diagnosed in 11% (20/189) patients. Significant differences were found only in the lPSA/tPSA ratio (p = 0.01). Using 27% as the cut-off value, cancer would have been diagnosed in 95% (19 of 20) patients, decreasing the total number of negative biopsies by 21% (39 of 189). Group II--Prostate cancer was diagnosed in 19% (15/78) patients. The only significant differences found were in prostate volume (p = 0.02). Using 30% as the cut-off value, 93% (14 of 15) patients with cancer would have been diagnosed, decreasing the total number of biopsies by 6.5% (5 of 78) and the number of negative biopsies by 8% (5 of 63). Group III--Prostate cancer was detected in 72% (48/67) patients. Significant differences were found in lPSA/tPSA ratio (p = 0.003), prostate volume (p = 0.02) and presence of ultrasound nodes (p = 0.004). Using 25% as the cut-off value, 96% (46 of 48) of patients with cancer would have been diagnosed, decreasing the total number of biopsies by 13% (9 of 67) and the number of negative biopsies by 47% (9 of 19). CONCLUSIONS: We advise use of lPSA/tPSA ratio only in patients with normal DRE and tPSA between 2.5 and 10 ng/ml. Biopsing patients with lPSA percent equal to or lower than 27% would have prevented 23% of negative biopsies while still maintaining a diagnostic sensitivity of 95%.

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PubMed1999

[Upper urothelium tumor in patients treated with radical cystectomy for transitional carcinoma of the bladder].

OBJECTIVE: To evaluate the incidence and characteristics of tumours in the upper endothelium (TUE) that develop in patients with transitional carcinoma of the bladder treated with radical cystectomy. MATERIAL AND METHOD: Between 1986 and 1996, 160 evaluable patients who underwent cystectomy due to transitional cancer of the bladder were reviewed and found to be infiltrant in 96% cases. Follow-up either until death or to the date of the study, was carried out with intravenous urography (IVU) in the first 6 months with additional urographies at least every two years. RESULTS: Five (3.1%) patients showed progress of the upper endothelium tumour, which was multifocal in 3 patients and infiltrant also in 3. No association was seen in these patients with in situ carcinoma of the bladder, or urethral invasion by the primary tumour: only one patient had tumour involvement of end ureters. After three months from diagnosis, tumour-related mortality was 50%. Incidence of upper endothelium tumours in patients with infiltrant tumour of the bladder was lower (1.9%) than in patients with surface tumour of the bladder (16.6%). CONCLUSION: Based on data from our series, the incidence of TUE was 3.1% with a mean time interval between cystectomy and TUE diagnosis of 25.4 months. IVU was diagnostic only in 40% cases. No risk factors were identified in our patients, and mortality due to advanced stage of TUE at three months was 50%. The high percentage of patients with advanced TUE in our series warrants the addition of an annual IVU in the follow-up of these patients.

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PubMed1999

[Hemorrhagic prostatic cyst following ultrasound guided biopsy. A case report].

OBJECTIVE: To describe a case of a hemorrhagic prostatic cyst following ultrasound-guided biopsy of the prostate gland. METHODS/RESULTS: We reviewed our series of 77 patients submitted to re-biopsy of the prostate; only one case (1.3%) of hemorrhagic post-biopsy prostatic cyst was found. The ultrasound features, differential diagnosis and management of these cystic lesions are discussed. CONCLUSIONS: Hemorrhagic post-biopsy prostatic cyst is rare in our series (1.3%). A history of a previous biopsy in the area of the cystic lesion, the results of punction-aspiration of the cystic content and biopsy of the prostate gland provide data that are necessary to make the diagnosis.

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PubMed1999

[Incidence of prostatic cancer in symptomatic patients with non-suspicious rectal palpation and PSA levels greater than 10 ng/ml].

