Does small prostate predict high grade prostate cancer?

Objective: The current is study aimed to assess the patients who underwent radical prostatectomy for prostate cancer and investigate the association between prostate size and adverse outcomes at final pathology

Study Design: Comparative, descriptive study

Place and Duration of Study: Haydarpasa Numune Training and Research Hospital, Turkey, from January 2008 to January 2016

Methodology: The patients treated with open radical prostatectomy for prostate cancer were reviewed. Patient characteristics including prostate specific antigen [PSA], free PSA levels, age, biopsy, and radical prostatectomy results were recorded. The patients whose data were complete or prostate weight was equal to or less than 80 gm, were included in the study. Patients with <40 gm prostate weight was in group 1 and the patients in group 2 had a prostate weight from 40 to 80 gm. High grade prostate cancer was defined to have a Gleason score between 7 or higher at biopsy and final pathology. Pathology and biopsy results were compared within groups. MedCalc Statistical Software demo version was used for statistical analyses

Results: There were 162 patients in this study. Of these, 71 [43.82%] patients were in group 1 and 91 [56.17%] patients were in group 2. The age ranged from 49 to 76 years. Mean value of 62.70 +/- 6.82 and 65.82 +/- 5.66 years in group 1 and 2, respectively. Fifty [70.42%] and 68 patients [74.74%] had a Gleason score of 6 in group 1 and 2, respectively. Organconfined disease was reported in 53 patients [74.64%] in group 1 and in 78 patients [85.71%] in group 2. Gleason score concordance between biopsy and prostatectomy was reported in 61 patients [67.03%] and downgrading was detected in 4 patients [4.4%] in group 2. The median tumor volume of the patients was 4.47 cm3 in group 1 and 6 cm3 in group 2 [p=0.502]. High grade prostate cancer was reported in 52.11% and 45.05% of the patients in groups 1 and 2, respectively at final pathology [p=0.373]

Conclusion: The present study demonstrated that smaller prostates are more likely to compose higher percentage of the high grade prostate cancer, local advanced disease, and the Gleason upgrading. The positive surgical margin rate is higher in patients with small prostates when it is compared with the other patients

Increased sperm DNA damage in experimental rat varicocele model and the beneficial effect of varicocelectomy

Varicocele, the abnormal dilatation of the veins in the pampiniform plexus is commonly seen in infertile patients. In this study, we aim to examine sperm DNA damage after the creation of experimental varicocele in rats and to observe the change of this damage after a varicocelectomy. In this experimental study, a total of 30 adult male Wistar albino rats were divided into three groups. The 10 rats in group 1 underwent a sham operation, an experimental varicocele was created in both the10 rats in group 2 and the 10 rats in group 3 [a total of 20 rats]. While the rats of group 2 were sacrificed after four weeks, the rats in group 3 underwent a varicocelectomy after four weeks and were sacrificed four weeks after the varicocelectomy to observe its effects. Sperm DNA fragmentation was assessed with a Halomax[registered sign] kit. The DNA Fragmentation Index [DFI] was calculated and the groups were compared according to their DFI. Statistical analysis was performed using the Mann-Whitney U test. Median sperm DFI was 17.6 [range: 7.6] in the right testicle and 18.3 [range: 6.8] in the left testicle in the control group; 30.7 [range: 8.8] in the right testicle and 31.8 [range: 9.6] in the left testicle in the varicocele group; 27.1 [range: 8.1] in the right testicle and 28.6 [range: 8.9] in the left testicle in the varicocelectomy group. DNA damage in both right and left testicles was statistically significant between the three groups [p<0.05]. The results of this study show that varicocele leads to increased sperm DNA damage and this damage is decreased by varicocelectomy

Significance of Atypical Small Acinar Proliferation and High-Grade Prostatic Intraepithelial Neoplasia in Prostate Biopsy

PURPOSE: In clinical practice, atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two common findings on prostate biopsies. Knowing the frequency of a prostate cancer diagnosis on repeat biopsies would aid primary treating physicians regarding their decisions in suspicious cases. MATERIALS AND METHODS: One hundred forty-three patients in whom biopsies revealed ASAP or HGPIN or both were enrolled in the present study; prostate cancer was not reported in the biopsy specimens and at least one repeat biopsy was performed. Age, digital rectal examination findings, prostate volumes, and free and total prostate-specific antigen (PSA) levels and the biopsy results of the patients were recorded. RESULTS: Of the 97 patients with ASAP on the first set of biopsies, prostate cancer was diagnosed in the second and third biopsies of 32 and 6 patients, respectively. Prostate cancer was not detected in the second or third biopsies of the 40 patients with HGPIN in the first biopsy. Of the 6 patients with ASAP+HGPIN in the first biopsy, prostate cancer was detected in 3 patients in the second biopsy and in 1 patient in the third biopsy. CONCLUSIONS: The diagnosis of ASAP is a strong risk factor for prostate cancer. A repeat biopsy should be performed for the entire prostate subsequent to the diagnosis of ASAP. In patients with HGPIN according to the biopsy result, the clinical decision should be based on other parameters, such as PSA values and rectal examination, and a repeat biopsy should be avoided if the initial biopsy was performed with multiple sampling.