A new promising indicator in prostate cancer screening: Prostate-specific antigen fluctuation rate.

OBJECTIVES: To evaluate whether PSA fluctuation can be used to predict the risk of prostate cancer. MATERIALS AND METHODS: The study included 1244 patients who underwent prostate biopsy at Kartal Dr. Lutfi Kirdar City Hospital between 2013 and 2021 (848 in non-cancer; 396 in cancer). The patient's age, last two PSA values (PSA1 and PSA2) within three months before the biopsy, the duration between two PSAs (days), prostate size (g) and PSA density (PSAD) were all recorded. PSA fluctuation rate (PSAfr) was defined as the change rate between two PSA values. RESULTS: PSAfr was significantly higher in the non-cancer group than in the prostate cancer group (15.2% (20.5) and 9.6% (14.4), P=.019). A Simple linear regression was used to examine the relationship between PSAfr and other factors such as age, PSA, PSAD, and prostate volume, but it was shown that these had no effect on PSA fluctuations. ROC analysis revealed a relatively low Area Under the Curve (AUC) for PSAfr (AUC, 0.584 (0.515-0.653)). However, the cut-off value of 12.35% was found to be significant, with a sensitivity of 58% and a specificity of 59% (P:.019, 95%CI). The odds ratio, adjusted for age, PSAD, and PSA2, was calculated as 0.545 (0.33-0.89) using logistic regression analysis to show the relationship between prostate cancer and PSAfr. As a result, those with high PSAfr were found to be 1.83 times less likely to be diagnosed with prostate cancer than those with low fluctuations. CONCLUSION: PSAfr could be used in nomograms to predict prostate cancer risk and reduce the number of unnecessary biopsies.

¿Podría el espesor de la pared ureteral afectar a los parámetros intra y postoperatorios de la ureteroscopia para el tratamiento de piedras ureterales proximales? / Could ureteral wall thickness have an impact on the operative and post-operative parameters in ureteroscopic management of proximal ureteral stones?

Objetivo: Evaluar la relación del espesor de la pared ureteral (EPU) con el éxito y los parámetros relacionados con la ureteroscopia para el tratamiento de cálculos ureterales proximales. Pacientes y métodos: Se incluyó a 82 pacientes con cálculos ureterales proximales y se dividieron en 2 subgrupos de acuerdo con el grosor de la pared ureteral: un grupo con 38 pacientes, EPU > 5 mm, y el segundo con 44, EPU < 5mm. Se evaluaron los siguientes parámetros: tamaño de la piedra, grado de hidronefrosis, diámetro de la luz ureteral proximal, el EPU y los datos demográficos de los pacientes. Se realizó ureteroscopia semirrígida con láser Ho-YAG y se evaluó el posible impacto del EPU sobre las tasas de éxito y los parámetros relacionados con el procedimiento. Resultados: La media de edad de los pacientes y el tamaño de los cálculos fueron 47,55 ± 1,78 años y 8,17 ± 0,29 mm, respectivamente. Con respecto al impacto del valor del EPU sobre los parámetros mencionados anteriormente, la tasa libre de cálculos una semana después del procedimiento fue mayor en el grupo 2 y la tasa de fragmentos residuales, así como la necesidad de colocación de catéter doble J, fueron más altas en el grupo 1. Adicionalmente, la duración media del procedimiento fue significativamente más larga en el grupo 1 y se observaron alteraciones patológicas en la pared ureteral significativamente mayores en estos casos (p = 0,0243). Conclusiones: El EPU es un factor útil al predecir el éxito del tratamiento ureteroscópico y otros parámetros relacionados con el procedimiento para los cálculos ureterales proximales. Con este enfoque, se podría realizar un plan operativo más adecuado, con mayores tasas de éxito, menos complicaciones y procedimientos adicionales

Aim: To evaluate the possible impact of stone impaction in terms of ureteral wall thickness (UWT) on the success and procedure related parameters of ureteroscopic management in proximal ureteral calculi. Patients and methods: 82 patients with proximal ureteric stones were included and were divided into 2 subgroups where UWT was > 5 mm in 38 cases; and < 5 mm in 44 cases. Stone size, degree of hydronehrosis, diameter of proximal ureteral luz, UWT and patient's demographics were evaluated. Semi-rigid ureteroscopy with Ho-YAG laser was performed and the possible impact of UWT as an objective parameter for stone impaction on the success rates and procedure related parameters was evaluated. Results: Mean patient age and stone size values were 47.55 ± 1.78 years and 8.17 ± 0.29 mm respectively. Regarding the impact of UWT value at the stone site for the parameters mentioned above stone free rates particularly at 1-week after the procedure was higher in group 2 and the rate of residual fragments as well as the need for double J stent placement was higher in group 1. Additionally, mean duration of the procedures was significantly longer in Group 1 during which pathologic alterations were significantly higher in ureteral wall at stone site were observed in these cases (P = .0243). Conclusions: UWT may be used to predict the success of ureteroscopic management and other procedure related parameters for proximal ureteral stones in an effective manner. With this approach a more rational operative plan with higher success rates, limited complications and auxiliary procedures could be made

Could ureteral wall thickness have an impact on the operative and post-operative parameters in ureteroscopic management of proximal ureteral stones? / ¿Podría el espesor de la pared ureteral afectar a los parámetros intra y postoperatorios de la ureteroscopia para el tratamiento de piedras ureterales proximales?

AIM: To evaluate the possible impact of stone impaction in terms of ureteral wall thickness (UWT) on the success and procedure related parameters of ureteroscopic management in proximal ureteral calculi. PATIENTS AND METHODS: 82 patients with proximal ureteric stones were included and were divided into 2subgroups where UWT was> 5mm in 38 cases; and <5mm in 44 cases. Stone size, degree of hydronehrosis, diameter of proximal ureteral luz, UWT and patient's demographics were evaluated. Semi-rigid ureteroscopy with Ho-YAG laser was performed and the possible impact of UWT as an objective parameter for stone impaction on the success rates and procedure related parameters was evaluated. RESULTS: Mean patient age and stone size values were 47.55±1.78 years and 8.17±0.29mm respectively. Regarding the impact of UWT value at the stone site for the parameters mentioned above stone free rates particularly at 1-week after the procedure was higher in group 2 and the rate of residual fragments as well as the need for double J stent placement was higher in group 1. Additionally, mean duration of the procedures was significantly longer in Group 1 during which pathologic alterations were significantly higher in ureteral wall at stone site were observed in these cases (P=.0243). CONCLUSIONS: UWT may be used to predict the success of ureteroscopic management and other procedure related parameters for proximal ureteral stones in an effective manner. With this approach a more rational operative plan with higher success rates, limited complications and auxiliary procedures could be made.