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PubMed1979

[Diagnostic possibilities of the prostate cytology, particularly considering the influence of the cytological degree of differentiation with the prostate carcinoma upon the 5 year survival rate (author's transl)].

Today, the transrectal fine-needle biopsy is firmly integrated in the establishment of the diagnosis of prostate carcinoma within the prophylactic examinations and as a check-up examination during the treatment of prostate carcinoma. Cytologically, the prostate carcinoma may be divided into four different degrees of malignancy: high-grade, medium-grade, low-differentiated and anaplastic carcinoma. Differential-diagnostically, chronic prostatitis may raise certain problems both clinically and cytologically. Electronmicroscopic examinations of samples taken by fine-needle biopsy are possible. Certain changes under anti-androgen treatment are examined at present. Under the contra-sexual treatment of the prostate carcinoma carrier there occur changes of the normal and carcinoma cells the extent of which permits conclusions as to the therapeutic hormone effect. This, in turn, results in consequences for the respective treatment. In 496 prostate carcinomata cytologically diagnosed since March 1970 the author was able to demonstrate that the 5 years' survival rate is determined by the cytological degree of differentiation. Whereas highly and medium-differentiated prostate carcinomata show an average 5 years' survival rate of 62.5 per cent, this amounts only to 33.9 per cent with the low-differentiated and anaplastic prostate carcinomata. The total 5 years' survival rate of all cytologically diagnosed carcinomata came up to 46.8 per cent. The 1-, 2-, 3-, 4- and 5 years' survival rate of all cytologically diagnosed prostate carcinoma carriers is almost in conformity with the values found by Esposti. The degree cytological differentiation in connection with the clinical stage clearly determines the clinical course with our patients.

Biopsy, Needle↗
PubMed1983

Comparison of soluble protein kinases from normal rat prostates and prostatic Dunning tumors.

The photoaffinity labeling of the regulatory subunits of adenosine cyclic 3':5'-monophosphate-dependent soluble protein kinases with an adenosine cyclic 3':5' monophosphate analogue, 8-azidoadenosine cyclic 3':5'-monophosphate (8-N3-cAMP) was compared in normal prostates and prostatic (Dunning) tumors. Marked differences in the proportions of photoincorporation of 8-N3-[32P]cAMP into the regulatory subunit of type I (RI) and type II (RII) protein kinases and the proteolytic fragment of these regulatory subunits (Rpf) were observed in normal prostate (ventral prostate versus dorsolateral prostate) and Dunning prostatic tumors [hormone-dependent (R-3327-H) versus hormone-independent (R-3327-HI) or anaplastic (R-3327-AT) tumors]. The proportion of 8-N3-[32P]cAMP photoincorporation into RII versus RI was 2-fold higher in the dorsolateral prostate than that observed in the ventral prostate, whereas the ratio of photoincorporation into RI or Rpf was comparable between these two tissues. Comparison between tumor tissues revealed that the proportion of photoincorporation of 8-N3-[32P]cAMP into RII versus RI was 4.2-fold higher in hormone-dependent than in hormone-independent or anaplastic tumors, whereas the ratio of photoincorporation into RI versus Rpf in the former was only 6 to 7% that found in the latter. Since Dunning hormone-dependent and hormone-independent tumors have similar morphology, the present photoaffinity labeling of these regulatory subunits of soluble protein kinases provides a sensitive method (4 mg tissue per assay) to distinguish these prostatic tumors of different hormonal dependency.

Animals↗
PubMed1995

A randomized study comparing visual laser ablation and transurethral evaporation of prostate in the management of benign prostatic hyperplasia.

