Preoperative Erythropoietin Administration in Patients With Prostate Cancer Undergoing Radical Prostatectomy Without Transfusion

PURPOSE: In this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure. MATERIALS AND METHODS: We evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis. RESULTS: Mean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups. CONCLUSIONS: Preoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.

Primary Adenocarcinoma of the Rete Testis With Preceding Detection of Unilateral Hydronephrosis

Primary adenocarcinoma of the rete testis is a rare malignant testicular tumor with a poor prognosis. Here we report the case of a 54-year-old man with right hydronephrosis that was detected before the diagnosis of the primary testicular lesion. During the evaluation of the right hydronephrosis by use of abdominopelvic computed tomography, a painless, hard, solid lesion was found on the right testis. The patient underwent radical orchiectomy, and the pathologic examination revealed an adenocarcinoma of the rete testis. Multiple metastases were present at the time of diagnosis. The patient received combined chemotherapy after the surgery but lived only 8 months after the initial diagnosis.

Primary Adenocarcinoma of the Rete Testis With Preceding Detection of Unilateral Hydronephrosis

Primary adenocarcinoma of the rete testis is a rare malignant testicular tumor with a poor prognosis. Here we report the case of a 54-year-old man with right hydronephrosis that was detected before the diagnosis of the primary testicular lesion. During the evaluation of the right hydronephrosis by use of abdominopelvic computed tomography, a painless, hard, solid lesion was found on the right testis. The patient underwent radical orchiectomy, and the pathologic examination revealed an adenocarcinoma of the rete testis. Multiple metastases were present at the time of diagnosis. The patient received combined chemotherapy after the surgery but lived only 8 months after the initial diagnosis.

Efficacy of Periprostatic Anesthesia according to Lidocaine Dose during Transrectal Ultrasound-Guided Biopsy of the Prostate

PURPOSE: The aim of this study was to evaluate the efficacy of periprostatic lidocaine injection according to lidocaine dose during transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: The subjects of this study were 92 patients who had undergone transrectal ultrasound-guided 12-core biopsy of the prostate. The patients were randomly assigned to three groups: group 1 (n=31, no lidocaine injection), group 2 (n=30, periprostatic injection of 10 ml 1% lidocaine), and group 3 (n=31, periprostatic injection of 20 ml 1% lidocaine). The patients were assessed for pain by use of a 10-point visual analogue scale (VAS) and for other complications after the procedure. RESULTS: The mean VAS scores of groups 1 through 3 were 0.93+/-0.89, 1.32+/-1.37, and 1.13+/-1.10, respectively. There were no statistically significant differences between the three groups. However, the mean VAS score of the biopsy pain was 5.0+/-1.48, 3.93+/-1.94, and 3.60+/-2.15, in the same groups, respectively, with statistically significant differences between group 1 and the other groups. Patients in groups 2 and 3 reported significantly less biopsy pain than did group 1 patients (p=0.004, 0.021), with no statistically significant difference in VAS score between groups 2 and 3 (p=0.533). With respect to post-biopsy complications, there were no significant differences in the incidence of hematuria, hematospermia, rectal bleeding, or infection among the three groups. CONCLUSIONS: Periprostatic injection of local anesthesia with lidocaine was associated with significantly less pain than in the absence of anesthesia. Furthermore, a 20-ml dose of lidocaine produced no better pain control than did a 10-ml lidocaine dose for prostate biopsy.

Efficacy of Periprostatic Anesthesia according to Lidocaine Dose during Transrectal Ultrasound-Guided Biopsy of the Prostate

PURPOSE: The aim of this study was to evaluate the efficacy of periprostatic lidocaine injection according to lidocaine dose during transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: The subjects of this study were 92 patients who had undergone transrectal ultrasound-guided 12-core biopsy of the prostate. The patients were randomly assigned to three groups: group 1 (n=31, no lidocaine injection), group 2 (n=30, periprostatic injection of 10 ml 1% lidocaine), and group 3 (n=31, periprostatic injection of 20 ml 1% lidocaine). The patients were assessed for pain by use of a 10-point visual analogue scale (VAS) and for other complications after the procedure. RESULTS: The mean VAS scores of groups 1 through 3 were 0.93+/-0.89, 1.32+/-1.37, and 1.13+/-1.10, respectively. There were no statistically significant differences between the three groups. However, the mean VAS score of the biopsy pain was 5.0+/-1.48, 3.93+/-1.94, and 3.60+/-2.15, in the same groups, respectively, with statistically significant differences between group 1 and the other groups. Patients in groups 2 and 3 reported significantly less biopsy pain than did group 1 patients (p=0.004, 0.021), with no statistically significant difference in VAS score between groups 2 and 3 (p=0.533). With respect to post-biopsy complications, there were no significant differences in the incidence of hematuria, hematospermia, rectal bleeding, or infection among the three groups. CONCLUSIONS: Periprostatic injection of local anesthesia with lidocaine was associated with significantly less pain than in the absence of anesthesia. Furthermore, a 20-ml dose of lidocaine produced no better pain control than did a 10-ml lidocaine dose for prostate biopsy.

