Ultrasound detection of prostatic calculi as a parameter to predict the appearance of hematospermia after a prostate biopsy

ABSTRACT Purpose: We evaluated the correlation between prostate calculi and hematospermia in patients undergoing prostate biopsy, and its impact on sexual activity of patients. Materials and Methods: A single-center prospective randomized study of 212 patients referred for transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed. All patients were divided into two groups: Group A (GA), 106 patients with moderate/marked presence of prostatic calculi visualized by TRUS; Group B (GB), 106 patients with absence/scarce of prostatic calcifications. Patients were handed questionnaires to obtain a validated data on the duration and impact of hematospermia on sexual activity. The anxiety scores were recorded using a visual analogue scale. Results: No significant difference was noted between the two groups when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for digital rectal examination (DRE) findings. Post-biopsy results of patients included in GA revealed that the complication of hematospermia was present in 65.1%, while in GB was present in 39.7% (p<0.001). On multivariate analysis for identifying significant preoperative predictors of hematospermia, which included variables of age, PSA, prostate volume, and prostate cancer were not shown to be significant predictors of hematospermia, except DRE and prostate calculi (p<0.001). The mean anxiety score was 3.7±2.8 in GA and 2.3±1.9 in GB, respectively (p<0.001). Conclusions: Prostatic calculi are an independent predictive factor of severe hematospermia after TRUSBx on the basis of multivariate analysis, but don't affect the positive rate of prostate cancer. Patients should be adequately counselled before TRUSBx to avoid undue anxiety and alterations in sexual activity.

Changing profile of prostatic abscess

PURPOSE: To compare the clinical presentation of prostatic abscess and treatment outcome in two different time frames with regards to etiologies, co-morbid factors and the impact of multidrug resistant organism. MATERIALS AND METHODS: We retrospectively assessed the charts of 48 patients with the diagnosis of prostatic abscess from 1991 to 2005. The period was divided arbitrarily into two different time frames; phase I (1991-1997) and phase II (1998-2005). Factors analyzed included presenting features, predisposing factors, imaging, bacteriological and antibiotic susceptibility profile, treatment and its outcome. RESULTS: The mean patient age in phase I (n = 18) and phase II (n = 30) were 59.22 ± 11.02 yrs and 49.14 ± 15.67 respectively (p = 0.013). Diabetes mellitus was most common predisposing factor in both phases. Eleven patients in phase II had no co-morbid factor, of which nine were in the younger age group (22 - 44 years). Of these eleven patients, five presented with pyrexia of unknown origin and had no lower urinary tract symptoms LUTS Two patients with HIV had tuberculous prostatic abscess along with cryptococcal abscess in one in phase II. Two patients had melioidotic prostatic abscess in phase II. The organisms cultured were predominantly susceptible to first line antibiotics in phase I whereas second or third line in phase II. CONCLUSION: The incidence of prostatic abscess is increasing in younger patients without co-morbid factors. The bacteriological profile remained generally unchanged, but recently multi drug resistant organisms have emerged. A worrying trend of HIV infection with tuberculous prostatic abscess and other rare organism is also emerging.

Prostatic cryptococcosis: a case report

Cryptococcosis is a systemic mycosis usually affecting immunodeficient individuals. In contrast, immunologically competent patients are rarely affected. Dissemination of cryptococcosis usually involves the central nervous system, manifesting as meningitis or meningoencephalitis. Prostatic lesions are not commonly found. A case of prostate cryptococcal infection is presented and cases of prostatic cryptococcosis in normal and immunocompromised hosts are reviewed. A fifty-year-old HIV-negative man with urinary retention and renal insufficiency underwent prostatectomy due to massive enlargement of the organ. Prostate histopathologic examination revealed encapsulated yeast-like structures. After 30 days, the patient's clinical manifestations worsened, with headache, neck stiffness, bradypsychia, vomiting and fever. Direct microscopy of the patient's urine with China ink preparations showed capsulated yeasts, and positive culture yielded Cryptococcus neoformans. This fungus was later isolated from cerebrospinal fluid and blood cultures, demonstrating thus its dissemination. The patient was discharged after 27 days in hospital and, despite a regimen of amphotericin B, he died four months later. This case points to cryptococcosis as a possible cause of prostatic disease and reinforces the importance of communication between the medical team and pathology and microbiology laboratories aiming at a more accurate diagnosis and successful treatment.

Association between prostate cancer and schistosomiasis in young patients: a case report and literature review

This case report refers to a 47-year old patient with prostate cancer associated with schistosomiasis mansoni, who was submitted to radical prostatectomy. This is the third report published in the literature with respect to this association, and up to the present time it is still not known whether a cause and effect relationship exists between the two pathologies. The association between schistosomiasis and cancer has been well-documented in bladder cancer; however, there are no data yet proving the association of this disease with prostatic neoplasia. In this report, a third documented case of prostatic adenocarcinoma and schistosomiasis mansoni is described and a literature review is performed.