PURPOSE: We evaluated the safety, efficacy, failure and complications of 2 techniques of laser prostatectomy for benign prostatic hyperplasia (BPH): transurethral evaporation of the prostate (evaporation) versus visual laser ablation of the prostate (coagulation) in a randomized trial. MATERIALS AND METHODS: A total of 64 consecutive patients with symptomatic BPH was randomized to undergo evaporation (32) or coagulation (32). American Urological Association symptom score, peak urinary flow rate and post-void residual urine volume were measured at baseline, and at 1, 3, 6 and 12 months. Other parameters evaluated included prostate volume by transrectal ultrasound, total laser energy per patient and per cc volume of the prostate, number of laser fibers per prostate, duration of catheterization and hospitalization, need for re-catheterization, and failure and complication rates. RESULTS: Our main findings were that patients undergoing laser prostatectomy using the coagulation technique (visual laser ablation of the prostate) had higher reoperation rates (16% versus 0%, p = 0.0199) and were 4 times more likely to have prolonged postoperative urinary retention (25% versus 6.3%, p = 0.0389), evaporation and coagulation were effective at relieving symptoms of prostatism with significant improvement in American Urological Association symptom scores and post-void residual urine volumes compared to baseline, improvement in peak flow rates was significantly greater in patients undergoing evaporation at 1, 3, 6 and 12 months (p < 0.001) compared to coagulation, and a significantly greater amount of laser energy was required to evaporate a unit volume of prostate tissue compared to coagulation (2,251 J./cc versus 1,036 J./cc, p < 0.03). CONCLUSIONS: Between the 2 major techniques of laser prostatectomy, transurethral evaporation is associated with better results at up to 12 months of followup.

Aged↗
PubMed1997

Bacteria in the prostate tissue of men with idiopathic prostatic inflammation.

PURPOSE: Although antibiotics represent the first line of treatment for prostatitis syndromes, physicians can document infection in remarkably few cases. We examined the relationship of genitourinary infection to inflammatory prostatitis in 85 subjects without bacteriuria. MATERIALS AND METHODS: Evaluation consisted of cultures of urethra, urine and transperineal prostate biopsies, specifically for commensal and fastidious organisms, and leukocyte counts of expressed prostatic secretions. RESULTS: Men with inflamed expressed prostatic secretions (25) were more likely to have any bacterial isolation (p = 0.01), positive cultures for anaerobic bacteria (p = 0.03), higher total bacterial counts (p = 0.02) and more bacteria, species isolated (p = 0.02) in prostate biopsy cultures than men without expressed prostatic secretion inflammation (60). CONCLUSIONS: Bacterial colonization/invasion of the prostate may be associated with inflammatory prostatitis in some cases.

Adult↗
PubMed1998

[Prostatic volume: suprapubic versus transrectal ultrasonography in the control of benign prostatic hyperplasia].

INTRODUCTION: During the follow-up of benign prostatic hypertrophy, the urologist needs the repeated evaluation of the gland size to monitor the effectiveness of drug treatment. We investigated the comparative adequacy of transabdominal and transrectal US for prostatic measurements, to possibly replace the gold standard transrectal examination with cheaper, easier and less invasive transabdominal studies. MATERIAL AND METHODS: February, 1994, to May, 1996, we submitted 196 patients to prostate US, with a transabdominal convex probe and a transrectal biplanar probe. The three prostatic diameters were measured and prostatic volume and height calculated. RESULTS: The transverse diameter was the same (+/- 5%) in 31.6% of cases, but transabdominal US overestimated it in 41.8% and underestimated it in 26.5% of cases. The AP diameter was the same in 33.1% of cases, but trans-abdominal US overestimated it in 15.3% and underestimated it in 51.5% of cases. The cranio-caudal diameter was the same in 25.5% of cases, but transabdominal US overestimated it in 59.1% and underestimated it in 15.3% of cases. Consequently, the volume calculated with transabdominal US was the same (+/- 15%) in 27.5% of cases, overestimated in 45.9% and under-estimated in 26.5% of cases; prostatic weight rates were about the same. CONCLUSIONS: Prostatic volume and weight measured with transabdominal US are overestimated in about 50% of cases and are the same (+/- 15%) in about 27% of cases only. Therefore, transabdominal US appears less reliable than transrectal US for prostatic measurements and the latter technique remains the gold standard to monitor drug treatment effectiveness in benign prostatic hypertrophy follow-up.

Humans↗
PubMed1998

Prostate specific membrane antigen expression in prostatic intraepithelial neoplasia and adenocarcinoma: a study of 184 cases.

