Plasma proteasomal chymotrypsin-like activity correlates with prostate cancer progression.

Previously, we demonstrated that inhibition of proteasomal chymotrypsin-like (CT-like) activity in human prostate cancer (PCa) PC-3 cultures and PC-3 xenografts results in accumulation of ubiquitinated proteins, followed by induction of cell death. Studies have shown that plasma CT-like proteasomal activity may be a powerful biomarker for risk stratification in hematologic malignancies. We hypothesized that circulating proteasomes could also be used to stratify risk for patients with PCa. A total of 109 patients with suspected PCa underwent prostatic biopsies were enrolled. Subjects were divided into non-cancer, low-risk PCa, and high-risk PCa groups. Three different proteasomal activity markers (CT-like, caspase-like, and trypsin-like) were measured and compared among the three groups. The proteasomal target proteins, Ub-prs, Hsp70, Bax, and P27 in plasma and prostate tissues were also evaluated. Multivariate analysis was used to assess whether CT-like activity was a predictor of PCa progression. Only proteasomal CT-like activity in the high-risk group was statistically higher than in the non-cancer group (P < 0.05). The expression of Ub-prs, Hsp70, Bax, and P27 protein was decreased in both plasma and PCa tissue of high-risk patients. CT-like activity was found to be an independent predictor of high-risk PCa. Subjects with CT-like activity ≥55 had a 2.15-fold higher risk of having high-risk PCa as compared to those with a CT-like activity of <55 (P = 0.021). We found CT-like activity to be an independent predictor of high-risk PCa, and as such, it may be a good candidate as a biomarker for high-risk PCa detection and stratification.

Percent free prostate-specific antigen does not improve the effectiveness of prostate cancer detection in Chinese men with a prostate-specific antigen of 2.5-20.0 ng/ml: a multicenter study.

The prostate-specific antigen (PSA) "gray zone" in Chinese men is likely higher than the traditional value (2.5-10.0 ng/ml) since the incidence of prostate cancer in Chinese men is relative low. The utility of percent free PSA in predicting prostate cancer is based on Western populations and may introduce sizable bias when applied to a Chinese cohort. We assessed the efficacy of percent free PSA in predicting prostate cancer in Chinese men with a PSA of 2.5-10.0 and 10.1-20.0 ng/ml. A total of 558 men with a PSA of 2.5-20.0 ng/ml who had undergone prostatic biopsy to detect prostate cancer from two Chinese centers were included. The rates of prostate cancer in different percent free PSA ranges were evaluated. Receiver operating characteristic curve (ROC) was used to evaluate and compare the efficiency of PSA and percent free PSA in the diagnosis of prostate cancer. The areas under ROC (AUCs) for percent free PSA for predicting prostate cancer were not higher than those for PSA, although prostate cancer detection rates increased with decreased percent free PSA in men with a PSA of 2.5-10.0, 10.1-20.0, and 2.5-20.0 ng/ml. Similarly, for men aged <70 and ≥ 70 years and with prostate volume <40 and ≥ 40 ml, AUCs showed percent free PSA was not better than PSA in predicting prostate cancer. By analyzing multicenter data, we first found that percent free PSA does not improve detection of prostate cancer in Chinese men with a PSA of 2.5-10.0 or 10.1-20.0 ng/ml.

Safety of the "drain and retain" option for defunctionalized urologic prosthetic balloons and reservoirs during artificial urinary sphincter and inflatable penile prosthesis revision surgery: 5-year experience.

OBJECTIVE: To present our 5-year experience using a "drain and retain" option, in which existing urologic prosthetic balloons and reservoirs (UPBR) were emptied but not removed during routine artificial urinary sphincter (AUS)/inflatable penile prosthesis (IPP) reoperation. METHODS: All genitourinary prosthetic surgeries by a single surgeon from July 2007 to September 2012 were reviewed. Patients were included in the study group if they underwent prosthetic replacement (with contralateral new UPBR placement) or subtotal device removal, although having their original UPBR drained and retained. Virgin cases, complete device removals for gross infection, and revision cases using the original UPBR were excluded. The "drain and retain" technique involved defunctionalizing the existing UPBR by aspirating all its fluid, placing the tubing on traction, and cutting proximally. Postoperative outcomes with specific attention to infection were reviewed and compared with patients receiving their first prosthesis (control group). RESULTS: A total of 551 urologic prostheses (251 AUS and 300 IPP) were inserted in 433 men during the 5-year study period. Among 120 reoperative prosthetic cases, UPBR were drained and retained in 55 (46%). The control group consisted of 352 patients undergoing initial AUS (154 cases) and/or IPP (236 cases) placement. No difference in infection rate was identified between the control group (6 of 390; 1.5%) and the "drain and retain" group (1 of 55; 1.8%; chi-square = 0.024; P = .88). CONCLUSION: Retention of defunctionalized uninfected genitourinary prosthetic balloons and reservoirs does not increase complication rate during reoperative AUS and/or IPP surgery.

