Hepatotoxicidad por tamsulosina / dutasterida: reporte de un caso probable

La tamsulosina y dutasterida son medicamentos ampliamente usados como tratamiento de la hipertrofia benigna de próstata. teniendo un buen perfil de seguridad. Existen escasos reportes de injuria hepática asociado al uso de tamsulosina; sin embargo, no hay reportes de toxicidad hepática por el uso de dutasterida y del uso combinado de tamsulosina/dutasterida. Se presenta el caso de un varón de 64 años quien desarrolla injuria hepática tras el uso combinado de tamsulosina/dutasterida, desarrollando un patrón de daño hepatocelular y clínica de hepatitis aguda. Se realizo descarte de patología hepática viral, autoinmune y enfermedades metabólicas de depósito, así como de patología biliar mediante ecografía abdominal y colangioresonancia. En la evaluación de causalidad, presentó CIOMS-RUCAM: 6 puntos (probable) y Naranjo: 4 puntos (posible). El paciente presentó respuesta clínica y laboratorial luego de suspender el medicamento.

Tamsulosin and dutasteride are drugs widely used to treat benign prostatic hypertrophy. having a good safety profile. There are few reports of liver injury associated with the use of tamsulosin; however, there are no reports of hepatic toxicity from the use of dutasteride and the combined use of tamsulosin/dutasteride. We present the case of a 64-year-old man who developed liver injury after the combined use of tamsulosin/dutasteride, developing a pattern of hepatocellular damage and acute hepatitis symptoms. Viral, autoimmune, and metabolic storage diseases of the liver were ruled out, as well as biliary pathology by means of abdominal ultrasound and resonance cholangiography. In the causality evaluation, CIOMS-RUCAM presented: 6 points (probable) and Naranjo: 4 points (possible). The patient presented a clinical and laboratory response after discontinuing the drug.

Utilidad del antígeno prostático específico total y del índice de antígeno prostático específico libre para detectar cáncer de próstata en el paciente asintomático / Utility of total prostate-specific antigen and free prostate- specific antigen index to detect prostate cancer in the asymptomatic patient

Resumen El antígeno prostático específico (PSA) en circulación se encuentra ligado a la alfa-1-quimiotripsina y una pequeña fracción circula de manera libre (PSAl). Se valoró la utilidad clínica del PSA total (PSAt) y el índice de PSA libre para la detección de cáncer prostático en pacientes asintomáticos. Se cuantificó el PSAt, el PSAl y el índice de PSAl en 364 pacientes estratificados por grupo de edad. La frecuencia de valores anormales de PSAt fue del 8,79% (32/364). El grupo de 50-59 años presentó la mayor incidencia de resultados anormales (19/32). No hubo diferencia estadísticamente significativa entre PSAt y el índice de PSAl (p<0,05). El índice PSAl puede potencializar el valor del PSAt para determinar la presencia o ausencia de cáncer prostático. Un índice superior a 0,24 ng/mL puede ayudar a evitar o posponer la indicación de biopsia, principalmente cuando los valores de PSAt están entre 4 y 10 ng/mL.

Abstract Circulating prostate-specific antigen (PSA) is bound to alpha-1-chymotrypsin and a small fraction is free (PSAl). The clinical utility of the total PSA (PSAt) and the PSAl index for prostate cancer screening in asymptomatic patients was assessed. PSAt, PSAl and the PSAl index were quantified in 364 patients stratified by age group. The frequency of abnormal PSAt values was 8.79% (32/364). The 50-59 year-old group presented the highest incidence of abnormal results (19/32). There was no statistically significant difference between PSAt and the PSAl index (p<0.05). The PSAl index can potentiate the PSAt value to determine the presence or absence of prostate cancer. An index greater than 0.24 ng/mL can help to avoid or postpone the indication for a biopsy, especially when the PSAt values are between 4 and 10 ng/mL.