BACKGROUND: Prostate specific membrane antigen (PSM) is a membrane-bound antigen that is highly specific for benign and malignant prostate epithelial cells. Its expression in high grade prostatic intraepithelial neoplasia (PIN) has not been compared with that in prostate carcinoma. METHODS: The authors performed an immunohistochemical study of representative sections from 184 radical prostatectomies from previously untreated patients with pathologic stage T2N0M0 adenocarcinoma treated at the Mayo Clinic between 1987 and 1991. Affinity-purified monoclonal antibody 7E11-5.3 directed against PSM was employed at a concentration of 20 microg/mL overnight. For comparison, serial sections in each case were stained with prostate specific antigen (PSA). Staining for all antibodies was performed using the streptavidin-biotin method. For each case, the percentage of immunoreactive cells in benign epithelium, PIN, and adenocarcinoma was estimated in increments of 10%. Cox proportional hazards models were used to identify the risk of carcinoma recurrence according to the number of immunoreactive PIN or cancer cells for PSM and PSA; the date of radical prostatectomy was used as the starting time, and serum PSA (biochemical) failure or clinical failure was the event. PSA biochemical failure was defined as serum PSA > 0.2 ng/mL at least 30 days after surgery. RESULTS: Intense cytoplasmic immunoreactivity for PSM was observed in the benign and neoplastic epithelial cells in all cases (100% of cases staining). The number of cells staining was lower in benign epithelium and PIN than in adenocarcinoma (69.5+/-17.3% [range, 20-90%] vs. 77.9+/-13.2% [range, 30-100%] vs. 80.2+/-13.7% [range, 30-100%], respectively). With rare exceptions, basal cells were negative, and there was no immunoreactivity of the prostate stroma, urothelium, or vasculature. Adenocarcinoma gave the most intense and extensive staining, and the highest grades of adenocarcinoma (Gleason primary patterns 4 and 5) showed staining in virtually every cell; there was greater heterogeneity of staining in lower grades of adenocarcinoma. By contrast, PSA immunoreactivity was more intense and extensive in benign epithelium than in PIN and adenocarcinoma. The number of immunoreactive PIN or cancer cells for PSM and PSA was not predictive of PSA biochemical or clinical failure as defined in this study. CONCLUSIONS: PSM was expressed in all cases of prostate adenocarcinoma, with the greatest extent and intensity observed in the highest grades. The expression increased incrementally from benign epithelium to high grade PIN or adenocarcinoma. Conversely, PSA showed the greatest staining in benign epithelium, with decreased expression incrementally from benign epithelium to high grade PIN or adenocarcinoma. Expression of PSM is clinically useful for the identification of prostate epithelium, particularly PIN or adenocarcinoma, and its expression is regulated independent of PSA. The number of PSM immunoreactive cells was not predictive of recurrence, most likely because of the presence of abundant immunoreactivity in most cases, or because of differential expression in primary and metastatic disease.

Adenocarcinoma↗
PubMed1993

Characterization of neuroendocrine differentiation in human benign prostate and prostatic adenocarcinoma.

BACKGROUND: This report describes an immunohistopathologic analysis characterizing the incidence, pattern of distribution, and hormonal content of neuroendocrine (NE) cells in human benign prostate and prostatic adenocarcinoma. METHODS: Formaldehyde-fixed, paraffin-embedded material from 15 benign prostates, 31 primary prostatic adenocarcinomas, 16 metastatic lesions, 21 primary tumors treated with short-course diethylstilbestrol (DES), and 10 specimens from hormone-refractory patients were examined. NE cells were identified using silver histochemistry and a panel of immunohistochemical NE markers (chromogranin-A, serotonin, neuron-specific enolase), and specific peptide hormone antibodies. RESULTS: NE cells were identified in all benign prostates. NE cells were identified in 77% of primary untreated adenocarcinomas with no significant differences with respect to pathologic stage. NE cells were found isolated and dispersed in the tumor, composing the minority of malignant cells. Double-labeling and serial section immunohistochemistry demonstrated the coexpression of prostate-specific antigen (PSA) in NE cells. In addition to serotonin, some tumors expressed multiple hormone immunoreactivities. NE cells were identified in 56% of metastatic deposits, with a similar pattern of distribution. In DES-treated cases, NE cells were found consistently in the adjacent benign epithelium, whereas 52% of tumors contained NE cells. Hormone-refractory tumors contained NE cells in 60% of cases. CONCLUSIONS: This analysis demonstrates that a significant proportion of primary and metastatic prostatic adenocarcinomas contain a subpopulation of NE cells, the expression of which does not appear to be suppressed with androgen ablation and does not correlate with pathologic stage. Furthermore, NE cells coexpress PSA, suggesting a common precursor cell of origin. The elaboration of biogenic amines and neuropeptides suggests that NE cells dispersed in prostatic carcinoma may play a paracrine growth-regulatory role.