Repeat prostate biopsies following diagnoses of prostate intraepithelial neoplasia and atypical small gland proliferation

OBJECTIVE: To assess the incidence of diagnosis of high-grade intraepithelial neoplasia or prostate intraepithelial neoplasia (PIN), and atypical small gland proliferation (ASAP) at a uropathology reference center. To assess the indexes and findings on repeat biopsies. MATERIALS AND METHODS: Diagnoses of PIN, ASAP or PIN + ASAP established between January 1, 2001 and December 31, 2003 were searched in our database. We studied repeat biopsies performed up to August 31, 2004. RESULTS: Of 1420 biopsies, ASAP was diagnosed in 26 (1.8 percent) patients, PIN in 142 (10 percent) and PIN + ASAP in 40 (2.8 percent). Repeat biopsies were performed in 98 patients, 16 (61.5 percent) with ASAP, 53 (37.3 percent) with PIN and 29 (72.5 percent) with PIN + ASAP. Carcinoma was diagnosed in 7 cases (43.8 percent) following a diagnosis of ASAP, 12 (41.4 percent) of PIN + ASAP and 7 (13.2 percent) of PIN. The mean interval between repeat biopsies was 299.6 days. There was no difference between groups where cancer was or was not diagnosed on repeat biopsy in relation to age and serum PSA levels. CONCLUSION: Despite explicit recommendations of repeat biopsy on pathology reports and the high incidence of adenocarcinoma on repeat biopsy, re-intervention rates following a diagnosis of PIN, ASAP, PIN + ASAP are low in our setting. The diagnosis that most frequently led to repeat biopsy was PIN + ASAP. Adenocarcinoma was most often diagnosed after the initial diagnosis of ASAP.

Hallazgos histológicos en resecciones transuretrales de próstata / Histological findings in transurethral resections of prostate

La resección transuretral prostática (RTUP) es un procedimiento quirúrgico que está indicado en el tratamiento de la hiperplasia prostática benigna obstructiva y en algunos casos de cáncer de próstata avanzado, con fines paliativos.El propósito de este trabajo es determinar cußles fueron los diagnósticos histopatológicos resultantes al analizar fragmentos de próstata obtenidos mediante RTU en el Hospital San Juan de Dios durante el año 2002. Los diagnósticos principales fueron: hiperplasia prostática benigna (89,01 por ciento), adenocarcinoma prostático (8,79 por ciento), prostatitis crónica granulomatosa (1,1 por ciento) en que el diagnóstico no pudo ser determinado.Se observó una buena correlación entre los diagnósticos histológicos y los clínicos que generaron la indicación de RTU.En conclusión existe una buena correlación clínico-histológica debido al adecuado uso de las herramientas diagnósticas.

Riesgo precoz de recidiva bioquímica en prostatectomizados radicales (T1c): aplicación de una ecuación predictiva validada / Precocious risk of biochemical recurrence in radical prostatectomy (Rp): application of a validated predictive equation

Muchos modelos predictivos de recidiva para cáncer de próstata (CaP) post prostatectomía radical (PR)son difíciles de aplicar y la tendencia es a encontrar modelos que consideren datos clínicos y patológicosde fácil y rápida obtención. El grupo de trabajo del Johns Hopkins Hospital desarrolló una ecuación deriesgo validada para identificar pacientes de alto riesgo de recidiva precoz de CaP (etapa clínica T1c),después de PR.Realizamos una revisión retrospectiva de pacientes sometidos a PR retropúbica por CaP etapa clínica T1,con un seguimiento mínimo de 6 meses. En estos pacientes aplicamos la ecuación Rw.De un total de 190 pacientes sometidos a PR en los últimos 7 años, encontramos 60 pacientes analizablesen etapa T1c. El promedio de seguimiento fue de 25,4 meses. Al aplicar la ecuación Rw encontramos unasensibilidad de 29 porciento, especificidad de 98 porciento, VPP de 83 porciento y VPN de 78 porciento. En nuestra serie la ecuación RWtiene una pobre sensibilidad pero una buena especificidad.

