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Objective@#To evaluate the prostate health index (PHI) as a tool for the diagnosis of PCa with a PSA level of 4－10 μg/L and determine the best cut-off value of PHI.@*METHODS@#Fifty-eight patients with a PSA level of 4－10 μg/L underwent transrectal ultrasound-guided prostatic biopsy in our hospital between April 2017 and June 2019. We constructed receiver operating characteristic (ROC) curves for the relationship of the biopsy results with the level of PSA, the ratio of ［－2］ proPSA to fPSA and PHI, and calculated the area under the ROC curves (AUC).@*RESULTS@#Prostatic biopsy revealed 18 cases of PCa in the 58 patients (31.0%). Statistically significant differences were observed between the PCa and non-PCa groups in ［－2］ proPSA, %［－2］ proPSA and PHI, but not in tPSA, % fPSA and PSA-density. The AUCs of PSA, % fPSA, PSA-density, ［－2］ proPSA, %［－2］ proPSA and PHI were 0.556, 0.407, 0.533, 0.746, 0.751 and 0.774, respectively. The specificity of PHI was 27.50% (95% CI: 14.6%－43.9%), the highest among the above predictors at 90% sensitivity. By applying PHI to this cohort, 13 cases (22.4%) of unnecessary biopsy could be avoided.@*CONCLUSIONS@#The application of PHI can increase the accuracy of PCa prediction and reduce unnecessary prostatic biopsy.、.
Subject(s)
Humans , Male , Asian People , Macau , Prostate , Prostate-Specific Antigen , Prostatic Neoplasms/diagnosisABSTRACT
Objective To evaluate the diagnostic value of urine-based prostate cancer antigen 3 ( PCA3 ) score in detecting prostate cancer during initial prostatic biopsy .Methods Urine was collected after digital rectal examination ( DRE) ( three strokes per lobe ) from 248 men before prostate biopsy .The specimens were collected between January 2010 and December 2012.The expression of PCA3 mRNA and prostate specifc antigen (PSA) mRNA was determined by quanti-tative real time polymerase chain reaction ( qRT-PCR ) .PCA3 scores were calculated by PCA 3 mRNA/PSA mRNA × 1000 .The ability of the PCA3 score to predict the biopsy outcome was assessed with AUC-ROC analysis and compared with the serum PSA levels.Results The rate of positive prostate biopsy was 32.3%(80 patients with positive prostatic biopsy versus 168 patients with negative prostate biopsy ) .PCA3 scores were significantly higher in patients with positive biopsy than in those with negative biopsy results (P<0.001).The ROC curve analysis demonstrated that the area under the ROC curve (AUC) of serum total PSA (tPSA), PCA3 score and the duplex model combining tPSA and PCA 3 score was 0.620, 0.693 and 0.724, respectively.Further analysis of the diagnostic performance of PCA3 score revealed that at a cut-off of 90.2456, the sensitivity was 67.5%and the specificity was 61.9%for discriminating positive biopsy from negative biopsy. The duplex model combining tPSA and PCA 3 score represented a better approach than tPSA alone in PCa diagnosis by pros-tatic biopsy (P=0.011), but there was no statistically significant difference between tPSA and PCA 3 score (P=0.160). In addition , a comprehensive diagnostic model based on multiple risk factors of prostate cancer combined with PCA 3 score could further improve the predictive accuracy of prostate cancer .Conclusion PCA3 could be a good predictor of prostate cancer in initial prostate biopsy in Chinese population .The comprehensive diagnostic model can improve the diagnostic potency .Further large-scale multicenter studies in China are needed to confirm our findings .
