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At least 865 records · Page 48Linked to original sources
PubMed1997

Prostatic intraepithelial neoplasia occurs spontaneously in the canine prostate.

PURPOSE: Prostatic intraepithelial neoplasia (PIN) is the most likely precursor of human prostate cancer. Although the dog is the only non-human species in which spontaneous prostate cancer occurs frequently, the prevalence of PIN in the canine prostate is unknown. A naturally occurring animal model of PIN has not been described. MATERIALS AND METHODS: To determine if high grade PIN occurs spontaneously in the canine prostate, we evaluated totally embedded prostates from 35 outbred dogs that had no clinical evidence of prostatic disease. Prostates from three groups of dogs were analyzed: (1) 11 sexually intact dogs 7-17 years old (elderly sexually intact); (2) 13 sexually intact dogs 1-4 years old (young sexually intact); and (3) 11 dogs 7-17 years old that had been castrated (elderly castrated). The prevalence of PIN was determined by systematic evaluation of hematoxylin/eosin and high molecular weight keratin 34 beta-E12 stained tissue sections from formalin-fixed, paraffin embedded prostates that had been serially sectioned at 4 mm intervals. RESULTS: Canine high grade PIN showed cytologic features identical to the human counterpart, including cell crowding, loss of polarity, and nuclear and nucleolar enlargement. Foci of high grade PIN were present in the prostates of 6 of 11 (55%) elderly, sexually intact dogs but only 1 of 13 (8%) dogs less than 4 years old. Foci of high grade PIN were detected in 1 of 11 (9%) elderly castrated dogs. In elderly, sexually intact dogs with PIN, foci of high grade PIN were present in 13 of 83 (16%) tissue sections evaluated; one of these dogs had focal adenocarcinoma in addition to PIN. CONCLUSIONS: These results indicate that high grade PIN is frequently present in the prostate of elderly, sexually intact dogs. The prevalence of canine PIN, like human PIN, is apparently influenced by age and testicular androgens. The canine prostate may serve as a useful model to determine the factors that regulate the apparent progression from benign epithelium to PIN and invasive carcinoma.

Age Factors↗
PubMed1997

Prostate-specific antigen (protein and mRNA) analysis in the differential diagnosis and staging of prostate cancer.

We analyzed complexed and free prostate-specific antigen (PSA), the free/total PSA and complexed/free PSA ratios, acid phosphatase, and prostatic phosphatase in serum from 36 patients with prostatic carcinoma and from 48 non-neoplastic control patients (20 with prostatitis and 28 with benign prostatic hyperplasia). Receiver-operating characteristic plots showed that serum PSA was the most efficient variable, singly used, in discriminating neoplastic from non-neoplastic patients. At a cut-off value of 10.0 ng/ml, serum PSA had a diagnostic sensitivity of 87% and a diagnostic specificity of 83%. In particular, three patients with prostatic carcinoma and twenty non-neoplastic controls had serum PSA levels of between 4 and 10 ng/ml. The subsequent analysis of the serum free/total PSA ratio, in this subgroup, using a cut-off level of 15%, allowed us to classify correctly all prostatic cancer cases and 18/20 non-neoplastic diseases. We next analyzed PSA mRNA in circulating cells using an improved reverse-transcriptase polymerase chain reaction dot blot procedure, from six patients with prostatic carcinoma with distant metastases, and in seventeen with localized cancer. The analysis had a high sensitivity (up to dilutions 1:10(6) of total RNA from prostatic cancer cells vs total RNA from normal blood cells). The analysis revealed circulating micrometastatic cells in 3/6 (50%) cases of metastatic cancer and in 4/17 cases of localized cancer. To conclude, serum total PSA combined with the free/total PSA ratio is a very efficient algorithm in discriminating neoplastic from non-neoplastic prostatic diseases, while other mRNA species must be analyzed, in addition to PSA mRNA, in circulating cells to increase the efficiency in detecting metastatic prostatic cancer.

Diagnosis, Differential↗
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↗
PubMedDate not supplied

Likelihood of prostate cancer based on prostate-specific antigen density by MRI: retrospective analysis.

OBJECTIVE: As a screening test for prostate cancer (PCA), prostate-specific antigen (PSA) may induce unnecessary prostate biopsy in patients with PSA 4.1-10.0 ng/ml. PCA detection may be delayed in patients with PSA < or =4.0 ng/ml. MRI-based PSA density of the prostate (PSAD) and of the prostatic transitional zone (PSAT) could improve differentiation of PCA and benign prostatic hyperplasia. MATERIAL AND METHODS: Total prostate and transitional zone volumes were planimetrically determined in axial, T2-weighted fast spin echo MR images of the prostate. Serum PSA concentration was measured with an automated standardized microparticle enzyme immune assay. PSAD and PSAT were calculated in 17 patients with clinically significant PCA and 42 patients with benign prostatic hypertrophy (BPH) (66 +/- 6 versus 64 +/- 8 years, p = 0.2410, t test) who had PSA levels < or =10.0 ng/ml. RESULTS: For differentiation of BPH and PCA, PSA alone above the optimal cutoff level of 4.2 ng/ml showed an odds ratio for PCA of 6.7 (95% confidence interval [CI], 1.9-23.2). PSAD showed an odds ratio for PCA of 71.3 (95% CI, 11.8-430.9) above the optimal cutoff level of 0.07 ng/ml/cc. PSAT demonstrated an odds ratio for PCA of 320.0 (95% CI, 27.1-3781.4) above the optimal cutoff level of 0.15 ng/ml/cc. CONCLUSIONS: In patients with PSA < or =10.0 ng/ml, MRI-based PSAD and PSAT appear to improve differentiation of prostate cancer and BPH and are feasible to reduce the frequency of unnecessary prostate biopsy.

