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PubMed1995

Prostate-specific antigen density: the role in benign prostate hyperplasia, prostate intraepithelial neoplasm, organ-confined prostate carcinoma and advanced prostate carcinoma.

To determine the relative role of prostate-specific antigen density (PSAD) in the early detection of prostate cancer and to assess the hypothesis that PSAD offers significant advantages over prostate-specific antigen (PSA) alone in the evaluation of patients with benign (BPH), pre-malignant (PIN) and malignant prostatic diseases, we studied retrospectively 149 patients who were evaluated with either prostatic biopsies or by surgical means. Mean PSAD was calculated to be 0.1 for BPH patients; 0.09 for PIN-1 patients; 0.1 for PIN-2 patients; 0.51 for organ-confined prostatic carcinoma (CaP) patients and 1.7 for advanced CaP patients. Although we could not be able to differentiate BPH from PIN-1 and PIN-2 by using PSAD alone (p > 0.05), there were statistically significant differences between BPH versus localized CaP, PIN-2 versus localized CaP and localized CaP versus advanced CaP (p < 0.05). In conclusion we suggest that the information provided by PSAD is superior to absolute PSA values in the differentiation between BPH and CaP but PSAD was not able to add more information on differentiating BPH from pre-malignant conditions.

Aged↗
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↗
PubMed2006

Optimum PSA reflex-range.

OBJECTIVE: Aim of this study was to evaluate different decision strategies based on variations in the cut-off value of percent free PSA and in the range of total PSA values (reflex range) in which free PSA testing was applied. We compared these strategies to conventional total PSA testing by determining which strategies would provide a maximum decrease in unnecessary biopsies with a minimum number of additional undetected cancers. MATERIALS AND METHODS: This retrospective study was conducted with 807 patients who were referred to transrectal ultrasound biopsies for elevated serum PSA levels or for abnormal digital rectal examination. Overall 156 patients were affected by primary prostate cancer (CaP), 651 were controls without prostate cancer (benign prostatic hypertrophy, prostatic intraepithelial neoplasm, prostatitis or normal prostatic gland). RESULTS: Total PSA was significantly higher (F=4.93; p<0.0001) and percent free PSA was significantly lower in cancer patients than in controls (F=2.16; p<0.0001). Sensitivity, specificity and the positive likelihood ratio (LR+) of PSA and percent free PSA have been calculated for several total PSA intervals: PSA 4-10 ng/ml, 3-10 ng/ml, 3-20 ng/ml, 2-10 ng/ml, 2-20 ng/ml. These data suggest that in the reflex range 2-10 ng/ml there are the best results. On ROC comparison restricted to men with total PSA between 2 and 10 ng/ml, percent free PSA also had a higher area under the curve than total PSA (AUC 0.7452 for free percent PSA; 0.6267 for total PSA: p = 0.0059). CONCLUSIONS: The PSA revolution that occurred over the previous 2 decades has positively impacted the detection of prostate cancer. Percent free PSA improves specificity, at the beginning the percent free PSA was used only in the gray zone 4-10 ng/ml. Analyzing our data, we confirm that the usefulness of percent free PSA in prostate cancer diagnosis increases, enlarging the reflex range. Our best result is obtained in the reflex range 2-10 ng/ml using a percent free PSA cut-off of 22%.

Aged↗
PubMedDate not supplied

Single testicular metastasis mimicking primary testicular neoplasm: a rare manifestation of prostate cancer.

The incidence of secondary testicular tumors ranges from 0.02 to 2.5% among autopsies in general. With the exception of leukemias and lymphomas, prostate cancer is the most common primary site. It is diagnosed in autopsies or incidentally, following therapeutic orchiectomies in more advanced stages of the disease. In the present report, we show a case of testicular metastasis derived from prostate neoplasm whose clinical presentation as a single metastasis was similar to a primary testicular neoplasm. The diagnosis was evidenced after orchiectomy by histological examination and immunohistochemical tests.

Adenocarcinoma↗
PubMed1991

Pharmacologic erection with intracavernosal injection for men with sexual dysfunction following irradiation: a preliminary report.