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Resumen: El cáncer de próstata es una enfermedad clínicamente caracterizada por un periodode latencia largo y un crecimiento tumoral lento. En la actualidad, es un problema de granimportancia para la salud pública, pues es el segundo cáncer más frecuentemente diagnosticadoy corresponde a la sexta causa de muerte por cáncer en hombres en el mundo. Se caracteriza poruna gran heterogeneidad clínica y molecular. Su diagnóstico se basa en el uso de tres pruebasfundamentales: el examen del tacto rectal y la medición de los niveles séricos del antígenoespecífico de próstata (AEP), los cuales se usan frecuentemente en el tamizaje, y la biopsiaprostática, mediante la cual se confirma el diagnóstico de cáncer de próstata. Actualmente, el AEPse ha constituido en la principal herramienta tamiz para el cáncer de próstata; no obstante, existeuna gran controversia en torno a su uso. Por ello, están siendo ampliamente estudiados nuevosbiomarcadores, a fin de disponer de pruebas diagnósticas más sensibles y específicas. Dado queel AEP es una prueba ampliamente utilizada internacionalmente y que han surgido biomarcadoresadicionales para el diagnóstico temprano del cáncer de próstata, es de fundamental importanciaque el personal de la salud en general y el personal de laboratorio en particular puedan contarcon información con respecto al uso de éstas y su relación con otras herramientas diagnósticas,además de otros aspectos generales del cáncer de próstata.
Abstract: Prostate cancer is a disease clinically characterized by a long latency period and slow tumorgrowth rate. Prostate cancer is currently a major public health problem because it is the second mostcommonly diagnosed cancer, and the sixth major cause of cancer-related death in men in the world.It is characterized by clinical and molecular heterogeneity. Diagnosis is based on the use of threebasic tests: digital rectal examination, measurement of prostate-specific antigen (PSA) serum levels,frequently used in screening, and prostate biopsy, which confirms the diagnosis of prostate cancer.Nowadays, PSA has become the main testing way for prostate cancer screening, although there ismuch controversy about its use. Therefore, new biomarkers are being widely researched, in order toprovide more sensitive and more specific diagnostic tests. Provided that PSA is a globally used test,and additional tests for early diagnosis of prostate cancer have aroused, is it essential that healthpersonnel, and particularly laboratory personnel, are granted with information about their use, andtheir relationship with further diagnostic techniques, besides other general aspects of prostate cancer.
Subject(s)
Humans , Biopsy , Prostate , Prostatic NeoplasmsABSTRACT
ObjectiveTo determine whether antibiotic prophylaxis can reduce the risk of postoperative infective complications in men undergoing transrectal prostatic biopsy (TPB) who had sterile preoperative urine.MethodsMEDLINE, EMBASE, Cochrane Collaboration Reviews, Chinese Medical Current Contents (CMCC), and National Knowledge Infrastructure (CNKI) were searched for rando-mized controlled trials that compared the effect of antibiotic prophylaxis with placebo or active controls for men undergoing TPB with preoperative sterile urine. Two reviewers independently extracted the data of patient characteristics and outcomes based on a prospectively developed protocol.ResultsA total of 12 trials (3 placebo controlled, 3 non-treatment controlled, and 6 activly controlled) involving 1 987 patients, met the inclusion criteria. Prophylactic antibiotic use in patients at low risk undergoing TPB significantly decreased bacteriuria and middle degree fever incidence, but could not decrease the incidence of bacteremia. The relative risk for post-TPB bacteriuria, middle degree fever, and bacteremia were 0.32 (95% CI 0.23 to 0.46), 0.37 (95% CI 0.17 to 0.77), and 0.96 (95% CI 0.61 to 1.50), respectively. Effective antibiotic classes included quinolone, co-quinolone and nitroimidazole, and co-trimethoprim and sulfamethoxazole. Treatment protocols of any duration were effective.ConclusionAntibiotic prophylaxis obviously decreases the incidence of bacteriuria and middle degree fever but not bacteremia in men with preoperative sterile urine undergoing TPB. A significant decrease in bacteriuria incidence can be achieved with a range of antibiotic agents, including quinolones and co-quinolone and nitroimidazole. Treatment protocols of any duration are effective with no heterogeneity.