Comparative Analysis of Clinical Parameters in Acute Pyelonephritis / 대한비뇨기과학회지

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.

The Effect of Anticholinergic Drug Treatment before a Midurethral Sling Operation in Mixed Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We investigated the effect of anticholinergic drug treatment before midurethral sling surgery in patients with mixed urinary incontinence(MUI). MATERIALS AND METHODS: Between January 2004 and December 2006, 112 female patients with MUI were evaluated. Forty-seven patients were not medicated with anticholinergic drugs(Group A) and 65 patients were medicated with anticholinergic drugs(Group B) for 2 weeks or more(2-8 weeks, mean 2.34+/-1.02) before the midurethral sling operation. After the midurethral sling operation, the patients were followed up for 4 weeks or more(4-48 weeks, Group A is 7.83+/-8.70, Group B is 6.77+/-7.58). Cure of the incontinence after the procedure was defined as the absence of subjective symptoms such as frequency, urgency, urge incontinence and the absence of objective leakage on stress testing. All other cases were considered failures. RESULTS: There were no significant differences between the group that was not medicated preoperatively (Group A) and the group that was preoperatively medicated(Group B)(cure rate of Group A was 87.2% and Group B was 89.2%, p=0.745) in the cure rate for pure stress urinary incontinence. However, comparison of the postoperative results for the MUI showed significant differences (cure rate of Group A was 63.8% and Group B was 81.6%, p=0.035). The cure rate was significantly higher in the preoperatively medicated patients than in the patients who were not preoperatively medicated with regard to the MUI. CONCLUSIONS: Our findings suggest that treatment with anticholinergic medications before a midurethral sling operation improves the cure rate in patients with MUI.

Correlation of Clinical Progress and Serum Prostate Specific Antigen in the Treatment of Chronic Prostatitis / 대한비뇨기과학회지

Purpose: We compared the baseline and post-treatment serum prostate specific antigen levels (s-PSA), the expressed prostatic secretion (EPS) and the chronic prostatitis symptom index (CPSI). We wanted to determine whether the serum PSA level could be used as a biochemical marker for checking the progress of patients with chronic prostatitis. Materials and Methods: Of the patients who diagnosed with chronic prostatitis, we respectively reviewed the records of 48 men who were under 50 years old and who presented with a serum PSA level lower than 4ng/ ml (group P). As a control group (group N), we used the s-PSA data obtained from 2,787 men under 50 years old who had no evidence for lower urinary infection, and these men were seen at a serial screening program of a primary health clinic. After the treatment with antibiotics and nonsteroidal anti-inflammatory agents, the serum PSA and EPS were rechecked every 4 weeks. The National Institutes of Health (NIH)-CPSI scores were rechecked after 8 weeks. Results: There are no different at mean age (group P vs N; 41.1 vs 41.1 years old). The baseline average serum PSA in group P was 1.53+/-0.73 ng/ml, and that in group N was 0.85 0.81ng/ml; the difference was significant (p=0.001). After 8 weeks of treatment, the average post-treatment serum PSA level was significantly decreased to 1.22+/-0.59ng/ml (p<0.05) and the leukocyte count in the EPS was also significantly decreased (p<0.05). The total NIH-CPSI score was significantly improved (p<0.05). Conclusions: These data suggest that serum PSA is increased in chronic prostatitis patients. Antibiotics and nonsteroidal anti-inflammatory treatment can relief patients' symptoms as well as decrease the serum PSA for chronic prostatitis after 8 weeks. Therefore, serum PSA could be used as a diagnostic factor in determining the patients' progress with employing the CPSI score and EPS results.