Impotence is a possible consequence of treatment of pituitary adenomas and prostatic carcinomas. Following pituitary irradiation, the effect has been attributed to decreased gonadotrophins, while a variety of mechanisms, primarily vascular and neurogenic, have been proposed to explain the impotence following irradiation of prostatic carcinomas. Men with impotence of any etiology have been entered on a program to evaluate prospectively the efficacy of intracavernosal injection of vasoactive compounds in producing a satisfactory erection with pharmacologic means. Ten of these men had developed impotence following therapy for pituitary adenomas (2) or prostatic carcinomas (8). Test doses of 0.1 to 0.5 ml of a phentolamine (1 mg/ml) and papaverine (30 mg/ml) mixture were used; the dose was titrated to produce an erection deemed sufficient for vaginal penetration. All patients achieved a satisfactory response (i.e., tumescence and rigidity) lasting 10 minutes to 3 hours. Seven patients have continued in the pharmacologic erection program, with six patients functioning normally, and the remaining patient noting decreased tumescence after 18 months of treatment, but adequate erections are maintained with supplemental penile ring. Two patients have discontinued intracavernosal injections due to inconvenience, and one patient was lost to follow-up. Recent substitution of prostaglandin E1 (PGE1) has produced similar results and has replaced the phentolamine-papaverine combination. These preliminary results indicate that pharmacologic erection can be achieved in patients with impotence related to the treatment of pituitary and prostatic neoplasms and represents a reasonable alternative to implanted penile prostheses.

Adenoma↗
PubMed1999

The role of androgen deprivation in the definitive management of clinically localized prostate cancer treated with radiation therapy.

PURPOSE: Multiple studies exploring the use of androgen deprivation given in combination with radiotherapy (RT) for localized prostate cancer have reported significant improvements in the rates of local, regional, and biochemical control (BC). The impact of this therapeutic strategy on overall and cancer specific survival (CSS) has not been established, however. We performed a MEDLINE search of all available studies on this topic to determine if any conclusions could be reached on the efficacy of this treatment approach and the patients most suitable for its application. MATERIALS AND METHODS: A MEDLINE search was conducted to obtain all articles in the English language on the use of androgen deprivation in combination with RT for the treatment of localized prostate cancer. The medical subject headings (MeSH) used to search the MEDLINE database included: a) prostatic neoplasms; b) prostatic neoplasms/radiotherapy; c) prostatic neoplasms/androgen deprivation; d) hormone therapy; e) English; and f) 1980 to 1998. RESULTS: A total of 14 retrospective studies were identified that compared some form of androgen deprivation given in combination with RT. Most studies showed significant improvements in various measures of local/regional control and disease-free survival (DFS). Three of four studies that analyzed BC rates showed significant improvements in this endpoint but conflicting results were obtained for overall survival (OS). No study showed an improvement in CSS. Six prospective randomized trials were identified that directly compared RT with or without androgen deprivation. Again, all six studies showed improvements in some measure of local/regional control or DFS but only two studies showed an improvement in OS. One study reported a statistically significant improvement in CSS and another study showed an improvement in the rate of negative biopsies with combined treatment. CONCLUSIONS: When all available literature on androgen withdrawal given in combination with RT for the definitive treatment of localized prostate cancer was reviewed, no definite conclusions could be reached on the impact of this treatment approach on OS and CSS. However, local/regional control, DFS, and BC were almost uniformly improved with the use of androgen withdrawal suggesting that these impressive early results may translate into improved cure rates. Data from recently initiated and completed randomized trials will be needed, however, to define the impact of this approach on cancer specific mortality and the patients most suitable for it's use.

Androgen Antagonists↗
PubMedDate not supplied

[Pelvic fibromatosis: a case with clinical urologic features].

We report on a patient with chronic prostate disease diagnosed as having a pelvic desmoid tumor (abdominal fibromatosis localized to the pelvis) whose presenting features were those of complete acute urinary retention. The findings on initial examination led us to suspect a prostate neoplasm which, however, was discarded by the results of the radiographic work up. The clinical and pathologic findings are presented and attention is drawn to the possibility that these mesenchymal neoplasms can have urological presenting symptoms and signs.

Aged↗
PubMedDate not supplied

Attitudes and practices of primary care physicians for prostate cancer screening.

Prostate cancer screening with digital rectal examination (DRE) and prostate-specific antigen (PSA) is recommended by several professional organizations. Our objective was to assess the prostate cancer screening practices and attitudes reported by primary care physicians. We randomly surveyed 454 Arizona primary care physicians, subsequently excluding 124 ineligible subjects. Overall, 141 of 329 eligible physicians completed the survey (42.9%). Survey data included physician demographics, practice characteristics, screening and follow-up strategies, and attitudes toward screening. One hundred thirty-one physicians (93%) reported screening asymptomatic men with DRE or PSA. Respondents generally agreed that screening tests were accurate and that early detection was beneficial. Screening began at an average patient age of 45 years, though 7.8% of respondents began screening men younger than 40 years and 7.0% began screening men older than 50 years. PSA levels ranging from 3.9 to 40 ng/mL were considered abnormal, and 11.6% of respondents used a cutpoint higher than 10 ng/mL. Primary care physicians report a high rate of screening for prostate cancer and consider PSA and DRE accurate and useful tests. Screening practices, however, varied considerably between physicians. The screening of younger men reported by practitioners would tend to increase the rate of false-positive tests, while using a high cutpoint for PSA and delaying screening beyond age 50 years would decrease the chance for early detection. These screening practices may increase health care costs without necessarily leading to improved health outcomes. Medical Subject Headings (MeSH): prostatic neoplasms, prostate-specific antigen, primary health care, screening.