Adenocarcinoma↗
PubMed1992

Nd:YAG laser ablation of the prostate as a treatment for benign prostatic hypertrophy.

Many techniques have been used to relieve obstructive symptoms associated with benign prostatic hypertrophy. Transurethral resection of the prostate (TURP) with an electrocautery loop is the most commonly performed operation to relieve bladder neck and urethral obstruction caused by prostatic adenoma. There is increased interest in alternative therapies to reduce prostatic size for symptom relief in this condition. We describe a technique using the neodymium:YAG (Nd:YAG) laser and a 600-microns laser quartz fibre with an attached terminal gold-plated metal alloy reflector to provide reliable deep penetration into prostatic tissue for prostatic adenoma ablation. We report the first use of this technique in three patients with benign prostatic obstruction and one with localised adenocarcinoma of the prostate.

Carcinoma↗
PubMed2002

Effects of the Bowman-Birk inhibitor on growth, invasion, and clonogenic survival of human prostate epithelial cells and prostate cancer cells.

BACKGROUND: The Bowman-Birk inhibitor (BBI) is a soybean-derived serine protease inhibitor with demonstrated anticarcinogenic activity in both in vitro and in vivo systems. METHODS: The effects of BBI and BBI Concentrate (BBIC), a soybean concentrate enriched in BBI, on cell growth, invasion, and/or survival were evaluated by the sulforhodamine B assay, a colony formation assay, the trypan blue dye exclusion assay and an in vitro invasion assay. The cells used in these studies were normal human prostate epithelial cells and prostate epithelial cell lines derived from embryonic prostate tissue (267B1) or benign prostatic hyperplasia (BPH) tissue (BRF-55T) and human prostate cancer cells established by Ki-ras oncogene transfection of 267B1 cells (267B1/Ki-ras) or from metastatic lesions of human prostate cancer (LNCaP and PC-3). RESULTS: BBIC had a statistically significant inhibitory effect on the growth and clonogenic survival of BRF-55T, 267B1/Ki-ras, LNCaP, and PC-3 cells. BBI also inhibited the growth of LNCaP cells and the clonogenic survival of BRF-55T and 267B1/Ki-ras cells and decreased the ability of LNCaP cells to invade across reconstituted basement membrane (Matrigel) when PC-3 cell-conditioned medium was utilized as the chemoattractant. BBI or BBIC did not affect the growth of normal prostate epithelial cells. CONCLUSION: BBI and/or BBIC could be a useful agent for treatment of prostate diseases.

Basement Membrane↗
PubMed1989

Prostate-specific antigen as a marker of adenocarcinoma of prostate.

Prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) serum levels were measured in 117 patients with prostatic adenocarcinoma, in 9 patients with prostatic hyperplasia and in 14 patients with other malignancies to compare the clinical usefulness of the PSA and PAP levels. PSA was elevated (PSA+) in 14 of 18 untreated patients (78%) with prostatic cancer. PAP was elevated (PAP+) only in 3 of these untreated cases (17%). Also in previously treated patients PSA was more often positive than PAP. PSA was positive in 40 of the 99 treated patients (40%), PAP was elevated only in 21 cases (21%). There was a significantly (P less than 0.001) higher tendency towards elevated PSA in the prostatic cancer patients: 32 (27%) patients with PSA+ and PAP- compared with only 2 cases (2%) with PAP+ and PSA-. The PSA+/PAP- patients were analyzed further. In seven of them the PSA level also returned to its normal level after orchiectomy or/and radiotherapy. In two patients the PSA levels indicated tumor progression earlier than PAP, their PAP levels did not rise until bone metastasizing was evident. There were also progressive disease in some patients evidenced only by increased PSA levels. In addition to cancer patients the PSA level was increased in three (30%) of the prostatic hyperplasia patients. It was also elevated in three patients with other malignancies. However, these three patients also had prostatic hyperplasia and the increase in the PSA level is considered more likely to be due to that.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Phosphatase↗
PubMed1996

Prostate-specific antigen density--a reliable parameter for the detection of prostate cancer?

We compared the prostate-specific antigen density (PSAD) in clinically and surgically staged patients with specimen-confined prostate cancer (n = 57) and in patients with benign hyperplasia (n = 69), who underwent transvesical adenomectomy. The PSAD was calculated from the preoperative PSA level and the specimen volume. The prostate volume was determined by dividing the prostate weight by the specific gravity of the tissue. The mean tissue values used for PSAD calculation were 51.9 g in men with prostate cancer (PCA) and 62.9 g in men with benign prostatic hyperplasia (BPH). The PSAD values showed significant differences (BPH 0.19 versus PCA 0.37, P = 0.029). Receiver operator characteristic (ROC) curves demonstrated the best cutoff value to be 0.15, with the sensitivity being 58%; the specificity, 51% and the positive predictive value of PCA, 49%. At a serum PSA level below 10ng/ml, the best cutoff value was 0.1 and the positive predictive value was 51%. The PSAD results we calculated from an accurate prostate volume (surgical estimate) show that PSAD is not a significant predictor of prostate cancer.

Aged↗
PubMed1996

Interpreting results of prostate-specific antigen testing for early detection of prostate cancer.

OBJECTIVE: Calculation of likelihood ratios for serum prostate-specific antigen (PSA) levels to discriminate potentially curable prostate cancer in men selected for having benign prostatic hyperplasia (BPH) or in randomly selected men. DESIGN: Retrospective analysis of prospectively measured PSA levels. SETTING: A tertiary referral center, a multicenter randomized controlled trial, and a community-based study, all providing PSA data. PATIENTS: We used PSA measurements from four groups of men aged 50 to 79 years: 276 men with organ-confined prostate cancer treated with radical prostatectomy, 305 randomly selected men without clinical evidence of prostate cancer or a history of surgery for BPH recruited for a community study, 173 men without cancer but with BPH coming to prostatectomy, and 770 men without cancer and with symptoms of BPH enrolled in the North American finasteride clinical trial. MEASUREMENTS AND MAIN RESULTS: Age-standardized, stratum-specific likelihood ratios for organ-confined prostate cancer were calculated separately for unselected men in the community sample and for selected men with BPH (pooling both BPH populations). Likelihood ratios ranged from 0.2 for PSA between 0.0 and 2.0 ng/mL to 54.8 for a PSA level of 10.1 ng/mL or higher in unselected men, but rose to only 2.9 for PSA values of 10.1 ng/mL or higher in men with BPH. Forty percent of the men in the community study had moderate to severe lower urinary tract symptoms. In these men, likelihood ratios ranged from 0.2 for PSA values between 0.0 and 2.0 ng/mL to 17.2 for PSA values of 6.1 ng/mL or higher, while in men with no or mild symptoms, likelihood ratios rose to 26.9 for PSA values of 6.1 ng/mL or higher. CONCLUSIONS: Likelihood ratios for PSA test results allow stratification of men along a continuum of risk for prostate cancer. Likelihood ratios demonstrate that the ability of the PSA test to discriminate potentially curable prostate cancer from BPH is dramatically lower in men selected with lower urinary tract symptoms than in randomly selected men.