Aged↗
PubMed2006

Serum and prostatic tissue concentrations of moxifloxacin in patients undergoing transurethral resection of the prostate.

The spectrum of pathogens causing chronic bacterial prostatitis comprises Gram-negative, Gram-positive and atypical microorganisms. Because of its broad spectrum of activity, the group 4 fluoroquinolone moxifloxacin might be a suitable antibiotic for treatment of bacterial prostatitis. The aim of this prospective study was to investigate the penetration of moxifloxacin into prostatic tissue in patients with benign prostatic hyperplasia. Patients received a single dose of moxifloxacin 400 mg in an 1 hour lasting infusion (250 ml) for perioperative prophylaxis before undergoing transurethral resection of the prostate (TURP). Serum concentrations were determined in all patients before infusion, at the end of infusion (time point 0), 0.5, 1 and 2 h after the end of infusion. Patients were randomized for tissue sampling either 0, 0.5, 1 or 2 h after the end of infusion. At beginning of TURP approximately 1 g of tissue was sampled for analysis. Concentrations of moxifloxacin in serum and tissue were determined by HPLC. 39 patients were evaluated. Median serum and prostatic tissue concentrations peaked at 0 h (4.94 mg/ L and 8.50 mg/ kg, respectively). The lowest concentrations were quantified at 2 h after the end of infusion (2.46 mg/ L and 3.88 mg/ kg, respectively). The prostatic tissue concentrations of moxifloxacin were approximately twice as high as in corresponding serum. At the end of infusion the tissue and serum concentrations seemed to be already equilibrated, as their ratios did not differ significantly during the time of investigation. After an intravenous infusion of 400 mg the serum and prostatic tissue concentrations of moxifloxacin were well above the MIC values of most important prostatic pathogens. The high tissue/ serum ratio and the extended antibacterial spectrum suggests active concentration in the prostate which may translate into increased efficacy compared to group 2 and 3 fluoroquinolones in the treatment of chronic bacterial prostatitis.

Aged↗
PubMed1991

[Study on frequency of prostate carcinoma and benign prostatic hypertrophy by mass screening in Hokkaido].

We conducted mass screenings for prostate diseases on male subjects over fifty years of age in three separate areas in Hokkaido. Prostate carcinoma and benign prostatic hypertrophy were searched in the 1,764 participants. Histopathologically proven prostate carcinoma was found in twenty-two (1.25%) of the 1,764 participants. This frequency of carcinoma was higher than any other carcinoma found in the mass screenings for gastric, uterine, breast and lung carcinoma in Hokkaido. Of the 22 prostate carcinomas found, 68% were in the early stage (stage B). This stage distribution was clearly distinct from that of prostate carcinoma found on the hospital visit, most of which had already progressed to an advanced stage. These results indicate that mass screening for prostate carcinoma on greater than or equal to 50 year old-male subjects is efficient in finding carcinoma of all stages but, in particular, carcinoma of early stage, when compared with mass screening for other carcinomas. BPH, defined as a moderately or markedly enlarged prostate on rectal palpation, was found in 10% of the participants. Questionnaire on subjective symptoms of voiding disturbance in the participants has confirmed that these symptoms, mainly elicited by BPH, become manifested in fifties and more frequent with age. Of thirteen patients with prostate carcinoma who received both rectal examination and prostate-related markers measurement in serum at the time of mass screening, three without induration of the prostate were diagnosed as having carcinoma from an abnormal value of the serum markers. This result suggests that the marker(s) is one of the useful screening tests for detecting carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗
PubMed2000

Optimal predictors of prostate cancer on repeat prostate biopsy: a prospective study of 1,051 men.