Resumo O antígeno prostático específico (PSA) em circulação é ligado à alfa-1-quimotripsina e a uma pequena fração circula livremente (PSAl). A utilidade clínica do PSA total (PSAt) e do índice de PSAl livre para o rastreamento do câncer de próstata em pacientes assintomáticos foi avaliada. PSAt, PSAl e o índice de PSAl foram quantificados em 364 pacientes estratificados por faixa etária. A frequência de valores anormais de PSAt foi de 8,79% (32/364). O grupo de 50-59 anos apresentou a maior incidência de resultados anormais (19/32). Não houve diferença estatisticamente significativa entre o PSAt e o índice PSAl (p<0,05). O índice PSAl pode potencializar o valor do PSAt para determinar a presença ou ausência de câncer de próstata. Um índice superior a 0,24 ng/mL pode ajudar a evitar ou adiar a indicação de biópsia, principalmente quando os valores de PSAt estão entre 4 e 10 ng/mL.

A Study of Immunohistochemical Expression of Epidermal Growth Factor Receptor in Prostatic Lesions

Epidermal growth factor receptor (EGFR) is a 170-kDa tyrosine kinase transmembrane glycoprotein expressed in normal tissues in many organs and different types of tumours. In prostate, EGFR is expressed mainly in epithelial cells, phosphorylation of EGFR (pEGFR) which is assessed by immunohistochemical methods could be useful prognostic marker for prostate cancer cases. Tumours may affect the surrounding non-malignant tissue and pEGFR immunoreactivity in the morphologically normal prostate tissue can be used to retrieve prognostic information. In this study the membranous and cytoplasmic expression of EGFR is checked in both the basal and luminal cells. Intensity of the staining and the pattern of the staining were noted in benign, in-situ and malignant lesions and it was found that the staining intensity of the luminal cells increase with a subsequent decreased staining in the basal layer as the lesion progress towards malignancy. Subsequently the staining intensity and patterns were correlated with the Gleason grade for triaging of the cases into different prognostic groups.

Clinical Observation of Fire-needle Acupuncture for Benign Prostatic Hyperplasia / 上海针灸杂志

Objective To observe the therapeutic efficacy of fire-needle acupuncture in treating benign prostatic hyperplasia. Method Sixty subjects were randomized into two groups by using the sealed envelope method. The control group was intervened by conventional medications; after classified into four syndrome types, down diffusion of damp-heat, liver qi stagnation, turbid stagnation and kidney qi deficiency, the treatment group was majorly treated with fire-needle acupuncture in addition to filiform-needle acupuncture. Fire-needle acupuncture was performed at Guanyuan (CV4), Qugu (CV2) and bilateral Dahe (KI12), once a week, for continuous 6 months; the filiform-needle acupuncture was majorly at Baihui (GV20) and Qihai (CV6) with adjunctive points modified according to different syndromes, twice a week, 8 sessions as a treatment course, for 5 courses in total. Result The improved rate was significantly higher in the treatment group than in the control group (P<0.05);the residual urine volume was significantly changed after the intervention in both groups (P<0.01), and the decrease in the treatment group was more significant than that in the control group (P<0.05). Conclusion Fire-needle acupuncture can improve the symptoms of benign prostatic hyperplasia and lower the residual urine volume.

Application of 12Fr catheter in catheteration for patients with prostatic hypertrophy / 现代临床护理

Objective To investigate the effect of 12 Fr catheter on the catheteration for the patients with prostatic hypertrophy after stroke. Methods One hundred and four sixteen patients with prostatic hypertrophy from urinary detention were divided into the control group (n=80) and the observation group (n=84) based on the odd and even numbers of admission date according to a digit random table. The control group received catheteration with a 14~20 Fr catheter, and the observation group did with a 12 Fr catheter. The two groups were compared in terms of pains, urethral injury and leakage of urine during intubation. Result The pain, urethral injury, leakage of urine in the observation group were all significantly lowered than those of the control group (all P<0.05). Conclusions 12 Fr catheter for catheteration for the patients with post-stroke prostatic hypertrophy can significantly reduce the degree of pain, the urethral injury and leakage of urine. Thus it is worthy of clinical application.

