Results of rebiopsy for suspected prostate cancer in symptomatic men with elevated PSA levels.

AIM OF THE STUDY: To develop indications for repeat biopsy in patients with suspected prostate cancer and first negative biopsy. MATERIALS AND METHODS: 148 consecutive patients, submitted to two or more biopsies for suspected prostate cancer, were extracted from our database on prostatic diseases. Patients were stratified according to the results of the last biopsy (benign or carcinoma) considering the results of the first and of the last biopsy when more than two biopsies had been performed. PSA velocity was calculated when the interval between PSA obtained before the initial and the final biopsy was at least 6 months; PSA velocities were annualized and absolute changes between the two groups were analyzed. RESULTS: Prostatic carcinoma was detected in 60 of the 148 patients (40.5%), including 19 of 41 (46.4%) with prostatic intraepithelial neoplasia (PIN) and 45 of 107 (42.1%) with normal tissue or prostatic epithelial atrophia on initial biopsy. 20% of patients (4 of 20) with low-grade PIN and 71.1% (15 of 21) with high-grade PIN had cancer at repeat biopsy. The mean PSA value of patients with carcinoma on the repeat biopsy was higher than that of patients without carcinoma (13.3 vs. 10.7 ng/ml). However, this difference was not statistically significant (p = 0.37). Mean PSA velocity increased for patients with a final diagnosis of carcinoma versus those without evidence of carcinoma (+0.3 vs. +1.4 ng/ml/year); this difference was statistically significant (p = 0.002). CONCLUSIONS: According to these results, patients with either PIN II-III, or high PSA and PIN I on initial biopsy, and/or with elevated PSA velocity (more than 1 ng/ml/year) should undergo repeat prostate needle biopsy, being at high risk of prostate carcinoma.

[Carcinoid of Vater's papilla. The authors' own experience]. / Il carcinoide della papilla di Vater. Esperienza personale.

Carcinoid tumours of the papilla of Vater, like all those of the gastroenteric tract, belong to the PUD system: in fact they excrete different amines and polypeptidic hormones that cause articulated and complex clinical features. We describe the clinical picture of a non secreting carcinoid tumour in a patient suffering from cholelithiasis in who jaundice has appeared after video-laparocholecystectomy; ERCP detected a papillary neoplasia which proved to be a carcinoid tumour at immunohistochemical investigation. The patient was submitted to surgical removal of the neoplasia by the trans-duodenal way. This kind of operation was chosen considering the small dimension of the tumour, the absence of lymph nodal and hepatic involvement and the elevated risk of pancreaticoduodenectomy. Eight months later hematic gastrine, NSE and total body scintigraphy with octreotide have shown normal values and the patients is in good clinical condition. The diagnosis of these tumours is always difficult when the typical hormonal syndrome is not present. The prognosis of this kind of tumours is better than others of the gastrointestinal tract due to the early symptoms (jaundice), and, consequently, of the treatment. A strict follow-up is recommended in these patients because a resumption of the tumour could also appear many years after the surgical intervention.

Procollagen type I carboxyterminal extension peptide in serum: a reliable marker of bone metastatic disease in newly diagnosed prostate cancer?

OBJECTIVE: This study evaluates the accuracy of type I procollagen, a bone matrix glycoprotein, and prostate-specific antigen (PSA) as markers for predicting the results of radionuclide bone scan in newly diagnosed, previously untreated patients with prostate cancer. METHODS: 74 patients underwent serum PSA and procollagen determination using specific antibodies. A staging radionuclide bone scan was then performed; patients with positive bone scan were submitted to x-rays of the suspicious zones. Then, we calculated sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of procollagen and PSA in the detection of bone metastases. RESULTS: Procollagen alone had 83.3% sensitivity, 96% specificity, 90.9% positive predictive value, 92.3% negative predictive value and 91.9% overall accuracy. PSA alone had 70.1% sensitivity, 86% specificity, 70.8% positive predictive value, 86% negative predictive value and 81.1% overall accuracy. CONCLUSIONS: According to our data, we no longer perform a staging radionuclide bone scan in patients with PSA < 20 ng/ml and normal procollagen level, diminishing the number of radionuclide bone scans and increasing the overall net savings for the health care system.

Comparison between digital rectal examination, prostate-specific antigen and transrectal ultrasound in symptomatic patients. Results on 141 cases.

In this study we proposed to verify sensitivity and specificity of prostate-specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasound (TRUS) in patients who referred at our institution for prostatic complaints. 141 patients, ages ranging between 55 and 86 years (mean 67.5), underwent DRE, blood PSA, TRUS and ultrasonically guided biopsy of the prostate. The comparison of the results obtained with the different diagnostic tools allowed us to draw a diagnostic algorithm for prostate cancer in symptomatic patients.