Clinical Outcome of Acute Bacterial Prostatitis, a Multicenter Study / 대한비뇨기과학회지

PURPOSE: Few studies have examined acute prostatitis in Korea. To initiate the investigation of this topic, a multi-center retrospective analysis of acute prostatitis was conducted. MATERIALS AND METHODS: The clinical records of 335 patients from 13 hospitals, diagnosed with acute prostatitis, between January of 1994 and October of 2004, were reviewed. For each patient, the urine culture, changes in the PSA (prostate-specific antigen) value and the prostate volume, the incidence of prostate abscess, the use of antibiotics, and whether the disease went into remission or progressed to chronic prostatitis were analyzed. RESULTS: The mean age of the patients, time from the onset of symptom to admission and number of days of admitted were 54.9+/-15.1 (16-85) years, 2.4+/-3.4 (16-85) days and 7.5+/-3.9 (1-25) days, respectively. The chief symptoms of the patients were high fever, dysuria and urinary frequency. Routine urinalysis found pyuria in 82% and hematuria in 70% of patients. The causative organisms of 43.0% of the patients were cultured, with the chief organisms found to be E. coli (67%) and P. aeruginosa (13%), et al. The mean PSA and prostate volume on initial diagnosis were 24.6+/-30.2ng/ml and 45.8 +/-17.4ml, respectively, and a prostate abscess was found in 4 patients (3.1%). The antibiotics injected during patient admission were: cephalosporin family (68%), aminoglycosides (70%) and quinolone family (43%). An additional alpha blocker was used in 49% of cases. Oral quinolone (91%), cephalosporin (9%) and alpha blocker (44%) were prescribed for a mean 32.5 (2-180) days after discharge. 259 (77%) of the patients were available for follow-up. Of these, 21% took antibiotics over an 8 week treatment period, and 8% over a 12 week period. The disappearance of pyuria after treatment was observed in a mean of 13 days after the end of treatment. After 13 weeks of treatment, 11 (50%) of the 22 patients who received prostate massage (4.2% of all follow up patients) were found to have chronic prostatitis. The mean PSA and prostate volume declined during follow up, to 6.13+/-10.38ng/ml and 37.5+/-13.5ml, respectively. CONCLUSIONS: In our study, the most common chief symptom of acute prostatitis was a high fever, with the most common causative organism being E. coli. Patients were admitted for approximately one week, and treated with antibiotic for about one month, after which time PSA elevation was observed in 80% of patients. Although all acute prostatitis patients were treated with proper antibiotics, progression to chronic prostatitis was observed in 4.2% of patients.

Effect of Sclerotherapy after Percutaneous Aspiration of the Simple Renal Cyst / 대한비뇨기과학회지

PURPOSE: Recently, percutaneous aspiration with sclerotherapy has become widely used as a treatment of the symptomatic, large, and simple renal cysts, due to its minimal invasiveness and high effectiveness. However, the reported recurrence rates of simple aspiration are high, in the range 30 to 70%. Therefore, the effect of percutaneous aspiration with sclerotherapy of simple renal cysts was analyzed. MATERIALS AND METHODS: The results of the treatment in 35 simple renal cysts, between June 1994 and July 2003, were evaluated. The symptoms associated with simple renal cysts were; none (40%), flank pain (31.4%), indigestion (17.1%), hematuria (8.6%) and a palpable mass (2.9%). The simple renal cysts were treated with percutaneous aspiration in only 7 cases (group I), single percutaneous aspiration with sclerotherapy, using 99% ethanol, in 18 (group II) and a repeated percutaneous aspiration with sclerotherapy, using 99% ethanol, in 10 (group III). All patient were followed up by ultrasound or CT scan for 12 to 80 months (mean 28.1 months). RESULTS: Complete and partial collapses and recurrences of the renal cysts occurred in 1 (14.2%), 3 (42.9%) and 3 (42.9%) in group I, 7 (39%), 10 (55.5%) and 1 (5.5%) in group II, and 6 (60%), 3 (30%) and 1 (10%) in group III. The overall efficacies were 92% in all 3 groups. Furthermore, all recurrences occurred within the first year of the follow up period in all groups. CONCLUSIONS: For a simple renal cyst, percutaneous aspiration with sclerotherapy, using 99% ethanol, either singly or repeatedly, appears to be effective in the prevention of re-accumulation of cystic fluid; it also proved to have a positive long term result in terms of a relapse of a simple renal cyst.

Affecting Factors on Erectile Dysfunction after Radical Prostatectomy and Treatment / 대한남성과학회지

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.

Affecting Factors on Erectile Dysfunction after Radical Prostatectomy and Treatment / 대한남성과학회지

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.

