Biomedical subjects

J M Díez Cordero

Publications and source records attributed to J M Díez Cordero.

At least 19 recordsLinked to original sources

PubMed2004

[Pediatric renal transplantation from young children donors (aged < or = 6 years). Complications and functional clinical course].

GOALS: To evaluate functional results and complications in a group of pediatric patients who received kidney transplants from donors aged 6 years or less. MATERIAL & METHODS: Thirty-four consecutive renal transplants were reviewed. Of 34 patients, 19 (55.8%) received kidneys from donors aged below 3 years (Group A) and 15 (44.2%) from donors aged 3-6 years (Group B). Long-term functional patient and graft survival results along with complications were compared in both groups. RESULTS: Seven patients in group A (36.7%) had vascular complications, in comparison to 3 in group B (20%, p<0.05). Kidneys preserved in Eurocollins (EC) solution had more vascular complications (35.3%) in comparison to University of Wisconsin (UW) solution kidneys (23.5%, p<0.05). Ten-year graft survival rate in group A was significantly lower in comparison to group B (35.5% vs 58.6%, p<0.05). In relation to preservation solution type used, 10-year graft survival rate was also significantly better in UW group (26.8% vs 63%, p<0.001). CONCLUSIONS: The exclusion of donors younger than 3 years and the utilization of optimal preservation solutions produces a decrease in figures of vascular complications and a significant improvement in graft survival rates.

Actuarial Analysis↗

PubMed2004

[Incidence and significance of "atypical acinar proliferation" in transrectal prostatic biopsies].

OBJECTIVE: To determine the incidence of atypical acini in our series, the percentage of prostate cancer and other suspicious or preneoplastic lesions in the successive biopsies and to establish a follow up strategy in these patients. MATERIAL AND METHOD: A total of 117 patients diagnosed with isolated atypical acini or associated with high grade PIN were obtained from our database, 75 (64%) of these were submitted to at least a second biopsy of the gland. The age, PSA, digital rectal examination (DRE), prostate volume, ultrasound nodule and previous pathological diagnosis were compared with the pathology results of the successive biopsies of the gland. RESULTS: Incidence of atypical acini was 4%. A total of 46.7% of patients undergoing a repeat biopsy presented prostate cancer. We did not find significant differences in the clinical variables studied between patients with or without a definite cancer diagnosis. Patients initially diagnosed with acinar atypia with associated high grade PIN presented a higher incidence of cancer in the repeat biopsy than patients with isolated acinar atypia (p=0.007). A total of 94.3% of all neoplasms diagnosed were detected in the 2nd and 3rd biopsy. CONCLUSIONS: Patients with atypical acini are at high risk of having prostate cancer not detected in the first biopsy. They should, therefore, undergo a second biopsy as soon as possible. There is only a very small probability of detecting cancer after the 3rd biopsy.

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PubMed2001

[Differences in survival of patients with bladder cancer depending on depth of muscle infiltration].

OBJECTIVE: To study the survival of patients with bladder cancer and infiltration into the muscle who undergo radical cystectomy, documenting any survival difference based on the depth of muscle infiltration (pT2a vs. pT2b). MATERIAL AND METHOD: 109 patients with infiltration into the muscle (T2) in the TUR were treated with radical cystectomy between 1986 and 1996; 39 patients were excluded due to infra-staging and 2 died in the immediate postoperative: 68 patients were eligible for the study. Median follow-up was 51 months. At the time of analysis 44 were alive (2 with tumoral disease and one with a second non-urological tumour), 21 had died (4 for causes other than vesical tumour) and 3 patients were considered lost to follow-up at 3, 31 and 111 months. Survival analysis was performed using the Kaplan-Meier method, and the variables were compared with the log-rank test. RESULTS: The 3- and 5-year overall survival of our series was 76% and 62%, while cancer specific survival was 80% and 70% respectively. Cancer specific survival at 5 years by stages was: pT0-83%, pT1-80%, pT2a-66% and pT2b-60% (p = 0.52). The cystectomy specimen (pT0) showed no residual tumour in 15 (22%) patients, and 5-year cancer specific survival in this group was 83% vs. 66% in patients with residual cancer (p = 0.24). CONCLUSIONS: Patients with pT2a and pT2b bladder cancer showed no differences in survival and we believe they should be all included in the same prognostic group (pT2). pT0 patients are a subgroup of patients with significant survival rates in which radical cystectomy should be considered as overtreatment, and a more conservative protocol should be preferred.

Adult↗

PubMed2001

[Incidence of high grade prostatic intraepithelial neoplasm in transrectal biopsy of the prostate].

