Can prostate cancer be predilected in BHP patients with elevated serum PSA negative initial sextant biopsy? A multivariate analysis study

Objective To define a predictor of prostate cancer in BPH patients with an intermediate PSA (4.1-10 ng/ml) and a negative initial sextant biopsy. Patients and Methods During 1999; 193 BPH patients with an intermediate PSA (4.1-10 ng/ml) underwent TRUS and sextant biopsy. The patients whose initial biopsies were negative for prostate cancer were re-evaluated by serum PSA every 6 months. A total of 76 patients were subjected to an extended 11-core biopsy in view of: (1) PSA velocity ? 1 ng/ml/year; (2) a PSA rise to 10 ng/ml and (3) suspicious biopsy findings (atypical adenomatous hyperplasia or high-grade prostatic intraepithelial neoplasia). Overall; 160 patients were subjected either to TURP (n=127) or open prostatectomy (n=33). Results On initial sextant biopsy; prostate cancer was diagnosed in 22 out of 193 patients (11.4). The specificity of the sextant biopsy was 91.8and its positive predictive value (PPV) was 61.1. A repeat 11-core biopsy revealed prostate cancer in 11 out of 76 patients (14.5). The specificity of the 11-core biopsy was 95.4and its PPV was 78.6. Three cancers out of 160 (2) were discovered on definitive pathology. The PSA velocity cut-off point at 1.4 ng/ml/year and the PSA density cut-off point at 0.12 were optimal for the prediction of cancer using receiver operating characteristic curves. The multivariate analysis (stepwise logistic regression) revealed that PSA density (p=0.011); PSA velocity (p=0.002) and age (p=0.021) were the most significant predictors of cancer when the data were inserted as a continuous format. The sensitivity; specificity and overall accuracy of the model were 80; 98.7and 95.9; respectively. When the data were re-inserted as a coded format; PSA velocity and PSA density were the only predictors. All the analyzed risk factors (age; PSA; DRE; prostate echogenicity and PSA/TZ index) were excluded from the model. Conclusion PSA velocity and PSA density were the most significant predictors of prostate cancer in BPH patients with an intermediate PSA (4.1-10 ng/ml) and a negative initial sextant biopsy

Prostatic adenocarcinnoma in cysprostatectomy specimens remolved for bladder tumors in bilharzial patients

Objective To determine the incidence of prostatic adenocarcinoma in bilharzial patients who previously underwent radical cystoprostatectomy for bladder tumors. Patients and Methods From February 1997 to February 1999; 249 male patients with bladder cancer were screened for prostate cancer prior to cystectomy using DRE and total PSA assay; as well as transrectal ultrasound-guided prostatic biopsies. Then the cystoprostatectomy specimens were serially sectioned (every 3 mm) and histologically examined. Results Prostatic adenocarcinoma was detected by ultrasound-guided prostatic needle biopsies in 2 cases; while in 18 it was discovered incidentally after cystoprostatectomy (total 20 patients = 8). Gleason score was 6 in 16 patients; 7 in 3 patients and 8 in the remaining patient. Perineural lymphatic permeation was observed in 4 cases and extracapsular extension in one. Conclusion Compared to previous reports on non-bilharzial patients; the incidence of prostate cancer in the cystoprostatectomy specimens of bilharzial patients was low; and the tumors were clinically insignificant in most of the cases