Effects of Finasteride on Hemospermia / 대한남성과학회지

PURPOSE: We evaluated the therapeutic efficacy of finasteride in the treatment of hemospermia, especially in prostatitis-related hemospermia. MATERIALS AND METHODS: Among the patients who visited our urologic department due to hemospermia from Jan 2000 to Oct 2003, 46 patients enrolled in the study. Semen analysis, expressed prostatic secretion, and transrectal ultrasonography were performed for all patients, and we determined whether or not the hemospermia was caused by inflammatory chronic non-bacterial prostatitis. We sorted all the subjects into 2 groups by the use of finasteride or not. We sub-divided the 2 groups by the presence or absence of prostatitis. In each of the 4 groups, the results were compared. Results were also recalculated after excluding sonographically abnormal cases. RESULTS: In the 35 finasteride-treated patients, the prostatitis group showed a 75% (12/16) success rate whereas the non-prostatitis group showed 31.6% (6/19) success. This difference was statistically significant (p=0.01). In the 11 non-finasteride patients, there was no difference in success rate between the prostatitis group (57.1%) and non-prostatitis group (50.0%). After excluding 15 sonographically abnormal patients, the finasteride-prostatitis group showed an 80% (8/10) success rate whereas the non-prostatitis group showed a 25% (3/12) success rate. CONCLUSIONS: Finasteride treatment in hemospermia was more successful in prostatitis than non-prostatitis patients. Efficacy was more prominent after excluding sonographically abnormal cases. Finasteride could be an useful agent in the treatment of prostatitis-related hemospermia. More extensive study is needed.

Hybrid Squamous-Verrucous Carcinoma of Penis / 대한비뇨기과학회지

We report a rare case of hybrid squamous-verrucous carcinoma of penis that grew extensively in the glans and prepuce of a 68-year-old man. He presented himself with penile discharge and pain upon voiding. The penile glans and prepuce were eroded and replaced by a large, fungating, cauliflower-like ulcerative mass. There was no inguinal or pelvic lymph node enlargement. Partial penectomy was done and histologically, the superficial spreading type, well differentiated squamous cell carcinoma was seen with only minimal invasion of the background verrucous carcinoma with a pushing margin. There were no complications and recurrence of the tumor at 12 months after partial penectomy.

Hybrid Squamous-Verrucous Carcinoma of Penis / 대한비뇨기과학회지

We report a rare case of hybrid squamous-verrucous carcinoma of penis that grew extensively in the glans and prepuce of a 68-year-old man. He presented himself with penile discharge and pain upon voiding. The penile glans and prepuce were eroded and replaced by a large, fungating, cauliflower-like ulcerative mass. There was no inguinal or pelvic lymph node enlargement. Partial penectomy was done and histologically, the superficial spreading type, well differentiated squamous cell carcinoma was seen with only minimal invasion of the background verrucous carcinoma with a pushing margin. There were no complications and recurrence of the tumor at 12 months after partial penectomy.

Long Term Results of Pubovaginal Sling Procedure Based on Anchoring Sites of Suture Material / 대한비뇨기과학회지

PURPOSE: The long term results of a pubovaginal sling procedure were assessed in females with stress urinary incontinence (SUI), and the safety and efficacy, between the Cooper's ligament anchoring and the abdominal wall anchoring of the suture material, compared. MATERIALS AND METHODS: Fifteen, and 20, women underwent a pubovaginal sling procedure, with abdominal wall anchoring (group I), or with Cooper's ligament anchoring (group II), respectively. The surgical outcomes, the satisfaction of patients and the complications were assessed by a questionnaire. RESULTS: In groups I and II the mean follow-ups were 58.1 (range 43-71) and 42.5 (range 36-50) months, respectively. Thirteen (86.6%) and 1 (6.7%), and 17 (85.0%) and 2 (10.0%) of the patients in groups I, and II, were cured and improved, respectively. No statistical difference in the self-reported satisfaction scores was shown between the two groups. The duration of the hospital stay and residual urine less than 50ml were significantly lower in group II (p<0.01). No permanent urinary retention or de novo urge incontinence occurred, but the postoperative urgency remained at 50.0% in both groups. CONCLUSIONS: According to our long term follow-up, the pubovaginal sling procedure is a highly effective and safe surgery for SUI, without urge incontinence. The modified technique, of a pubovaginal sling procedure, with anchoring of the fascia at the Cooper's ligament, is an alternative treatment for SUI, with a low complication rate.

