scholarly journals The relation between baseline PSA and symptomatic progression in Egyptian BPH patients receiving tamsulosin monotherapy: an exploratory multicentric prospective study

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Mahmoud S. El-Adawy ◽  
Ahmed Y. Abdelaziz ◽  
Fouad Zanaty ◽  
Amr Hodhod ◽  
Ayman S. Moussa ◽  
...  
Keyword(s):  
Specific Antigen ◽  
Symptomatic Improvement ◽  
Urinary Flow ◽  
Urine Retention ◽  
Baseline Serum ◽  
Once Daily ◽  
Acute Urine Retention ◽  
Egyptian Patients ◽  
Baseline Psa

Abstract Background To examine the relation of baseline serum prostatic-specific antigen (PSA) to symptomatic changes in men with benign prostatic hyperplasia (BPH) receiving tamsulosin through its relation to changes in international prostate symptom score (IPSS) and maximum urinary flow rate (Qmax) and the occurrence of acute urine retention (AUR). Results We conducted a multicentric prospective cohort study. BPH patients were included from May 2015 till January 2018. We collected IPSS recording, prostate volume (PV) Qmax. After 2 years of medical treatment with tamsulosin 0.4 mg once daily, full initial evaluation was repeated for all patients. Improvement in IPSS and Qmax was recorded and compared to initial PSA levels. Follow-up was aborted for patients who developed AUR. Moreover, the data of AUR patients were recorded and compared to initial PSA levels. The study included 437 Egyptian patients, and 414 patients (94.7%) had symptomatic improvement through the 2 years of follow-up on tamsulosin monotherapy. In total, 23 patients (5.3%) developed AUR during follow-up. There was a significant association between AUR and higher baseline PSA level (p < 0.001). On the other hand, statistical analysis showed that there was no significant correlation between baseline serum PSA and the improvement in IPSS (r = − 0.02, p = 0.684) or Qmax (r = − 0.06, p = 0.267). The multivariate analysis showed that baseline PSA and PV were independent predictors for AUR (p < 0.001 for both). Conclusions There was a significant relation between baseline PSA and incidence of AUR. However, there was no significant relationship between the serum PSA level and symptoms improvement in BPH.

scholarly journals Active surveillance in patients with a PSA >10 ng/mL

2014 ◽  
Vol 8 (9-10) ◽  
pp. 702 ◽  
Author(s):  
Paul Toren ◽  
Lih-Ming Wong ◽  
Narhari Timilshina ◽  
Shabbir Alibhai ◽  
John Trachtenberg ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Specific Antigen ◽  
Sufficient Evidence ◽  
Hazard Ratios ◽  
Diagnostic Biopsy ◽  
Selection Of Patients ◽  
Baseline Psa ◽  
Selection Of

Introduction: The use of prostate-specific antigen (PSA) in active surveillance (AS) for prostate cancer is controversial. Some consider it an unreliable marker and others as sufficient evidence to exclude patients from AS. We analyzed our cohort of AS patients with a PSA over 10 ng/mL.Methods: We included patients who had clinical T1c–T2a Gleason ≤6 disease, and ≤3 positive cores with ≤50% core involvement at diagnostic biopsy and ≥2 total biopsies. Patients were divided into 3 groups: (1) those with baseline PSA >10 ng/mL, (2) those with a PSA rise >10 ng/mL during follow-up; and (3) those with a PSA <10 ng/mL throughout AS. Adverse histology was defined as biopsy parameters exceeding the entry criteria limits. We further compared this cohort to a concurrent institutional cohort with equal biopsy parameters treated with immediate radical prostatectomy.Results: Our cohort included 698 patients with a median follow-up of 46.2 months. In total, 82 patients had a baseline PSA >10 ng/mL and 157 had a PSA rise >10 ng/mL during surveillance. No difference in adverse histology incidence was detected between groups (p = 0.3). Patients with a PSA greater than 10 were older and had higher prostate volumes. Hazard ratios for groups with a PSA >10 were protective against adverse histology. Larger prostate volume and minimal core involvement appear as factors related to this successful selection of patients to be treated with AS.Conclusion: These results suggest that a strict cut-off PSA value for all AS patients is unwarranted and may result in overtreatment. Though lacking long-term data and validation, AS appears safe in select patients with a PSA >10 ng/mL and low volume Gleason 6 disease.