OBJECTIVE: To evaluate the overall incidence of prostate cancer in patients with symptoms of prostatism, no suspicious DRE and PSA > 10 ng/ml. MATERIAL AND METHOD: 397 eligible patients based on the above criteria, mean age 69.3 +/- 7.7 years and mean PSA level of 21.3 +/- 29.3 ng/ml, underwent ultrasound-guided transrectal biopsy of the peripheral and central areas. Patients with no cancer in the biopsy and surgery indication underwent prostate surgery. Incidence of cancer in the transitional area was evaluated in these patients. RESULTS: Biopsy was found to be positive for cancer in 15.4% patients. Patients with prostate cancer had PSA concentrations (p = 0.06) and PSAD (p < 0.0001) lower than cancer-free patients. Thirteen (21%) of these patients underwent radical prostatectomy; an extracapsular tumour was found in 46% of the surgical specimens. Of the 336 patients with benign histology in the biopsy, 94 (28%) underwent prostate surgery. Cancer in the transitional zone was found in 15% cases (5 T1a and 8 T1b), with significant differences between PSA (0.03) and PSAD (0.04) concentrations between patients with BPH or T1b tumour in the surgical specimen but not among patients with BPH and T1a cancer. CONCLUSIONS: Approximately 30% of these patients had prostate cancer, half of them found in the transitional area. PSA and PSAD did not show enough diagnostic strength to identify these patients. Most patients with cancer had clinically significant tumours. Therefore, we believe that prior to deciding the course of therapy these patients should undergo another series of biopsies including the transitional area, mainly in those with long-term life expectancy.

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PubMed1999

[The diagnostic effectiveness of repeat echo-guided transrectal biopsy as a function of the clinical and anatomicopathological findings].

OBJECTIVE: To evaluate the incidence of false negatives in our series of ultrasound-guided prostate biopsies. MATERIAL AND METHOD: 106 patients (79% with high PSA and the remainder with suspicion digital rectal examination) with cancer-free transrectal biopsy underwent at least a second biopsy limited to the peripheral area: mean age 68 +/- 6.4 years, mean number of biopsy punctures 5 +/- 1, 95% patients with biopsies from both lobes. Re-biopsy indication was the result of persistently high PSA in 84 patients (13 with glandular atypia and 3 with PIN 3), or suspicion digital rectal examination in 22 patients (4 with glandular atypia and 2 with PIN 3). Second biopsy was performed in 89% patients, third in 10% and fourth in just one patient. RESULTS: 14% patients were found to have cancer, tumour diagnosis being made on the second biopsy in 93.3% cases. In patients with suspicion digital rectal examination only, cancer was detected in 31%, and 7.3% patients with high PSA had cancer; 40% patients with PIN 3 and 18% patients with glandular atypia had cancer. In patients with high PSA only, PSA (p = 0.6) and PSAD (p = 0.3) levels and the presence of changes in the ultrasound (p = 0.8) were not enough to detect cancer patients. Deobstructive prostate surgery was performed in 15 patients after re-biopsy, cancer being found in the transitional area in 20% cases. CONCLUSIONS: Our recommendation is that all patients with suspicion digital rectal examination, high grade PIN or glandular atypia should undergo re-biopsy which should include the transitional area. Due to the low incidence of cancer in patients with persistently high PSA and the inefficiency of biochemical and ultrasound parameters to detect patients with cancer, we suggest that each case should be assessed on an individual basis.

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PubMed1999

[Clinical and ultrasonographic characteristics of prostatic cancer diagnosed with transrectal biopsy].

OBJECTIVE: To analyze the clinical, ultrasound and pathological characteristics of patients with prostate cancer diagnosed by ultrasound-guided transrectal biopsy who consulted for lower urinary tract symptoms compatible with benign hyperplasia of the prostate. METHODS: From 1994 to 1998 ultrasound-guided transrectal biopsy of the prostate was performed in 1,548 patients aged 49-90 years (mean age 70 +/- 7). Of these, 613 (40%) were diagnosed with cancer. Biopsy was performed in 161 patients (60%) with elevated PSA but no suspicion of cancer on digital rectal examination, and 452 patients with a suspicious DRE. Only 10 of these 452 patients (2%) had a PSA value within the normal ranges. Ninety-seven percent of the patients with cancer were diagnosed at the first biopsy. RESULTS: The DRE findings were compatible with locally advanced cancer in 25% of the patients. An echogenic nodule was detected in 79%; the nodule was hypoechoic in 93% of the cases. Ninety-four percent of the patients with a suspicious DRE versus 37% of those with a normal DRE showed a nodule on ultrasound (p < 0.001). According to the ultrasound and DRE findings, 41% of the patients had a localized cancer. Cancer was diagnosed in 70% of the patients with a nodule; 51% of the cases had high grade carcinoma (score 8, 9 or 10). Sixty percent of the patients with a suspicious DRE had high grade cancer versus 30% of the patients with a normal DRE (p < 0.001). Twenty-three percent of the patients underwent radical prostatectomy. Only 34% of the patients had a localized tumor. CONCLUSIONS: Most of the tumors of the prostate diagnosed in patients who presented with lower urinary tract symptoms compatible with BHP were high grade and locally advanced and therefore not susceptible to cure. PSA determination and digital rectal examination at the primary care level can be useful in detecting prostate cancer in the early stages without significantly increasing costs.

