Evaluation of prostate-specific antigen and total serum acid phosphatase in prostatic carcinoma

Background: The importance of prostatic carcinoma and its detection has increased manifold over the last few decades. Total serum acid phosphatase (ACP) was the world’s first emerged clinically useful tumor marker in the 1940s and 1950s in patients with prostatic diseases. With the introduction of the prostatic specific antigen (PSA) test in the 1980s, which performed significantly better in screening and treatment programs bringing disfavor to the advent of ACP. Aims and Objectives: To determine serum PSA and total serum ACP in patients with prostatic cancer and benign prostatic diseases, followed by evaluation of these tumor markers. Materials and Methods: This study was conducted on 30 patients with histologically proven cases of prostatic carcinoma and compared against 30 patients as control with benign prostatic pathology, residing in Punjab who were admitted and treated with symptoms complex of prostatism or retention urine or other urinary complaints as the primary symptoms. PSA and ACP in serum were determined using ELISA test kit and King and Kind method, respectively. Results: The mean level of serum PSA was 81.19 ± 49.02 for cancer prostate and 4.975 for benign prostatic diseases, while the mean level of serum ACP was 5.22 ± 1.70 and 2.52 ± 2.27, respectively, for the cancer prostate and benign prostatic diseases showing statistically difference between study and control groups was highly significant as P < 0.0001. Conclusion: Statistical analysis and results of the present study indicated that although serum ACP has better specificity to PSA, yet later is a very sensitive tumor marker in prostate diseases for screening, diagnosis, and post-treatment follow-up.

Correlative study of prostatic-specific antigen, digital rectal examination, prostatic volume, and prostatic biopsy in patients of enlarged prostate for accurate diagnosis and management outcome

Background: Prostate is an exocrine gland in male which is derived from Greek word prostates which means “one who stands before” or “protector” or a “guardian.” Its anatomical, chemical, and physiological functions digger among species. Differentiation of benign and malignant condition on sole clinical basis is difficult. Furthermore, there are various conditions in which serum prostate-specific antigen (PSA) is raised such as UTI and prostatitis. Our intent to conduct this study was to correlate clinical examination, Sr. PSA, and ultrasound to find prostatic volume to arrive at accurate diagnosis. Aims and Objectives: Our aim was to improve the accuracy of diagnosing prostatic disease and to effectively predict the nature of the disease; mainly benign or malignant (which is not accurate with a single investigation). Materials and Methods: The present study was conducted at C.U. Shah Medical College, Surendranagar, between December 2011 and September 2013. It was prospective observational study for which ethical clearance was obtained from the Institutional Ethics Committee. One hundred patients presenting to the outpatient department were enrolled in this study. Patients detailed presenting history with origin duration and progress, history, and personal history digital rectal examination (DRE) were recorded in pro forma. Serum PSA of all the patients was sent. After which, transurethral ultrasound (TRUS) was performed and a biopsy was taken and sent for histopathology. Comparison of all modalities was done and conclusion was made on basis of final diagnosis. Results: A total of 100 number of cases of enlarged prostate were studied who were admitted in the surgery department of our hospital. In our series, maximum patients with symptoms with enlarged prostate were in the age group of 40–60 years (54%). In our study, out of 100 patients, 52 (52%) were having obstructive symptoms, 28 (28%) were having irritative symptoms, and 20 (20%) patients were having both obstructive and irritative symptoms. On the basis of DRE, 76 (76%) cases were diagnosed as benign prostatic hyperplasia (BPH), 15 (15%) as Ca prostate, and 9 (9%) as prostatitis. On combination of DRE and PSA, 73% of cases had BPH, 21% Ca prostate, and 6% as prostatitis. With the help of DRE PSA and TRUS, 71% of patients were diagnosed as having BPH, 15% Ca prostate, and 14% as prostatitis. Final diagnosis was made on combination of all four modalities, that is, DRE PSA TRUS and TRUS-guided prostatic biopsy. About 66% of cases had BPH,13% had CA prostate, and 21% had prostatitis. Conclusion: The diagnosis of CA prostate was more accurate on the basis of all four modalities rather than considering only DRE and PSA which were sensitive but less specific.

Etapa de diagnóstico del Cáncer de Próstata ¿Estamos llegando a tiempo? / Prostate cancer stage at diagnosis. Are we running late?