Docetaxel Plus Prednisone or Mitoxantrone Plus Prednisone for Advanced Prostate Cancer: Updated Survival in the TAX 327 Study

2008 ◽  
Vol 26 (2) ◽  
pp. 242-245 ◽  
Author(s):  
Dominik R. Berthold ◽  
Gregory R. Pond ◽  
Freidele Soban ◽  
Ronald de Wit ◽  
Mario Eisenberger ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Survival Benefit ◽  
Advanced Prostate Cancer ◽  
Specific Antigen ◽  
Weekly Docetaxel ◽  
Original Analysis ◽  
Hormone Resistant Prostate Cancer ◽  
Baseline Psa

Purpose The TAX 327 study compared docetaxel administered every 3 weeks (D3), weekly docetaxel (D1), and mitoxantrone (M), each with prednisone (P), in 1,006 men with metastatic hormone-resistant prostate cancer (HRPC). The original analysis, undertaken in August 2003 when 557 deaths had occurred, showed significantly better survival and response rates for pain, prostate-specific antigen (PSA), and quality of life for D3P when compared with MP. Here, we report an updated analysis of survival. Methods Investigators were asked to provide the date of death or last follow-up for all participants who were alive in August 2003. Results By March 2007, data on 310 additional deaths were obtained (total = 867 deaths). The survival benefit of D3P compared with MP has persisted with extended follow-up (P = .004). Median survival time was 19.2 months (95% CI, 17.5 to 21.3 months) in the D3P arm, 17.8 months (95% CI, 16.2 to 19.2 months) in the D1P arm, and 16.3 months (95% CI, 14.3 to 17.9 months) in the MP arm. More patients survived ≥ 3 years in the D3P and D1P arms (18.6% and 16.6%, respectively) compared with the MP arm (13.5%). Similar trends in survival between treatment arms were seen for men greater than and less than 65 years of age, for those with and without pain at baseline, and for those with baseline PSA greater than and less than the median value of 115 ng/mL. Conclusion The present analysis confirms that survival of men with metastatic HRPC is significantly longer after treatment with D3P than with MP. Consistent results are observed across subgroups of patients.

scholarly journals Transurethral Intraprostatic Botulinum Toxin-a Injection in Patients with Benign Prostatic Hyperplasia: A Case Series and Literature Review

2022 ◽  
Vol 16 (1) ◽  
pp. 9-16
Author(s):  
Mahmoud Tavakkoli ◽  
◽  
Hamidreza Ghorbani ◽  
Amin Nobahar ◽  
Maryam Emadzadeh ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Botulinum Toxin A ◽  
Specific Antigen ◽  
Case Series ◽  
Optimal Number ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Pubmed Database ◽  
The Mean

