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PubMed1999

In vivo proton magnetic resonance spectroscopy of diseased prostate: spectroscopic features of malignant versus benign pathology.

In vivo Proton Magnetic Resonance Spectroscopy appears potentially useful for non-invasive discrimination between benign prostatic hyperplasia (BPH) and prostate carcinoma (PC). Aiming to delimit the range within which spectra from one or the other pathology should occur, and establish extreme spectroscopic features of malignant versus benign prostate disease, we performed endorectal proton MR spectroscopy on 20 patients severely affected of either benign prostatic hyperplasia (BPH) (n = 10) or prostate cancer (PC) (n = 10). They were selected on the basis of the large volume and homogeneity of their lesions, which were histologically confirmed after spectroscopy. Consequently, high-quality short-TE proton spectra with well-resolved metabolite signals, and practically free of volume averaging issues were obtained in all cases. Apart from the typical citrate, creatine, and choline signals of prostate spectra, both BPH and PC spectra showed a peak centered at 3.6 ppm which was assigned to myo-inositol. The intensity of this contribution was found significantly increased in PC cases compared to BPH. Possible relationships between neoplastic transformation and the metabolic pathways in which myo-inositol participates are discussed. Average spectroscopic profiles were calculated for both advanced pathologies, and showed obvious differentiated features. In quantitative terms, the ratio of citrate to choline peak areas as well as that of creatine to myo-inositol appeared as the most convenient to discriminate between advanced PC cases (both ratios below 1.0) and advanced BPH cases (both ratios above 1.0).

Aged↗
PubMedDate not supplied

Prostate-specific antigen (PSA) and cancer-associated serum antigen (CASA) in distinguishing benign and malignant prostate disease.

The Prostate-Specific Antigen (PSA) and the Cancer-Associated Serum Antigen (CASA) assay for the MUC1 mucin were compared in the serum of 303 patients with malignant or benign prostatic disease. Using cutpoints of 4, 10, and 20 micrograms/l, PSA was elevated in 93%, 81%, and 64% of patients with prostate cancer (n = 113), with corresponding specificities of 55%, 84%, and 96% in benign prostate disease (prostatic hyperplasia or prostatitis, n = 190). Using the recommended cutpoint of 4 Units/ml, CASA was elevated in 38% of patients with prostate cancer, with a specificity of 91% in benign disease. PSA and CASA showed a poor correlation in prostate cancer (r = 0.367) and benign disease (r = 0.158), and CASA was elevated in some PSA negative samples. Used together, PSA > or = 20 micrograms/l and CASA > or = 4 kU/l gave perfect specificity in benign disease, with a corresponding sensitivity of 29% (positive and negative predictive values of 100% and 70%, respectively). However, this combination gave no improvement over the use of PSA alone, with sensitivity 47% when the cutpoint was raised to give perfect specificity. These data suggest that CASA is of little use as an adjunct to PSA in the differentiation of benign and malignant prostate disease.

Aged↗
PubMed1996

Clinical efficacy of prostate-specific antigen testing in patients with prostate disease.

Prostate-specific antigen (PSA) has become the most commonly used marker for the detection of prostatic adenocarcinoma (PCa) in recent years. To understand the clinical value of PSA testing in patients with prostate disease, the preoperative serum PSA values of 562 patients who underwent prostatic surgery from April 1993 to December 1995 were correlated with histologic findings in samples taken during surgery. Histopathologic findings revealed 93 cases of PCa and 469 cases of benign prostatic hyperplasia (BPH). Of the 220 patients with a serum PSA level within the normal range (0-4 ng/mL), PCa was diagnosed in six (2.7%) cases. However, among the 342 patients (61%) who had serum PSA > 4.0 ng/mL, BPH was diagnosed in 225 (75%) patients. With a PSA cutoff value of 4.0 ng/mL, the sensitivity, specificity and positive predictive value of PSA in distinguishing PCa from BPH were 94%, 45% and 25%, respectively. Raising the cutoff value to 10 ng/mL enhanced the specificity (76%) and positive predictive value (42%) with a slight compromise in sensitivity (85%). Of the 469 patients with BPH, 255 (54%) had a serum PSA > 4.0 ng/mL and 107 (24%) had a serum PSA > 10.0 ng/mL. Prostate volume, histologically documented prostatic inflammation and history of urinary retention prior to PSA determination may partly explain the abnormal elevation of serum PSA in patients with BPH. Our data confirmed the sensitivity of PSA in the detection of PCa in a country with a low incidence of PCa. However, a considerable proportion of patients with BPH had elevated serum PSA levels caused by factors unrelated to malignancy. Raising the cutoff value of PSA or employing adjunct parameters derived from PSA determination may be helpful in improving the diagnostic efficacy of PSA.

