Detection rate of prostate cancer using prostate specific antigen in patients presenting with lower urinary tract symptoms: a retrospective study.

BACKGROUND: Need for undertaking prostate biopsies for detection of prostate cancer is often decided on the basis of serum levels of prostate specific antigen (PSA). AIM: To evaluate the case detection rate of prostate cancer among patients presenting with lower urinary tract symptoms (LUTS) on the basis of PSA levels and to assess the scope of prostate biopsy in these patients. SETTING AND DESIGN: A retrospective study from a tertiary care center. MATERIALS AND METHODS: The clinical and histopathological data of 922 patients presenting with LUTS in the last five years was obtained from the medical record section. They had been screened for prostate cancer using PSA and /or digital rectal examination examination followed by confirmation with prostate biopsy. STATISTICAL ANALYSIS USED: Detection rate and receiver operating characteristic curve were performed using SPSS 16 and Medcalc softwares. RESULTS: The detection rate of prostate cancer according to the PSA levels was 0.6%, 2.3%, 2.5%, 34.1% and 54.9% in the PSA range of 0-4, 4-10, 10-20, 20-50 and> 50 ng/ml, respectively. Maximum prostate cancer cases were detected beyond a PSA value of 20 ng/ml whereas no significant difference in the detection rate was observed in the PSA range of 0-4, 4-10 and 10-20 ng/ml. CONCLUSION: A low detection rate of prostate cancer observed in the PSA range of 4-20 ng/ml in LUTS patients indicates the need for use of higher cutoff values of PSA in such cases. Therefore we recommend a cutoff of 20 ng/ml of PSA for evaluation of detection rate of prostate cancer among patients presenting with LUTS.

Gastrostomy without laparotomy--a percutaneous endoscopic technique: review of 35 cases.

Percutaneous endoscopic gastrostomy (PEG) was performed in 33 patient with head injury, one with laryngeal cancer, and one with gastric volvulus. The gastrostomy tube was prepared from 20 F Foley catheter and a plastic micropipette tip. The complications encountered included peritubal leak in three patients (9%) and abdominal wall hematoma in one patient (3%). There was no procedure-related mortality. We recommend PEG for tube enteral feeding in patients who have lost the swallowing reflex.