The risks of prostate cancer detection by transrectal ultrasound guide biopsy in Thai men with abnormal prostatic-specific antigen or abnormal digital rectal examination.

OBJECTIVE: To determine the risks of prostate cancer detection in Thai men with abnormal prostatic-specific antigen (PSA) or abnormal digital rectal examination (DRE). MATERIAL AND METHOD: One hundred and forty four Thai men with abnormal PSA or abnormal DRE or both were biopsied at the prostate gland with the use of transrectal ultrasound guide biopsy (TRUSBX). The risks of prostate cancer detection were evaluated. RESULTS: Mean age was 65.7 years old (S.D. = 9.88). The risks of positive biopsy according to the PSA levels of 0-4 ng/ml, 4.1-10 ng/ml, 10.1-20 ng/ml, 20.1-50 ng/ml, 50.1-100 ng/ml and more than 100 ng/ml were 6.25 per cent, 6.67 per cent, 10.8 per cent, 33.3 per cent, 60 per cent and 100 per cent, respectively. The risks of positive biopsy according to DRE appearances of total hard consistency, nodule, induration and benign prostatic hyperplasia were 57.1 per cent, 23.5 per cent, 34.6 per cent and 10 per cent, respectively. Of 144 men, 32 had adenocarcinoma of prostate. Radical prostatectomy was performed on 15 patients with clinically localized disease. Ten patients (66.6%) had free margin on their pathological specimens and 6 (40%) had organ confined disease. CONCLUSION: PSA testing alone or DRE alone is not a perfect test to diagnose prostate cancer since prostate cancer may present in men with normal PSA or men with no suspicious cancer DRE. For early detection of prostate cancer, both PSA testing and DRE need to be performed. When either PSA testing or DRE or both is abnormal, TRUSBX should be carried out.

Five-year follow-up of prostate cancer in Siriraj Hospital.

OBJECTIVE: To determine the clinical features, tumor characteristics, and treatment outcomes of Thai men with prostate cancer. MATERIAL AND METHOD: We retrospectively evaluated the clinical features, tumor characteristics, and treatment outcomes of 95 patients who were registered in Siriraj Hospital from 1993 to 1995. A survival end point in each stage was determined. RESULTS: The mean age was 72.37. The distributions of stage were 7.5 per cent for stage A, 1.1 per cent for stage B, 67.7 per cent for stage C, and 23.7 per cent for stage D. The prognosis of a clinical localized disease appeared good. Most patients with a urinary symptom were highly associated with stage C or stage D disease and were treated by hormonal therapy. With a maximal follow-up of 60 months, the median survival of stage C and D patients was 45 and 12 months, respectively. CONCLUSION: Most Thai patients with prostate cancer were older than the life expectancy of Thai men. They presented with urinary symptoms and had locally advanced or advanced disease. With hormonal treatment, their prognoses were not impressive.

Is prostate-specific antigen still the best tumor marker for prostate cancer?

PSA has been utilized for more than a decade. Since the overwhelming benefit of PSA, the previous markers for prostate cancer have been abandoned. Even though PSA is no more an organ specific agent, its function as an organ specific marker remains in all clinical situations. PSA is significantly involved not only in screening for early detection but also in all clinical spectrums of prostate cancer. Never before has the tumor marker played such a significant role in all purposes of clinical utilization for prostate cancer as PSA has. The answer to the title of this article is absolutely positive. Nevertheless, the following question of whether PSA has an impact in decreasing the mortality rate of patients with prostate cancer is yet to be answered. In Siriraj Hospital, though PSA has been available since 1991, the majority of patients registered with the advanced stage of disease and their treatment outcomes are not always satisfactory. Since the prognoses of the patients with an early stage of disease appear very good, to improve the mortality of Thai patients with prostate cancer, screening using PSA for early detection should be introduced and widely used.

Ileal neobladder.

Twenty-five male patients undergoing cystoprostatectomy and ileal neobladder for muscle-invasive transitional cell carcinoma of bladder are reported lleum segments of 60-80 cm. long were detubularized and reconfigurated to produce low pressure, high compliant neobladder. There was no operative mortality. Two patients were lost to follow up. Follow up period ranged from 1 to 54 months with mean 24 months. Nineteen patients were still alive. There were 4 patients died from metastasis or local recurrence. AII patients could void per urethra except one. Enuresis was found in 5 and daytime incontinence In 2 Vesicoureteral reflux was observed in 3 renal units. No electrolytes disturbances occurred. Ileal neobladder offers an alternative to standard ileal conduit and more acceptable to male patients undergoing cystoprostatectomy.

Suprapubic prostatectomy for benign prostatic hypertrophy at Siriraj Hospital during 1986-1988.

A three-year retrospective analysis of patients with benign prostatic hypertrophy being treated by suprapubic prostatomy at Siriraj Hospital during 1986-1988 was carried out in order to determine the epidemiological characteristic of diseases and the results of treatment. There were 91 patients whose average age was 70.9 years. The significant symptoms of the patients were prostatism (100%), retention of urine (36.3%) and gross haematuria (15.4%). The abnormal laboratory findings before surgery were anaemia, azotemia, serum acid phosphatase above normal value and bacteriuria encountered in 3.2, 6.5, 20.0 and 62.7 percent of the cases respectively. The significant complications were bleeding during surgery (51.6%) and wound infection (27.5%) ; the mortality rate was 2.2 percent. Most of the patients (85.4%) could be discharged from the hospital before 14 days.