A Adult Primary Prostatic Wilms' Tumor with Liver Metastasis / 대한비뇨기과학회지

A case of extrarenal Wilms' tumor, arising in the prostate, with liver metastasis in a 44-year-old male is reported. A literature review indicated that the incidences of Wilms' tumors arising in the extrarenal region are extremely rare, with only one reported case in the literature. The clinical features, and a review of the disease, are briefly discussed.

Clinical Significance of Semen Analysis and Recanalization Rates after Vasectomy / 대한남성과학회지

PURPOSE: We tried to determine how many patients comply with semen analysis recommendations after vasectomy and how often the operation is followed by surgical failure or recanalization. MATERIALS AND METHODS: We determined the percentage of patients who underwent vasectomy from 1995 to 2003 who had follow-up semen analysis. To determine the vasectomy failure or recanalization rate, we evaluated the rates of sperm appearance in patients who were preparing for vasovasostomy and those with chronic prostatitis who had undergone vasectomy in the past. RESULTS: Among the 130 vasectomized patients, 29(22.3%) had received semen analysis, and in 120 healthy vasectomized patients, only 19(9.9%) received semen analysis. Of the 8 semen samples examined before vasovasostomy, 2(25%) had sperm. In the 121 chronic prostatitis patients, 9(7.4%) had sperm in their semen despite earlier vasectomy. Overall, 11 of 129 vasectomized patients(8.5%) were potentially fertile. CONCLUSIONS: The vasectomy failure or recanalization rate is higher than we generally think. Vasectomy failure or recanalization is usually followed by unwanted pregnancy and abortion. Unfortunately, physicians as well as patients are indifferent to the need for post-vasectomy semen analysis, and we need to emphasize its importance.

Change of PSA Density after Finasteride Therapy in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The prostate-specific antigen (PSA) density has been proposed to distinguish between benign prostatic hyperplasia (BPH) and prostate cancer. It is of importance that patients who take finasteride for their BPH should be taken deep interest in the potential for malignancy. The PSA density after finasteride therapy for 12 months in patients with BPH was investigated. MATERIALS AND METHODS: Sixty-two patients (mean age 64 years) with BPH were enrolled in this study. The PSA densities were calculated before and after 12 months of finasteride therapy. The prostate volumes were measured by transrectal ultrasonography and the PSA was measured by an enzyme immunoassay. RESULTS: After 12 months of the finasteride therapy, the PSA decreased by 45.5%, the prostate volumes by 15.4% and the PSA densities by 30.5% (p >0.01). The PSA density after the finasteride therapy ranged from 0.01 to 0.14 ng/ml/cm3. In 62 patients, the cumulative percent of the PSA densities was 96.8% at 0.11 ng/ml/cm3 or less. In 31 patients over the PSA of 4.0 ng/ml, the cumulative percent of PSA densities also showed the same result. CONCLUSIONS: In most BPH patients treated with finasteride for 12 months, the PSA densities ranged 0.11 ng/ml/cm3 or less.

Change of PSA and PSAD after Antibiotic Treatment in Patients with Prostatitis / 대한남성과학회지

PURPOSE: Serum prostate specific antigen (PSA) is widely used for the early detection of prostate cancer, with biopsies often being performed when the serum concentration exceeds a defined threshold. The concept of prostate specific antigen density (PSAD) was introduced to enhance the specificity of serum PSA for cancer. We investigated the change in serum PSA and PSAD in patients with clinical prostatitis after antibiotic treatment. MATERIALS AND METHODS: A series of 39 patients with chronic prostatitis whose serum PSA and PSAD exceeded 4.0 ng/ml and 0.15 ng/ml/cm3, respectively, were reviewed retrospectively. After they received 4 to 8 weeks of antibiotics, the serum PSA concentration was remeasured. Men with persistently elevated serum PSA concentrations underwent prostate biopsy. RESULTS: The mean pretreatment serum PSA and PSAD was 8.73 ng/ml and 0.24 ng/ml/cm3, respectively. After antibiotic treatment, the mean values decreased significantly, to 4.55 ng/ml and 0.13 ng/ml/cm3, respectively (p<0.05). The mean decrease in serum PSA was 4.19 3.78 ng/ml, a mean relative change 44.3 31.7%. Among 39 men, 22 (56.4%) had their serum PSA and PSAD values return to the normal ranges. Prostate biopsy in 24 patients with persistently elevated serum PSA or PSAD after antibiotic therapy revealed prostate cancer in 4. CONCLUSIONS: Prostatitis is one of the most important factors in serum PSA and PSAD elevation in men without clinically detectable prostate cancer. A decrease in PSA and PSAD after antibiotic treatment can help in avoiding unnecessary prostate biopsies.