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PubMed2003

Bisacodyl rectal preparation can decrease infectious complications of transrectal ultrasound-guided prostate biopsy.

OBJECTIVES: To assess whether rectal preparation before transrectal ultrasound (TRUS)-guided prostate biopsy could decrease the rate of infectious complications and to find any possible risk factors affecting the development of complications. METHODS: This retrospective study included 879 cases of TRUS-guided prostate biopsy. All patients received antibiotic prophylaxis with levofloxacin or cefixime orally before biopsy and continually for 7 days after. A total of 456 patients received bisacodyl rectal preparation the night before or on the morning of the biopsy, and 423 did not. Major complications were defined as serious side effects requiring additional treatment. Infectious complications were classified as sepsis, fever (greater than 38 degrees C) without sepsis, and other clinical infection. We evaluated whether rectal preparation before biopsy could decrease infectious complications. Other potential risk factors were also investigated. RESULTS: Major complications developed in 47 cases (5.3%), including 1 vasovagal episode, 10 cases of urinary retention, and 46 infectious complications, of which 19 were sepsis and 11 fever without sepsis. Among the potential risk factors, the number of biopsy cores and use of a rectal preparation were statistically significant risk factors influencing the development of infectious complications in multiple logistic regression analysis (P = 0.038 and P = 0.000, respectively). CONCLUSIONS: The number of biopsy cores and prebiopsy rectal preparation use were statistically significant risk factors for infectious complications after prostate biopsy in our study. Thus, we recommend a rectal preparation before prostate biopsy to minimize the risk of infectious complications.

Adenocarcinoma↗
PubMed2003

Effect of subclinical prostatic inflammation on serum PSA levels in men with clinically undetectable prostate cancer.

OBJECTIVES: To examine whether subclinical prostatic inflammation might influence serum prostate-specific antigen (PSA) levels in men with clinically undetectable prostate cancer. METHODS: A total of 461 patients who underwent prostate biopsy at our hospital were studied between January 1996 and December 1999. Of these patients, a total of 125 patients without detectable prostate cancer or a history or symptoms of prostatitis, with serum PSA levels of less than 20.0 ng/mL and other specified exclusion criteria, were included in the study. Inflammation observed at biopsy was scored for inflammation extent and inflammatory aggressiveness, and the effects of these morphologic aspects of inflammation on serum PSA levels were examined. RESULTS: The extent of inflammation tended to increase as the prostate volume increased (P = 0.006). Patients with a PSA greater than 2.5 ng/mL had a greater extent and aggressiveness of inflammation than those with PSA levels of 2.5 ng/mL or less (P = 0.004 and P = 0.050, respectively). However, no statistically significant differences were found in terms of the extent of inflammation or inflammatory aggressiveness between patients with PSA levels greater than 4.0 ng/mL and those with PSA levels of 4.0 ng/mL or less. Furthermore, the extent of inflammation did not account for PSA levels greater than 2.5 or 4.0 ng/mL by multivariate analysis. CONCLUSIONS: Our results indicate that subclinical prostatic inflammation is not the etiology of a serum PSA greater than 4.0 ng/mL in men without clinically detectable prostate cancer.

Adenocarcinoma↗
PubMed1997

Diagnostic value of additional systematic prostate biopsies in patients undergoing transurethral resection of the prostate.

OBJECTIVES: There are patients with obstructive voiding symptoms and suspicious screening parameters in whom prostate cancer (PC) cannot be excluded prior to transurethral resection of the prostate (TURP). The goal of our study was to assess the diagnostic value of systematic biopsies of the peripheral zone of the prostate performed during TURP. METHODS: Between 1990 and 1995, 132 patients (average age 69.5 +/- 7.4 years) with at least one suspicious screening parameter underwent a TURP and additional systematic prostate biopsies. Pathology reports were reviewed to verify whether PC was present in the TURP chips or in the biopsy cores. RESULTS: Histologic examination found benign prostatic hyperplasia in 52, prostatitis in 53, and PC in 27 patients. PC was detected only with TURP in 11 patients (40.8%). In 15 patients (55.6%), both TURP and prostate biopsies showed PC. There was only 1 patient (3.7%) with a positive biopsy in whom the examination of the resection chips did not detect PC. In patients with negative digital rectal examination and intermediate prostate-specific antigen levels, prostate-specific antigen density was not able to differentiate between benign and cancerous lesions. CONCLUSIONS: There seems to be a subgroup of patients where systematic and repeated prostate biopsies fail to detect PC prior to TURP. Although the increase in the detection rate through additional prostate biopsies of the peripheral zone is limited, we would recommend these biopsies in addition to TURP, especially if patients are eligible for further curative treatment options.

Adult↗
PubMed1998

The usefulness of prostate-specific antigen (PSA) density in patients with intermediate serum PSA level in a country with low incidence of prostate cancer.