Patología prostática diagnosticada mediante biopsias en el servicio de anatomía patológica Dr Hans Doehnert del Hospital Central Universitario Antonio María Pineda (HCUAMP) de Barquisimeto durante el año 2000 / Prostatic pathology diagnosed by means of biopsies at the service of pathologycal anatomy Dr Hans Doehnert of the Hospital Central Universitario Antonio María Pineda

Se realizó una revisión de resultados de biopsia entr Enero y Diciembre del año 2000, tipo descriptiva longitudinal retrospectiva con la finalidad de analizar la patología prostática diagnosticada mediante biopsias en el Servicio de Anatomía Patológica Dr Hans Doehnert del Hospital Central Universitario "Antonio María Pineda" de Barquisimeto, para lo cual se seleccionaron 91 resultados con dichos diagnósticos. La patología más frecuente fue la Hiperplasia Prostática Benigna con Inflamación Crónica (39,6 por ciento), seguida de la Hiperplasia Prostática Benigna Aislada (31,8 por ciento), el Adenocarcinoma prostático fue diagnosticado en 9,9 por ciento de los casos. La Hiperplasia Prostática Benigna fue más frecuente entre 61 y 70 años (40 por ciento de los casos) y la prostatitis crónica entre 61 y 70 años (46 por ciento). En un 75,3 por ciento de los casos hubo correlación entre el diagnóstico preoperatorio y los hallazgos histológicos. El adenocarcinoma de próstata fue mas frecuente entre 71 y 75 años (37,5 por ciento), predominando los grados II y IV con un porcentaje de 37,5 por ciento cada uno. En la Neoplasia Intraepitelial Prostática el grado I se presentó con mayor porcentaje (63,6 por ciento)

Recomendaciones urológicas en pacientes masculinos: en edades donde se apliquen los conceptos de suplemento nutricional prostático (SNP) y/o de quimioprevención del cáncer prostático / Recomendation urological in male patients: in age where to apply the concept of prostatic nutritional supplement (SNP) and of prostate cancer chemoprevention

Este artículo tiene como objetivo primordial analizar el por que de cada recomendación que se le da a los pacientes masculinos en general, aunado a las recomendaciones de Suplemento Nutricional Prostático y/o Quimioprevención del Cáncer Prostático, sobre todo en poblaciones de alto riesgo de padecer un cáncer prostático (afroamericano, hijos de pacientes que han padecido cáncer prostático, pacientes con niveles séricos elevados de PSA total (por arriba de 2.5 ng/ml, o con alteraciones de cualquier otra fracción del PSA), incluyendo anormalidades de los índices oncológicos de la ecosonografía prostática endorrectal, pacientes con lesiones premalignas de cáncer prostático como el PIN (neoplasia intraepitelial prostática) de alto grado, la Hipertensión Adenomatosa Atípica (HAA), obtenidas en biopsias prostáticas por trucul, o en biopsias de prostatas resecadas o extirpadas quirúrgicamente (RTUP) o prostatectomías abiertas por presentar crecimiento prostático benigno sintomático (CPB), cosiderando todos los argumentos terapéuticos que están a nuestro alcance (agentes químicos sintétidos o naturales contenidos en los alimentos, raices o plantas) para reducir o inclusive eliminar con las recomendaciones analizadas y con el suplemento nutricional prostático, los síntomas urinarios de llenamiento y de vaciamiento vesical (irritativos- obstructivos) y con ello mejorar los cuestionarios de calidad de vida dependiendo de los síntomas urinarios molestos

Nivel de antígeno prostático específico en 100 sujetos con biopsia prostática / Serum level of prostatic specific antigen in 100 patients with prostatic biopsy

Objetivo. Caracterizar mejor los niveles de APE (antígeno prostático específico) en pacientes con biopsias prostáticas benignas y malignas. Métodos. Se estudiaron 100 pacientes con sospecha clínica de carcinoma prostático por elevación de APE y/o tacto rectal anormal, a los cuales se les realizó biopsia prostática. Resultados. Hubo 66 biopsias benignas y 34 carcinomas. Las medianas de APE fueron 11.2 y 45.6 ng/mL en benignos y malignos, respectivamente. En los pacientes con elevación ligera de APE (4-9.9 ng/mL. Sólo en aquéllos con 30+ hubo mayoría de carcinomas (81 por ciento). Conclusiones. Hubo una sobreposición significativa de los niveles de APE en pacientes con biopsias benignas y malignas. Solamente los valores de 30+ ng/mL fueron fuertemente sugestivos de carcinoma. Nuestros valores de APE están muy por arriba de los informados en la literatura y podrían deberse, cuando menos en parte, a las marcas de los reactivos empleados en nuestra institución (Cedex de Francia y Diagnostic Products Corp de EEUU)

Mast cell profile in prostatic lesions.

Mast cell profile in common prostatic lesions was analysed in this study. 17B consecutive prostatic biopsy specimens specimens were categorised broadly into nodular hyperplasia without prostatitis (101), nodular heperplasia with prostatitis (50, prostatic intraepithelial neoplasia (2) and adenocarcinoma (25). Toluidine blue stain (0.1%) was used to demonstrate the mast cells and their count was expressed per square millimeter. Mast cell count was significantly higher in the fibromuscular stroma when compared to the glandular areas in nodular hyperplasia (p < .05). The mast cell counts were very significantly lower in inflammatory lesions (p < 0.0001) probably due to degranulation. Absence or a low count was the most significant finding in adenocarcinoma irrespective of the grade of the tumour with concentration of mast cells around the tumour. This study shows the variations in mast cell distribution in commonly encountered prostatic lesions. There is paucity of such studies in the literature and the possible utility of mast cell count to differentiate malignant from benign and atypical conditions needs further evaluation.