Aged↗
PubMed1993

[Local hyperthermia in the treatment of benign prostatic diseases].

Local Prostatic Hyperthermia is a 8 year old procedure that has been used for treating benign prostatic hypertrophy, chronic non bacterial prostatitis and prostatic carcinoma. We treated 80 patients affected by benign prostatic diseases who referred to our Clinic from November 1990 to December 1991. 42 patients were affected by benign prostatic hypertrophy (7 of them with permanent bladder catheter) and 18 patients were affected by chronic non bacterial prostatitis. A 915 Mhz microwaves generator apparatus with endorectal probe and cooling circuit has been used. The criteria we used to include patients in treatment were the following: high operating risk, the refusing of the operation, a prostatic volume bigger than 180 cc and finally a rectum thick less than 10 mm. All patients underwent preliminary echographic, hematic , urodynamic and rectoscopic exams. A prostatic biopsy was taken at the beginning and at the end of the treatment. During every session, which lasted sixty minutes and was repeated twice a week, we applied a temperature of 42 C degrees in patients with benign prostatic hypertrophy, and a temperature of 41 C degree in those with chronic non bacterial prostatis. Patients were checked with the same echographic and urodynamic parameters three months, six months and 1 year after the treatment. Subjective and objective symptoms improved in 65% of cases, and we also noticed a 50% reduction of post-urination residue, with an increase of maximal urinary flux. We also noticed a decrease of the dysuria and nycturia.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1994

Papilledema secondary to metastatic prostate disease.

BACKGROUND: Prostate cancer increases in incidence with age, and is common in older men. If allowed to progress or detected late, prostate cancer readily metastasizes to bone and accounts for about 11 percent of all cancer deaths. Associated conditions with prostate metastatic disease are anemia, pathological bone fractures, and paraplegia. Occasionally, prostate cancer may metastasize to the skull or spinal cord and result in papilledema. Two cases presenting with papilledema secondary to metastatic prostate disease are discussed.

Adenocarcinoma↗
PubMed1990

An immunohistochemical characterisation of the inflammatory cell infiltrate in benign and malignant prostatic disease.

The prostate gland is said to be immunologically privileged because it lacks afferent lymphatics and because of the immunosuppressive properties of seminal fluid. To elicit the presence or absence of an immune response within the diseased prostate gland, the infiltrate in prostate glands affected by hyperplasia or adenocarcinoma was phenotypically characterised, using immunohistochemical techniques. An infiltrate, composed mainly of T-lymphocytes (CD-3+), was demonstrated in all glands examined. No difference in the type, level of activation or degree of infiltration was found between those glands affected by hyperplasia (n = 20) and those affected by adenocarcinoma (n = 20). In the malignant cases, there was no correlation between grade (Gleason) or stage (TNM) and the type or degree of mononuclear cell infiltrate. Our findings suggest that the host response, in situ, to hyperplasia and adenocarcinoma is similar and may reflect the fact that the two diseases are often found concurrently in the same gland and in close proximity to one another. The infiltrate, therefore, is unlikely to represent a tumour specific immune response to tumour specific antigens. The significant infiltrate we have demonstrated, and its phenotypic characterisation, would not support the hypothesis that the prostate is immunologically privileged as has been suggested previously.

Adenocarcinoma↗
PubMed1994

[Role of CT in patients with prostatic disease: usefulness of depiction of prostatic zonal anatomy].

The purpose of this study was to evaluate the role of CT in patients with and without prostatic disease. CT and MR findings were reviewed in 25 patients without known prostatic disease, 11 patients with benign prostatic hyperplasia and 11 patients with prostatic cancer. Differential attenuation allowed for distinction of the peripheral zone and inner gland of the prostate by CT in 72% of normal patients. The distinction rate of prostatic zonal anatomy by CT decreased to 30% in the diseased group. When zonal anatomy of the prostate is not visualized on pelvic enhanced CT, the presence of prostatic disease might be considered.

Adolescent↗
PubMed2003

Expression of the zinc transporter ZnT4 is decreased in the progression from early prostate disease to invasive prostate cancer.