INTRODUCCIÓN: El cáncer de próstata es el segundo cáncer más diagnosticado en hombres en Chile y el mundo. El tamizaje modificó la etapa de diagnóstico, siendo actualmente en EE.UU. un 80 por cinto localizada, 12 por cinto compromiso regional y 4 por ciento metastásico. Tamizaje con APE no está considerado dentro de un programa nacional en Chile. El objetivo de este estudio es caracterizar a la población diagnosticada de cáncer de próstata en un Hospital público en Chile. MATERIALES Y MÉTODO: Estudio descriptivo, retrospectivo. Se revisaron todas las fichas de los pacientes ingresados al GES por Cáncer de Próstata en el Hospital Carlos Van Buren de Valparaíso desde el año 2014 a 2016. RESULTADOS: Se revisaron 259 fichas y se analizaron 226. Edad promedio fue 70,5 años. 46 por ciento presentó APE sobre 20 ng/dL. 31 por ciento presentó metástasis. 42 por ciento recibió tratamiento paliativo. 57 por ciento se realizó tratamiento curativo, con edad promedio 67,4 años. De estos, 31,8 por ciento a cirugía, 68 por ciento índice Gleason <6 y 90 por ciento APE <20. 68 por ciento a RDT con o sin HT, 44 por ciento índice Gleason <6, 75 por ciento APE <20. DISCUSIÓN: El tamizaje del cáncer de próstata es un tema en discusión. En Chile no hay un programa nacional para realizar APE. Centros de atención primaria con acceso a APE tienen mayor tasa de tamizaje. La etapa al diagnóstico en nuestro centro difiere a las series de países desarrollados, siendo considerablemente superior la etapa metastásica. Esto podría deberse a la poca cobertura para detección temprana. Parece ser necesario implementar un programa nacional con cobertura de tamizaje para cáncer de próstata.(AU)

INTRODUCTION: Prostate cancer is the second most diagnosed cáncer in Chile and the world. Screening modified the stage at diagnosis, beeing now in the US 80 pertcent localized, 12 pertcent with regional compromised and 4 pertcent metastatic. Screening with PSA isn't considerd within a national program in Chile. The objetive of this study is to caracterize men diagnosed with prostate cancer at a public hospital in Chile. MATERIALS AND METHODS: Retrospective and descriptive study. Every patient who entered GES because of prostate cancer at the Carlos Van Buren Hospital from Valparaiso between 2014 and 2016 was review. RESULTS: 259 clinical records were review and 226 analized. Mean age was 70,5 years. 46 pertcent had PSA above 20 ng/dL. 31 % had metástasis. 42 % received paliative treatment. 57 % had curative treatment with a mean age of 67,4 years.From this group 31,8 pertcent surgery with a Gleason index <6 and 90 pertcent PSA <20. 68 pertcent had EBRT with or without HT, 44 pertcent of this group had Gleason index <6 and 75 pertcent PSA <20. DISCUSSION: Prostate cancer screening it's a debated topic. In Chile there's no national program to do a PSA. Primary care centers with acces to PSA have more rate of screening. Stage at diagnosis in our center difers from developed countries series, beeing metastatic stage considerably superior. This could be because of the low screening rate for early diagnosis. It seems necesary to implement a national program for prostate cancer screening.(AU)

Value of the resistance index of prostatic capsular artery in screening prostate cancer / 中华医学超声杂志（电子版）