Transurethral enucleation and resection of the prostate vs transvesical prostatectomy for prostate volumes >80 mL: a prospective randomized study.

OBJECTIVES: To compare the efficacy and safety of transurethral enucleation and resection of the prostate (TUERP) and transvesical prostatectomy (TVP) for patients with benign prostatic hyperplasia (BPH) and prostate volumes >80 mL. PATIENTS AND METHODS: A total of 100 patients with urodynamic obstruction and prostate volume >80 mL were prospectively randomized and enrolled in the study at a tertiary hospital. Patients underwent TVP or TUERP performed by one of two surgeons with experience of a large number of cases. All patients were preoperatively evaluated using patient age, prostate volume measurement, clinical characteristics of digital rectal examination, self-assessment using the International Prostate Symptom Scores (IPSS) questionnaire, a quality-of-life (QoL) questionnaire, maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR), urine analysis, blood sample analysis, including determination of prostate-specific antigen (PSA) and haemoglobin concentration. All patients were assessed peri-operatively and postoperatively at 3 and 12 months. All complications were documented. RESULTS: Of 100 patients eligible to participate, 92 patients completed 12 months of follow-up. Patients who underwent TUERP had shorter catheterization times and hospital stays. Operation duration was not significantly different between the two surgical groups (P = 0.107). The resected adenoma weight in the TVP group was more than that in the TUERP group, but the difference was not significant (P = 0.062). There were no significant differences in IPSS, PVR, Qmax or QoL scores between the groups at 3 and 12 months. The patients in the TVP group appeared to have a better Qmax at 3 months, however, the difference was not significant (P = 0.081). Adverse events were similar in the two groups. CONCLUSION: We found that TUERP had efficacy and safety equivalent to that of TVP for patients with BPH and prostate volume >80 mL.

Prostate volume as an independent predictor of prostate cancer in men with PSA of 10-50 ng ml(-1).

Prostate volume (PV) has been shown to be associated with prostate cancer (PCa) detection rates in men with a prostate-specific antigen (PSA) in the 'grey zone' (2.0-10.0 ng ml(-1)). However, the PSA 'grey zone' in Asian men should be higher because the incidence of PCa in Asian men is relatively low. Therefore, we evaluated the association between PV and PCa detection rates in men with PSAs measuring 10-50 ng ml(-1). Men who underwent a 13-core prostatic biopsy with PV documentation participated in the study. A multivariate stepwise regression was used to evaluate whether the PV at time of prostate biopsy could predict the risk of PCa. The rates of PCa among men in different PSA ranges, stratified by PV medians (<60 and ≥60 ml), were calculated. There were 261 men included in the final analysis. PV was the strongest predictor of PCa risk (odds ratio, 0.02; P<0.001) compared to other variables. The PCa rates in men with PVs measuring <60 and ≥60 ml in the 10-19.9 ng ml(-1) PSA group were 40.6% and 15.1%, respectively, while the rates for men with PSAs measuring 20-50 ng ml(-1) were 65.1% and 26.8%. PV is an independent predictor of PCa in men with PSA measuring 10-50 ng ml(-1). In clinical practice, particularly for those countries with lower incidences of PCa, PV should be considered when counselling patients with PSAs measuring 10-50 ng ml(-1) regarding their PCa risks.

A nomogram based on age, prostate-specific antigen level, prostate volume and digital rectal examination for predicting risk of prostate cancer.

Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) status, % free PSA and transrectal ultrasound (TRUS) findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% (223/535). The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.

Transition zone PSA density improves the prostate cancer detection rate both in PSA 4.0-10.0 and 10.1-20.0 ng/ml in Chinese men.