We have utilized oligonucleotide microarrays to identify novel genes of potential clinical and biological importance in prostate cancer. RNA from 74 prostate cancers and 164 normal body samples representing 40 different tissues were analysed using a customized Affymetrix GeneChip oligonucleotide microarray representative of over 90% of the expressed human genome. The gene for the zinc transporter ZnT4 was one of several genes that displayed significantly higher expression in prostate cancer compared to normal tissues from other organs. A polyclonal antipeptide antibody was used to demonstrate ZnT4 expression in the epithelium of all 165 elements of benign and 326 elements of localized prostate cancers examined and in nine of 10 advanced prostate cancer specimens by immunohistochemistry. Interestingly, decreased intensity of ZnT4 immunoreactivity occurred in the progression from benign to invasive localized prostate cancer and to metastatic disease. Immunofluorescence analysis and surface biotinylation studies of cells expressing ZnT4 localised the protein to intracellular vesicles and to the plasma membrane. These findings are consistent with a role for ZnT4 in vesicular transport of zinc to the cell membrane and potentially in efflux of zinc in the prostate.

Adolescent↗
PubMed2000

Prostate cancer in men age 50 years or younger: a review of the Department of Defense Center for Prostate Disease Research multicenter prostate cancer database.

PURPOSE: Prostate cancer in men age 50 years or younger traditionally has accounted for approximately 1% of those diagnosed with prostate cancer. Prior studies of prostate cancer in men of this age led many clinicians to believe that they have a less favorable outcome than older men. Most of these studies were conducted before the advent of prostate specific antigen (PSA) screening programs. We evaluated a surgically treated cohort of men age 50 years or younger to determine whether disease recurred more frequently among them than in those 51 to 69 years old in the PSA era. MATERIALS AND METHODS: We reviewed the medical records of 477 men who underwent radical prostatectomy between 1988 and 1997. Age, ethnicity, preoperative PSA, clinical and pathological stage, margin and seminal vesicle involvement, and recurrence were compared between 79 men age 50 years or younger (study group) and 398, 51 to 69 years old (comparison group). Disease-free survival rates were compared using Kaplan-Meier and Cox regression techniques. RESULTS: There were 6 (7.6%) recurrences in the study group (79) and 107 (26.9%) in the comparison group (398). The disease-free survival curves were significantly different (log-rank p = 0.010). Age remained a significant prognostic factor (Wald p = 0.033) in multivariate Cox regression analyses that controlled for race, clinical and pathological stage, and pretreatment PSA. Similar results were found when the comparison group was limited to 116 patients 51 to 59 years old (log-rank p = 0.034, Wald p = 0.069). CONCLUSIONS: These data suggest that patients in the PSA era who underwent radical prostatectomy and were age 50 years or younger have a more favorable disease-free outcome compared to older men.

Adenocarcinoma↗
PubMed2001

[PSA/volume ratio in prostatic disease in the elderly].

Prostate Specific Antigen (PSA) is the most important marker of prostate diseases actually available. The aim of this study was to evaluate the relations between aging, PSA and prostatic volume's increase, and whether these relations justify the adoption of different normality ranges of PSA in the elderly. We considered 285 patients aged over 60 years (mean age 69.01 years), with Benign Prostatic Hyperplasia (BPH) and absence of malignant prostatic disease, prostatic phlogosis and absuntion of drugs that can influence the PSA's levels in the serum. Patients underwent PSA, digital rectal exploration and transrectal ultrasonography, with determination of the three prostatic diameters, of the prostatic volume by the ellipsoid formula and of the maximum adenoma diameter; PSA was determined in all patients and PSA free in those with total PSA > 4 ng/ml; the PSA density was calculated. We found that age does not correlate with PSA and is poorly correlated with prostatic volume (p < 0.05); on the contrary, PSA values are strongly related with prostatic volume and maximum diameter of adenoma (p < 0.01). Mean free PSA value was 16.3 +/- 5.99%, and most of patients had values in the so-called grey zone of discrimination between benignity and malignity. We conclude that in elderly patients with volume. These results suggest the possibility to consider as indicative of benignity also total PSA values between 4 and 10 ng/ml, when they are associated with a significative prostatic volume's increase and with free PSA greater than 10%.

Aged↗
PubMed2000

Prostate-specific antigen as a marker of prostate disease.

Serum prostate markers, in particular prostate-specific antigen (PSA), have truly revolutionised all aspects of the management of men with prostatic carcinoma (PCa), the most important application being related to its early detection and screening. Several studies have shown the clinical utility of PSA levels for staging patients with PCa, especially when associated with other parameters, such as tumour grade, digital rectal examination and transrectal ultrasound findings, to establish the likelihood of disease extension outside the gland and of positive lymph nodes. Also, serum PSA levels are useful in monitoring patients either after the initial diagnosis of PCa or following therapy.

Carcinoma↗
PubMed1980

Evaluation of diagnostic techniques for canine prostatic diseases.