Objective To explore the clinical value of resistance index(RI)of prostatic capsular artery in predicting or screening of prostate cancer(PCa)by comparing prostatic capsular artery RI with the serum total prostatic specific antigen(TPSA),fPSA/tPSA ratio and prostatic specific antigen dernsity(PSAD).Methods RI of prostate capsular artery,serum TPSA,of fPSA/tPSA ratio and PSAD were measured with colour Doppler ultrasonography in this subset of 203 patients who had undergone transrectal ultrasound guided prostate puncture biopsy.The patients were divided into two groups [PCa and benign prostatic hyperplasia(BPH)group] for comparative study.Results Of them,the level of TPSA were between 4 and 10 ng/ml(grey area)in 34 cases,accounts for 16.75%of the total subjects.All the others were outside the grey area.ROC curve analysis showed that the area under the curve(AUC)of RI of the capsular artery was 0.77,which was close to 0.84 and 0.86 of TPSA and PSAD.It indicated a similar value in predicting or screening PCa; while the AUC of fPSA/tPSA ratio was only 0.49,which had little clinical value.The fPSA/tPSA ratio and the mean value of PSAD in the grey area had significant differences(t=2.78,3.94,P＜0.02)between the two groups.However,the fPSA/tPSA ratio had no statistical significance in the high value area outside the grey area(t=0.873,P ＞ 0.05).And the mean value of RI of prostatic capsular artery had significant differences between the two groups both in the grey area and in the high value area outside the grey area(t=4.56,5.10,P ＜ 0.001).Conclusions RI of prostatic capsular artery can be steadily used to predict or screen PCa.It is not affected by the gray area of TPSA and is of great value in clinical practice.

Does PSA reduction after antibiotic therapy permits postpone prostate biopsy in asymptomatic men with PSA levels between 4 and 10ng/mL?

Purpose We investigated the effect of antibiotics on PSA in asymptomatic patients with mild PSA elevation. Materials and Methods We prospectively evaluated, in a non-randomized design, 106 asymptomatic patients with PSA of 4-10ng/mL, with a negative digital rectal examination and with no urinary tract infection evidence for 2 years. Patients were divided into two groups: those treated with antibiotics for 3 weeks (G1) and those who were not treated (G2). PSA was taken six weeks after and prostate biopsy was performed in all patients. Results PCa was diagnosed in 25 of 106 patients (23.6%): 16 (25.0%) in G1 and 9 (21.4%) in G2 (p>0.05). PSA normalization was experienced in 24.5%. In G1, PSA returned to <4ng/mL in 15 (23.4%) patients compared to 11 (26%) patients in G2. In the patients with a positive biopsy, no significant variation was noted in PSA, fPSA, %fPSA and DPSA after antibiotic treatment. A significantly lower cancer detection rate was noted with decreased PSA, fPSA, and DPSA after antibiotic use. A PSA reduction rate of ≥10% occurred in 58.5%, and this was similar in both G1 and G2 groups. The sensibility, specificity and accuracy of PSA reduction of ≥10% were 31%, 23% and 25%, respectively. Conclusion Empirical antibiotic therapy in asymptomatic male patients is not related to PSA reduction. The greater than 10% PSA reduction after antibiotic in this population cannot postpone prostate biopsy. .

Clear cell adenocarcinoma of the male urethral tract.

We present a rare case of clear cell adenocarcinoma of the male bulbomembranous urethra. Mostly these tumors have been described in the female urethral tract with its possible origin from mullerian remnants, wolffian remnants or paraurethral glands. Histologically, these tumors have typically tubulocystic pattern comprising of hobnailed cells with clear glycogenated cytoplasm along with well-defined cytoplasmic membranes. This case is being presented due to its rarity, aggressive behavior and to discuss, trauma as its possible etiological factor

Pesquisa del fliido seminal en víctimas de violencia sexual por el laboratorio foresee / SEMINAL FLUID SEARCH ENVICTIMS OF SEXUAL VIOLENCE BY THE FORENSIC LABORATORY

La violencia sexual es un problema de salud y de justicia social, la inmediata actuación médico legal, la buena colecta de indicios fueron fundamentales para el diagnóstico certero por el laboratorio forense. Se evaluaron y validaron tres ensayos forenses para la investigación de fluido seminal en indicios de víctimas de violencia sexual. Se analizó 251 indicios colectados a 215 víctimas por Medicina Forense en el Laboratorio de Biología Forense del Instituto de Investigaciones Forenses de La Paz. Se aplicó tres métodos para la pesquisa de componentes del semen: Fosfatasa ácida, espermatozoides y Antígeno Prostático Específico (PSA). El 55% de las víctimas comprendían edades entre 4 a 17 años. El 86% de los casos correspondieron a delitos de violación. Se detectó la presencia de semen en 130 víctimas (60%). Componentes seminales individuales como la Fosfatasa Acida en 120 víctimas (56%); espermatozoides en 55 víctimas (26%) y PSA en 130 víctimas (60%). Se detectó la presencia de fluido seminal mediante 3 ensayos forenses en el 60% de las víctimas, siendo la mayoría casos de Violación. Indicios impregnados con sangre no interfirieron en la pesquisa de semen.