OBJECTIVES: We hypothesized the prostate-specific antigen (PSA) "grey zone" in Chinese men was higher than the traditional value (4.0-10.0 ng/ml) since incidence of prostate cancer (CaP) in Chinese men was relative low. We then assessed the efficiencies of transition zone PSA density (TZPSAD) in the diagnosis of CaP in Chinese men with a PSA of both 4.0-10.0 and 10.1-20.0 ng/ml. MATERIALS AND METHODS: Men had a prostatic biopsy for detecting CaP from November 1999 to August 2009 were retrospectively retrieved from our computer center. Those had a document of transrectal ultrasound transition zone measurement with a PSA of 4.0-20.0 ng/ml were included. Receiver-operating characteristic (ROC) curve was used to analyze the efficiencies of PSA and TZPSAD in the diagnosis of CaP. RESULTS: A total of 189 men were included in the study. Of these men, 78 and 111 had a PSA of 4.0-10.0 and 10.1-20.0 ng/ml, respectively. The rate of CaP in men with a PSA of 4.0-10.0 ng/ml was not statistically significantly different compared with those with a PSA of 10.1-20.0 ng/ml (20.5% vs. 21.6%, P = 0.854). The areas under the ROC curve (AUCs) in diagnosis of CaP for PSA and TZPSAD were 0.569 and 0.702 in men with a PSA of 4.0-10.0 ng/ml and 0.463 and 0.730 in men with a PSA of 10.1-20.0 ng/ml, respectively. The best cut-off of TZPSAD in predicting CaP in men with a PSA of 4.0-10.0 ng/ml was 0.370 ng/ml/ml, the sensitivity of which equaled 68.8%, specificity 72.6%. The best cut-off of TZPSAD in predicting CaP in men with a PSA of 10.1-20.0 ng/ml was 0.500 ng/ml/ml. Its sensitivity equaled 70.8%, specificity 70.1%. CONCLUSIONS: Using TZPSAD can improve the efficiency of PSA in diagnosis of CaP and decreases the unnecessary prostatic biopsy in men with a PSA of both 4.0-10.0 and 10.1-20.0 ng/ml in Chinese men.

[Holmium laser enucleation versus open prostatectomy for large volume benign prostatic hyperplasia: a meta-analysis of the therapeutic effect and safety].

OBJECTIVE: To compare holmium laser enucleation (HoLEP) versus open prostatectomy (OP) for large volume benign prostatic hyperplasia. METHODS: The randomized controlled trials (RCTs) pertaining to HoLEP and OP for management of large volume benign prostatic hyperplasia were retrieved from Medline and Embase. Meta-analysis was performed using Review Manager 5.0 software. RESULTS: Three RCTs were included in the analysis. No significant differences were found in IPSS or Qmax between HoLEP and OP (P>0.05). Compared with OP, HoLEP was associated with significantly less blood loss, a shorter catheterization time and a shorter hospital stay, but a longer operating time. HoLEP and OP were similar in terms of urethral stricture, stress incontinence, transfusion requirement and the rate of reintervention. CONCLUSION: HoLEP and OP have similar therapeutic effects in the management of large volume benign prostatic hyperplasia. Although with a longer operating time and less resected tissue, HoLEP causes less blood loss and requires a shorter catheterization time and a shorter hospital stay. HoLEP has a comparable safety to OP in terms of the adverse events.

Urodynamically diagnosed detrusor hypocontractility: should transurethral resection of the prostate be contraindicated?

BACKGROUND: Patients with benign prostatic hyperplasia (BPH) suffering from hypocontractile detrusor were generally regarded unsuitable for surgery. This prospective study is to evaluate the efficacy of transurethral resection of the prostate (TURP) on BPH patients diagnosed detrusor hypocontractility on urodynamic study (UDs). METHODS: Twenty patients were included in the study with mean age of 74.20 ± 7.93 years (range: 57-88). Outcomes were determined by patients' self-assessment questionnaires, International Prostate Symptom Score (IPSS) and Quality of Life (QoL), and UDs parameters including maximum uroflow rate (Qmax), postvoid urine volume (PVR), bladder compliance, maximal cystometric capacity (MCC), and maximum detrusor pressure (Pdetmax). RESULTS: Median follow-up duration was 12 months (range: 10-16). After TURP, IPSS/QoL, Qmax, PVR, and Pdetmax were significantly improved and there were no significant differences with regard to bladder compliance and MCC. CONCLUSION: UDs may play a very limited role in detecting bladder outlet obstruction (BOO) in BPH patients with hypocontractile detrusor. TURP may obtain a promising effect on such patients with unidentified BOO. These patients should not be arbitrarily excluded from surgical indications simply based on UDs findings.

A randomized trial of transvesical prostatectomy versus transurethral resection of the prostate for prostate greater than 80 mL.