Ejaculation, prostatic massage, prostatic aspiration biopsy, and prostatic punch biopsy were performed in adult male dogs. The dogs had no abnormalities, as determined by physical examination, CBC, urinalysis, and urine culture. In 7 of 18 dogs, results of bacterial culture of an ejaculate were negative. Bacteria of several species, but primarily gram-positive cocci, were isolated from ejaculates from the remaining 11 dogs. The concentration of bacteria varied from 550/ml to greater than 100,000/ml (1 dog). More than one genus of bacteria was isolated from 8 of the 11 dogs with positive culture results. These organisms were attributed to urethral or preputial contamination during collection. The large numbers of organisms isolated from a few dogs indicated the results of culture of ejaculates must be interpreted cautiously when trying to determine whether prostatic infection is present. Low numbers of neutrophils and occasional squamous cells were found in 66% and 50% of semen samples, respectively, but their presence did not correlate with positive culture results. Massaging the prostate was not associated with recovery of cells or bacteria from proximal urethral washes. An adequate specimen of prostatic tissue for microscopic examination was obtained in 8 of 17 dogs by aspiration and in 8 of 12 dogs by punch biopsy. Bacteria were not isolated from 15 of the 16 samples. Small, focal lesions in the prostate were not detected by aspiration or biopsy. Hematuria of less than 4 days' duration and mild periprostatic hemorrhage were the only complications of aspiration or punch biopsy.

Animals↗
PubMed2005

[Advances in researches on the relationship between prostatic diseases and erectile dysfunction].

Prostatic diseases and erectile dysfunction (ED) are common diseases in urology and andrology. Basic and clinical studies have proved that there is a close relationship between the two. This article reviews the mechanism, diagnosis and treatment of ED caused by several prostatic diseases, such as acute prostatitis, chronic prostatitis, benign prostate hyperplasia and prostate cancer.

Chronic Disease↗
PubMed2003

Histopathological review of prostatic diseases in Kano, Nigeria.

Diseases of the prostate are common causes of morbidity in adult males and show wide geographical and ethnic variations in incidence and mortality worldwide. It is in the light of this that records of prostatic biopsies were reviewed in retrospect at the Aminu Kano Teaching Hospital, Kano and Murtala Mohammed Hospital Kano over a 4-year period in order to determine the histological pattern and age distribution of the various prostatic lesions. Three hundred and three prostatic lesions constituting 7.4% of all surgical biopsy specimens received were studied. Two hundred and thirty five (77.6%) of these were cases of BPH while prostatic cancer accounted for 22.4% of cases. The ratio of benign to malignant prostatic disease was 3:5:1. Chronic non-specific prostatitis, acute prostatitis, schistosomiasis and tuberculosis were present in 22.8%, 3.3%, 0.7% of the total number of cases respectively. The mean age of BPH patients was 63.7 years, and 88% of them had a glandulostromal histological pattern. Majority (64.2%) of the prostate cancers were well-differentiated adenocarcinoma and the mean age was 67.1 years. The findings confirm earlier observations that prostatic diseases are common causes of morbidity in our environment, and early diagnosis and treatment remain key measures in reducing mortality. The practice of 5-region biopsy is advocated to improve detection of clinical prostate cancer.

Adenocarcinoma↗
PubMed1994

Concordance rates for benign prostatic disease among twins suggest hereditary influence.

OBJECTIVES: The etiology of benign prostatic hyperplasia (BPH) is unknown. Evidence for a hereditary trait would provide new avenues for investigation. METHODS: We compared the concordance for benign prostate disease in monozygotic (MZ) and dizygotic (DZ) twins who served in the United States military in World War II and have been followed by the Medical Follow-up Agency, Institute of Medicine of the National Academy of Sciences. Questionnaires completed in 1985 by 10,000 twins were reviewed for evidence of prostatic disease. Key words indicating benign prostatic disease (prostate, prostatectomy, BPH, TURP, and prostatism) were identified in 533 (5.3%) of the questionnaires. RESULTS: The average age was 64 +/- 3 years (range 56 to 68 in 1985). After eliminating men with known prostate cancer, there were 256 twin pairs that were informative for benign prostatic disease: both twins were concordant in 25 instances and discordant in 231, with only one twin mentioning benign prostatic disease. The pairwise concordance for MZ twins was 14.7% (19 of 129) and for DZ pairs it was 4.5% (5 of 112). The relative risk for benign prostatic disease for MZ twins was thus 3.3 (p = 0.008). The probandwise concordance rates, which express the probability of BPH in a cotwin of an affected twin, were 25.7% for MZ twins and only 8.5% for DZ twins. A covariance analysis estimated that 49% of the observed variance between twins could be attributed to genetic effects. CONCLUSIONS: These data provide preliminary evidence for the heritability of benign prostatic disease.

Aged↗