ABSTRACT
BACKGROUND: Despite being formally included in the assessment of patients presenting with lower urinary tract symptoms (LUTS), transrectal ultrasonography (TRUS) is not routinely offered to these patients. This tactic however might not be optimum since data exist on the superiority of TRUS over transabdominal ultrasound in accurately predicting prostate volumes. We aimed to evaluate TRUS as a standard tool in the evaluation of patients with benign prostate hyperplasia (BPH) with a special focus on the potential impact it might have on the decision of open versus transurethral surgery. PATIENTS AND METHODS: Seventy-one patients presenting with LUTS due to BPH and eventually managed with open surgery based on their preference and prostate volume were included in the protocol. TRUS was performed in all patients preoperatively and calculations of the transition zone were made. These were compared with respective transabdominal calculations of the prostate volume as well as the enucleated specimen weight (W). RESULTS: TRUS slightly underestimated W by 4.4% (95% CI 10.5, 1.7) while transabdominal ultrasound overestimated it by 55.7% (95% CI 31.8, 79.6). Regression analysis indicated TRUS as a better predictor of W (R (2) = 0.817, P < 0.0005) followed by transabdominal ultrasound (R (2) = 0.669, P < 0.0005). Strictly based on European Association of Urology (EAU) criteria, transabdominal measurements miscategorized 25 cases by falsely assigning them to the open surgery (>80 cc) group while TRUS did so for four cases. CONCLUSION: TRUS is more accurate than transabdominal ultrasound in predicting adenoma volume in patients with BPH and its standard use might lead to fewer open approaches, with consequent less morbidity and hospitalization.
Subject(s)
Prostate-Specific Antigen/blood , Prostatectomy/methods , Prostatic Hyperplasia/diagnostic imaging , Ultrasound, High-Intensity Focused, Transrectal/methods , Urinary Tract Infections/diagnosis , Abdomen/diagnostic imaging , Adenoma/diagnostic imaging , Aged , Aged, 80 and over , Diagnosis, Differential , Follow-Up Studies , Humans , Male , Middle Aged , Organ Size , Predictive Value of Tests , Preoperative Care/methods , Preoperative Care/standards , Probability , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/surgery , Prostatic Neoplasms/diagnostic imaging , Regression Analysis , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Treatment Outcome , Ultrasonography, Doppler/methods , Urinary Tract Infections/drug therapy , Urinary Tract Infections/etiologyABSTRACT
This study aimed to identify candidate new diagnosis and prognosis markers and medicinal targets of prostate cancer (PCa), using state of the art proteomics. A total of 20 prostate tissue specimens from 10 patients with benign prostatic hyperplasia (BPH) and 10 with PCa (Tumour Node Metastasis [TNM] stage T1-T3) were analyzed by isobaric stable isotope labeling (iTRAQ) and two-dimensional liquid chromatography-tandem mass spectrometry (2DLC-MS/MS) approaches using a hybrid quadrupole time-of-flight system (QqTOF). The study resulted in the reproducible identification of 825 nonredundant gene products (p < or = 0.05) of which 30 exhibited up-regulation (> or =2-fold) and another 35 exhibited down-regulation (< or =0.5-fold) between the BPH and PCa specimens constituting a major contribution toward their global proteomic assessment. Selected findings were confirmed by immunohistochemical analysis of prostate tissue specimens. The proteins determined support existing knowledge and uncover novel and promising PCa biomarkers. The PCa proteome found can serve as a useful aid for the identification of improved diagnostic and prognostic markers and ultimately novel chemopreventive and therapeutic targets.
Subject(s)
Biomarkers, Tumor/metabolism , Prostatic Hyperplasia/metabolism , Prostatic Neoplasms/metabolism , Proteome/metabolism , Aged , Amino Acid Sequence , Biomarkers/metabolism , Chromatography, Liquid , Humans , Immunohistochemistry , Male , Middle Aged , Molecular Sequence Data , Prognosis , Prostate-Specific Antigen/metabolism , Prostatic Hyperplasia/diagnosis , Prostatic Hyperplasia/therapy , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Reproducibility of Results , Tandem Mass SpectrometryABSTRACT
BACKGROUND: We present our findings in a series of T1 renal cell carcinomas (RCC) treated with excision of the tumor surrounded by a minimal layer of grossly normal parenchyma. PATIENTS AND METHODS: A total of 43 patients who underwent elective nephron-sparing surgery performed with enucleoresection were studied retrospectively. None of the patients had preoperative or intraoperative suspicion of positive nodes and were free from distant metastases before surgery (N0, M0). Patients status was last evaluated in January 2006. RESULTS: Median age was 58.7 years (35-78). Median tumor size was 3.3 cm (1.5-7). There were no major complications such as bleeding and urinary leakage/ urinoma requiring re-operation. Pathological stage was pT1a in 38 (89%), pT1b in 4 (9%) and pT3a in 1 (2%) patient. Median followup was 32 months (6-89). A total of 5 patients with RCC had died as of January 2006. Overall, 3 (6.9%) patients had disease progression, of whom 2 (4.6%) were local recurrence, 1 alone and 1 associated with distant metastases. The overall cancer-specific survival was 95.4%, and the overall progression-free survival was 93%. CONCLUSIONS: Enucleoresection reproduces the results of partial and radical nephrectomy with minimal morbidity. It is a safe and acceptable approach for elective nephronsparing surgery.
