Detection Rate of Prostate Cancer on the Basis of the Vienna Nomogram: A Singapore Study

PURPOSE: The purpose of this study was to determine the efficacy of the Vienna nomogram prostate biopsy model in the detection of prostate cancer in our local population. We also assessed the incidence of complications from using such a template. MATERIALS AND METHODS: From January 2006 to June 2007, 120 men with either elevated prostate-specific antigen (PSA) scores (>4 ng/mL) and/or abnormal digital rectal examination were enrolled prospectively to undergo extraction of 6 to 18 cores for transrectal ultrasound-guided prostate biopsy, as indicated by the Vienna nomogram. RESULTS: The mean age was 62.6+/-8.3 years (range, 40-86 years). The mean PSA score was 13.42 ng/mL. The mean number of cores obtained was 9.68+/-3.1. According to the Vienna nomogram, 27 out of a total of 120 patients had prostate cancer, for a detection rate of 22.5%. In the group of patients with PSA scores 10 ng/mL had a detection rate of 50% (13 of 26). The complication rate in our study was 7.5%. CONCLUSIONS: With the use of the Vienna nomogram, our prostate cancer detection rate is comparable to previously published data for Asian patients. This nomogram offers an easy tool with which to select the optimal number of prostate biopsy cores to be taken on the basis of patient age and total prostate volume. With this biopsy strategy, we also have found that the complication rate from prostate biopsy is low.

Acute pyelonephritis and renal abscesses in adults--correlating clinical parameters with radiological (computer tomography) severity

<p><b>INTRODUCTION</b>The aim of this study is to evaluate the correlations between clinical and biochemical parameters with radiological severity of CT diagnosed acute pyelonephritis (APN) and renal abscesses, thereafter defining clinical predictors to identify patients with severe APN or renal abscesses.</p><p><b>MATERIALS AND METHODS</b>The inpatient medical records of all patients diagnosed with APN or renal abscesses admitted over one year were reviewed. Patients with CT imaging performed were classified into 3 groups--mild APN, severe APN and renal abscesses. Clinical and biochemical parameters were correlated with radiological severity.</p><p><b>RESULTS</b>One hundred and thirty patients were included in the study. Male gender, older age, presence of diabetes mellitus and unobstructing renal stones were significantly associated with severe APN or renal abscesses. Clinical and biochemical parameters that were associated with more severe disease include a higher leucocyte count and C-reactive proteins, left neutrophil shift, thrombocytosis or thrombocytopenia, low serum albumin, acute renal impairment and bacteremia. The percentage of patients had positive urine and blood cultures were 40.8% and 30.7% respectively. Of these patients, 97.9% had severe APN or renal abscesses on CT imaging had diabetes mellitus (DM), hypotension, acute renal failure or leucocyte count of >20K.</p><p><b>CONCLUSION</b>Our study showed a good correlation between clinical and radiological severity in adult patients with APN and renal abscesses. Patients with severe APN or renal abscesses were likely to be diabetics presenting with hypotension, acute renal impairment and a leucocyte count of greater than 20K.</p>

Presentation and progression of benign prostatic hyperplasia: a Singapore experience profiling ethnic differences in a multiracial study cohort

<p><b>INTRODUCTION</b>While benign prostatic hyperplasia (BPH) incidence has been shown to vary by race and ethnicity, data is lacking among Asians. This study aimed to describe the baseline symptom profile and response to medical therapy in a multiracial Singaporean cohort with BPH.</p><p><b>MATERIALS AND METHODS</b>International Prostate Symptom Score (IPSS), uroflowmetry and prostate specific antigen (PSA) levels were retrospectively analysed for 887 men at presentation and on follow-up 1 year later. Following diagnosis, 150 men were managed conservatively and 586 men with drugs; 151 received surgery.</p><p><b>RESULTS</b>Overall median IPSS scores were 9.0 at baseline. Malay men most often had severe symptoms (17.3%), compared to other groups (Chinese 11.7%, Others 11.1%, Indians 10.7%). Indians most frequently showed improvement in the Quality of Life (QOL) score following intervention (64.3%). Malays had the poorest initial mean peak-flow rates (9.6 mL/s) and Chinese, the highest (12.0 mL/s). Initial post-void residual urine volume was highest in Malays (100.1 mL) but showed greatest reduction with medical treatment. Median IPSS scores decreased from 10.5 below 50 years old to 7.0 above 80 years old. Peak-flow rates were 12.6 to 7.2 mL/s respectively, with a corresponding upward trend in RU. Treatment with a combination of 5-alpha-reductase inhibitor and alpha-blocker yielded the greatest improvement in IPSS and QOL scores, and residual urine volume (71.4%, 60% and 68.8%, respectively). Indians had the lowest initial and follow-up PSA (1.5 and 1.2, P = 0.8 and 0.6, respectively).</p><p><b>CONCLUSIONS</b>Inter-ethnic differences in symptom perception and quantitative assessment of BPH were evident among our multiracial urban study cohort, as well as varied degrees of response to the medical treatments instituted.</p>

Efficacy and tolerability of vardenafil in Asian men with erectile dysfunction / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the efficacy and tolerability of vardenafil, a phosphodiesterase type-5 (PDE-5) inhibitor, in men of Asian ethnicity with erectile dysfunction (ED).</p><p><b>METHODS</b>In this prospective, double-blind, multinational study, Asian men were randomized to receive vardenafil (10 mg) or placebo (4:1 ratio) for 12 weeks. The primary efficacy variables were the International Index of Erectile Function erectile function domain (IIEF-EF), and Sexual Encounter Profile (SEP) questions related to penetration and intercourse completion. Significant mean improvements were required in all three measures to show positive benefits of vardenafil treatment. Secondary efficacy variables included the Global Assessment Question (GAQ) on erection improvement.</p><p><b>RESULTS</b>Least-squares mean baseline IIEF-EF domain scores (vardenafil 14.6, placebo 13.4) were consistent with moderate ED. After 12 weeks, vardenafil treatment was associated with significant increases from the baseline in IIEF-EF domain scores compared with the placebo (22.4 vs. 14.3; P<0.001). Vardenafil was associated with significant improvements from baseline in least squares (LS) mean success rates for SEP-2 (vardenafil 82.2 vs. placebo 43.6; P<0.001) and SEP-3 (vardenafil 66.1 vs. placebo 24.0; P<0.001). Positive GAQ responses were reported by 81.8% of vardenafil recipients vs. 24.3% of placebo recipients. Adverse events were reported by 25.4% of the vardenafil group, the majority mild and transient.</p><p><b>CONCLUSION</b>Vardenafil (10 mg) is a highly effective and well-tolerated treatment for moderate ED in Asian men. These results add to the increasing amount of data demonstrating the safety and efficacy of vardenafil for the treatment of ED in a range of patient populations.</p>