Since the first report on the efficacy of sextant biopsy under transrectal ultrasound guidance, there have been many modifications related to the total number of cores and the localization of biopsies to improve the prostate cancer (PCa) detection rate. The 2010 National Comprehensive Cancer Network Early PCa Detection Guidelines noted the 12-core biopsy scheme as the standard. However, this extended biopsy scheme still fails to detect 20% of high-grade PCa that can be detected by detailed pathological evaluation of radical prostatectomy; therefore, there is need for saturation biopsies. The existence of suspicions of PCa after previous negative biopsy or biopsies represents a valid indication for saturation biopsy. There has been no significant increment in morbidity or in insignificant PCa detection rates when a saturation biopsy scheme was used with an extended biopsy scheme. Along with the improvement in the PCa detection rate, accurate oncological mapping of PCa is another important consideration of saturation biopsies. The ideal number of cores and the diagnostic value of saturation biopsy after the failure of initial therapy are some of the issues that need to be addressed. Preliminary reports have shown that magnetic resonance imaging can improve the PCa detection rate, save patients from unnecessary biopsies, and decrease the need for a high number of cores; however, multiple limitations continue to exist
Objeetive: To evaluate the diagnostic value of prostate specific antigen (PSA) and its derivatives in detecting prostate cancer at biopsies. Materials and methods: Between July 2004 and March 2005, 1,05patients who underwent transrectal ultrasound-guided (TRUSO) systemic sextant core biopsies were included. All patients had PSA values 4-20 ng/ml ± abnormal digital rectal examinations (DRE) findings. PSA density (PSAD) and PSA density of the transition zone(TZPSAD) were calculated for each patient. Comparison between the clinical variables of patients with prostate cancer and benign prostatic hyperplasia (BPH) in terms of TPSA, total volume, TPSAD, TZPSAD, TRUS findings and DRE findings, "vas done. The diagnostic value of TRUS and DRE were also evaluated. Results: Out of 105 patients 11 had prostatic cancer (10.47%). There was no significant difference between subjects with BPH and subjects with prostate cancer in terms of total prostate volume, TPSA values, TRUS findings and DRE findings. However the values ofTPSAD and TZPSAD for patients with BPH differs significantly from that of patients with prostate cancer (P = 0.0001, P = 0.009 respectively). The accuracy ofDRE and TRUSO were 59.04% and 50.470/0respectively, both of them are poor predictors with insignificant difference (P= 0.25). Conclusion: Total PSA is of no diagnostic value in detecting prostate cancer in Egyptian patients with PSA < 20 ng/ml. However TPSAD and TZPSAD could be considered as accurate parameters with clinical significant for prostate cancer prediction in patients with PSA below 20 ng/ml. TRUS and DRE are poor predictor of prostate cancer with no significant difference.
Retrospectively, we investigated the association of prostatic calculi with prostate cancer. Between July 2004 and March 2005, 141 patients who underwent sextant core transrectal ultrasound (TRUS) guided prostate biopsy were enrolled. All patients had a suspicion of prostate cancer in the form of prostate specific antigen (PSA) > 4 ng/ml and/or abnormal digital rectal examination (DRE). The patients were divided into three groups according to their PSA values (PSA < 10 ng/ml, PSA 10-20 ng/rnl, and PSA > 20 ng/ml respectively) and were evaluated separately. Prostatic calculi were detected in 76 patients (53.9 %). Out of 141 patients, 29 had positive prostate biopsy (20.6%). No significant difference was found between the presence of prostatic calculi in patients with benign prostatic hyperplasia (BPH) and prostate cancer (54.9%, 51:-7% respectively; P = 0.56). Patients with prostate cancer and PSA < 10 nglml were associated with statistically insignificant higher incidence of prostate calculi compared to patients with BPH in the same group (83.33%, 59.3% respectively; p = 0.2). There is no association between the presence of prostatic calculi and prostate cancer. The prostatic calculi show similar distribution between patients with BPH and prostate cancer.
Locally recurrent prostate cancer after radiation therapy, also known as radiorecurrent prostate cancer, has an unfavorable prognosis. Two-thirds of patients with radiorecurrent prostate cancer have an advanced pathological disease status by the time they undergo salvage therapy. Several salvage therapies for radiorecurrent prostate cancer are available. Salvage radical prostatectomy (SRP) and salvage cryoablation are the most feasible and effective therapies for radiorecurrent prostate cancer. Although SRP is technically more difficult and has a higher complication rate than do other salvage therapies, the procedure provides a long-term survival benefit. Preliminary studies of salvage robot-assisted radical prostatectomy (SRARP) suggest that SRARP may be similar to or at least as effective as SRP. The intermediate oncological efficacy and morbidity of salvage cryoablation are similar to those of SRP. Prognostic factors for successful salvage therapy include serum prostate-specific antigen level ≤10 ng/mL, Gleason score ≤8, and a clinical disease stage T1c or T2. Assessing the comparative oncological efficacy and complications of the available salvage therapies for radiorecurrent prostate cancer requires strict guidelines, including universal patient selection criteria and an intergrade definition of biochemical failure.
Objective: We aimed to evaluate the relationship between serum total testosterone and total prostate specific antigen (TPSA) levels in healthy men from two different regions of Turkey.
Material and methods: The study included two separate groups of healthy men from two geographically distinct regions in Turkey. Group 1 included 119 patients with a mean age of 52.73±7.53 years who visited Osmaniye State Hospital for routine check-up between January 2006 and January 2007. Group 2 consisted of 196 patients with a mean age of 50.32±7.84 years who were sent to outpatient clinics in İzmir Atatürk Teaching Hospital between July 2008 and July 2009. The relationships among testosterone and TPSA levels and patients’ age were evaluated.
Results: The mean TPSA levels for Group 1 and Group 2 were 1.11±0.78 ng/mL and 1.75±1.06 ng/mL, respectively (p=0.5). The mean testosterone levels in Group 1 (386.4±154.6 ng/dL) and Group 2 (383.9±170.6 ng/dL) showed no significant difference (p=0.89). There was a positive correlation between the age of the patients and testosterone level (r=0.22, p=0.015) in Group 1; however, in Group 2, there was a significant negative correlation between age and serum testosterone levels (r=-0.16, p=0.022). Serum testosterone level showed no significant correlation with TPSA level in either group (Group 1: r=0.03, p=0.72; Group 2: r=-0.04, p=0.67).
Conclusion: Testosterone or TPSA levels did not change between geographical regions of Turkey. However, the effect of age on testosterone levels varies according to geographical regions. Further studies with more patients are needed to confirm these preliminary results and to investigate the impact of geographical regions on the oncologic features of prostate cancer and other urologic diseases.