Effect of some antioxidants on the prostate of adult and aged albino rats: a histological and immunohistochemical study.

Effect of some antioxidants on the prostate of adult and aged albino rats. Twenty-five adult and twenty-five aged male albino rats were divided into four groups: group I (control group) group II (zinc sulphate treated group), group III (vitamin E) & group IV (vitamin C) zinc administered in doses of 0.2673 mg for adult rat and 0.693 mg for aged rat, vitamin E administered in doses of 0.973 mg for adult rat and 2.52 mg for aged rat, vitamin C administered in doses of 1.215mg for adult rat and 3.15 mg for aged rat. The prostate glands were processed and stained by H&E, Masson trichrome & immunoreaction of androgen receptor for light microscopic examinations. Morphometric analysis for collagen fibers and immunoreaction area percent was performed and statically analyzed. Zinc showed improvements, in which decrease in number of mucosal fold and increase in immunoreactions of nuclear androgen receptor in ventral lobe also, Decrease fibrosis and increase in immunoreactions of nuclear androgen receptor in dorsolateral lobe. vitamin E showed improvements, in which decrease in number of mucosal fold, decrease size of acini, decrease of epithelial heights and increase in immunoreactions of nuclear androgen receptor in ventral lobe also, decrease of epithelial heights, decrease fibrosis and increase in immunoreactions of nuclear androgen receptor in dorsolateral lobe. vitamin C there were improvements, in which decrease in number of mucosal fold, dilatation of acini and slightly increase in immunoreactions of nuclear androgen receptor in ventral lobe also, rarified collagenous fibers and increase in immunoreactions of nuclear androgen receptor in dorsolateral lobe. It also ameliorated blood vessels congestion. Zinc, vitamin E and vitamin C exerted no harmful effects on adult prostate but ameliorated effects against aged prostate.

Prevalencia de hiperplasia benigna de próstata en mayores de 40 años como causa de insuficiencia renal crónica / Prevalencia of benign prostatic hyperplasia at age 40 as a cause of chronic renal failure

Con el objetivo de determinar la prevalencia de uropatía obstructiva crónica en pacientes mayores de 40 años con insuficiencia renal crónica como consecuencia de hiperplasia benigna de próstata (HBP), se desarrolló un estudio observacional, descriptivo y retrospectivo en una población conformada por todos los pacientes varones mayores de 40 años con insuficiencia renal crónica (IRC) como consecuencia de hipertrofia benigna de próstata, atendidos en el consultorio de Nefrología del Hospital EsSalud “Augusto Hernández Mendoza” de la ciudad de Ica, entre Mayo del 2011 y Abril del 2012; encontrándose que la edad promedio fue 74,3 ±0,9 años, el tiempo promedio de insuficiencia renal crónica fuede 28,8±1,2 meses, 62 (53,4 %) pacientes presentaron comorbilidades, siendo la diabetes mellitus la más frecuente (37; 31,9%), 62 (53,4%) pacientes recibían tratamiento farmacológico, 35 (30,17%) presentaron uropatía obstructiva crónica, con un tiempo de enfermedad promedio de 24,8±2,2 meses, ademas la presencia de diabetes mellitus (6; 16,2%) y la administración de antagonistas de calcio (7; 58,3%) se asociaron a uropatía obstructiva crónica; concluyendo que la uropatía obstructiva crónica es frecuente en el paciente con IRC a consecuencia de HBP y se asocia a diabetes mellitus y tratamiento con antagonistas de calcio. (AU)