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PubMed1998

[Abdominal pain in patients undergoing radical cystectomy for bladder cancer].

OBJECTIVE: To analyze the incidence and causes of emergency admission for abdominal pain in patients submitted to radical cystectomy for bladder cancer. METHODS: A retrospective study was conducted on 176 patients who had undergone radical cystectomy for bladder cancer. The preoperative treatment, urinary diversion procedure, postoperative tumor stage, complications and adjuvant treatment required were analyzed. The patients had a follow-up of 43.7-58.3 months (mean 51). RESULTS: 18 patients required admission for abdominal pain; 7 for complete bowel obstruction, 5 for partial obstruction of the intestine and 6 for intestinal fistula (4 to the neobladder, 1 to the urethra, and 1 to the vagina). In 6 patients abdominal pain was caused by recurrence of a pelvic tumor. Seven patients required emergency surgery and 5 elective surgery. CONCLUSIONS: 10.5% of the patients who had undergone radical cystectomy for bladder cancer had at least one episode of abdominal pain requiring admission to hospital. During the first 6 months postoperatively, partial obstruction of the intestine was the most common cause of abdominal pain, and thereafter, complete bowel obstruction and intestinal fistula to the neobladder. Abdominal pain was caused by recurrence of a pelvic tumor in 33% of the patients and by a benign condition in the remaining patients. We found no risk factors related with the preoperative treatment, tumor, urinary diversion procedure or early complications that may predispose to episodes of abdominal pain.

Abdominal Pain↗

PubMed1998

[Local recurrence after radical cystectomy for cancer of the bladder].

OBJECTIVE: The objective of the present study is to analyze the incidence, pathoanatomical characteristics, form of presentation and evolution of local relapses in patients undergoing radical cystectomy due to bladder cancer. MATERIAL AND METHOD: Analysis of our series of 170 bladder cancer cystectomies performed between 1986 and 1997 with a follow-up median of 51 months. 91% patients received no pre-operative treatment, 58% had localized disease (pT1-pT3a) while the remaining 42% had locally advanced disease (pT3b-pT4a). In 94% cases, a staging lymphadenectomy was performed which was pN0 in 84% instances, 21% patients underwent adjuvant chemotherapy. RESULTS: The incidence of local relapse was 6.5%, 45.5% of which already showed distant metastasis at the time of diagnosis. Preoperative (9% vs 6.5%) or adjuvant (8.3% vs 6.7%) treatment did not decrease the incidence of relapse. Local relapse was more frequent in patients with higher histologic degree (p < 0.05) and in patients with locally advanced disease (9.7% vs 4%). Mean time between cystectomy and relapse detection was 10.5 (4-23) months and mean survival 3.8 (1-15) months. CONCLUSIONS: Incidence of local relapse was 6.5%, half of the patients showing distant spread at the time of diagnosis. The type of pre- or post-operative treatment had not influence on the incidence of relapse. Patients with higher degrees and locally advanced stages had local relapse more frequently. The appearance of a local recurrence implies a bad prognosis with a medial survival of 3.8 months.

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PubMed1998

[Prostate cancer in the transition zone in sympatomatic patients with no rectal signs and negative peripheral zone biopsy].