Background: We aimed to assess the efficacy of Intraprostatic Onabotulinumtoxin-A (BTA) on the International Prostate Symptom Score (IPSS) and other objective measures of patients with Benign Prostatic Hyperplasia (BPH). Methods: Fifteen patients were included in this study. The drug (BTA; 150 IU) was reconstituted in 20 mL of 0.9% saline before administration to the patients. After providing urethral anesthesia, 20 intraurethral injections were made to lateral lobes of the prostate, 10 injections in each lobe. Follow-up visits were planned 3 and 12 months after the intervention. Pre- and post-interventional IPSS, Prostate-Specific Antigen (PSA), Prostate Volume (PV), Post-Void Residue (PVR), and maximum urinary flow rate (Qmax) compared via paired t-test. Finally, we reviewed the Pubmed database to provide a more precise conclusion. Results: The Mean±SD age of patients was 69±8.24 years, and the mean IPSS score decreased significantly from 24.3±3.3 to 14.6±3.7 (p<0.001) and 16.86±3.06 (p<0.009) on the 3rd and 12th months, respectively. The Mean±SD PSA, PVR, Qmax, and PV were 3.26±1.38, 82.33±35.55, 8.56±1.76, and 47.86±8.93, respectively at baseline. These factors significantly improved to 2.72±1.33 (P<0.000), 71.33±30.55 (p<0.000), 9.5±1.33 (p<0.011), and 42.86± 6.04 (p<0.000), respectively, on the 12th month follow-up. Conclusion: Although the overall results support the efficacy of BTA for BPH, the best route of administration, the most effective dose, the optimal number, and the volume of injections need further investigations. The probable placebo effect and underlying medical conditions (e.g., insulin resistance) should be considered as the confounding factors.

scholarly journals Research on Applications of Transurethral Plasmakinetic Enucleation of the Prostate in Elderly Patients Aged ≥80 Years

2021 ◽  
Vol 8 ◽  
Author(s):  
Wen Su ◽  
Ye Yi ◽  
Liang Zeng ◽  
Jin Tang
Keyword(s):  
Elderly Patients ◽  
Transurethral Resection ◽  
Benign Prostate Hyperplasia ◽  
Specific Antigen ◽  
Urinary Flow ◽  
Prostate Hyperplasia ◽  
Flushing Time ◽  
Benign Prostate

Objective: To evaluate the safety and efficacy of transurethral plasmakinetic enucleation of the prostate (PKERP) vs. transurethral resection of the prostate (TURP) in elderly patients aged ≥80 years with benign prostate hyperplasia.Materials and Methods: We conducted a retrospective analysis of the PKERP (n = 123) and TURP (n = 143) in patients aged ≥80 years at urology department of The Third Xiangya Hospital of Central South University from January 2016 to October 2019. Then the preoperative, intraoperative, and postoperative data of different indicators were compared between the two groups. The follow-up was done at 3 months, 1 year after surgical treatment.Results: No significant differences were observed between the two groups for the baseline characteristics, including age, prostate volume, prostate-specific antigen (PSA) level, concurrent disease, maximum urinary flow rate (MFR), international prostate symptoms score (IPSS), and quality of life (QoL) score. The operative time, hemoglobin decrease, and postoperative flushing time were significantly lower in the PKERP group compared with the TURP group. However, no significant differences were observed between both groups for postoperative hospital stay, incidence of transurethral resection syndrome (TURS), prostatic capsular perforation, and genuine urinary incontinence. The follow-up results showed that the MFR of the PKERP group was significantly higher than the TURP group at 1 year after surgery.Conclusion: Compared with TURP, PKERP is a safe and efficacious method for treating patients aged ≥80 years with benign prostate hyperplasia, and it may improve long-term urination symptoms.

scholarly journals Prostatic artery embolization for giant prostatic hyperplasia: a single-center experience

2021 ◽  
Vol 54 (4) ◽  
pp. 219-224
Author(s):  
André Moreira de Assis ◽  
Airton Mota Moreira ◽  
Francisco Cesar Carnevale ◽  
José Ramón Lanz-Luces
Keyword(s):  
Prostate Volume ◽  
Specific Antigen ◽  
Specific Treatment ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Artery Embolization ◽  
Prostatic Artery Embolization ◽  
Single Center Experience ◽  
Prostatic Artery

Abstract Objective: To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods: This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm3, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results: The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm3); and post-void residual volume (from 143.7 to 28.3 mL)-p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion: In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.