Aged↗
PubMed1988

Prostatitis and aspiration biopsy cytology of prostate.

Aspiration biopsy of the prostate is contraindicated when active prostatitis is present. However, we have found prostatitis in 45.2 percent of 250 consecutive aspiration biopsy specimens, confirming that urologists have difficulty in distinguishing prostatitis from carcinoma on a clinical basis. The epithelial changes accompanying prostatitis also may be confused with carcinoma. We review the microscopic features which distinguish prostatitis from carcinoma. Because 14.1 percent of the patients with prostatitis in this study also had carcinoma, repeat follow-up biopsy is necessary if suspicion of carcinoma persists after adequate therapy for prostatitis.

Biopsy, Needle↗
PubMed1989

Serum prostate-antigen levels in patients with benign prostatic hypertrophy treated with leuprolide.

We studied serum prostate-specific antigen levels in 12 men with benign prostatic hypertrophy treated with a long-acting GnRH analogue, leuprolide, 1 mg (0.2 mL) sc. daily for six months. The average decrease in prostate size measured by ultrasound was 45 percent after six months with concomitant improvement in the obstructive symptoms of prostatism. There was a steady decline in serum PSA levels which paralleled the decrease in prostate size. One patient who discontinued treatment after six months demonstrated both a regrowth of his prostate and a rise in serum PSA levels to pretreatment levels four months post-discontinuation of treatment. We conclude that treatment with a GnRH analogue caused reversible involution of prostatic epithelial cells with parallel effects on serum PSA levels. Consideration of the initial prostate size together with the serum PSA levels can help predict the response to medical castration in men with BPH.

Antigens, Neoplasm↗
PubMed1996

Prostate cancer volume adds significantly to prostate-specific antigen in the prediction of early biochemical failure after external beam radiation therapy.

PURPOSE: A new clinical pretreatment quantity that closely approximates the true prostate cancer volume is defined. METHODS AND MATERIALS: The cancer-specific prostate-specific antigen (PSA), PSA density, prostate cancer volume (VCa), and the volume fraction of the gland involved with carcinoma (VCafx) were calculated for 227 prostate cancer patients managed definitively with external beam radiation therapy. 1. PSA density = PSA/ultrasound prostate gland volume. 2. Cancer-specific PSA = PSA - [PSA from benign epithelial tissue] 3. VCa = Cancer-specific PSA/[PSA in serum per cm3 of cancer] 4. VCafx = VCa/ultrasound prostate gland volume A Cox multiple regression analysis was used to test whether any of these clinical pretreatment parameters added significantly to PSA in predicting early postradiation PSA failure. RESULTS: The prostate cancer volume (p = 0.039) and the volume fraction of the gland involved by carcinoma (p = 0.035) significantly added to the PSA in predicting postradiation PSA failure. Conversely, the PSA density and the cancer-specific PSA did not add significantly (p > 0.05) to PSA in predicting postradiation PSA failure. The 20-month actuarial PSA failure-free rates for patients with calculated tumor volumes of < or = 0.5 cm3, 0.5-4.0 cm3, and > 4.0 cm3 were 92, 80, and 47%, respectively (p = 0.00004). CONCLUSION: The volume of prostate cancer (VCa) and the resulting volume fraction of cancer both added significantly to PSA in their ability to predict for early postradiation PSA failure. These new parameters may be used to select patients in prospective randomized trials that examine the efficacy of combining radiation and androgen ablative therapy in patients with clinically localized disease, who are at high risk for early postradiation PSA failure.

Adenocarcinoma↗
PubMed2006

Detection rate of prostate cancer on biopsy according to serum prostate-specific antigen in Korean men: a multicenter study.