OBJECTIVE: To evaluate the incidence of transition zone prostate cancer in patients with symptoms of benign prostatic hyperplasia, elevated PSA values, negative DRE and central and transition zone biopsies in order to determine the risk factors in the subgroup of patients with a high incidence of transition zone prostate cancer. METHODS: Of 541 patients with benign histological findings on ultrasound-guided transrectal prostatic peripheral and central zone biopsies, 125 (23%) underwent prostatic surgery. The mean age was 68.2 +/- 6.8 years, the mean PSA value was 16.5 +/- 25.9 ng/ml (Hybritech). RESULTS: Transition zone prostate cancer was found in the surgical specimen of 11.2% of the patients. No significant differences were found between patients with and without cancer for age, PSA and PSAD values, prostate size, nodules on ultrasound, or number of biopsies performed. Patients with stage Tb1 prostate cancer showed much higher PSA levels than those with stage T1a cancer (p = 0.06). Only one stage T1a cancer was found (4%) in patients < or = 70 years with PSA values < or = 10 ng/ml, while 12.5% of the cancers were found in patients < or = 70 years with PSA > 10 ng/ml (p = 0.2). CONCLUSIONS: The incidence of transition zone prostate cancer in this series was 11.2%. The incidence of cancer and the probability of tumor progression are higher in the subgroup of patients < or = 70 years with PSA > 10 ng/ml. Hypothetically, had ultrasound-guided transition zone biopsies been performed in this subgroup of patients, one case of stage T1a prostate cancer (11%) would not have been diagnosed but biopsy would have been avoided in 41% of the patients.

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PubMed1998

[Cystic carcinoma of the prostate. Echographic diagnosis].

OBJECTIVE: To analyze the incidence of cystic cancer in our series of patients with prostatic cancer diagnosed by US-guided transrectal prostate biopsy and to describe the clinical and ultrasound features. METHODS: Of 497 cases of prostatic cancer diagnosed by US-guided transrectal biopsy, 369 (74%) showed a hypoechoic nodule, 15 (3%) had a hyperechoic nodule, 17 (3%) showed a mixed echogenicity, 3 (0.6%) had a cystic lesion and 96 (19%) were isoechoic. The 3 patients with cystic cancer of the prostate are analyzed. RESULTS: In these three cases ultrasound showed a large, weakly echogenic, prostatic cystic lesion with mammillated margins. Punction-aspiration of the cyst yielded 20 and 7 cc of bloody liquid. The prostate was biopsied. Pathological analysis showed a typical prostatic adenocarcinoma in cases one and three; small areas of endometriod carcinoma were found in case two. The cytological analyses and cultures of the cystic liquid were negative in all three cases. Complementary studies were done; cases one and three were classified as disseminated tumor and case two as locally advanced tumor. CONCLUSIONS: In our series, cystic carcinoma of the prostate accounts for 1% of prostate carcinomas. Punction-aspiration is advocated for prostatic cystic lesions with irregular margins. Bloody or dark cystic liquid warrants a prostate biopsy including cyst wall.

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PubMed1998

[Non-specific granulomatous prostatitis diagnosed with ultrasonography-guided transrectal biopsy].

OBJECTIVE: To evaluate the incidence of non-specific granulomatous prostatitis (GP) in our series of prostate biopsies and to verify whether there were differences in the features of DRE, PSA and ultrasound findings in patients with GP and patients with prostate cancer that could be used as clinical indications in GP diagnosis. MATERIAL AND METHODS: Between 1994 and 1996, 835 patients with prostatic syndromes underwent echoguided transrectal biopsy. Neoplasia was diagnosed in 323 (39%) patients, non-specific GP in 11 (1.5%), whereas no malignancy signs were found in the remaining 501 (59.7%). A retrospective comparison of DRE features, PSA levels and the existence of echographic nodes was conducted between cancer patients and GP patients. RESULTS: 55% GP patients had suspicious DRE; in 64% at least one node with different echogeneicity was identified in the transrectal ultrasound, and the mean PSA value was 17.3 ng/ml. When they were compared to the group of patients with prostate cancer, no significant differences were found. CONCLUSION: In our experience we have not found any specific feature in DRE. PSA levels or ultrasound examination that allows to differentiate GP from prostate cancer. Transrectal biopsy of the gland is essential for the differential diagnosis of both entities.

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PubMed1997

[Reliability of CT for determining lymphatic involvement in patients with prostate cancer].

OBJECTIVE: To determine the utility of CT in assessment of lymph node metastasis in patients with prostatic cancer. METHODS: We conducted a retrospective study of 131 patients with prostatic cancer and a negative bone scan, in whom CT was utilized to assess lymph node metastasis. The mean age was 67.7 +/- 7.1 years. Lymphadenectomy of both obturator chains was performed in 85 patients (65%); by surgery in 65 patients (76%) and laparoscopy in 20 (24%). RESULTS: 6% had a positive CT scan. In the univariate analysis only PSA (p = 0.04) was shown to be a predictive factor for a positive CT. The maximum yield of CT was at cut-off 30 ng/ml PSA; patients with lower values had a negative predictive value of 98%. When lymphadenectomy was performed, 14% of the patients with a negative CT presented lymph node invasion, for a sensitivity of 8%, specificity of 100% and diagnostic accuracy of 86%. CONCLUSION: Due to the scanty prevalence of positive CT scans and its low sensitivity, this imaging technique may be obviated in patients undergoing radical treatment with PSA < or = 30 ng/ml.