In order to determine the prevalence of chronic obstructive uropathy in patients older than 40 years with chronic renal failure as a result of benign prostatic hyperplasia (BPH ) , an observational, descriptive and retrospective study was conducted in a population consisting of all male patients over 40 years with chronic (CRF) renal failure as a result of benign prostatic hypertrophy, served in the office of Nephrology Essalud " Augusto Hernandez Mendoza" Hospital of the city of Ica, between May 2011 and April 2012 , finding that the average age was 74.3 +/- 0.9 years, the average time of chronic renal failure was 28.8 +/- 1.2 months, 62 ( 53-4%) patients had comorbidities , diabetes mellitus being the most frequent ( 37, 31.9%) , 62 ( 53-4%) patients received pharmacological treatment, 35 ( 30.17 %) had chronic obstructive uropathy with a mean disease duration of 24.8 +/- 2.2 months, plus the presence of diabetes mellitus (6 , 16.2% ) and administration of calcium antagonists (7 , 58.3 % ) were associated with chronic obstructive uropathy, concluding that chronic obstructive uropathy is common in patients with CRF as a result of BPH associated with diabetes mellitus and calcium antagonist therapy. (AU)

Clinical effect of suprapubic transvesial prostatectomy for the treatment of patients with large volume and high-risk benign prostatic hypertrophy / 中国基层医药

Objective To evaluate the safety and efficacy of suprapubic transvesial prostatectomy for the treatment of patients with large volume and high-risk benign prostatic hypertrophy in basic hospital.Methods The clinical datas of 85 patients with large volume and high-risk benign prostatic hypertrophy for suprapubic transvesial prostatectomy in our hospital were retrospectively analyzed.The operating time,intra-operative blood loss,the mean bladder irrigating time,catheration time,hospital stay and operative complications were observed.The indices such as IPSS,QOL,Omax and PVR were recorded preoperatively,and at 6 and 12 months postoperatively.Results The mean operating time was (63.5 ± 18.2) min,the intra-operative blood loss was (121.3 ± 10.6) ml,the mean bladder irrigating time was (4.2 ±0.6)days,the catheration time was (5.1 ± 1.7) days and the hospital stay was (7.8 ±2.3)days.At 6 and 12 months postoperatively,IPSS,OOL,Omax and PRV were significantly different compared with those preoperatively(all P ＜0.05).There were few complications and great patients satisfaction with the post-operative results.Conclusion suprapubic transvesial prostatectomy for the treatment of patients with large volume and high-risk benign prostatic hypertrophy has significant advantages of good safety,simple operation,reliable efficacy in basic hospital.It is an effective and alternative method.

Predicting Outcome of Trial of Voiding Without Catheter in Acute Urinary Retention with Intravesical Prostatic Protrusion

Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed. Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP. Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041). Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment.

A clinical research of transurethral plasmakinetic resection of prostate for benign prostatic hyperpla-sia / 中国医师杂志

Objective To investigate clinical efficacy and safety and complications of transurethral plasmakinetic resection of prostate ( PKRP) for benign prostatic hyperplasia ( BPH) .Methods Totally 186 BPH patients were underwent PKRP .Comparison of clinical parameters before and after operation .Results Following-up at 3 and 6 months after the operation showed that international prostate symptom score ( IP-SS),quality of life(QQL),residual urine volume(RUV) scores increased and maximal urinary flow rate ( Qmax) scores decreased .The incidence of complications was 8.2%.Conclusion PKRP have efficacy in the treatment of BPH , and PKRP is safer and less complications .

Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience?

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

Modified retropubic prostatectomy for the treatment of benign prostatic hyperplasia / 中国基层医药

Objective To evaluate modified retropubic prostatectomy in the treatment of benign prostatic hyperplasia.Methods Modified retropubic prostatectomy was carried out for 56 cases of benign prostatic hyperplasia and the patients were followed up for 1～24 months.Results The procedure were satisfactory in all with less complication.Conclusion Modified retropubic prostatectomy is belived to be the idea surgical procedure for the treatment of benign prostatic hyperplasia.