OBJECTIVES: To evaluate the detection rate of prostate cancer on biopsy according to the serum prostate-specific antigen (PSA) level in Korean men and compare the detection rate with those of Japanese and American men in other studies. METHODS: We retrospectively analyzed 2422 Korean men who had undergone prostate biopsy at 12 medical centers from 1993 to 2002. In the case of a PSA level greater than 4.0 ng/mL or abnormal digital rectal examination findings, prostate biopsy was performed. RESULTS: Of the 2422 men, 962 (39.7%) were diagnosed with prostate cancer. With PSA levels between 4.0 and 10.0 ng/mL, the detection rate of prostate cancer was 15.9%. This rate was similar to that of Japanese men (15.8%), but lower than that of American men (25%). In the cases with a PSA level greater than 10.0 ng/mL, the detection rate for Korean and Japanese men was 59.5%, and was also lower than the 67% rate for American men. When serum PSA levels were divided into five subgroups (less than 4.0, 4.0 to 10.0, 10.0 to 20.0, 20.0 to 100.0, and greater than 100.0 ng/mL), the detection rate of prostate cancer was 12.4%, 15.9%, 34.1%, 66.2%, and 93.8%, respectively. CONCLUSIONS: In Korean men, the detection rate of prostate cancer on biopsy according to serum PSA level appears to be comparable to that for Japanese men and lower than that for American men.

Adult↗
PubMed2006

Prostate specific antigen remains an independent predictor of cancer at prostate biopsy in black american men but not in white men: results from a consecutive series of 914 men.

PURPOSE: Black American men may be at increased risk for prostate cancer but differences in prebiopsy parameters between black and white men have not been fully examined. Therefore, we identified the prebiopsy parameters that may be predictive of prostate cancer in black and white men. MATERIALS AND METHODS: From January 2000 to July 2004, 914 consecutive men undergoing prostate needle biopsy were prospectively examined by a single urologist. Urinary symptoms were measured by AUASS. Prebiopsy parameters recorded were PSA, free PSA, DRE, age, race, biopsy history, prostate volume, TRUS lesion and AUASS. RESULTS: Prostate biopsy was performed in 914 men with a mean age of 63.9 years. Mean PSA in the entire cohort was 11.2 ng/ml (median 5.8). Abnormal TRUS and abnormal DRE were found in 37% and 52% of men, respectively. Mean AUASS was 9.6. The overall positive biopsy rate was 37%. In black and white men the positive biopsy rate was 44% and 34%, respectively. Analysis of AUASS indicated that 47% of patients had low symptom scores (less than 7), 39% had moderate scores (8 to 19) and 14% had severe scores (20 to 35). Multivariate analysis revealed that PSA was an independent predictor of positive biopsy in black but not in white men (p = 0.001 and 0.79, respectively). Multivariate analysis also showed that race alone was an independent predictor of positive prostate biopsy (p = 0.013). CONCLUSIONS: PSA remains an independent predictor of positive prostate biopsy on multivariate analysis. Other independent predictors are black race, age, low AUASS, prostate volume, abnormal DRE, no previous biopsy and abnormal TRUS. In the black group low AUASS, PSA, no previous biopsy and DRE were unique independent predictors, while in the white group age and abnormal TRUS were unique predictors.

Adult↗
PubMed1994

Comparison of prostate specific antigen with prostate specific antigen density for 3 clinical applications.

We compared prostate specific antigen (PSA) to PSA density for 3 clinical uses: detection of nonpalpable prostate cancer, staging of clinically localized prostate cancer and prediction of PSA detectability following radical prostatectomy. Of 153 men with normal digital rectal examinations undergoing prostate biopsy 25% had prostate cancer. Analysis of receiver operator characteristic curves demonstrated that PSA density predicted the outcome of biopsy significantly better than did PSA (p = 0.0013). Pathological examination of 155 radical prostatectomy specimens revealed that 56% had pathologically uncontained disease. There was no difference between the ability of PSA and PSA density to predict the pathological findings (p = 0.2379). PSA data more than 1 year postoperatively were available in 96 of the 155 prostatectomy patients. Of these men 41% had postoperative PSA levels of 0.1 ng/ml. or more. Preoperative PSA and PSA density values were almost identical in the ability to identify these patients (p = 0.6776). While PSA density is superior to PSA for the detection of prostate cancer in patients with a palpably normal prostate, it does not offer any improvement over PSA for staging of prostate cancer or for the prediction of PSA detectability after radical prostatectomy.

Aged↗