OBJECTIVES: We compared the safety and efficacy of transvesical prostatectomy (TVP) and transurethral resection of the prostate (TURP) for prostate greater than 80 mL in a prospective randomized trial. METHODS: Eighty patients with urodynamic obstruction and prostate volume >80 mL were prospectively randomized and assigned to TVP or TURP. Patients were assessed preoperatively and followed up at 3 and 12 months postoperatively. International prostate symptom score (IPSS), quality of life score (QoLS), maximum flow rate (Q(max)(.)), and postvoid residual volume (PVR) were obtained at each follow-up. Perioperative data and postoperative outcomes were compared. All complications were recorded. RESULTS: Of 80 patients eligible to participate, 69 patients completed 12 months of follow-up. TURP procedure was not faster than TVP procedure (P = .41); 53.2% and 84.4% of prostatic tissue were resected after TURP and TVP, respectively (P < .001). In the TVP group, IPSS, Q(max)(.), QoLS, and PVR volume were significantly better than those in TURP group at 3 and 12 months of follow-up. At 12 months postoperatively, IPSS improved 87.6% and 62.3%, mean Q(max)(.) increased by 11.49 mL/s (230.2%) and 6.33 mL/s (102%), and mean PVR volume decreased by 71.2 mL (88.6%) and 65.4 mL (70.5%) in TVP and TURP group, respectively. Two TURP patients developed urethral stricture requiring reoperation. CONCLUSIONS: TVP may be more effective and safer than TURP for the benign prostatic hyperplasia patient whose prostate volume is >80 mL.

[The effect of prostatectomy on nocturia in patients with benign prostatic hyperplasia].

OBJECTIVE: To explore the effect of prostatectomy on nocturia in patients with benign prostatic hyperplasia (BPH). METHODS: The data of patients who had received prostatectomy for BPH between June 2006 and December 2007 were collected. Nocturia severity was assessed preoperatively and 3 to 6 months after prostatectomy by the number of nocturia events, the time from falling sleep to the first awakening to void (hours of undisturbed sleep, HUS), the score of the nocturia quality of life (N-QOL) questionnaire, the International Prostatic Symptom Score (IPSS) and the quality of life (QOL) score. RESULTS: One hundred and twenty five cases were included. Of them, 73 patients finished the follow-up completely. There were 62 patients whose number of nocturia events before the operation was equal or more than 2. The data from these 62 patients were analyzed. Of them, 56 patients underwent transurethral resection of prostate, the remaining 11 patients suprapubic prostatectomy. Significant improvement (P < 0.01) was noted in all the following parameters after treatment: the number of nocturia events decreased from 4.2 ± 2.4 to 2.2 ± 1.0, HUS increased from (1.8 ± 0.7) h to (3.0 ± 1.4) h, N-QOL score raised from 30 ± 10 to 40 ± 7, IPSS decreased from 23 ± 5 to 8 ± 5, and QOL score fell down from 4.4 ± 0.7 to 1.5 ± 1.0. CONCLUSION: The prostatectomy can markedly improve the symptoms of nocturia, sleep and life quality in the BPH patients who accompanied with nocturia.

Antibacterial therapy improves the effectiveness of prostate cancer detection using prostate-specific antigen in patients with asymptomatic prostatitis.

OBJECTIVES: To improve prostate cancer (PC) detection accuracy among patients with a prostate-specific antigen (PSA) above 4.0 ng/ml and asymptomatic prostate inflammation. MATERIALS AND METHODS: A total of 136 patients with PSA ranging from 4.0 to 50.0 ng/ml with asymptomatic prostatitis were included in the study cohort. All these patients underwent antibacterial therapy for 2 weeks followed by repeat PSA determination and transrectal ultrasound-guided needle prostate biopsy. The PSA, PSAD (PSA density), and f/t PSA (free/total PSA) before and after antibacterial therapy were compared using t-test. The receiver-operating characteristic (ROC) technique was used to evaluate the effectiveness of PSA, PSAD, f/t PSA, and their changes after antibacterial therapy (DeltaPSA, DeltaPSAD, and Deltaf/t PSA) on PC detection. RESULTS: Among the 136 patients, 33 had PC and the other 103 histologically confirmed benign prostatic disease. After antibacterial therapy for 2 weeks, the PSA (mean +/- standard deviation) decreased from 14.0 +/- 7.8 ng/ml to 10.4 +/- 7.7 ng/ml (P < 0.01). The DeltaPSA, DeltaPSAD, and Deltaf/tPSA were -3.60 +/- 4.3 ng/ml, -0.1 +/- 0.1 ng/ml/ml, and -0.1 +/- 0.1 respectively. The areas under ROC curve were 0.29 for PSA, 0.64 for PSAD, and 0.50 for f/t PSA. The areas under ROC curve were 0.91 for DeltaPSA, 0.96 for DeltaPSAD, and 0.98 for Deltaf/t PSA. These values were increased significantly when compared with those for the PSA-related parameters before antibacterial therapy (P value, DeltaPSA, DeltaPSAD, and Deltaf/t PSA were <0.01). CONCLUSIONS: Using the changes in PSA-related parameters after antibacterial therapy DeltaPSA, DeltaPSAD, and Deltaf/t PSA improve the PC detection rate and decrease unnecessary prostate biopsies in patients with asymptomatic prostatitis.