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Relationship between serum prostate specific antigen and the pattern of inflammation in both benign and malignant prostatic disease in Middle Eastern men.

To determine the effect of prostatitis on serum prostate specific antigen in the diagnosis of prostate cancer in Middle Eastern men, H&E-stained sections of all consecutive prostate specimens were reviewed for diagnosis (malignant or benign) and pattern of inflammation. Inflammation was categorized into acute, active chronic and chronic inactive and graded semi-quantitatively according to previously published criteria. Results were correlated with serum PSA obtained from patients' records. Of 513 prostate specimens reviewed; 435 (84.8%) were benign and 78 (15.2%) were malignant. Chronic inactive prostatitis was present in 259 (204 benign, 55 malignant) and active chronic prostatitis in 221 (204 benign, 17 malignant). Acute prostatitis alone was not observed and prostatitis was absent in 33 (27 benign, 6 malignant). There was no significant difference in the prevalence of inactive chronic prostatitis between benign and malignant specimens (p < 0.071), but active chronic prostatitis was more prevalent in benign specimens (p < 0.001). Increasing serum PSA was observed for increasing grades of both inactive and active chronic prostatitis in both benign and malignant disease. Prostate cancer showed higher serum PSA levels than benign, at different cut-off points (4 ng/ml = p < 0.0001; 8 ng/ml = p < 0.0001; 12 ng/ml = p < 0.0001). However, significant numbers of patients with benign prostate biopsies presented with PSA above 12 ng/ml (82/260 = 32%). We conclude that active chronic prostatitis is common in Middle Eastern men with benign prostatic disease and a significant number of these present with very high PSA levels, some over 300 ng/ml.

Acute Disease↗

Canine prostatic disease--comparison of ultrasonographic appearance with morphologic and microbiologic findings: 30 cases (1981-1985).

A retrospective analysis was made of 30 cases of canine prostatic disease, with the objective of identifying (via a prepubic approach) the 2-dimensional, gray-scale ultrasonographic appearance most often associated with the various spontaneous prostatic diseases. Ultrasonography was of value in characterizing the parenchymal architecture as normal vs focally hyperechoic and diffusely hyperechoic (associated with chronic inflammation and neoplasia) or focally hypoechoic or anechoic (either accompanied by distant enhancement), which was associated with retention cyst or abscess. Further specificity based only on abnormal echotexture was not possible. Ultrasonography facilitated the differentiation of radiographically identifiable prostatomegaly attributable to abscess or neoplasia from apparent prostatomegaly attributable to paraprostatic cyst. An imaging protocol consisting of distention retrograde urethrocystography and prepubic ultrasonography was recommended, as a distended bladder aided ultrasonographic identification of the prostate gland. In addition, the combination of urethral morphologic features and urethroprostatic reflux appearance complemented the ultrasonographic appearance for differentiation of prostatic abscess from prostatic carcinoma. A classification scheme for spontaneous canine prostatic disease combining germane imaging morphologic features with microscopic and microbiologic findings was proposed.

Animals↗

Human prostatic aldehyde dehydrogenase of healthy controls and diseased prostates.

Aldehyde dehydrogenase (ALDH, EC 1.2.1.3) of the human prostate was the subject of investigation in this study. The possible physiological role of aldehyde dehydrogenase in the human prostate might be to detoxify aldehydes arising from the oxidation of the polyamines via monoamine or diamine oxidases. The specific activity of the enzyme with 1 mM propionaldehyde as substrate and 0.5 mM NAD at pH 7.4 in the control normal prostates and prostates afflicted with the disease, benign prostatic hyperplasia (BPH), was 26.06 +/- 2.96 and 5.17 +/- 0.48 nmol/g prostate per min, respectively. When 100 microM gamma-aminobutyraldehyde was used as a substrate, the specific activity in the normal controls and prostates with benign prostatic hyperplasia was 19.80 +/- 1.33 and 2.95 +/- 2.46 nmol/g prostate per min, respectively. Upon isoelectric focusing of the extracts of the control prostates when the gels were developed for aldehyde dehydrogenase activity, there were three aldehyde dehydrogenase activity bands visible, pI 4.9 (mitochondrial), 5.4 (cytosolic) and about 6.0-6.5, on the IEF gels developed with gamma-aminobutyraldehyde as a substrate. With the extracts of prostates with benign prostatic hyperplasia the pI 4.9 band was significantly reduced, the pI 5.4 band enhanced and the approx. pI 6.0 band was not detectable on the IEF gels with propionaldehyde as a substrate. There was no detectable aldehyde dehydrogenase activity in the extract of the prostate with cancer on IEF gels nor in the activity assays with propionaldehyde or gamma-aminobutyraldehyde as substrates.