Sexual assault is a problem of public health and social justice, the immediate procedure, the successful collection of the physical evidence at the time from Legal Medical, were essentials to accurate investigation by Forensic laboratory. Were applied three assays to Forensic investigation of semen in evidences from sexual assault victims. 251 evidences were analyzed from 215 victims by Medical Forensic and Biology Forensic Laboratory, IDIF - La Paz to victims by Medical Forensic and Biology Forensic Laboratory, IDIF - La Paz to investigate semen components were applied 3 methods: Phosphatase acid, spermatozoa, and Prostatic Specific Antigen (PSA). 55% victims had between 4 to 17 years. 86% were rape assault cases. Seminal fluid was identified on 130 victimas (60%); Phosphatase acid about 120 victims (56%); sperms in 55 victims (26%) and PSA in 130 victims (60%). Seminal fluid component was detected about 60% victimas from rape assault. Blood stains don't produce interference.

Retrospective study comparing six - and twelve-core prostate biopsy in detection of prostate cancer

OBJECTIVE: We compared the safety and efficacy of the 12-core biopsy with those of the conventional systematic 6-core biopsy with PSA levels between 4.1 and 20.0 ng/mL. MATERIALS AND METHODS: This study included 428 patients who underwent a 6-core biopsy and 128 patients who underwent a 12-core biopsy. Biopsies were performed transrectally under ultrasound guidance. The 12-core biopsy scheme involved obtaining 6 far lateral cores. RESULTS: For patients with PSA level between 4.1 and 10.1 ng/mL, 47 of the 265 patients who underwent 6-core biopsy and 32 of the 91 patients who underwent a12-core biopsy were diagnosed with prostate cancer (p = 0.0006). Among the patients with a PSA level between 10.1 and 20.0 ng/mL, 48 of 163 patients who underwent the 6-core biopsy and 16 of 37 patients who underwent the 12-core biopsy were diagnosed with prostate cancer (p = 0.0606). Three of the 95 patients who were diagnosed with prostate cancer through the 6-core biopsy and 12 of the 48 patients who were diagnosed through the 12-core biopsy had cancer located in the anterior apex. The 12-core biopsy increased the diagnostic rate in the apex (p = 0.001). No statistically significant differences were found in incidence of complications. CONCLUSION: We concluded that the 12-core biopsy is a safe and more effective procedure for increasing the diagnostic rate of prostate cancer than the 6-core biopsy in patients with PSA level between 4.1 and 10.0 ng/mL, and the most useful anatomical area to be added was found to be cores from the anterior apex.

Relationship between bladder outlet obstruction and serum prostatic specific antigen in patients with benign prostatic hyperplasia / 中国医师进修杂志

Objective To investigate the relationship between bladder outlet obstruction(BOO) and serum prostatic specific antigen(PSA) in patients with benign prostatic hyperplasia(BPH).Methods The study of pressure-flow urodynamic examination,IPSS score and serum PSA were performed in 253 cases with BPH.Results Based on the bladder outlet obstruction index(BOOI),all patients were divided into three groups: Definite BOO group had 156 patients,mild BOO group had 61 patients,no BOO group had 36 patients.The data of tPSA were(4.54?1.71) ?g/L,(2.45?1.74) ?g/L and(1.85?1.71) ?g/L respectively,there were significant differences between definite BOO group and other two groups(P0.05).Conclusion As a easy detection index,serum PSA may partially reflect the severity of BOO,combined with IPSS score,uroflow, type of B supersonic wave,it would give some guide for patients with BPH to select therapies and judge the prognosis.

Universidade Estadual Paulista

Serum and urinary prostatic acid phosphatase (PAP) and prostatic specific antigen (PSA) from 20 dogs were measured. PAP and PSA tests were carried out in authomatized equipment with commercial kits used for humans. Mean PAP serum value was 0.7U/l and urinary 0.1U/l. Mean serum and urinary PSA were 0.005ng/dl and 0.004ng/dl, respectively. In vivo determination of these two biomarkers in dogs is a new form of diagnosis in veterinary medicine and these values should be correlated with the morphological lesion of the prostate gland.