Intraluminal enucleation in transurethral vaporization and electro-resection of the prostate / 中国基层医药

Objective To investigate the clinical efficacy of intraluminal enucleation in transurethrat vapor- ization and electro-reesection of the prostate.Methods A retrospective analysis was reviewed in 62 case of prostatic hypertrophy,which were treated with intraluminal enucleation in vaporization of prostate.All pacients had a sucessful operation.There were 12 case in unipolar vaporization and 50 in plasmakenitic bipolar vaporization.Results Opera- tion time ranged from 50 to 162 minutes,with an average of 76min.Bleeding ranged from 40 to 200 ml,with an av- erage of 110ml.There was no blood transfusion.The weight of prostate was 62～138g,the catheter was maintained for 3～5 days postoperatively.The hospital stay was 7～10 days,average 8 days.All patients were cured.There was a fllow-up for 1～20 months,with an average of 8 months.The IPSS decreased by 22 points on average,and peak urine flow(Qmax)increasd to(16.8?3.3)ml/s.There wre no urethralstricture,permanent urinary incontinence, TURS,postoperative hemorrhage,retrograde ejaculation and recurrence.Conclusions Intraluminal enucleation in treatment of prostalic hypertroply is a new,safe,and effective method,which should be popularized in clinical prac- tice.

Treatment of Prostatic Hyperplasia by Plum-blossom-magnet-needle Synthetic Therapy:A Report of 149 Cases / 针灸推拿医学（英文版）

Purpose: To observe the therapeutic effect of plum-blossom-magnet-needle synthetic therapy on benign prostatic hyperplasia (BPH). Method: 219 cases of BPH patients were randomly divided into two groups. There were 149 cases in treatment group, which treated by pressing, needling with plum-blossom-magnet-needle and putting effect-increasing pads on Prostate Reflex Area, bilateral Zhongliao (BL 32), Neck 1, Neck 7, Mingmen (GV 4) and Yongquan (KI 1). There were 70 cases in control group, which treated by orally taken Terazosin Hydrochloride (Gaoteling) tablets, 2 mg/time, twice a day. The therapeutic course was 4 weeks.After one therapeutic course, the therapeutic effect was evaluated. Results: The marked effect rate was 63.3% and total effective rate was 91.8%; in the control group, there were no markedly effective cases and the total effective rate was 72.7%. There was a significant difference between two groups (P<0.05). Conclusion: The plum-blossom-magnet-needle synthetic therapy had a significant therapeutic effect for the treatment of benign prostatic hyperplasia (BPH), so it was a safe and effective therapy for BPH.

Observation on Therapeutic Effect in Treatment of Prostate Hyperplasia by Needle-warming Moxibustion / 针灸推拿医学（英文版）

With Shenshu (BL 23), Ciliao (BL 32), Pangguangshu (BL 28), Huiyin (CV 1) and Zhibian (BL 54) as the main acupoints, and with Sanyinjiao (SP 6), Zhongji (CV 3) and Guanyuan (CV 4) as the combined acupoints, 51 cases of the patients sick with prostatic hypertrophy were treated by acupuncture, together with 47 cases treated with oral administration of Terazosin Hydrochloride Tablets as the control group. The total effective rate was respectively 88.2% and 70.2% in the two groups, better in the former than in the latter (P＜ 0.05).

Prostatosis Treated with Acupuncture and Herbal Medicine / 针灸推拿医学（英文版）

According to differentiation of symptoms and signs, prostatosis was divided into pattern of dampness and heat in the lower energizer, pattern of qi stagnation and blood stasis, pattern of deficiency and cold in the lower abdomen, and pattern of qi deficiency and kidney deficiency. Prostatosis were treated mainly by acupuncture, plus moxibustion and Chinese medicine, and the effect was good.

