[Sensitivity and specificity of serum PSA, free to total PSA ratio and transrectal ultrasonography findings in prostate cancer detection]

We conducted this study to evaluate and compare the sensitivity and specificity of various para-clinic parameters in detecting prostate cancer. In this cross-sectional study, 220 patients who underwent prostate biopsies for either high serum PSA level or abnormal digital rectal examination. Sensitivity and specificity of serum PSA, free to total PSA ratio and transrectal ultrasonography findings were calculated. Based on the pathological findings in 220 cases, 25% were diagnosed with prostate cancer. The mean age of patients with prostate cancer was 69.11 +/- 8.6 years. Mean serum PSA level among prostate cancer patients was significantly higher than in other patients [19.5 +/- 17.5 ng/dl vs. 10.5 +/- 8.1 ng/dl] [P=0.003]. The sensitivity and specificity of PSA for detecting prostate cancer, considering cut-off value of 4 ng/dl, was 92% and 2%, respectively. Free to total PSA ratio with cut-off value of 10% revealed 82% sensitivity and 17% specificity. Moreover, hypoechoic lesions detected by transrectal ultrasound had a sensitivity and specificity of 34% and 93%, respectively. Combination of different PSA related parameters with tranrectal ultrasound findings might increase sensitivity and specificity in detecting prostate cancer and reduce unnecessary biopsies

Extensive surgical management for renal tumors with inferior vena cava thrombus

The aim of this study was to evaluate the outcome in patients with renal cell carcinoma [RCC] and the inferior vena cava [IVC] or the right atrium tumor thrombus that were treated with radical nephrectomy and thrombectomy. Eleven of a total of 105 patients who underwent radical nephrectomy due to RCC had tumor thrombus extended to the IVC and/or the right atrium. We evaluated the surgical techniques used and the perioperative mortality and morbidity in these patients. The median age of the patients was 47 years [range, 16 to 59 years]. They all underwent radical nephrectomy with cavotomy, tumor thrombus removal, and lymphadenectomy. Eight patients underwent extracorporeal circulation and hypothermic circulatory arrest; 2, temporary venovenous bypass by chevron incision and median sternotomy; and 1, only chevron incision with mobilization of the right lobe of the liver and cross-clamping proximal to the tumor thrombus and cavotomy. In 1 case, a solitary liver metastasis was excised and the patient died within 30 days postoperatively because of massive hemorrhage due to liver metastatectomy. Two patients had invasion to the IVC wall and 7 had pathological lymph node involvement. Four patients were tumor free [follow-up range, 9 to 18 months] and 7 died due to multiple metastases during the follow-up. This study supports the role of extensive surgical treatment as the best initial management of patients with renal cancer extended to the IVC only in highly selected cases