Preventing Unnecessary Invasive Cancer-Diagnostic Tests: Changing the Cut-off Points.

BACKGROUND: To determine a cut-off point of tPSA and PSAD to prevent unnecessary invasive cancer-diagnosing tests in the community. METHODS: This study was performed on 688 consecutive patients referred to our center due to prostatism, suspicious lesions on digital rectal examination and/or elevated serum PSA levels. All patients underwent transrectal ultrasound guided biopsies and obtained PSAD. Serum levels of tPSA and fPSA were measured by chemiluminescence. Comparisons were done using tests of accuracy (AUC-ROC). RESULTS: Prostate cancer was detected in 334 patients, whereas the other 354 patients were suffering from benign prostate diseases. The mean tPSA in case and control groups were 28.32±63.62 ng/ml and 7.14±10.04 ng/ml; the mean f/tPSA ratios were 0.13± 0.21 and 0.26±0.24 in PCa and benign prostate disease groups; the mean PSAD rates were 0.69±2.24, 0.12±0.11, respectively. Statistically significant differences were found (P <0.05). Using ROC curve analysis, it was revealed that AUC was 0.78 for tPSA and 0.80 for f/tPSA. Sensitivity was 71% for the cut-off value of 7.85ng/ml. For f/tPSA ratio, the optimal cut-off value was 0.13 which produced the sensitivity of 81.4% and for PSAD, it was15%. CONCLUSIONS: As this trial is different from the European and American values, we should be more cautious in dealing with the prostate cancer upon the obtained sensitivity and specificity for PCa diagnosis (7.85ng/mL for tPSA, 15% for PSAD and 0.13 for f/tPSA ratio).

Identification and investigation on antagonistic effect of Trichoderma spp. on tea seedlings white foot and root rot (Sclerotium rolfsii Sacc.) in vitro condition.

The aim of this two years research work is to recognize bio control agents and its antagonistic efficiency on Sclerotium rolfsii in vitro condition. Sclerotium rolfsii Sacc. is a causal agent of white foot and root rot disease in many plants. This fungi causing damage in tea nurseries of tea cultivated countries especially in Iran. Due to importance this disease in tea nurseries of Iran and impossibility using of chemical control against this damaging agent In this research, five species of Trichoderma viride, Trichoderma harzianum, Trichoderma hamatum, Trichoderma longibrachiatum and Trichoderma parceramosum as antagonist fungi against Sclerotium rolfsii were collected and identified from tea nurseries and seedlings in Iran. Then efficiency of these bio control agent against Sclerotium rolfsii were investigated in vitro condition. Results showed that these species with different mechanism such as lysis of sclerotia, inhibited mycelial growth of Sclerotium rolfsii with volatile metabolites producing and parasitized the hyphal trends of disease agent were showed its antagonistic effects against causal agent of white foot and root rot in tea seedling. Trichoderma viride, Trichoderma harzianum and Trichoderma hamatum after 30 days destructed and lysis the sclerotia 98.5, 86.5 and 85%, respectively. Producing of volatile metabolites after 72 h reciprocal growth of Trichoderma viride, Trichoderma harzianum and Trichoderma longibrachiatum till 60.8, 54.8 and 54.4% prevented mycelium growth of Sclerotium rolfsii, respectively. All identified species caused parasitize (to hyphal contact method) pathogen fungal hypha that the first three species showed more parasite effect.

A comparison between clinical and pathologic staging in patients with bladder cancer.

PURPOSE: To determine the accuracy of clinical staging methods of bladder cancer and TURBT results in estimating the pathologic stage of tumor. MATERIALS AND METHODS: Thirty two patients who had undergone radical cystectomy were studied in this retrospective survey. The results of bimanual examination, cystoscopy, TURBT pathology report and the tumor contour in CT scan, (size, infiltrative deepness, pelvic lymph nodes involvement and hydronephrosis) were recorded. The type of surgery and pathologic report of cystectomy sample were analyzed as well. Then the results of bimanual examination, tumor size, hydronephrosis and CT scan findings including tumor infiltrative deepness, pelvic lymph adenopathy and TURBT findings were compared to pathologic results of cystectomy sample. RESULTS: Seven patients were females and 25 were males. Their mean age was 62 (range 36 to 80) years. Gross hematuria and irritative urinary symptoms were the most common complaints. The duration between symptom manifestation and patient's referral was 5 days to 72 months (mean 12 months). Bimanual examination in estimating the extravesical involvement of tumor had a specificity of 82%, sensitivity of 46%, positive predictive value of 70% and negative predictive value of 63%. The size of tumor in determining extravesical involvement had a specificity of 41%, sensitivity of 93%, and positive predictive value of 58% and negative predictive value of 87%. Hydronephrosis was present in 15 patients of whom, 14(93%) had bladder muscle involvement. CT scan specificity was 70%, and sensitivity was 46% regarding pelvic lymph adenopathy and perivesical fat involvement. In TURBT report no muscle sample was observed in 11 cases, so that the interpretations of results were impossible. The reported grade of tumor was lower than pathologic sample of cystectomy in 4 patients. CONCLUSION: Clinical staging in invasive bladder cancers has not high accuracy regarding the involvement of bladder surrounding fats and pelvic adenopathies. A tumor sized more than 5 cm could be sensitive in estimating extravesical involvement. Positive predictive value of hydronephrosis is considerable regarding bladder muscle involvement. Tumor understaging by TURBT is happened in high percentage of patients with invasive bladder cancer.