Telomerase RNA expression and DNA ploidy as prognostic markers of prostate carcinomas.

AIMS AND BACKGROUND: The objective of this study was to determine whether there was a correlation between telomerase RNA expression and DNA ploidy status with clinicopathological parameters and biochemical recurrence after radical prostatectomy. STUDY DESIGN: Telomerase RNA expression and DNA ploidy were evaluated in imprint smear samples obtained from 112 prostates after radical prostatectomy. The results were correlated with pathological stage, Gleason score and serum PSA. RESULTS: Positive telomerse RNA expression was detected in 67.8% of prostate carcinomas. The multiple linear regression model showed a statistically significance increase in telomerase RNA expression with increased Gleason score (P < 0.0001) and preoperative serum PSA values (P = 0.0125). DNA ploidy status also varied significantly with Gleason score (P < 0.0001) and preoperative serum PSA values (P = 0.0110). Five patients with diploid tumors and negative telomerase RNA expression developed a recurrence. However, recurrence was associated with DNA aneuploidy (P = 0.001) as well as with high telomerase RNA overexpression (P = 0.001). CONCLUSIONS: We conclude that telomerase RNA expression and DNA ploidy could be additional markers in the field of prognosis of prostate carcinomas.

[Correlation of serum prostate specific antigen, the volume and the intravesical prostatic protrusion for diagnosing bladder outlet obstruction in patients with benign prostate hyperplasia].

Benign prostate hyperplasia (BPH) is common in elderly men. Nevertheless, the pathophysiology of low urinary tract symptoms (LUTS) may not be due only to BPH. Many men with LUTS are submitted to unnecessary medications or surgical interventions because their symptoms have not been correctly evaluated. Can diagnostic test such as serum prostate antigen (PSA), performed by nuclear medicine techniques and the trans-abdominal ultrasound determine with high sensitivity whether LUTS is due exclusively to BPH? The aim of the study was to correlate serum PSA, prostate volume (PV), intravesical prostatic protrusion (IPP), uroflowmetry measuring maximal urine flow/sec (Qmax), and the international prostate symptom score (IPSS) questionnaire, to estimate urine bladder outlet obstruction (BOO), in patients with BPH. A hundred and twelve patients with mean of age 72 +/- 8 years and LUTS were studied. All patients were examined according to the IPSS questionnaire, had their serum PSA tested and also Qmax of prostate volume and IPP by trans-abdominal ultrasound were examined. The patients were separated in groups according to serum PSA values (or= 4.1 ng/ml), prostate volume (PV< 20.20-40 and > 20 ml) and the intravesical prostatic protrusion (IPP < 5.5-10.10 mm). There was a statistical correlation between the BOO and: a) PSA (P = 0.004), b) prostate volume with P of < 0.001) and c) IPP = 0.005. On the contrary, there was no statistical correlation between BOO and IPSS, Qmax with P values 0.228 and 0.745 respectively. Receiving operating curve (ROC) showed that patients with a serum PSA value of 1.5-4 ng/ml, IPP of type II and PV 20-40 ml, had a sensitivity of 48% for PSA, of 50% for PV and of 47% for IPP and a specificity of 75%, 47% and 60% respectively. In conclusion, according to the results of this study, a more objective evaluation of BOO, which is exclusively due to BPH, should include, not only PV but also serum PSA values and IPP.

[Serum testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone versus prostate specific antigen in patients with localized prostate adenocarcinoma who underwent radical prostatectomy. Radioimmunoassays measurements].

The relation of steroid hormones (SH) with carcinogenesis is not well understood. There is a variation of opinions among researchers about the prognostic value of serum SH in patients with localized prostate cancer (PC). The aim of this was to study serum SH in patients with localized PC before and after radical prostatectomy (RP). Seventy patients with mean age 67+/-8 years, were studied. The diagnosis was confirmed by histology after a biopsy. None of the patients was submitted to hormonal treatment or radiotherapy prior to RP. Serum testosterone (TST), dihydrotestosterone (DHT), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were examined prior RP and one year following RP, by radioimmuno assay (RIA) or immunoradiometric assay (IRMA) methods. Based on serum PSA levels before and one year after RP, 66 of the patients did not have biochemical recurrence while 4 patients developed biochemical recurrence due to residual disease and were treated with flutamide and a LH-RH analogue. In the group of 66 patients there was a statistically significant increase in serum TST (P<0.001), LH (P=0.004) and FSH (P<0.001), and statistically significant decrease in serum DHT (P<0.001). In the four patients with biochemical recurrence, TST increased and serum DHT, LH and FSH decreased. In this group the reduction of DHT and LH, FSH were due to treatment with flutamide and a LH-RH analogue respectively. Our findings suggest that after RP increase of serum LH and FSH may have caused an increase in serum TSH and a decrease of serum DHT. If those changes are due to the hypothalamic-pituitary axis it may be that the prostate neoplasm before RP may have secreted a substance that induced a negative feedback to the pituitary gonadotrophin secretion, which was unrelated to varying serum PSA levels.