[Correlation of prostatic specific antigen, tumor grade, and local stage with bone scintigraphy in the staging of patients with prostatic cancer]. / Correlación entre el antígeno específico prostático, el grado tumoral y el estadio local con la gammagrafía ósea en el estadadiaje de los pacientes con cáncer de próstata.

OBJECTIVE: To determine the capacity of PSA, tumor grade and local stage to predict the bone scintiscan findings in patients with newly diagnosed, untreated prostate cancer. METHODS: We analyzed the records of 189 patients with prostate cancer that had been seen at our institution from January, 1993 to September, 1995. PSA determination was performed prior to biopsy, local staging by DRE or transrectal US was done and they had a bone scintiscan before treatment. RESULTS: 21% of the patients had metastasis. Univariate analysis showed PSA (p < 0.001), tumor grade (p = 0.01) and local stage (p = 0.001) independently predicted the positive bone scintiscans. However, multivariate regression analysis showed tumor grade (rc = 0.05) or stage (rc = 0.07) did not increase the predictive value of PSA (rc = 0.22). The highest negative predictive value of PSA [95% (IC95 = 87.5%, 98.6%)] was obtained when 20 ng/ml was used as cutoff. Therefore 1.4% to 13.5% of the patients with bone metastasis could not have been diagnosed without scintigraphy. CONCLUSION: Bone scintigraphy should be performed routinely to determine the extent of the lesion in patients with prostatic cancer, particularly in those patients that are likely to undergo radical treatment.

[Morbidity of and tolerance to ultrasonography-guided transrectal biopsy of the prostate]. / Morbilidad y tolerancia de la biopsia transrectal ecodirigida de la próstata.

OBJECTIVE: The objective of the study is to evaluate the infectious complications of the ultrasound-guided prostate transrectal biopsy using two different antibiotic prophylactic regimes. Also, patient tolerance to ultrasound-guided transrectal biopsy is assessed. METHODS: Prospective study in 100 patients randomized to antibiotic prophylaxis with Pefloxacin (800 mg as single dose) versus Ciprofloxacin (250 mg/8 h/72 h). Tolerance data collection was done through completion of a questionnaire immediately after biopsy. RESULTS: Out of the 92 patients eligible for the study, 44 (48%) were assigned to Pefloxacin and 28 (52%) to Ciprofloxacin. In-house validation indicated both groups were matched. 90% patients showed good tolerance to the ultrasound technique and 81.5% patients to the transrectal biopsy. 31.5% patients presented no post-biopsy events; among the remaining only one patient (1%) required medical care and hospitalization. No patient had infectious complications. CONCLUSIONS: Prostate transrectal ultrasound and transrectal prostate biopsy was an approach well tolerated by most (81.5%) patients studied. Percentage of major complications was very small (1%), while post-biopsy events (haematuria, rectorrhage, etc) which do not require medical care should be considered not as complications but as effects intrinsic to the approach itself. Antibiotic prophylaxis whether with Pefloxacin or Ciprofloxacine was highly effective, although Pefloxacin is preferred due to its single dose administration and lower cost.