PURPOSE: We compare the ability of total prostate specific antigen (PSA), percent free PSA, PSA density and transition zone PSA density to predict the outcome of repeat prostatic biopsy in men with serum total PSA 4 to 10 ng./ml. who were diagnosed with benign prostatic hyperplasia after initial biopsy. MATERIALS AND METHODS: In this prospective study 1,051 men with total PSA 4 to 10 ng./ml. underwent transrectal ultrasound guided sextant biopsy with 2 additional transition zone biopsies. In 254 subjects biopsy specimens were also obtained from suspicious areas identified during transrectal ultrasound and digital rectal examination. All subjects with biopsy specimens negative for prostate cancer underwent repeat biopsy 6 weeks after initial biopsy. The ability of total PSA, percent free PSA, PSA density and transition zone PSA density to improve the diagnostic power of PSA testing was assessed with univariate and multivariate analyses as well as receiver operating characteristics (ROC) curves. RESULTS: Initial biopsy was positive (prostate cancer) in 231 and negative (benign prostatic hyperplasia) in 820 of the 1,051 subjects. Prostate cancer was detected on repeat biopsy in 10% of subjects (83 of 820) with negative initial biopsy. Percent free PSA and transition zone PSA density were the most accurate predictors of prostate cancer in these subjects. At a cutoff of 30% percent free PSA would have detected 90% of cancers (sensitivity) and eliminated 50% of unnecessary repeat biopsies (specificity). Sensitivity and specificity of transition zone PSA density at a cutoff of 0.26 ng./ml./cc was 78% and 52%, respectively. ROC curve analysis also showed that percent free PSA was a significantly better predictor of repeat biopsy results than total PSA, PSA density and transition zone PSA density. The area under the ROC curve was 74.5% for percent free PSA, 69.1% for transition zone PSA density, 61.8% for PSA density and 60.3% for total PSA. CONCLUSIONS: At least 10% of patients with negative initial prostatic biopsy results will be diagnosed with prostate cancer on repeat biopsy. Percent free PSA and transition zone PSA density enhance the specificity of PSA testing compared to total PSA or PSA density when determining which patients should undergo repeat biopsy. Repeat biopsy should be performed in patients with percent free PSA less than 30% or transition zone PSA density 0.26 ng./ml./cc or greater. In our study percent free PSA was the most accurate predictor of prostate cancer in repeat biopsy specimens.

Aged↗
PubMed2006

Prostatic intraepithelial neoplasia in TURP specimens and subsequent prostate cancer.

PURPOSE: Prostatic intraepithelial neoplasia (PIN) is considered as a precursor lesion for adenocarcinoma of the prostate. Most data supporting this relationship comes from the short-term follow-up of patients with repeated biopsies. We report a study in which patients were followed-up for 11 years to assess the relationships between the presence of high grade PIN, low grade PIN, and atypical adenomatous hyperplasia (AAH) and the subsequent occurrence of prostate cancer. MATERIALS AND METHODS: For 601 men treated by TURP in 1990-1993, prostate specimens were reviewed to assess the presence of high grade PIN, low grade PIN, and AAH. Incidental carcinoma was observed in 67 men. Follow-up of the 534 men without incidental prostate cancer was conducted until December 2003 and 24 new prostate cancers were diagnosed. Multivariate regression models were used to assess the relationships between PIN and AAH and prostate cancer on both cross-sectional and prospective data. RESULTS: High grade PIN (odds ratio (OR) = 6.16, 95% confidence interval (CI): 3.28-11.58), low grade PIN (OR = 3.06, 95% CI: 1.45-6.46), and AAH (OR = 2.06, 95% CI: 1.00-4.29) were significantly associated with incidental prostate cancer. In the prospective study, only high grade PIN was associated with a statistically significant increased risk of prostate cancer: hazard ratio = 3.12, 95% CI: 1.15-8.49. CONCLUSION: Although high grade PIN, low grade PIN, and AAH were all associated with incidental prostate cancer, the long-term prospective study showed that only high grade PIN was a significant determinant of the subsequent occurrence of prostate cancer.

Adenocarcinoma↗
PubMed1996

[Early diagnosis of prostate carcinoma with reference to the density of prostate-specific antigen].

Early diagnosis of prostate cancer is based on determination of serum prostate specific antigen (PSA) and digital rectal examination (DRE). In men with PSA values above 10 ng/ml and where there is a positive DRE, the indication for prostatic biopsy is given. However, there is controversy as to whether men with an intermediate PSA level of 4-10 ng/ml should undergo further evaluation. Since cancer secretes 12 times more serum PSA per volume than benign prostatic hyperplasia, PSA density (PSAD, serum PSA divided by the volume of the entire prostate) has been suggested as an additional diagnostic criterion. In 153 men with prostatism and PSA values between 4 and 10 ng/ml (Hybritech assay), the volume of the prostate was determined by transrectal ultrasonography and 6 systematic biopsies were performed. The groups with positive and negative biopsies respectively were compared according to age of the patient, results of DRE and PSAD. Histological grade of positive biopsies and pathological stage of patients who underwent radical prostatectomy were also compared with diagnostic criteria. Prostate cancer was found in 45 of 153 men (29.4%). Patient's age had no influence on detection rates. The positive predictive value of a PSAD of 0.2 or more was twice the value of a PSAD below 0.2, irrespective of DRE findings. An increasing number of positive biopsies was associated with increasing PSAD and histological grade. Only half of the tumors operated on were still confined to the prostate. Pathological stage could be predicted by the number of positive biopsies. We conclude that PSAD may be useful as a diagnostic parameter in men with prostatism and PSA values of 4-10 ng/ml. The prostate cancers that were detected in this setting are of clinical significance.

Adult↗