Realizaram-se mensurações sérica e urinária de fosfatase ácida prostática (PAP) e antígeno prostático específico (PSA) de 20 cães. Os testes de PAP e PSA foram feitos em um equipamento automatizado, com o uso de kits comerciais para humanos. A média de PAP sérico foi de 0,7U/l e urinário 0,U/l. As médias do PSA sérico e urinário foram 0,005ng/dL e 0,004ng/dl, respectivamente. A determinação do dois biomarcadores in vivo é uma nova opção de diagnóstico na medicina veterinária e os valores obtidos devem ser correlacionados com a lesão morfológica da próstata.

Serum total PSA and the ratio of free to total PSA in patients of benign prostatic hyperplasia and prostate cancer / 中华泌尿外科杂志

Objective To compare the serum PSA (T PSA and F/T PSA ratio) between patients of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Methods We studied retrospectively 810 cases of BPH and 103 cases of PCa consecutively from November of 1996 to June of 1999 and compared the differences of T PSA level and F/T ratio between these two kinds of diseases. Results In BPH patients,serum T PSA 10 ng/ml were 71.7%, 22.1 % and 6.2% respectively while these were 10.7%,17.5% and 71.8% in PCa patients ( P 10 ng/ml(0.110 ng/ml.

Changes in serum PSA after brachytherapy for prostate cancer / 中华泌尿外科杂志

Objective To evaluate the serum prostate specific antigen(PSA)change after I-125 radioactive seed implantation without androgen ablation therapy for prostate cancer,Methods A total of 13 patients with prostate cancer were included.The clinical stage was T_(1c)N_0M_0 in 8 cases,and T_(2a)N_0M_0 in 5. The Gleason scores were 5 in 4 cases and 6 in 9.The mean serum PSA was 8.2 ng/ml(range,2.8-14.6 ng/ml).I-125 seed implantation(D90=140-155 Gy)was performed.Serum PSA was monitored every month for the first 3 months and every 3 months for the next 20 months.Results The range of follow-up time was 3-23 months.At 1,2,3,6,9,12,15,18 and 21 months after implantation,the median serum PSA values were 6.7,5.0,2.7,1.6,1.2,0.9,0.8,0.8 and 0.7 ng/ml;and the median percentage change in ser- um PSA were 72%,51%,29%,20%,13%,11%,9%,9% and 8%,respectively.One month after brachy- therapy,30% of the patients had fluctuation in PSA.Conclusions Compared with radical prostatectomy and androgen ablation therapy,the rate of PSA decline is slower with fluctuation at early phase.The most sig- nificant decline of PSA occurs in the first 12 months,especially in the first 3 months after I-125 seed implan- tation.

Clinical and pathological study on the correlation between serum prostate specific antigen and benign prostatic hyperplasia / 中华泌尿外科杂志

Objective To evaluate the clinical and pathological factors that may influence serum prostate specific antigen(PSA)level in patients with benign prostatic hyperplasia(BPH).Methods A total of 561 cases of BPH diagnosed by pathological examination following operation were analyzed retrospec- tively.The patients'mean age was(68.3?6.3)years.The International Prostate Symptom Score(IPSS)was 21.1?7.4;the quality of life(QOL)was 4.5?0.8;Qmax was(7.3?3.3)ml/s;prostate volume(PV) was(69.8?36.8)ml;andpost-void residue(PVR)was(81.9?105.8)ml.Results Of 561 cases,223 cases(39.8%)had serum PSA level at 4-10 ng/ml,and 91 cases(16.2%),over 10 ng/ml.The level of serum PSA was not significantly associated with age,IPSS,QOL,Qmax and PVR(r=0.08,0.03,0.06,0.04 and 0.09,respectively;P＞0.05),but significantly associated with prostate volume of BPH(r=0.42,P＜0.01).The level of serum PSA was significantly elevated in BPH patients with enlarged prostate volume (F=93.45,P＜0.05)and the history of acute urinary retention(x~2= 59.1,P＜0.01).Additionally,a significantly increased PSA level was noted in tissue specimens with glandular hyperplasia(x~2=16.14,P＜0.01)or necrotic loci in BPH patients(x~2=36.06,P＜0.01).Conclusions An elevated serum PSA level was observed in more than 50% of BPH patients undergoing surgical resection.Enlarged prostate volume,the history of acute urinary,retention,and tissue specimens with glandular hyperplasia or necrotic foci are considered to be the main causes leading to elevated PSA level in BPH patients.