Poliploidia em células cultivadas de lesões de próstata / Polyploidy in cultured cells of prostate lesions

O câncer prostático é uma das neoplasias mais frequentes em homens e, apesar da sua alta incidência na população, os dados citogenéticos são limitados quando comparados com outros tumores sólidos comuns. Esse fato provavelmente decorre das dificuldades referentes ao cultivo de suas células e, consequentente, da obtenção de boas preparações cromossômicas. O objetivo deste trabalho foi investigar com técnicas citogenéticas, após culturas de curta duração, quatro adenocarcinomas prostáticos, três hiperplasias nodulares da próstata e duas prostatites crônicas. Todas as amostras apresentaram células com número cromossômico próximo ao tetraplóide e, em alguns adenocarcinomas, foram observados cromossomos em anel, double minutes, figuras trirradiais e fragmentos acêntricos

Infecção por Cryptococcus limitada à próstata em paciente aidético com micobacteriose disseminada: relato de necropsia / Cryptococcus infection limited to the prostate in an AIDS patient with disseminated mycobacteriosis: a necropsy report

Relata-se caso de infecção criptocócica confinada à próstata, como achado de necropsia, em homem de 32 anos portador da síndrome da imunodeficiência adquirida (SIDA) com micobacteriose disseminada. Enfatiza-se a importância do achado incidental em necropsia e a persistência dessa infecção micótica na próstata.

This is a case report of asymptomatic and restrained cryptococcal prostatic infection in a 32-year-old black male with the acquired immunodeficiency syndrome, whose death was caused by systemic mycobacteriosis probably pertaining to MAI complex. The importance of autopsy studies to evaluate the real prevalence of fungus infections in AIDS patients, specially in cases of persistent silent focuses, is emphasized.

Low grade adenocarcinoma simulating benign glandular lesions in needle prostatic biopsy

Con el fin de definir la frecuencia y las características morfológicas de los adenocarcinomas de bajo grado que fueron confundidos con proliferaciones glandulares benignas, revisamos retrospectivamente 135 biopsias con carcinoma prostática. Tres biopsias (2.2 por ciento) mostraron adenocarcinomas de bajo grado en campos aislados que semejaban glándulas hiperplásicas en algunos campos histológicos y adenosis prostática en otros. Estas tres biopsias mostraron retrospectivamente características del adenocarcinoma prostático originado en la zona de transición. Algunos criterios de malignidad como el patrón infiltrante, los núcleos y nucléolos prominentes fueron observados aisladamente. No se identificaron secreciones basófilas intraluminales, cristaloides, células neoplásicas aisladas en el estroma ni mitosis en ningún caso. Concluímos que el análisis detallado de las características arquitecturales y citológicas de las proliferaciones glandulares prostáticas es necesario ya que el adenocarcinoma de bajo grado se puede encontrar esporádicamante como patrón histológico único en las biopsias por punción semejando lesiones glandulares benignas

Cytohistomorphology of prostatic lesions--by FNAC & scrape methods.

A pilot study of transrectal fine needle aspiration biopsy was conducted in 44 patients, above the age of 50 years, who presented with features of obstructive uropathy during a one year period between August 1990 and April 1991. Histopathological study was carried out in 23 out of 44 patients, who underwent total prostatectomy or transurethral resection following the aspiration biopsy procedure. In 21 patients FNAB by the transrectal route could not be obtained because of technical difficulties; therefore intraoperative scrape cytology was studied prior to histopathology, of the fresh prostatic specimen. A good cytohistopathological correlation was obtained by both methods; an accuracy of 95.6% and 95.2% with FNAC and scrape respectively. A wide range of benign and malignant lesions were studied.

Estudo crítico de 120 casos de biopsia transretal de próstata / Critical study of 120 cases of transrectal biopsies of the prostate

Foram realizados biopsias transretais de próstata em 120 pacientes com toque suspeito de carcinoma, utilizando-se agulha de Franklin-Silvermann modificada e sob anestesia local. Os resultados obtidos foram: 47,5% de adenocarcinoma; 28,3% de hiperplasia benigna; 10,8% prostatile crônica; 9,2% sem alteraçöes histológicas e 4,2% inconclusivas. Em cinco pacientes houve necessidade de repetiçäo do procedimento, para a confirmaçäo diagnóstica. Conclui-se que a biopsia é de grande valia para o diagnóstico do carcinoma de próstata e ressaltam a alta possibilidade de erro do toque retal, mesmo nos casos sugestivos de caráter neoplásico