Indications of the mechanisms involved in improved sperm parameters by zinc therapy

To determine possible indications of the mechanisms involved in improved sperm parameters by zinc therapy in asthenozoospermic men. Forty-five men with asthenozoospermia [>/= 40% immotile sperm] were randomized into four therapy groups: zinc only: n = 11; zinc + vitamin E: n = 12 and zinc + vitamins E + C: n = 14 for 3 months, and non-therapy control group: n = 8. Semen analysis was done according to WHO guidelines. Malone dialdehyde, tumour necrosis factor-alpha [TNF-alpha], total antioxidant capacity, superoxide dismutase [SOD] and glutathione peroxidase were determined in the semen and serum. Antisperm antibodies IgG, IgM and IgA were evaluated by immunobeads. Sperm chromatin integrity was determined by acid denaturation by acridine orange and sperm apoptosis by light and electron microscopy. The effect of zinc on in vitro induced sperm oxidative stress by NADH was evaluated. Asthenozoospermia was significantly associated with oxidative stress with higher seminal malone dialdehyde [8.8 vs. 1.8 mmol/l, p < 0.001] and TNF-alpha [60 vs. 12 pg/l, p < 0.001], and low total antioxidant capacity [1.8 vs. 8.4, p < 0.01], SOD [0.8 vs. 3.1, p < 0.01] and glutathione peroxidase [1.6 vs. 4.2, p < 0.05], compared to normozoospermia. Zinc therapy alone, in combination with vitamin E or with vitamin E + C were associated with comparably improved sperm parameters with less oxidative stress, sperm apoptosis and sperm DNA fragmentation index [DFI]. On the whole, there was no difference in the outcome measures between zinc only and zinc with vitamin E and combination of vitamins E + C. In the in vitro experiment zinc supplementation resulted in significantly lower DFI [14-29%, p < 0.05] compared to zinc deficiency. Zinc therapy reduces asthenozoospermia through several mechanisms such as prevention of oxidative stress, apoptosis and sperm DNA fragmentation

Normal serum alkaline phosphatase in the presence of extensive skeletal metastases of prostate cancer

Alkaline phosphatase [ALP] is a nonspecific tumor marker as it is neither organ or tumor specific. An elevation of the enzyme in relation to carcinoma of the prostate is usually due to boene or liver involvement, or both, by metastatic disease. We report the case of a 91-year-old man who presented with chronic urinary retention. Investigations revealed prostate specific antigen [PSA] of 831.4 ng/ml, biochemical evidence of moderate renal impairment, normal liver function tests and normal alkaline phosphatase. Whole body skeletal scintigraphy with 99mTC-MDF showed widespread skeletal metastases. Transrectal ultrasound of the prostate revealed a 40 gm prostate gland with a hypoechoic defect in the periphery of the gland. Prostate biopsy revealed prostate cancer [Gleason's score 8]. Total serum testosterone, zinc and magnesium were below the normal range. Bone densitometry revealed osteoporosis. Channel transurethral resection of the prostate was performed together with bilateral orchidectomy. Testicular histology revealed atrophic tests. Normal serum alkaline phospatase in this patient in the presence of extensive skeletal metastases may be due to the combination of the following factors: relative hypogonadism, osteoporosis, low serum zinc and magnesium. This case report may provide a possible explanation for the observation that about 10% of men with widespread skeletal metastases from prostate cancer may not have elevated serum alkaline phosphatase