Adult↗
PubMed1989

[Calcifications of the prostate: a transrectal echographic study].

Prostatic lithiasis is a well know phenomenon. It has little clinical significance and is not easily shown by conventional radiography, which has poor sensitivity and specificity. The authors have studied 612 patients with both suprapubic and transrectal US in order to 1) assess US sensitivity and specificity and 2) report the frequency, spatial distribution, number and features of prostatic calcifications with special emphasis on differential diagnosis between prostatic neoplasms and chronic prostatitis. The authors have also studied the relationship between morphology and symptoms and the results agree with those reported in the scanty literature. The authors conclude that the parameters studied are directly related to age, except for a younger group with clear evidence of genital inflammation. The authors emphasize the impossibility to correlate morphology of prostatic calcifications with pathologic conditions: there are no specific symptoms clearly connected with calcification even though the inflammation is often associated with calcifications.

Calcinosis↗
PubMed2000

Tubulocystic clear cell adenocarcinoma arising within the prostate.

Neoplasms resembling ovarian common epithelial-type tumors, including clear cell adenocarcinomas, rarely occur in the lower urinary tract of men. When they do, they develop in the urethra or urinary bladder. We report a case of such a tumor arising within the prostate of a 47-year-old man. The tumor was a cystic mass in the left posterolateral region of the prostate. Histologically, the tumor was chiefly composed of tubulocystic and papillary glands lined by glycogen-rich, cuboidal or hobnail cells with clear to eosinophilic cytoplasm. The tumor cells were strongly positive for pan-cytokeratin, low molecular weight cytokeratin, and epithelial membrane antigen, and focally positive for high molecular weight keratin. The tumor did not immunohistochemically express prostate-specific antigen (PSA) and prostatic acid phosphatase. Serologically, the patient had increased levels of CA125 instead of PSA. The clinical as well as the pathologic features are consistent with a clear cell adenocarcinoma as seen in the female genital tract rather than a typical prostatic adenocarcinoma.

Adenocarcinoma, Clear Cell↗
PubMed1997

Immunohistochemical determination of p53 protein in prostatic cancer and prostatic intraepithelial neoplasms.

A role of genetic alterations in the p53 tumor suppressor gene has been implicated in many types of human malignancies. In this study, we examined the prevalence of immunohistochemically detectable p53 accumulation in prostatic tissues obtained from patients with prostatic adenocarcinoma, benign prostate hyperplasia and prostatic intraepithelial neoplasms. Six of 36 (16.7%) cancer cases and 2 of 11 (18.2%) cases of high-grade prostatic intraepithelial neoplasms showed p53 expression while no nuclear staining was observed in normal and hyperplastic prostatic tissues. Correlation of p53 expression with cancer stage, Gleason score and serum prostate-specific antigen level demonstrated that there was no statistically significant relationship between p53 expression and these clinicopathological parameters. Also, no significant association between p53 expression and prognosis was observed.

Adenocarcinoma↗
PubMed2000

Differences in reproductive endocrinology between Asian men and Caucasian men--a literature review.

This review provides an overview of the literature on aspects of reproductive endocrinology wherein Asian men may differ from Caucasian, notably, prostatic neoplasm and the sensivity to pharmacological regimens of male contraception. Both genetic and environmental factors, such as nutrition, might be relevant. Asian men residing in Asia seem to be relatively protected from clinical prostatic neoplasm while the prevalence of preclinical prostatic neoplasm is not different. Migration to an area with a higher prevalence reduces this difference but does not undo it. With regard to prostatic neoplasm the following factors have been considered as relevant in Asian men: 1) a reduction in 5 alpha-reductase level, 2) decreased levels of androgenic ketosteroid precursors of 5 alpha-reduced androgen metabolites, 3) the decreased presence of a P53 mutation, 4) a higher CAG-repeat length of the androgen receptor, 5) a possible higher level of physical activity, 6) differences in sexual activity. Furthermore, Asian men respond to a higher degree with azoospermia in response to contraceptive steroids. Possible explanations offered for the more pronounced response to contraceptive steroids are: 1) differences in testicular structure and decreased spermatogenic potential, 2) an earlier and more marked suppression in LH secretion by exogenous androgens. The differences may be due to genetical and/or environmental factors influencing the peripheral testosterone metabolism. Dietary factors such as the higher intake of phytoestrogens in Asians might exert effects on 5 alpha-reductase activity and/or on sex hormone binding globulin (SHBG) levels, thus having an impact on the biological efficacy of circulating androgens.

