Diagnosis of carcinoma prostate: the yield of serum PSA, DRE and TRUS

This randomised study was conducted on 100 patients with bladder outlet obstructive symptoms, their age ranged from 55 to 84 years, at a teaching hospital. The cancer detection rate with three tumour markers, the prostate specific antigen [PSA] and Transrectal Ultrasonography [TRUS] was 6%. Serum PSA level determination was followed by digital rectal examination [DRE] and TRUS. The mean value of serum PSA levels for this study was 15.57 ng/mL [Normal value upto 5 ng/mL] serum PSA level were > 10 ng/mL in 36 patients. DRE of prostate was positive [Hard, nodular] in 8 [8%] patients. On TRUS of prostate, the mean volume of prostate was 35.54 cm[3] + 11.98 cm[3]. More than 7 mm hypoechoic or hyperechoic focal defects were found in 17 individuals, they were 14 [82.3%] in peripheral and 3 [17.6%] in central zone of prostate gland. TUR prostat biopsies were performed in all patients. Histopathological reports revealed adenocarcinoma in 6%, chronic prostatitis in 2% and BPH in 92% cases. The sensitivity of three tumour markers [PSA, DRE, TRUS] was 83%. The specificity of DRE [96%] was higher as compared to that of PSA and TRUS. Positive predictive value [PPV] of TRUS was 50% and was higher than of PSA but less than of DRE. However, PPV significantly rose to 83% when results of abnormal TRUS were corroborated with abnormal results of DRE and PSA. The average cost of detection of carcinoma prostate by DRE, PSA and TRUS was Rs. 2100 per patient excluding hospital and equipment charges. Since use of these tumour markers in symptomatic individuals provide very high PPV, their routine use may be recommended in patients with bladder outlet obstructive symptoms

Value of screening of population for carcinoma prostate

Five hundred [500] asymptomatic individuals were screened for carcinoma of prostate. They were evaluated through history, physical examination, DRE and PSA. Patients with PSA> 10 ng/ml were subjected to transrectal ultrasound [TRUS]. TRUS guided transperineal biopsy was taken in individuals having more than 7mm focal defects. Results revealed that 47 individuals had raised serum PSA [> 10ng/ml] levels. TRUS was positive in ten patients. On histopathology five of them were found to have prostatic cancer. Carcinoma had infiltrated the proastatic capsule in all patients. Screening proved useless for the patients, as curative treatment was not possible. In this study the cost of detecting one case of prostatic cancer was Rs. 14,000 utilising Government facilities free of cost. So this screening is not cost effective, considering the poor socio-economic conditions of our country

Bioburden and theoretical sterility dose calculation for radiation sterilization of surgical cotton and bandages

The initial bioburden, count of colony forming unit [CPU] was determined on the locally manufactured non-sterilized surgical cotton and bandages. In all 489 tests were conducted on 163 cotton samples and 246 tests on 82 bandage samples. The surgical cotton showed an average of 198 microbes with a maxima of 287 and minima 94 whereas bandages showed an average of 179 microbes with a maxima of 268 and minima of 89. In the 20% samples subjected to identification no anaerobic microorganism was isolated while the aerobic microorganisms isolated were all bacilli. The sterilization dose [SD] for sterility assurance level [SAL] of 10[-6] was 2.23 Mrads and 2.21 Mrads, whereas the device verification dose [DVD] was 0.6 and 0.59 Mrads for cotton and bandages respectively as calculated by the method proposed by the Sterilization Standard Committee, Association of Advancement of Medical Instrumentation [AAMI]