Use of PSA threshold to identify an increased 4-year risk of a prostate cancer diagnosis in U.S. men

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5051-5051
Author(s):  
E. D. Crawford ◽  
J. Moul
Keyword(s):  
Prostate Cancer ◽  
African American Men ◽  
Randomized Study ◽  
Specific Antigen ◽  
Reductase Inhibitors ◽  
Increased Risk ◽  
The Future ◽  
Henry Ford ◽  
Baseline Psa

5051 Background: Recent studies have shown that prostate specific antigen (PSA) values can be used to predict risk of developing prostate cancer (PCa) in the future. In the European Randomized Study of Screening for PCa (ERSPC) subjects with PSA of ≥1.5 ng/mL had a significantly greater risk of developing PCa after 4 years than subjects with PSA of <1.5 ng/mL (9.2% vs 1.5%, respectively; OR = 7.466; p < 0.001). This current analysis aimed to validate the ability of PSA of ≥1.5 ng/mL to predict the future risk of PCa in a US population of men within the Henry Ford Healthcare System (HFHS). Methods: This is a retrospective analysis of men enrolled in the Health Alliance Plan of the HFHS between 1997–2004 with at least 4 years of follow-up data. Men ≥40 years of age, with a baseline PSA value between 0–4.0 ng/mL, not receiving 5-alpha reductase inhibitors were included. Men were followed for 4 years after their first PSA value. The risk of 4-year PCa diagnosis was evaluated based on a 1.5 ng/mL PSA threshold, and was assessed by logistic regression, controlling for age and race. Results: A total of 21,502 patients were included in the analysis. At baseline, patients had a mean age of 55 years and a mean PSA of 1.0 ng/mL. Overall, 7.9% of patients with baseline PSA of 1.5–4 ng/mL were diagnosed with PCa after 4 years, compared to 0.5% of patients with a baseline PSA of <1.5 ng/mL. In a multivariate analysis (controlling for race and age), patients with a baseline PSA of 1.5–4 ng/mL were 12 times more likely to be diagnosed with PCa over 4 years than patients with baseline PSA of <1.5 ng/mL (OR = 12.4; 95% CI: 9.7–15.9; p < 0.0001). African Americans (n = 6,367) with baseline PSA 1.5–4 ng/mL vs baseline PSA<1.5 ng/mL had an even higher risk of being diagnosed with PCa over 4 years (OR = 17.0; 95% CI: 11.0–26.1; p < 0.0001). Conclusions: This analysis validates that men with PSA values 1.5 to 4 ng/mL are at a significantly increased risk for developing future prostate cancer compared to those with a PSA value below the 1.5 threshold. This threshold also confers increased 4-year risk in African American men. [Table: see text]

scholarly journals Efficacy of bipolar transurethral resection of the prostate using TURIS: our short term experience

2019 ◽  
Vol 6 (5) ◽  
pp. 1556
Author(s):  
Praveen Singh ◽  
Mohd Mubashir A. Khan
Keyword(s):  
Urethral Stricture ◽  
Transurethral Resection ◽  
Specific Antigen ◽  
Resected Specimen ◽  
Transurethral Resection Of Prostate ◽  
Urinary Flow ◽  
Short Term ◽  
Stricture Rate ◽  
The Mean

Background: Objective of the study was to report our short term experience regarding efficacy of bipolar transurethral resection of prostate using TURIS (transurethral resection in saline) system.Methods: Between May 2016 to April 2017 49 consecutive patients underwent bipolar transurethral resection of prostate (B-TURP) at our institute. All patients were evaluated preoperatively by physical examination, ultrasonography and laboratory studies, including measurement of hemoglobin, serum sodium, and prostate specific antigen levels. Patients were assessed postoperatively at three, six and 18 months.Results: The mean age of the patients was 64.83±7.47 years and mean preoperative prostate volume was 64.73±13.59 ml. The mean preoperative hemoglobin was 13.32±0.9 g/l and mean postoperative hemoglobin was 12.09±1.11 g/l. The mean resection time was 57.02±14.37 minutes and mean resected specimen weight was 41.69±12.15 gm. The mean preoperative maximum urinary flow rate (Qmax) was 8.6±1.17 ml/s and mean Qmax at three, six and 18 months follow up was 18.85±2.15, 19.43±1.49 and 18.98±1.6 ml/s respectively. The mean preoperative international prostate symptom score (IPSS) was 26.32±2.69 and mean IPSS at three, six and 18 months follow up was 6.68±1.36, 6.47±0.79 and 6.30±0.9 respectively. Only one patient developed urethral stricture during follow up.Conclusions: The B-TURP is efficacious and results in significant improvement in IPSS and Qmax. The urethral stricture rate after B-TURP is not different from monopolar TURP.