Asian People↗
PubMed1993

[Immunohistochemical study of the prostatic tissues with monoclonal antibody against gamma-seminoprotein. Analyses of benign prostatic hyperplasia, metastatic foci from adenocarcinoma of the prostate and malignant neoplasms other than adenocarcinoma of the prostate].

The immunohistochemical specificity of the monoclonal antibody (43-21-1-1) against gamma-seminoprotein (gamma-Sm) in the prostatic tissues was evaluated by avidin-biotin peroxidase complex method. The normal tissues of various organs, other than male genitourinary organs already examined in the previous study, the brain, skin, spinal cord, tongue, esophagus, stomach, small intestine, rectum, trachea, lung, pleura, diaphragm, liver, spleen, pancreas, mesentery, kidney, lymph node, bone, bone marrow and striated muscle were examined for control study. The prostatic tissues obtained by surgery or biopsy, benign prostatic hyperplasia (BPH; 72) urethral polyp with prostatic-type epithelium (1), bone (3) or testicular (2) metastases from adenocarcinoma of the prostate and malignant neoplasms other than adenocarcinoma of the prostate, including primary small-cell carcinoma (1), secondary embryonal carcinoma (1) and secondary mucinous adenocarcinoma (1) of the prostate were then examined. Since all but 2 (97%) specimens of BPH were obtained by transurethral resection (TUR), which might cause non-specific staining due to electro-mechanical effects, the tissue of BPH obtained by suprapubic prostatectomy were examined simultaneously, serving as a control for immunostaining. The normal tissues of various organs were never stained positively for gamma-Sm. Positive reactions of gamma Sm with this monoclonal antibody were recognized in the cytoplasms of urethral polyp with prostatic-type epithelium, bone or testicular metastases from adenocarcinoma of the prostate. The malignant neoplasms other than adenocarcinoma of the prostate examined in this study, were never stained positively. There was obviously evidence of non-specific staining in the TUR tissues of BPH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed2001

[Prostatic intraepithelial neoplasm diagnosed with transrectal biopsy. Overall review].

OBJECTIVE: To review the incidence, clinical features and management guidelines for patients with isolated prostatic intraepithelial neoplasia (PIN) diagnosed through prostate transrectal biopsy. METHODS AND RESULTS: Search in Medline database for papers published between 1990 and 2000 based on the following key words: "prostatic intraepithelial neoplasia and needle biopsy". Nineteen papers fulfilling the search criteria were selected. CONCLUSIONS: The incidence of PIN in patients seen as part of an early diagnosis program is much lower than in patients attending standard Urology practices. PSA level and ultrasound changes are poor predictors of PIN presence in the biopsy. Prostate cancer incidence in successive biopsies ranges between 13.3% and 100%. None of the clinical variables used to diagnose prostate cancer (DRE, PSA and transrectal ultrasound) can predict accurately the existence of cancer associated to PIN, and only prostatic intraepithelial neoplasia grading is considered a good cancer predictor. There is no consensus with regard to diagnostic and therapeutic management in these patients.

Algorithms↗
PubMedDate not supplied

[Nucleolus organizer regions in prostatic intraepithelial neoplasm].

Using a silver staining technique, Nucleolar Organizer Region-associated proteins (NORs) were evaluated on paraffin sections of 16 resected prostatic adenocarcinomas stage A1. Then 30 histological areas was selected which comprised 6 areas for each grade of Prostatic Intraepithelial Neoplasia: PIN 1, PIN 2, PIN 3, 6 areas of normal glandular prostatic epithelium and 6 areas of well differentiated prostatic adenocarcinoma (Gleason I). The mean numbers of argyrophilic nucleolar organizer regions (AgNORs) increased from normal glandular prostatic epithelium to PIN 3, while the mean numbers of well differentiated prostatic adenocarcinoma was similar to PIN 1. A statistically significant difference (P less than 0.01) for AgNORs was found between normal glandular epithelium, PIN 1, PIN 2 and PIN 3 and between PIN 3 and well differentiated adenocarcinoma. It was concluded that AgNORs counts provide to significant kinetic evaluation of PIN and prostatic adenocarcinoma besides to supply a better definition of PIN.

Adenocarcinoma↗