Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml / Usefulness and Predictive Value of PSA Density, Adjusted by Transition Zone Volume, in Men With PSA Levels Between 2 and 4 ng/ml

Objetivo: Evaluar la significación diagnóstica del PSA, de su densidad (PSAD) y de la PSAD ajustada por el volumen de la zona de transición (PSATZD) en hombres con valores de PSA entre 2,0 y 4,0 ng/ml. Material y métodos: Entre los años 2000 y 2010, 138 hombres con niveles de PSA entre 2,0 y 4,0 ng/ml fueron sometidos a ultrasonografía transrectal (USTR) y biopsia prostática de 12 fragmentos. Se investigó la precisión diagnóstica de varios puntos de corte de la PSAD y de la PSATZD en rangos de PSA de 2,0 a 3,0ng/ml y de 3,1 a 4,0ng/ml. Resultados: La tasa de detección del cáncer de próstata fue del 23,9% (32/134). El porcentaje de pacientes con enfermedad extracapsular fue del 28,1% (10/32) y se obtuvieron primarios de grado Gleason 4 o 5 en 8 de 32 casos (25%). El volumen de la zona de transición y la PSATZD en los casos de cáncer fueron significativamente diferentes en comparación con los obtenidos en los casos sin cáncer. El área bajo la curva de la característica operativa del receptor (ROC) de la PSATZD fue significativamente mayor que la de la PSAD en los mismos rangos de subdivisión del PSA. La eficiencia diagnóstica de la PSATZD fue mayor que la de la PSAD. La eficiencia diagnóstica fue mayor en los niveles de corte de PSATZD de 0,23 y 0,28 en hombres con valores de PSA de 2,0 a 3,0ng/ml y de 3,1 a 4,0ng/ml, respectivamente. Conclusiones: El uso de puntos de corte de la PSATZD como indicación para biopsias evitaría muchas biopsias innecesarias sin pasar por alto la mayor parte de cánceres de próstata en el rango de PSA de 2,0 a 4,0ng/ml (AU)

Objective: To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0ng/ml. Material and methods: Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0ng/ml and 3.1 to 4.0ng/ml. Results: The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0ng/ml and 3.1 to 4.0ng/ml, respectively. Conclusions: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0ng/ml (AU)

[Usefulness and predictive value of PSA density, adjusted by transition zone volume, in men with PSA levels between 2 and 4 ng/ml]. / Utilidad y valor predictivo de la densidad de PSA ajustada por el volumen de la zona de transición en hombres con niveles de PSA entre 2 y 4 ng/ml.

OBJECTIVE: To assess the diagnostic significance of prostate-specific antigen (PSA), density (PSAD) accuracy, and PSAD adjusted by transition zone volume (PSATZD) in men with PSA levels between 2.0 and 4.0 ng/ml. MATERIAL AND METHODS: Between 2000 and 2010, 138 men with PSA levels between 2 and 4.0 ng/ml underwent transrectal ultrasonography (TRUS) and 12-core prostate biopsy. Diagnostic accuracies for various cut-offs of PSAD and PSATZD were investigated according to subdivided PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml. RESULTS: The detection rate of prostate cancer was 23,8% (32/134). The percentage of patients with extracapsular disease was 28.1% (10/32) and primary Gleason grade 4 or 5 was obtained in 8/32 (25%) patients. The transition zone volume and PSATZD in cancer cases were significantly different in comparison with those in non-cancer cases. The area under the receiver operating characteristic curve for PSATZD was significantly higher in comparison with that for PSAD in the same subdivided PSA ranges. The diagnostic efficiency for PSATZD was higher than that for PSAD. The diagnostic efficiency showed the highest value at the cut-off level for PSATZD of 0.23 and 0.28 in men with PSA levels of 2.0 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively. CONCLUSIONS: The use of PSATZD cut-offs as a biopsy indication may reduce many unnecessary biopsies without missing most prostate cancer cases in the PSA range of 2.0 to 4.0 ng/ml.

[Evaluation of HER2 protein overexpression in non-muscle-invasive bladder cancer with emphasis on tumour grade and recurrence]. / Evaluación de la sobreexpresión de proteína HER2 en cáncer vesical no músculo invasivo con énfasis en el grado tumoral y en la recurrencia.

OBJECTIVE: To evaluate the prognostic value of HER2 expression in non-muscle invasive bladder transitional cell carcinoma (TCC) with special emphasis in the high grade population. MATERIALS AND METHODS (PATIENTS): Tissue microarrays (TMA) were performed with representative TUR-B specimens from 84 patients with non-muscle invasive bladder TCC (40 pT1GII and 44 pT1GIII) treated in our institution. Depth of invasion and grade were uniformly assigned by the same pathologist who performed blind immunohistochemical analysis with Hercep test: 3+ was considered strong positive HER2 overexpression. Other clinico-pathological variables were also assessed. RESULTS: HER2 protein overexpression was detected in 30/44 (68.2%) pT1GIII lesions and predicted recurrence in this subgroup of bladder TCC (p<0.01). Negative HER2 expression was detected in 26/40 (65%) cases with pT1GII TCC, and this condition was more frequent in unifocal tumours, without angiogenesis, with low recurrence rate and without progression. Recurrence-free survival can also be anticipated by HER 2 expression within pT1GII tumours (p<0.01). CONCLUSION: HER2 expression using Hercep test may be useful to predict recurrence in non-muscle invasive bladder TCC. The potential application of this study, especially regarding prediction of response to BCG, should be prospectively confirmed in multi-institutional trials.