Aged↗

[Three-dimensional ultrasonic visualization in the diagnosis of prostatic diseases].

Three-dimentional (3D) ultrasound investigation (USI) covered 60 patients with various prostatic diseases. 3D USI was made with a computer tomographic device "Echotom-3D" allowing getting three-dimentinal images on two-dimentional scanners as well as 1846 scanner ("B&K Ultrasound Systems", Denmark), sensors 3.5, 5.0 and 7.0 MHz. Transabdominal, perineal and transrectal 3D USI were performed. These proved highly effective in diagnosis of prostatic diseases.

Aged↗

Incidental discovery of ano-rectal disease during transrectal ultrasound performed for prostatic disease.

Transrectal ultrasound (US) has long been a routine investigation for the study of various diseases of the prostate. The use of 360 degrees transverse scanning probes and recently, of 3D probes, has been proposed as a suitable means of studying the rectal wall. Between January 1997 and February 2004, 3758 subjects suffering from lower urinary tract symptoms associated with micturition disturbances underwent transrectal ultrasound (TRUS) with a multiplane probe having a variable frequency ranging up to 7.5 MHz and, in the later period, with a transrectal 3D volumetric probe. In 489 patients (13%) TRUS yielded suspicious images of the rectal wall. This finding was verified by a proctologic and rectoscopic examination. In 132 cases (27%) it was shown to be a false positive, mainly due to imperfect cleansing of the anal canal; in 284 cases (58%) benign disease was demonstrated (hemorrhoids in 192 patients, abscesses in 21, perianal fistulas in 18, inflamed lymph nodes in 27, polyps in 16). In 34 patients (7%) a malignant tumor was found (infiltration of the anterior rectal wall by a prostatic adenocarcinoma in 13, and a primitive adenocarcinoma of rectal origin in the remaining 21). It can be concluded that transrectal US does not permit a certain diagnosis of the nature of rectal disease, but does raise a diagnostic suspicion that can orient the surgeon to schedule more invasive diagnostic investigations.

Humans↗

[Prostate diseases of occupational origin].

BACKGROUND: Prostatitis is a poorly defined group of syndromes with multiple causes. Chronic prostatitis may be non-bacterial and due to intrapelvic venous congestion. If the causes persist and adequate treatment is not given, the congestive syndrome may become chronic and interfere with fertility with severe biological damage. OBJECTIVES: Little is known in the field of occupational medicine (as regards clinical and pathogenic aspects) and, on the other hand, little is known by urologists (as far as the aetiological aspects are concerned), the prostatitis-like syndrome due to intrapelvic congestion has been defined in recent studies as non-bacterial prostatitis or prostatodynia, but we prefer to call it "prostatosis". The results of a close cooperation between urologists and occupational physicians are reported. METHODS: Patients with non-bacterial chronic prostatosis were evaluated from the urological and occupational point of view and all the etiological factors of both occupational and non occupational origin were considered. When occupational factors are a conditio sine qua non prostatosis is considered an occupational disease. RESULTS: Two cases of "occupational prostatosis" are described where driving vehicles and a sedentary employment played the most important etiological part. Many other similar cases were observed. CONCLUSIONS: Close cooperation between urologists and occupational physicians makes it possible to complete clinical diagnosis with a careful evaluation of all the factors of both occupational and non-occupational origin and allows the identification of those cases that must be defined as occupational diseases. Prostatosis due to venous congestion deserves the attention of occupational physicians since the distinction between occupational and non-occupational origin must be found both in individual cases and in groups of workers subject to the same factors. Moreover, the present state of knowledge is enough to take preventive measures aimed at reducing the frequency of new cases and avoiding the deterioration of existing cases. It is also possible that some cases of pseudo-cystitis in women might be the result of intrapelvic venous congestion of occupational origin. Anatomical and physiological non-occupational factors as well as certain habits of life style can favor intrapelvic venous congestion, producing conditions of hypersusceptibility to occupational factors and could sometimes cause the disease even in the absence of causes connected to work.

Adult↗

Canine prostatic disease--comparison of radiographic appearance with morphologic and microbiologic findings: 30 cases (1981-1985).