OBJECTIVE: To analyze the incidence of high grade prostatic intraepithelial neoplasia (PIN) in the transrectal prostate biopsies of patients from the Urology department. METHODS: From 1995 to 1999, 2018 patients aged 46-92 years (mean 68 +/- 10) had a transrectal biopsy. Thirty-six percent had a suspicious DRE and the mean serum PSA was 31.7 +/- 152.9 ng/ml. The anatomopathological diagnoses were: a) cancer, b) benign pathology, c) high grade PIN and d) glandular atypia. Statistical analysis using the chi square and Mann-Whitney tests was performed to compare the following variables: age, DRE, PSA, PSAf/PSAt ratio and the finding of a suspicious node on ultrasound. RESULTS: The incidence of high grade PIN in this series was 8% and the incidence of prostate cancer was 38.6%, PIN grade 3 was diagnosed in 94 patients and PIN grade 2 in 67, and was associated with glandular atypia in 13 patients. Patients with prostate cancer were older and showed statistically significant higher PSA, percentage of suspicious DRE, sonographically suspicious nodes, and a lower PSAf/PSAt ratio than the other diagnoses (p < 0.001). Comparison of patients with high grade PIN and those with benign pathology showed no differences for age, DRE, PSA levels and PSAf/PSAt ratio. However, a significantly lower incidence of sonographically suspicious nodes was found (p < 0.001). CONCLUSIONS: The incidence of high grade PIN was 8%. High grade PIN does not cause sufficient changes in the clinical variables analyzed to suspect this lesion before it is confirmed by the pathological findings.

Aged↗

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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PubMed2000

[Radical cystectomy in the treatment of cancer of the bladder].

OBJECTIVE: To analyze retrospectively the efficacy of radical cystectomy alone in the treatment of transitional cell carcinoma of the bladder. METHODS: 125 patients who underwent radical cystectomy were evaluated. The mean follow-up was 62 months. At the time of the study, 65 patients were alive (3 with bladder tumor and 1 with a second primary) and 60 patients had died (50 from bladder cancer and 10 from other causes). Nine patients were lost to follow-up. The Kaplan-Meier method was used for the survival analysis and the log-rank test for the comparison of the variables. RESULTS: The overall survival at 5 years was 50% and the cancer-specific survival was 56%. By tumor stage, the cancer-specific survival at 3 and 5 years were respectively: 83% and 85% for pT1, 78% and 70% for pT2, 52% and 42% for pT3, 24% and 12% for pT4 and 14% for pN+ (p < 0.0001). No differences were found between stages pT2a (73% and 68%) and pT2b (71% and 53%) (p = 0.2). The survival was significantly higher in patients with no residual tumor in the cystectomy specimen (pT0) (93% and 83%) than in those with residual tumor (60% and 53%) (p = 0.03). CONCLUSIONS: Radical cystectomy alone in the treatment of transitional cell carcinoma of the bladder was found to be effective in patients with tumor stage pT2. It is less effective in patients with tumor in the advanced stages (pT3 or pT4) or lymph node invasion. Radical cystectomy is an overtreatment in patients with no residual tumor in the cystectomy specimen.

Carcinoma, Transitional Cell↗

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.

Adult↗

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.

Aged↗

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.

Aged↗

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.

Aged↗

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.

Adult↗

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.

Aged↗

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

[Uretero-iliac fistula].

OBJECTIVE: To describe a case of uretero-iliac fistula, an extremely rare condition that is not easily diagnosed. METHODS/RESULTS: Herein we describe a 76-year-old female who had undergone repeated pelvic surgery for adenocarcinoma of the sigmoid. She had a right ureteral fistula that had been managed conservatively by insertion of a ureteral catheter. Diagnosis was made by selective arteriography of the iliac arteries. The patient was submitted to surgery; primary closure of the arterial fistula and nephroureterectomy were performed. CONCLUSIONS: Uretero-iliac fistula should be suspected in patients with a history of repeated pelvic surgery and ureteral catheter placement that present with massive hematuria.

Adenocarcinoma↗

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.

Aged↗

PubMed1997

[Correlation of prostatic specific antigen, tumor grade, and local stage with bone scintigraphy in the staging of patients with prostatic cancer].

OBJECTIVE: To determine the capacity of PSA, tumor grade and local stage to predict the bone scintiscan findings in patients with newly diagnosed, untreated prostate cancer. METHODS: We analyzed the records of 189 patients with prostate cancer that had been seen at our institution from January, 1993 to September, 1995. PSA determination was performed prior to biopsy, local staging by DRE or transrectal US was done and they had a bone scintiscan before treatment. RESULTS: 21% of the patients had metastasis. Univariate analysis showed PSA (p < 0.001), tumor grade (p = 0.01) and local stage (p = 0.001) independently predicted the positive bone scintiscans. However, multivariate regression analysis showed tumor grade (rc = 0.05) or stage (rc = 0.07) did not increase the predictive value of PSA (rc = 0.22). The highest negative predictive value of PSA [95% (IC95 = 87.5%, 98.6%)] was obtained when 20 ng/ml was used as cutoff. Therefore 1.4% to 13.5% of the patients with bone metastasis could not have been diagnosed without scintigraphy. CONCLUSION: Bone scintigraphy should be performed routinely to determine the extent of the lesion in patients with prostatic cancer, particularly in those patients that are likely to undergo radical treatment.

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