Prostate specific antigen: 25 years of clinical use in Kuwait

Since the late 1980s, prostate specific antigen [PSA] has established itself as the most important tumor marker in all solid tumor oncology and has become indispensable in the management of prostate cancer. Since the introduction of PSA-based screening, there has been a marked increase in the incidence of clinically, and pathologically, organ-confined disease, and the majority of prostate cancers diagnosed today in most countries in the West are non palpable PSA-detected tumors [T1C]. However, controversy surrounds the use of PSA as a routine screening tool, and for this reason, great efforts have been devoted to understanding the relationship between PSA and tumor biology. A central issue in this controversy is the fact that PSA is organ-specific, not cancer-specific, such that changes in serum PSA are not always a manifestation of cancer, but rather may be due to inflammation, trauma, or most commonly, simple benign prostatic hyperplasia [BPH]. Furthormore, considerable overlap exists in PSA levels among men with prostate cancer and BPH. This is in the so called "diagnostic gray zone" of srum PSA levels between 4.0 and 10.0 ng/mL. Due to questions surrounding the specificity of PSA in the diagnosis of prostate cancer a number of modifications have been proposed to increase the value of this analyte, namely PSA-derivatives such as age specific PSA, PSA density, PSA volume and PSA isoforms. In this review we will first present the practical applications of PSA and PSA derivatives in the diagnosis and management or prostate cancer. We also emphasize, the importance of establishing local reference ranges and the need for knowledge of other factors affecting PSA levels

Serum prostate-specific antigen levels in Middle Eastern men with subclinical prostatitis

To investigate the influence of subclinical or histologically diagnosed prostatitis on serum prostate-specific antigen [PSA] in patients investigated for prostatic disease in Kuwait. Serum PSA was assayed in patients investigated for prostatic disease in Mubarak Al-Kabeer Hospital, Kuwait, between December 2002 and December 2004. These included patients undergoing transrectal ultrasound with needle biopsy of the prostate gland and those who were treated with transurethral resection of the prostate or retropubic prostatectomy. The tissue was evaluated for prostatitis as well as the underlying disease, and the type and severity of prostatitis were compared with levels of serum PSA. Of the 331 tissue specimens, 18 [5.4%] did not show prostatitis, while 233 [70.4%] with benign prostate and 80 [24.2%] with malignant prostate disease showed prostatitis. Of 270 men with known serum PSA levels, 198 and 72 had benign and malignant prostate disease, respectively. Of the 198, 77 [41%] with benign prostate disease and prostatitis and of the 72, 52 [76%] with malignant prostate disease and prostatitis had serum PSA levels >10 ng/ml. The data showed that although raised serum PSA is more commonly associated with prostate cancer, subclinical prostatitis is a significant source of high serum PSA in over 40% of men in Kuwait. That local factors may obscure the usefulness of serum PSA as a screening tool suggests the need for a locally applicable paradigm to identify prostate cancer

Sectorial technetium-99m-dimercaptosuccinic acid scintigraphy for monitoring the effect of extracorporeal piezoelectric lithotripsy for calyceal calculi on regional renal function

To apply a semiquantitative method for analysis of technetium-99m-dimercaptosuccinic acid [99mTc-DMSA] renal scintigraphy for monitoring the effect of extracorporeal piezoelectric lithotripsy [EPL] in patients with calyceal stones on regional kidney function and to check whether EPL had caused any deleterious effect on the target calyceal renal parenchymal function. Patients and Forty patients [mean age 35 years] suffering from calyceal stones documented by abdominal plain radiography, intravenous urogram or abdominal ultrasound were studied. All patients were treated by EPL. 99mTc-DMSA scan was performed before and 4 weeks after EPL. Sector analysis involved calculation of the relative function of the target calyx to the function of the ipsilateral kidney and the relative function of the treated kidney to global renal function. The stone sizes were 6-11 mm in diameter and 11 were located in the upper, 13 in the middle and 16 in the lower calyx. After EPL, the overall stone clearance rate was 85% [100% for calculi in the upper and middle calyces, 62% for lower calyces]. The sector analysis did not show statistically significant change of the relative regional [calyceal] or whole kidney function between the pre- and post-EPL 99mTc-DMSA scans. Using sector analysis, EPL appeared to be a safe modality and its usage was not associated with any untoward effect on calyceal or whole kidney function. Sector analysis of 99mTc-DMSA renal scan is a simple semiquantitative method for monitoring regional changes of kidney function after EPL for treatment of calyceal stone