A retrospective analysis was made of radiographs from 24 clinically normal young adult male Beagles used in previously reported base-line research on the distal male urinary tract. The ventrodorsal and craniocaudal prostate gland dimensions were measured, as visualized on the lateral radiographic view, and expressed as a ratio of the distance between the cranial aspect of the public bone and the sacral promontory. In 17 of these 24 dogs, there was sufficient image clarity to permit confident measurement of prostatic dimensions. From these data, the largest acceptable prostatic dimension, as visualized on the lateral radiographic view, was 70% of the public-promontory distance. A retrospective analysis was made of 30 cases of canine prostatic disease, with the objective of identifying the radiographic (survey and distention retrograde urethrocystogram) appearance most often associated with the various spontaneous prostatic diseases. Prostatomegaly was not specific for the cause of prostatic disease, except if the apparent parenchymal dimensions were greater than or equal to 90% of the public-promontory distance wherein neoplasia, abscess, and paraprostatic cysts (readily differentiated from diffuse intraparenchymal disease by ultrasonography) were the principle considerations. Multifocal, irregularly shaped, parenchymal mineral densities were observed only in dogs with prostatic carcinoma (4/7 cases) or prostatitis (1 case of chronic prostatitis). Narrowing of the prostatic portion of the urethra was observed only in association with abscess, neoplasm, or noninflammatory nonneoplastic disease (possibly benign hypertrophy/hyperplasia), whereas widening of this part of the urethra was not observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Serum prostatic acid phosphatase determination in prostatic diseases: a critical comparison of an enzymatic and a radioimmunologic assay.

A prospective study comparing a new radioimmunologic and a classical enzymatic assay for prostatic acid phosphatase was done to evaluate their respective roles in patients with prostatic diseases. We studied 50 patients with cancer of the prostate, 101 with benign prostatic hypertrophy and 17 with prostatitis as well as patients with nonprostatic malignancy, and various hematological and bone diseases. The results showed a low incidence of elevated values in patients with early cancer of the prostate and a high incidence of false positive values with the radioimmunoassay in patients with benign prostatic diseases, especially prostatitis. These data suggest that tests for serum prostatic acid phosphatase levels remain disappointing in the assessment of prostatic disease regardless of the technique used.

Acid Phosphatase↗

Essential fatty acid distribution in the plasma and tissue phospholipids of patients with benign and malignant prostatic disease.

There is increasing evidence that essential fatty acids (EFA) may have a role to play in the aetiology of some types of cancer although their precise mode of action is unknown. Differences in the metabolism of EFA between patients with benign or malignant prostatic disease may help to elucidate their role in the latter. We have, therefore, measured the concentration of the essential fatty acids, and their metabolites, in the phospholipid fractions of both plasma and tissue, in patients with either benign or malignant prostatic disease. Comparison of the median concentration of fatty acids in each group (n = 10) revealed significant differences between them. The phospholipid component of total lipid was greater in malignant (P less than 0.04, unpaired t-test) than in benign tissue. The concentrations of linoleic acid (LA) and di-homo gamma linolenic acid (DGLA) in plasma and tissue were not different between the two groups of patients, but a significant reduction in arachidonic acid (ARA) (P less than 0.002, Mann-Whitney U-test) and docosapentaenoic acid (DPA) (P = 0.009) concentrations was observed in malignant tissue as compared to benign. Patients with malignant prostatic disease also had a significantly higher concentration of oleic acid in phospholipids from both plasma and prostatic tissue. The stearic to oleic acid ratio was similar in plasma but was significantly reduced in malignant tissue (P = 0.006). We suggest that the decreased arachidonic acid concentration in malignant tissue may be due to its increased metabolism, via the lipoxygenase and cyclooxygenase pathways to produce higher concentrations of eicosanoids, rather than an impairment in desaturase activity in situ.

Arachidonic Acid↗

The role of prostatic planimetry using transrectal sonography in prostatic diseases.

