[The clinical usefulness of routine biopsy of the transition zone in the diagnosis of prostate cancer]. / Utilidad clínica de la biopsia rutinaria de la zona transicional en el diagnóstico del cáncer de próstata.

OBJECTIVE: To evaluate the effectiveness of routine biopsy of the transitional area in patients undergoing early systematic sextant biopsy. PATIENTS AND METHODS: Two biopsies were taken from the transitional area further to a sextant biopsy in 164 consecutive patients. 98 cases had serum PSA levels higher than 4 ng/mL and 66 suspicious rectal digital examination. RESULTS: Cancer was detected in 77 patients (46.9%). In 28 (36.4%) cases cancer was found only in the peripheral area, in 2 (2.6%) in the transitional area and in 47 (61%) in both areas. CONCLUSION: Routine biopsy of the transitional area in early systematic prostate biopsy appears to be little effective. This would probably be indicated for patients undergoing rebiopsy.

[The incidence of lesions associated with prostatic biopsy and its effect on the serum concentration of the prostate-specific antigen]. / Incidencia de lesiones asociadas en la biopsia prostática y su influencia en la concentración sérica del antígeno prostático específico.

OBJECTIVE: To analyze the incidence of pathoanatomical lesions seen in systematic prostate biopsies and to evaluate their influence on PSA serum levels. MATERIAL AND METHODS: 495 consecutive prostate biopsies, indicated by a suspicion digital rectal examination in 194 patients (39.2%) and raised serum PSA in 301 (60.8%), were evaluated. Biopsy was performed by sextant and hypoechoic nodes, and PSA serum measurements by dual monoclonal antibody radioimmunoassay, Tandem PSA. RESULTS: Cancer was diagnosed in 42.6% biopsies and BPH in 67.4%; additionally, other associated lesions were detected in 74.6% cases, the most frequent ones being chronic prostatitis (47.3%), glandular atrophy (35.9%) and acute prostatitis (23%). All lesions were significantly related to the primary BPH diagnosis in 74.2% to 85% cases. High grade PIN (14.1%) was related to primary cancer diagnosis in 87.1% cases. The multivariate analysis showed that the main diagnosis (BPH vs cancer) was the only variable that had a significant influence on PSA serum levels. When BPH patients were considered separately, the only variable with significant influence on PSA serum levels was the prostatic volume. The univariate analysis showed a nonsignificant increase in association with acute prostatitis and high grade PIN, and a decrease in association with chronic prostatitis. CONCLUSIONS: BPH or cancer associated damage is very frequent in prostatic biopsies. However, the only factors showing a significant contribution to PSA serum levels appear to be the presence or absence of cancer, or the prostatic volume when the main diagnosis is BPH.

Utility of tumor marker CA 72.4 in patients with chronic renal failure.

The tumor marker CA 72.4 is composed of two monoclonal antibodies, B 72.3 and cc49, which detect the glycoprotein TAG 72 present in tumor cells. The levels of CA 72.4 may be modified depending on the route of excretion of the antigen TAG 72. The objective of this study was to evaluate the behavior of CA 72.4 in healthy subjects and to assess the influence of chronic renal failure (CRF) on the levels of this tumor marker. Random serum samples were collected in 181 individuals (148 healthy volunteers and 33 patients with CRF) and 214 determinations of CA 72.4 were performed. We also performed 66 determinations of plasma creatinine. In healthy subjects the cutoff value of CA 72.4 was established at 3 U/mL, with a sensitivity of 53% and a specificity of 85.8%. In the CRF patients we found no statistically significant differences when we compared the values of CA 72.4 predialysis and postdialysis (p = 0.197). However, a statistically significant difference was found in the plasma creatinine levels (p < 0.001). Chronic renal failure does not affect the result of CA 72.4 determinations; this tumor marker may therefore be useful in the monitoring of patients with cancer, independent of their renal function.

[Analysis of free PSA percentage predicting potential surgical failure in patients treated with radical prostatectomy]. / Análisis del porcentaje de PSA libre en la predicción del fallo quirúrgico potencial en pacientes sometidos a prostatectomía radical.

OBJECTIVE: To analyze if free PSA percentage can help to predict a potential surgical failure (PSF) in patients undergoing radical prostatectomy. MATERIAL AND METHODS: Analysis of serum PSA concentration and free PSA percentage in 92 patients undergoing retropubic radical prostatectomy. In 38 cases, the carcinoma was organ-confined, 26 had capsule penetration, 20 had positive margins, 6 seminal vesicle invasion and 2 lymph nodes. PSF was demonstrated in 28 patients (30.4%) and in 64 (69.6%) the carcinoma was organ-confined. RESULTS: No significant relationship was found between PSA serum concentration or free PSA percentage to the pathological stage. The logistic regression analysis where the clinical status, Gleason sum, and free PSA percentage were included as predictive variables, showed that the latter was the only factor with capacity for PSF prediction. Over all, the probability of a carcinoma being confined in the surgical specimen when percentage of free PSA was greater than 10 was 83.8% and 60% when it was lower or equal, p < 0.03. However, the distribution was only significant when PSA concentration ranged between 4.1 and 10 ng/mL, p < 0.008. In this range of PSA, the relative risk of PSF was 5.5 (95% CI 1.4-21.8) when free PSA percentage was equal or lower than 10, the probability being 50% versus 9.1% when it was greater than 10. CONCLUSIONS: Free PSA percentage can help to predict PSF. PSA serum concentration lower than 10 ng/mL and free PSA percentage greater than 10 allows to detect a subgroup of patients with good prognosis and with less than 10% probability of having positive margins, seminal vesicles invasion or lymph nodes.