Effect of Age, Family History of Prostate Cancer, Prostate Enlargement and Seasonality on PSA Levels in a Contemporary Cohort of Healthy Italian Subjects

2011 ◽  
Vol 26 (2) ◽  
pp. 102-107 ◽  
Author(s):  
Angelo Naselli ◽  
Vincenzo Fontana ◽  
Carlo Introini ◽  
Rossana Andreatta ◽  
Paolo Puppo
Keyword(s):  
Prostate Cancer ◽  
Family History ◽  
Specific Antigen ◽  
Joint Effect ◽  
Prostate Enlargement ◽  
History Of ◽  
Cancer Prostate ◽  
Effect Of Age ◽  
Baseline Psa

We assessed the joint effect of age at enrolment, age at follow-up, family history of prostate cancer, prostate enlargement and seasonality on prostate-specific antigen (PSA) estimated through log-normal mixed-effects modeling in an Italian cohort of healthy, 45- to 65-year-old subjects over a 4-year period. The median ratio was used as the measure of effect. Median and mean baseline PSA were 0.78 (interquartile range: 0.41–1.50) and 1.27 (95% CI: 1.19–1.35) ng/mL, respectively. A similar median annual increase of 5.7% (95% CI: 4.8%-6.5%) was found for age at enrolment and age at follow-up. Individuals with moderate to severe prostate enlargement had a median PSA ratio of 1.040 (95% CI: 0.919–1.176) and 1.318 (95% CI: 1.128–1.539), respectively. Median ratios of 1.200 (95% CI: 0.026–1.404) and 1.300 (95% CI: 0.915–1.845), respectively, were computed for subjects with only one or more than one prostate-cancer-affected relatives. Regarding seasonality, the highest value was shown in summertime, the lowest in wintertime, and the resulting median ratio was 1.280 (95% CI: 1.117–1.468). Irrespective of age, baseline PSA was in most cases about 1.00 ng/mL with a yearly median variation of about 5% over a 4-year period. Indeed, prostate enlargement, prostate cancer family history and seasonality showed a remarkable impact on PSA measurement. This should be considered when counseling patients with a PSA history.

scholarly journals Clinical profile and outcomes of patients with clinical benign prostate hyperplasia treated by trans urethral resection of prostate at Bugando Medical Centre, Mwanza, Tanzania

2021 ◽  
Vol 15 (3) ◽  
pp. 025-040
Author(s):  
George Elisamehe Mocha ◽  
Bartholomeo Nicholaus Ngowi ◽  
John Zakayo Igenge ◽  
Willium Rhys Mahalu ◽  
Frank Kora Chacha ◽  
...  
Keyword(s):  
Clinical Profile ◽  
Urine Retention ◽  
Prostate Hyperplasia ◽  
Acute Urine Retention ◽  
Urinary Tract Symptoms ◽  
Benign Prostate ◽  
Bugando Medical Centre ◽  
Lower Urinary