Clinical investigation on the source of elevated serum PSA in BPH patients with large-volume prostate / 中华泌尿外科杂志

Objective To investigate the source of the elevated serum prostatic specific antigen(PAS) in prostate hyperplasia patients with large volume prostate. Methods Open surgery (ie,suprapubic prostatectomy) was performed in 27 patients who had a preoperative PSA between 8.1 and 75.1 ng/ml and the volume measured by ultrasonography over 50 ml,DER≥Ⅲ? size,but without symptoms and signs of prostate cancer (PCa).The 27 patients were post operatively followed up to measure the serum PSA,to analyze the change in PSA and the source of pre operative elevated PSA. Results The post operative gross examination showed that the average weight of the prostate enucleated was 82.7 g (40 to 185 g).Pathological evaluation of the surgical specimen revealed that no prostate cancer lesion was found in 25 patients;however,PCa lesions were found in 2.Within 1 month the PSA rapidly dropped down to normal in 26 patients;however,in the remaining one with pathologically proven PCa,PSA increased.24 patients were followed up between 17 and 57 months after surgery.The average PSA level was 1.16 ng/ml(0.08 to 2.39 ng/ml). Conclusions In BPH patients with large volume prostate the increased PSA originates from hyperplastic gland (transition zone),not from the peripheral zone.

Effects of Benign Prostatic Diseases on the Level of Serum Prostate Specific Antigen / 대한비뇨기과학회지

PURPOSE: Prostatic specific antigen (PSA) may be elevated in patients with benign prostatic diseases. We evaluated the causes of elevated serum prostatic specific antigen concentration in men without prostatic carcinoma by periodic determination of serum PSA. MATERIALS AND METHODS: From January 1996 to December 2000, of the 85 patients with elevated serum PSA (>4 ng/ml), 53 (62.4%) had clinical evidence of benign prostatic diseases such as BPH or acute prostatic inflammation. In 47 patients serum PSA was measured every 1-4 weeks until the PSA returned to base line level. RESULTS: In 42 (89.4%) patients the serum PSA concentration decreased to less than 4 ng/ml. within 3 months. The recovery rate of serum PSA within 4 weeks was high at 69% (29 of 42). The base line PSA was greater than 4 ng/ml during the follow-up period of 3 months in five patients. An elevation of PSA by acute prostatic inflammation (mean 34.1 40.0ng/ml) was abrupt and significantly greater than by prostatic hyperplasia (12.4 9.4 ng/ml, p=0.026). In patients with BPH, an initial elevation in serum PSA correlated with prostatic volume (r2=0.211, p=0.036), but no significant correlations between prostatic volume and elevated PSA levels were observed in patients with acute prostatic inflammation (r2=0.051, p=0.480). CONCLUSIONS: Benign prostatic hypertrophy and acute prostatic inflammation were main benign causes for serum PSA elevation. Majority of patients with elevated PSA by benign causes returned to base line less than 4 ng/ml in 4 weeks. However in some patients the serum PSA still remained elevated after 4 weeks, who should undergo TRUS guided biopsy of prostate to rule out the presence of malignancy. We recommended to wait at least 6 weeks for a repeat PSA determination.

Variation of serum PSA with age in benign prostatic hyperplasia patients / 中华泌尿外科杂志

Objective To establish age specific reference ranges of serum total prostatic specific antigen (T PSA) and to investigate the relationship between T PSA,free PSA (F PSA) and ratio of F PSA/T PSA(F/T) with age in benign prostatic hyperplasia (BPH) patients. Methods 913 consecutive cases were studied retrospectively.In all of them with the age ranged from 30 to 89, serum T PSA and F PSA levels were assayed.All the patients were suspected to be BPH or PCa,103 being diagnosed as PCa on biopsy under B ultrasound and the other 810 being BPH. Results The incidence rate of PCa was 11.3% in this group.Serum T PSA and F PSA levels were positively correlated with the age ( r=0.22,P

Retrospective Study about Prognostic Significance of Gleason Score and PSA Change of Pre- and Post-treatment Period in Hormonally Treated Prostatic Adenocarcinoma / 대한비뇨기과학회지

