A Prospective Study of Reducing Unnecessary Prostate Biopsy in Patients with High Serum Prostate-Specific Antigen with Consideration of Prostatic Inflammation

PURPOSE: We aimed to reduce unnecessary prostatic biopsy in patients with high prostate-specific antigen (PSA) by consideration of prostatic inflammation. MATERIALS AND METHODS: The investigation was conducted prospectively in 413 patients with a PSA level of 4 to 10 ng/ml from January 2004 to December 2009. All patients underwent the expressed prostatic secretion (EPS) or voided bladder urine 3 (VB3) test to be classified into two groups: positive group and negative group. Patients with a positive result on the EPS or VB3 test were treated with antibiotics for 2 months, and in cases in which the PSA level remained high, we performed prostate biopsy. In patients with a negative result on the VB3 test, we performed prostate biopsy directly. RESULTS: Of the 413 study patients, 215 (52%) patients had positive findings on the EPS or VB3 test. After 8 weeks of antibiotics therapy, 53 of the 215 men avoided prostate biopsy because their PSA level was normalized. The other patients (162 of 215) still had elevated PSA levels of more than 4 ng/ml, including 7 patients in whom the biopsy revealed cancer. Patients with negative findings (198 of 413) underwent prostate biopsy. Of the 198 patients, 41 were diagnosed with prostate cancer. The total prostate cancer detection rate was 11.6% in our subjects, where as it was 20.7% in the patients with negative findings on the EPS or VB3 and 3.3% in the patients with positive findings, respectively. CONCLUSIONS: In cases in which the PSA level is increasing, if we first exclude prostatitis and carry out a serial diagnostic procedure, it may help to reduce unnecessary prostatic biopsy.

Comparision of Prostate-specific Antigen Reduction after Performing Transurethral Resection of the Prostate according to a Preoperative Prostate-specific Antigen Value of 4 ng/ml / 대한남성과학회지

PURPOSE: We compared prostate-specific antigen (PSA) reduction after performing transurethral resection of the prostate (TURP) according to a preoperative PSA value of 4 ng/ml and analyzed the meaning of elevation of the preoperative PSA value over 4 ng/ml. MATERIALS AND METHODS: We investigated the PSA level and prostate volume by transrectal ultrasonography (TRUS), urine flow rate, residual urine volume, and international prostate symptom score (IPSS) preoperatively and at 1 year after performing TURP in 61 clinically diagnosed BPH patients who had lower urinary tract symptoms (LUTS). We enrolled the 61 patients into 2 groups according to their preoperative PSA level relative to 4 ng/ml and compared the PSA reduction ratio (postoperative PSA level/preoperative PSA level), prostate volume reduction ratio, preoperative prostate volume, resected prostate volume, preoperative residual urine volume, preoperative maximal flow rate, and IPSS in each group. RESULTS: In the preoperative PSA group > or =4 ng/ml, the PSA reduction ratio was significantly lower than the PSA group or =4 ng/ml, who are expected to have more severe bladder outlet obstruction (BOO).

Stuttering Priapism happened in Sleep / 대한남성과학회지

Priapism is an abnormal persistent penile erection that continues for more than 4 hours, without sexual stimulation according to the definition of the AUA (American Urological Association) guideline on the management of priapism. It was relatively rare in the past but has been increasing in the incidence since the advent of pharmacological agents. Stuttering priapism is a recurrent form of ischemic priapism and its treatment goal is to prevent the recurrences of priapism and resultant erectile dysfunction. We present the case of a patient who took tadalafil and thereafter had idiopathic recurrent episodes of ischemic priapism during the sleep and we show several treatment options of stuttering priapism with review of recent related articles.