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PubMed1997

[Ultrasonographic and pathologic differences between non-palpable prostate cancer (T1c) and palpable lesions detected with rectal examination].

OBJECTIVE: To determine whether non-palpable cancers (T1c) have different ultrasound and pathological features from other palpable cancers of the prostate gland. MATERIAL AND METHOD: PSA levels, ultrasound features and Gleason score in 178 patients diagnosed with prostate cancer between 1994-1995 were compared. Correlation of pathological findings in surgical sections from 47 patients undergoing radical prostatectomy. RESULTS: 22% tumours were non-palpable. No difference was observed between both age groups (p = 0.5) and PSA levels (p = 0.09). Differences were noted in favour of palpable cancer in PSAD (p = 0.01), incidence of ultrasound nodes (p < 0.001), capsule changes (p < 0.001), seminal vesicles (p < 0.001), Gleason score (p = 0.006) and bone scan (p < 0.05). Two (14%) patients with non-palpable cancer showed no tumour in the prostatectomy section. Apart from these 2 patients, no differences were found between both groups in terms of Gleason score (p = 0.3), local stage (p = 0.7) and node involvement (p = 0.4) in patients undergoing radical prostatectomy. CONCLUSIONS: 86% patients with non-palpable prostate cancer has clinically significant tumours and showed no differences from the rest of tumours undergoing radical prostatectomy.

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PubMed1997

[Yield of transrectal ultrasonography in the diagnosis of prostatic cancer in symptomatic patients with normal rectal digital test].

The purpose of this retrospective study is to evaluate the incidence of prostate cancer in symptomatic patients with non-suspect rectal examination and its correlation to PSA, PSAD levels and ultrasound findings. A total of 235 patients with non-suspect rectal examination underwent transrectal ultrasound and echo-guided prostate biopsy to assess an echographic node, PSA > 10 ng/mL and/or PSAD > 0.15 Incidence of prostate cancer was 16% and no correlation was seen to either PSA (95CI = 5%, 14.9%) or the existence of ecographic nodes (95CI = 5.2%, 22.2%), mainly in the subgroup of patients with PSA > 10 ng/mL and no identifiable echographic node (95CI = 5.5%, 29.5%). A PSA > 10 ng/mL or identifiable echographic nodes in symptomatic patients with non-suspect rectal examination did not involve a risk factor for prostate cancer, however a PSAD > 0.15 within the group with PSA > 10 ng/mL with no echographic nodes did involve a risk factor.

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PubMedDate not supplied

[Incidental prostatic cancer].

OBJECTIVE: To evaluate the incidence of incidental prostate cancer and PSA ability to predict its presence. MATERIAL AND METHOD: Retrospective study of 862 patients undergoing prostate surgery between 1994 and 1997, both inclusive. Digital rectal examination provided no suspicion of neoformation. Mean age was 68 +/- 7.5 years. Mean PSA, 8.3 +/- 10 ng/ml (Hybritech). 15% patients had previously undergone at least one ultrasound-guided biopsy in the peripheral area. 55% patients underwent retropubic surgery and the remaining 45% prostate transurethral resection. Ultrasound prostate volume for both patient groups was 107 +/- 63 cc and 45 +/- 25 cc, respectively. RESULTS: Incidental cancer was found in 6% patients; 65% were T1a and 35% T1b. Mean PSA concentration in cancer patients was almost significantly (p = 0.05) higher than in patients with BPH. Patients with PSA > 10 ng/ml presented a significantly higher incidence of cancer (p = 0.02). Patients with previous prostate biopsy showed a cancer incidence rate of 12% versus 5% patients with no previous biopsy (p = 0.001). CONCLUSIONS: Incidence of incidental prostate cancer was 6%. PSA was not a good predictor of incidental cancer. Patients with PSA > 10 ng/ml, showed higher incidence of cancer. Younger patients with PSA > 10 ng/ml, and at least one negative biopsy of the peripheral area should undergo biopsy of the transitional area prior to surgery.

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