The Prostate Health Index in predicting initial prostate biopsy outcomes in Asian men with prostate-specific antigen levels of 4-10 ng/mL.

PURPOSE: To investigate the role of the Prostate Health Index (phi) in prostate cancer (PCa) detection in patients with a prostate-specific antigen (PSA) level of 4-10 ng/mL receiving their first prostatic biopsy in an Asian population. METHODS: This was a retrospective study of archived serum samples from patients enlisted in our tissue bank. Patients over 50 years old, with PSA level of 4-10 ng/mL, a negative digital rectal examination, and received their first prostatic biopsy between April 2008 and April 2013, were recruited. The serum sample collected before biopsy was retrieved for the measurement of various PSA derivatives and the phi value was calculated for each patient. The performance of these parameters in predicting the prostatic biopsy results was assessed. RESULTS: Two hundred and thirty consecutive patients, with 21 (9.13 %) diagnosed with PCa, were recruited for this study. Statistically significant differences between PCa patients and non-PCa patients were found for total PSA, PSA density, [-2]proPSA (p2PSA), free-to-total PSA ratio (%fPSA), p2PSA-to-free PSA ratio (%p2PSA), and phi. The areas under the curve of the receiver operating characteristic curve for total PSA, PSA density, %fPSA, %p2PSA, and phi were 0.547, 0.634, 0.654, 0.768, and 0.781, respectively. The phi was the best predictor of the prostatic biopsies results. At a sensitivity of 90 %, the use of the phi could have avoided unnecessary biopsies in 104 (45.2 %) patients. CONCLUSIONS: Use of the phi could improve the accuracy of PCa detection in patients with an elevated PSA level and thus avoid unnecessary prostatic biopsies.

A prospective, randomized study of the clinical effects of shock wave delivery for unilateral kidney stones: 60 versus 120 shocks per minute.

PURPOSE: We assessed the effects of different shock wave delivery rates in patients treated with shock wave lithotripsy for renal stones, particularly treatment success, degree of renal injury and pain experienced, and analgesic demand. MATERIALS AND METHODS: A total of 206 patients with renal stones were prospectively randomized to receive shock waves delivered at 60 (group 1) or 120 (group 2) shocks per minute using a Sonolith® Vision at a single institution in October 2008 and August 2010. The primary outcome was successful treatment 12 weeks after 1 lithotripsy session. Secondary outcome measures included the degree of renal injury, as reflected by changes in urinary markers of renal injury, as well as patient pain scores and analgesia consumed during treatment. RESULTS: Mean stone size in groups 1 and 2 was 8.95 and 9.28 mm, respectively (p = 0.525). The overall treatment success rate was 43.2%. It was significantly better in group 1 than in group 2 (50.5% vs 35.9%, p = 0.035). There was no between group difference in the success rate for stones 10 mm or less but the success rate was statistically better for group 1 patients with stones greater than 10 mm (p = 0.002). Immediately after shock wave lithotripsy there was a statistically significant greater increase in urinary NAG (p = 0.003) and interleukin-18 (p = 0.022) in group 1. There was no between group difference in pain scores, analgesic consumption during shock wave lithotripsy or unplanned hospital visits. CONCLUSIONS: Slower shock wave delivery yielded better treatment outcomes, particularly for stones greater than 10 mm, without increasing patient pain or analgesic demand. However, slower shock wave delivery also appeared to cause a statistically significant increase in acute renal injury markers, although the clinical implication was uncertain.

A randomized controlled trial comparing the efficacy of hybrid bipolar transurethral vaporization and resection of the prostate with bipolar transurethral resection of the prostate.

BACKGROUND AND PURPOSE: In comparison with monopolar transurethral resection of the prostate (TURP), bipolar TURP has been shown to have similar efficacy and complication profiles. Whether the hybrid technique of bipolar resection and vaporization of the prostate further improves catheterization time, dysuria, and complication profiles has not been defined, however. The objective of this study was to compare the efficacy and safety profile of bipolar hybrid prostate surgery using both resection and vaporization modes, with bipolar resection undertaken using the transurethral resection in saline bipolar system. PATIENTS AND METHODS: This was a randomized controlled trial that compared bipolar hybrid surgery and bipolar resection of the prostate among men aged ≥ 50 years with benign prostatic hyperplasia (BPH) whose course of medical therapy had failed or who had recurrent urinary retention (CUHK_CCT00623). Patients were randomly assigned to receive either bipolar hybrid surgery or bipolar resection of the prostate. Both patients and assessors were blinded to the type of surgery performed. The primary study end point was catheter time. The secondary end points included postoperative hospital stay and dysuria score. We report the interim results for 86 patients. RESULTS: Forty-six patients were in the hybrid group and 40 were in the resection group. There were no differences between the two groups in prostate volumes (61.5 cc, standard deviation [SD]=34.5 vs 61.0 cc, SD=23.8), preoperative prostate-specific antigen levels (8.7 ng/mL, SD=8.5 vs 9.5 ng/mL, SD=8.4), or preoperative retention status (56.5% vs 70%). The mean operative time was 46.2 minutes for the hybrid group (SD=20.2) and 39.2 minutes for the resection group (SD=17.5). The hybrid group had a significantly shorter postoperative catheter time (34.5 h, SD=15.8 vs 44.7 h, SD=24.5, P=0.027). There was a significant difference between the two groups in the postoperative pain score on day 1 postsurgery (3.5 in the hybrid group vs 1.0 in the resection group, P=0.028). There was no difference between the groups in terms of changes in serum hemoglobin and serum sodium levels or the reintervention rate. All patients voided well after operation, with maximal flow improvements of 9.9 mL/s (SD 8.1) and 8.2 mL/s (SD 10.0) for the hybrid and resection groups, respectively, 1 month postsurgery. CONCLUSION: Transurethral bipolar resection and vaporization of the prostate reduces catheterization time and facilitates postoperative care.