PURPOSE: Gleason score is well known prognostic factor of prostatic cancer, Especially Gleason score above 8 measns poor prognosis. But in intermediate range(Gleason scorn 5-7), it does not provide useful information about the prognosis. Therefore, in the range of intermediate Gleason score, additional information such as PSA changes in pre and post treatment period may be helpful for predicting prognosis. In this study, we retrospectively evaluated relationship between prognosis and PSA change of pre and post hormonal treatment period in different Gleason score group(intermediate Gleason score group: 5-7/high Gleason score group: 8-10). MATERIALS AND METHODS: Total 42 patients who were diagnosed as stage D1, D2 prostatic cancer with Gleason score 5-10 were studied. All patients were treated by hormonal treatment(Orchiectomy or gonadotropin releasing hormone agonist) between May 1992 and May 1996 in Korea university. Mean follow-up duration was 18.9 months. And mean age of patients was 67.0+/-7.5 years. Patients were classified into two groups. One group was consisted of 28 patients whose Gleason score was 5-7 And in the other group, 14 patients with Gleason score above 8 were included. In each group, pre- treatment PSA, post-treatment nadir PSA, time for post-treatment PSA fall to nadir and time for PSA reelevation were analysed. Also In each group, expired and survived patients were analysed. All data was statistically processed by Exact Fisher's test and Mann-Whitney Rank Sum score. RESULTS: Mean Gleason score of total 42 patients was 7.1 +/-7.5. Mean pre-treatment PSA value of 42 patients was 146.9+/-222.6ng/ml and mean nadir PSA value after treatment was 8.2+/- 15.9ng/ml. The mean time for nadir PSA fall after treatment was 6.2+/-4.4 months and mean time for PSA reelevation was 13.3+/-9.9 months. 14 patients had Gleason score 8 or more and the other 28 patients had Gleason score 5-7. There was significant difference in mortality between patients with intermediate Gleason score(4/28 patients) and high Gleason score(7/14 patients, p=0.024). In patients with high Gleason score(8-10), there were no significant difference of pre-treatment PSA, post-treatment nadir PSA , duration for post-treatment PSA fall to nadir and time for PSA reelevation between survived and expired patients(p> 0.05). But in case with intermediate Gleason score range(5-7), expired patients had significantly higher post-treatment nadir PSA value than survived patients(19.8+/- 0.4ng/ml vs 7.3+/-4.2ng/ml respectively, p=9.036). But in both Gleason scone group, there was no mortality difference between patients with nadir PSA above 4ng/ml and below 4ng/ml. CONCLUSIONS: With these result, we concluded that patients with high Gleason score (especially 8 or more) had poor prognosis. And in patients with high Gleason score PSA change in pre and post-treatment period have no additional prognostic importance on Gleason score. But in patients with intermediate Gleason score(5-7), higher post treatment nadir PSA means poor prognosis. But conventionally used criteria of post-treatment PSA level below normal range(<4ng/ml) cannot discriminate between good and poor prognostic group in both high and intermediate Gleason score patients. So we think that in cases of patients with intermediate Gleason score(5-7), a physician must try to check up post-treatment PSA change(especially post-treatment nadir PSA) thronghly for early detection of tumor recurrence or progression.

Assessment of Screening for Prostatic Cancer in Men with Prostatism more than 50 years old / 대한비뇨기과학회지

Screening for prostatic cancer remains controversial because a decrease in the mortality rate is not demonstrated in screened populations. During a 2 year period, 172 men with prostatism more than 50 years old, were examined for prostatic cancer prospectively. A prostatic biopsy was performed on 77 men and 13 malignant tumor were detected, of which 85 per cent were clinically localized. Sensitivity of digital rectal examination, serum PSA, and transrectal ultrasonography for detection of prostatic cancer was 46.2%, 76.9%, and 53.8% respectively. A combination of abnormal ultrasonographic findings, an elevated PSA value, and abnormal findings on rectal examination carried a positive predictive value of 62.5%. These results suggest that screening examination may benefit for early detection of prostatic cancer in men with Prostatism more than 50 years old. Screening program should include digital rectal examination, serum PSA initially. Transrectal ultrasonography is reserved for cases with abnormal finding on rectal examination or elevated PSA value.