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Desde julio de 2004 hasta marzo de 2005 se reclutaron 114 pacientes con indicación de biopsia de próstata bajo guía ecográfica los cuales se dividieron en dos grupos según la colocación o no de xilocaína gel al 2 por ciento intrarrectal antes del procedimiento. Se comparó el dolor que sintieron durante la biopsia a través de una escala de dolor. No hubo diferencia estadísticamente significativa entre los pacientes a quienes se colocó anestésico local frente a quienes no se les colocó. Por otro lado, el dolor fue mayor cuando se usó una aguja esterilizada que cuando se usó una aguja nueva.
From July 2004 until March 2005 we prospectively studied 114 patients who underwent transrectal ultrasound guided needle biopsy of the prostate. Patients were divided in two groups: intrarectal 2 percent lidocaine gel was used prior to biopsy in one of the groups. We compared the pain that patients felt during the procedure using a pain scale. We did not find differences between both groups, but the patients in whom we used a new needle felt less pain than the patients in whom we used a reesterilized one.
Subject(s)
Humans , Male , Middle Aged , Anesthetics, Local/administration & dosage , Biopsy, Needle/adverse effects , Pain/prevention & control , Lidocaine/administration & dosage , Prostate/pathology , Ultrasonography , Regression Analysis , Biopsy, Needle/methods , Pain Measurement , Pain/etiology , Sterilization , GelsABSTRACT
Nuestro objetivo fue evaluar la necesidad real de enema rectal previo a la realización de biopsia prostática y su implicación en posibles complicaciones infecciosas asociadas al procedimiento. Material y Métodos. Entre Enero y Junio del 2006, 128 pacientes recibieron biopsia prostática. Fueron asignados a dos grupos, recibiendo o no enema rectal. De estos, 90 pacientes presentaron información evaluable y constituyeron la población de estudio. Resultados. No se verificaron diferencias significativas entre los dos grupos de estudio. Conclusiones. El presente trabajo demuestra la utilidad limitada que tiene el enema rectal previo a biposia prostática.
We aimed to evaluate the real usefulness of rectal enema previous to transrectal prostatic biopsy and its possible implications in infectious complications. Methods. Between January and June 2006, 128 consecutive patients underwent transrectal prostatic biopsy at our institution. Patients were assigned to two groups receiving rectal enema or not. Of these, 90 patient shad complete available information and constituted the population of study. Results. No significant differences were verified between the two groups of study. Conclusions. Present manuscript shows the limited usefulness of rectal enema previous a transrectal prostate biopsy.
Subject(s)
Humans , Male , Middle Aged , Aged, 80 and over , Biopsy/methods , Enema , Prostate/pathology , Prospective Studies , Case-Control StudiesABSTRACT
Diagnosis of adenocarcinoma of the prostate based purely on digital rectal examination will be correct in only 70% of cases. Transitional cell carcinoma also arises in the prostate, as may more rarely sarcoma. The fibrous prostate, granulomatous prostatitis and stone may also result in a prostate that feels firmer than normal. Estrogen or orchiectomy will be of no benefit in these condition and may cause harm. Histological or cytological proof of the diagnosis is essential. Examination of prostatic tissue obtained by biopsy has been used to confirm malignancy or any type, judge the response of a tumor to either hormonal or cytotoxic manipulation and bacteriologic confirmation. The transrectal prostatic biopsy was performed on 48 cases of oriental, from May 1979 to February 1982. The results are as follows. 1. The patients ranged in age from 25 to 82 years old and the percentage of patients more than 50 years old is 85.4% (38 cases). 2. The highest reason of referral for prostatic biopsy is obstructive symptoms (62.5% - 30 cases). 3. As shown in table 3, only in 2 cases the specimens obtained with Silverman needle proved inadequate for a reliable diagnosis even though in 46 cases the specimens were thought to be adequate. In 46 cases, the highest disease is B.P.H. (73.9% - 34 cases), 2nd prostatic adenocarcinoma (17.5% - 8 cases), 3fd chronic prostatitis (4.3% - 2 cases) and normal prostate (4.3% - 2 cases). 4. There were 7 complications of transrectal prostatic biopsy and the hematuria (4 cases) was the most common.