Introduction: Benign Prostate Hyperplasia (BPH) is the most common prostatic pathology in elderly men with Trans Urethral Resection of the Prostate (TURP) still being considered as the gold standard surgical management. TURP is the commonest endoscopic surgery performed for BPH in developing countries including Tanzania, however its outcome in this part of the world has not been documented. Therefore, the study aimed to determine the clinical profile, outcome as well as predictors of outcome in patients with clinical BPH undergoing TURP at Bugando Medical Centre (BMC), a tertiary hospital in Mwanza, Tanzania. Methods: This was a cross sectional longitudinal hospital based study to evaluate the clinical profile as well as the outcome of patients with clinical BPH treated by TURP at BMC from November 2018 to April 2019. All participants scheduled for TURP for the diagnosis of clinical BPH who signed informed consent for the study were included, their international prostate symptom score (IPSS) with the 8th question for quality of life (QoL) was scored, social demographic data and clinical profile information were obtained from their files. Participants were followed in the theatre to document any intraoperative complications and other necessary data required by this study. Progress in the ward was recorded and following discharge, patient was scheduled for follow up at 6 and 12 weeks. During follow up, IPSS and QoL scores as well as complication was recorded. Results: A total of 210 participants met the eligibility criteria. The median age was 69 (IQR 63-75) years. Prostate size ranged from 15 – 200 grams with median size of 77 (IQR 51-107) grams. Acute urine retention was the most common indication 69 (33%), followed by lower urinary tract symptoms 52 (25%). Urologist operated most of the patient 122 (58.1%) with the rest operated by either resident alone or finished up by urologist, and the median weight resected was 20 (IQR 13.5 –28.3) grams. About 66 (31.4%) developed perioperative complication with majority having clot retention. During follow up, the median IPSS score was 9 (IQR 7 – 12) and 2 (IQR 0 – 6) and median QoL score of 3 (IQR 1 – 3) and 0 (IQR 0 – 1) with improvement of 93 (45.4%) and 184 (89.8%) on 1st and 2nd follow up visits respectively. There were a total of 9 (4.3%) patients whom developed Trans urethral resection (TUR) syndrome, with overall mortality of 3 (1.4%). Conclusion: BPH is common from 6th decade of life onwards. Though most participants were operated because of either acute urine retention or severe lower urinary tract symptoms (LUTS), some presents late already with renal insufficiency. Despite the fact that most of the participants had severe symptoms and their quality of life was poor at presentation, TURP improved symptoms in most of the participants. The improvement is even better in the hands of experienced surgeon, for the participants with small prostate and in absence of UTI prior to surgery.

Polymer-glue as a life and kidney function saver: a life-threatening hemorrhage in the ruptured upper pole artery of the kidney managed by percutaneous embolization — a case report and literature review

Open Medicine ◽  
2013 ◽  
Vol 8 (3) ◽  
pp. 339-342
Author(s):  
Artur Antoniewicz ◽  
Izabela Wojtkowska ◽  
Mirosław Dziekiewicz ◽  
Cezary Kępka ◽  
Elżbieta Kremis ◽  
...  
Keyword(s):  
Pleural Cavity ◽  
Percutaneous Angioplasty ◽  
Urine Retention ◽  
Selective Embolization ◽  
Percutaneous Embolization ◽  
Acute Urine Retention ◽  
Fatal Hemorrhage ◽  
Life Threatening ◽  
The Right

AbstractIn this paper we report the case of a nearly fatal hemorrhage in the artery of the renal upper pole that occurred in a 84-year-old woman on anticoagulation treatment in connection with aortic valve replacement 4 days prior to the incident. The artery was injured during the evacuation of a hematoma of the right pleural cavity. While the patient was in the intensive care unit recovering from cardiac valve surgery, the consulting urologist was summoned in order to cope with massive hematuria and acute urine retention. Unfortunately, conservative urological management based on catherization via a three-way catheter and constant transurethral lavage with saline was unsuccessful. Angio-computed tomography revealed a ruptured branch of the renal upper pole artery. A highly selective embolization using histoacryl injection during percutaneous angioplasty was performed. There were no complications in the following days. The patient was subject to postoperative follow-up at 3, 6 and 9 months and renal scintigraphy was performed at 6 months revealing symmetrical function of both kidneys without any changes in the upper pole of the right kidney.

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