Transrectal sonography (TRS) remains the best method for prostatic planimetry, providing much information of value for the diagnosis and treatment of prostatic diseases, particularly of prostatic cancer. Currently, TRS is a routine tool in the detection and treatment of prostatic cancer. Prostatic planimetry is also available for a better understanding of elevated prostate-specific antigen (PSA). PSA indices modified by prostatic volume are applicable to the detection of prostatic cancer. The most critical application of prostatic planimetry is in monitoring prostatic cancer after treatment. Prostatic volume decreased exponentially after androgen deprivation therapy without exception in patients with prostatic cancer. The parameter "tau" (Tau), calculated from kinetic analysis based on sequential planimetric volumetry using TRS after the initiation of treatment, is a reliable prognosticator in an individual patient. Furthermore, tau predicts the manner of disease progression, and local or metastatic progression. Thus, transrectal ultrasonic prostatic planimetry is of special value in prostatic cancer.

Biomarkers, Tumor↗

Quantitation of serum prostate-specific membrane antigen by a novel protein biochip immunoassay discriminates benign from malignant prostate disease.

The lack of a sensitive immunoassay for quantitating serum prostate-specific membrane antigen (PSMA) hinders its clinical utility as a diagnostic/prognostic biomarker. An innovative protein biochip immunoassay was used to quantitate and compare serum PSMA levels in healthy men and patients with either benign or malignant prostate disease. PSMA was captured from serum by anti-PSMA antibody bound to ProteinChip arrays, the captured PSMA detected by surface-enhanced laser desorption/ionization mass spectrometry, and quantitated by comparing the mass signal integrals to a standard curve established using purified recombinant PSMA. The average serum PSMA value for prostate cancer (623.1 ng/ml) was significantly different (P < 0.001) from that for benign prostate hyperplasia (117.1 ng/ml) and the normal groups (age <50, 272.9 ng/ml; age >50, 359.4 ng/ml). These initial results suggest that serum PSMA may be a more effective biomarker than prostate-specific antigen for differentiating benign from malignant prostate disease and warrants additional evaluation of the surface-enhanced laser desorption/ionization PSMA immunoassay to determine its diagnostic utility.

Adult↗

Transforming growth factor-alpha expression in benign and malignant human prostatic disease.

Investigation of biological variables in prostatic disease may not only prevent patients with a good prognosis being overtreated, but allow better selection of appropriate therapy, and may identify potential targets for novel therapies. This study investigates the growth factor transforming growth factor-alpha (TGF alpha) expression in benign and malignant prostatic biopsies using both radioimmunoassay and immunohistochemistry, considering its role in malignant epithelial transformation and as a prognostic indicator. Biochemical methods were less satisfactory than the more selective immunohistochemical methods, due to the heterogeneity of prostatic tissue. Seventy-one percent of benign biopsies (range 0-18.62ng/mg DNA) and 69% of malignant biopsies (range 0-11.1ng/mg DNA) had detectable levels of TGF alpha using radioimmunoassay. Immunohistochemical staining for TGF alpha identified expression in 15% of benign (4 out of 27) and 53% malignant biopsies (18 out of 34). Positive staining was also identified in premalignant lesions and within stromal elements, thus implying the factor's role in autocrine/paracrine growth and/or malignant transformation. Immunostaining for TGF alpha may enhance detection of premalignant lesions and small foci of malignant glands which are otherwise difficult to identify using standard histopathological techniques.

Biomarkers, Tumor↗

Acid phosphatase and zinc in semen of subjects with no clinical evidence of prostatic disease.

We evaluated the distribution of values for prostatic acid phosphatase (EC 3.1.3.2) activity and zinc concentration in semen of 80 men without clinical evidence of prostatic disease. Both substances have log normal distributions. Reference intervals were defined by parametric tests after logarithmic transformation of data and by nonparametric tests. There is a correlation between zinc concentration and prostatic acid phosphatase activity in semen.

Acid Phosphatase↗

Nonassociation of hyperamylasemia and prostatic disease.

The possible correlation of hyperamylasemia and prostatic disease was investigated in patients with benign prostatic hyperplasia, adenocarcinoma of the prostate, and in patients without clinical evidence of prostatic lesion. Our results indicate that prostatic lesions whether benign or malignant are not associated with either elevation of serum amylase or abnormal isozyme zymograms.

Adenocarcinoma↗

Analysis of prostatic fluid in prostatic disease.

The current studies of expressed prostatic fluid tend to confirm our previous reported pilot observations of a shift in lactic dehydrogenase (LDH) isoenzymes to a predominance of LDHV in patients with prostatic malignancy. They also suggest a decrease in concentration of acid phosphatase and an increase in concentration of protein in the presence of carcinoma of the prostate. These observations suggest a diffuse metabolic alteration of the prostate in the presence of prostatic carcinoma.

Acid Phosphatase↗