OBJECTIVES: To evaluate if a calculated PSA density (PSAD) prior to biopsy could be useful to determine the need for prostate biopsies in patients with serum PSA levels of 4.1-20.0 ng/mL in a country with low incidence of prostate cancer (PCa). METHODS: A total of 185 consecutive patients aged 50-79 years who underwent prostate biopsies were evaluated by correlating the biopsy results with the results of digital rectal examination (DRE), transrectal ultrasonography (TRUS), serum PSA levels, and PSAD. Prostate volume was calculated from TRUS using prolate ellipse formula and PSAD was obtained by dividing serum PSA level by prostate volume. RESULTS: In this study population, 27 cases (14.6%) had positive biopsies. Of 158 cases with negative biopsies, 43 (23.2%) had histologically verified prostatic inflammation. The diagnostic value of DRE and TRUS was hampered by unsatisfactory sensitivity and specificity in differentiating patients with positive biopsies from those with negative biopsies. The use of PSAD alone as an indicator for biopsy was also limited by its low specificity. A PSAD cutoff value of 0.15 resulted in a sensitivity of 100% and a specificity of only 12%. Prostatic inflammation was a confounding factor for the inadequate specificity of DRE, TRUS and PSAD. Combined use of DRE and PSAD provided the best information regarding the need for biopsies. Accordingly, if the 47 patients (25.4%) who presented with both a negative DRE and a PSAD < or = 0.20 were not biopsied, the rate of positive biopsy could have increased to 19.6% (27 of 138) without missing any cancer detection. CONCLUSIONS: It is concluded from this study that for patients with serum PSA levels of 4.1-20.0 ng/mL, biopsies should only be recommended for those with abnormal DRE and/or PSAD >0.20.

Aged↗
PubMed1999

New concepts in tissue specificity for prostate cancer and benign prostatic hyperplasia.

Of the hundreds of species of mammals, all of which have prostate glands, only humans and dogs are known to suffer from benign prostatic hyperplasia (BPH) and prostate carcinoma. In humans, prostate carcinoma is common, yet carcinomas of other sex accessory tissues are rare. In addition, different anatomic regions within the prostate gland have very different rates of BPH and carcinoma. In this article, we explore ideas and potential mechanisms relating to these paradoxical findings that may help explain the species, organ, and zone specificity of BPH and prostate cancer. We present an evolutionary argument that attempts to relate a high-fat diet, with its potential for generating oxidative DNA damage, to the species selectivity of prostate cancer. In addition, we outline an argument based on our preliminary studies indicating that chronic inflammation and the associated increase in cell turnover in the setting of increased oxidative stress may help to account for the organ selectivity of genitourinary carcinomas.

Animals↗
PubMed1997

The effect of prostatitis, urinary retention, ejaculation, and ambulation on the serum prostate-specific antigen concentration.

PSA remains an immensely valuable tool in the diagnosis of prostate adenocarcinoma. Factors such as prostatitis, urinary retention, ejaculation, and inpatient versus outpatient measurement, however, may have a profound effect on the serum PSA concentration. Furthermore, prostate biopsy and TURP result in an increase in the serum PSA value that resolves in 4 to 6 weeks. It is imperative that these factors be taken into account to interpret serum PSA values, to optimize the diagnostic utility of the PSA test.

Aged↗
PubMed1969

Hernia-sac cancer.

Explore the source record for details and available documents.

Abdominal Neoplasms↗
PubMed1978

Aryl-hydrocarbon-hydroxylase inducibility in patients with cancer.

Aryl-hydrocarbon-hydroxylase (A.H.H.) inducibility has been studied in the peripheral-blood lymphocytes of patients with squamous-cell lung cancer, of patients with cancer at other sites, and of controls matched for age, sex, social class, and smoking habits. The proportion of high inducers was significantly greater among patients with lung cancer (but not patients with other cancers) than among controls, which suggests that, besides smoking, a constitutional factor may be involved in the pathogenesis of lung cancer.

Adult↗
PubMed1978

Primary hyperparathyroidism in paraneoplastic hypercalcaemia.

Hypercalcaemia is often associated with malignant disease. Causes of elevated serum-calcium levels in the absence of bony metastases include parathyroid-hormone production by the tumour, osteolytic factors made by the tumour, and coexistent primary hyperparathyroidism. By measuring nephrogenous cyclic-A.M.P. excretion to assess parathyroid-hormone function, we have determined the mechanism of such hypercalcaemia in 15 patients. Nephrogenous cyclic A.M.P. ranges from 0.05 to 2.40 mumol/g of creatinine in normal subjects, from 2.27 to 8.45 mumol/g in patients with primary hyperparathyroidism, and from 0.50 to 1.30 mumol/g in patients with proven non-hyperparathyroid hypercalcaemia without malignancy. 9 patients (60%) with hypercalcaemia and malignancy had normal levels of nephrogenous cyclic A.M.P. (range 0.35-2.07 mumol/g creatinine). The other 6 (40%) had elevated nephrogenous cyclic A.M.P. (range 2.70-5.55 mumol/g) consistent with increased parathyroid-hormone secretion. Surgical exploration of the neck in these patients showed that the increased parathyroid-hormone secretion was secondary to primary hyperparathyroidism, not ectopic hyperparathyroidism. Thus, the data indicate that coexistent hyperparathyroidism may be common in patients with hypercalcaemia and malignancy and that the measurement of nephrogenous cyclic A.M.P. is very useful in identifying patients at risk for hyperparathyroidism.

Adenocarcinoma↗