Curative Effect of Electro-acupuncture and Tuina on Prostatic Hypertrophy / 针灸推拿医学（英文版）

Objective To observe the curative effect of electro-acupuncture plus Tuina on prostatic hypertrophy.Method Fifty-six cases of prostatic hypertrophy were treated according to the principle of taking the kidney as the main aspect. Points Guanyuan (CV 4), Qugu ( CV2), Shenshu(BL 23), Ciliao(BL32) and Sanyinjiao( SP6) were selected and electro-acupuncture were used together with Tuina. Those who took the tablet Finasteride orally were treated as the control group. Result The total effective rate was 94.6% in treating group, while that was 86.7% in the control group, P＞0.05. Conclusion It is suggested that electro-acupuncture plus Tuina has a certain effect on prostatic hypertrophy. Compared with western medicine, it is lower in price and has no side effect.

Changes of some of urodynamic indexes in patiens with benign prostatic hypertrophy

30 patients with benign prostatic hypertrophy, aged 69.2  8.58, at Hue Central Hospital were studied from November 2001 to April 2002. Disuria was the main symptoms, accounted for 60%. Ultrasound showed that 100% of cases had large size of the tumors with mean weight of 80.3  58.1g. Pre-operative indices were: bladder residual volume 207.5  139ml, urine voided time 43.7  19.4 seconds, voided volume 84.2  47.5 ml, mean flow of urine 2.5  1.93ml/second, and post-operative indices were 84.2  72.3ml, 40.1  21.8 seconds, 118.3  46.7 ml, 4.5  3.34 ml/second respectively

Effect of Prostatectomy on Detrusor Instability Associated with Benigh Prostatic Hyperplasia: 11 Cases

PURPOSE: Detrusor instability is common in men with benign prostatic hypertroplasia(B.P.H.) and known to be reversed in about two thirds of patients after operation. We evaluated the fate of detrusor instability in B.P.H patients after operation. MATERIALS AND METHODS: In 11 patients with urgency or urge incontinence combined with B.P.H., cystometries were performed at baseline and 3 months after operation. RESULTS: Detrusor instability associated with B.P.H was reversed postoperatively in 7 patients (63.6%). CONCLUSIONS: Detrusor instability with urgency or urge incontinence can be managed by operation for B.P.H. This will improve the quality of life for B.P.H. patients.

Effects of Benign Prostatic Diseases on the Level of Serum Prostate Specific Antigen / 대한비뇨기과학회지

PURPOSE: Prostatic specific antigen (PSA) may be elevated in patients with benign prostatic diseases. We evaluated the causes of elevated serum prostatic specific antigen concentration in men without prostatic carcinoma by periodic determination of serum PSA. MATERIALS AND METHODS: From January 1996 to December 2000, of the 85 patients with elevated serum PSA (>4 ng/ml), 53 (62.4%) had clinical evidence of benign prostatic diseases such as BPH or acute prostatic inflammation. In 47 patients serum PSA was measured every 1-4 weeks until the PSA returned to base line level. RESULTS: In 42 (89.4%) patients the serum PSA concentration decreased to less than 4 ng/ml. within 3 months. The recovery rate of serum PSA within 4 weeks was high at 69% (29 of 42). The base line PSA was greater than 4 ng/ml during the follow-up period of 3 months in five patients. An elevation of PSA by acute prostatic inflammation (mean 34.1 40.0ng/ml) was abrupt and significantly greater than by prostatic hyperplasia (12.4 9.4 ng/ml, p=0.026). In patients with BPH, an initial elevation in serum PSA correlated with prostatic volume (r2=0.211, p=0.036), but no significant correlations between prostatic volume and elevated PSA levels were observed in patients with acute prostatic inflammation (r2=0.051, p=0.480). CONCLUSIONS: Benign prostatic hypertrophy and acute prostatic inflammation were main benign causes for serum PSA elevation. Majority of patients with elevated PSA by benign causes returned to base line less than 4 ng/ml in 4 weeks. However in some patients the serum PSA still remained elevated after 4 weeks, who should undergo TRUS guided biopsy of prostate to rule out the presence of malignancy. We recommended to wait at least 6 weeks for a repeat PSA determination.