Empiric antibiotics for an elevated PSA: A randomized, prospective multi-institutional trial.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 32-32
Author(s):  
Michael Christopher Large ◽  
Glenn Scott Gerber ◽  
Joseph Atkins Pettus ◽  
John Smith ◽  
Ofer Yossepowitch ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Asymptomatic Patient ◽  
Digital Rectal Examination ◽  
Antibiotic Use ◽  
Control Group ◽  
Early Stopping ◽  
Detection Rates ◽  
Medical Centers ◽  
The Impact

32 Background: The impact of an empiric course of antibiotics for a newly elevated PSA in an asymptomatic male is poorly understood. Methods: Men of any age with a PSA > 2.5 ng/ml and normal digital rectal examination undergoing their first prostate biopsy were recruited from six medical centers. Patients with previous biopsy, prostate cancer, urinary tract infection (UTI) or prostatitis within the prior year, antibiotic use within one month, 5−alpha reductase inhibitor use, allergy to fluoroquinolones or clinical suspicion of UTI were excluded. Men were randomized to two weeks of ciprofloxacin 500 mg twice daily or no antibiotic. A PSA was obtained 21−45 days following randomization and immediately prior to prostate biopsy. All patients received institution−specific prophylactic peri−procedural antibiotics. Primary endpoint was change in PSA between baseline and on the day of biopsy. The trial was closed early following an interim analysis and decision rule for futility and early stopping. Results: Complete data was available on 77 men with a mean age of 60.6 (IQR: 53.8 – 66.7). In the control group (no antibiotic; n=39), mean baseline and pre−biopsy PSA were 6.5 and 6.9 ng/ml, respectively (p=0.8). In men receiving antibiotic (n=38), mean baseline and pre−biopsy (post−antibiotic) PSA were 7.6 and 8.5 ng/ml, respectively (p=0.7). Prostate cancer was detected in 36 (47%) men. Detection rates did not significantly differ between individuals with an increasing PSA or decreasing PSA between the two measurements. Conclusions: Empiric use of antibiotics for an elevated PSA in an asymptomatic patient is not of clinical benefit.

scholarly journals Magnetic Resonance Imaging in Hematospermia: Does It Increase Unnecessary Prostate Biopsy?

2016 ◽  
Vol 10 (1) ◽  
pp. 50-54
Author(s):  
Luke A. McGuinness ◽  
Samer Obeidat ◽  
Christopher Powell
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Prostate Biopsy ◽  
Detection Rate ◽  
Digital Rectal Examination ◽  
Cancer Detection Rate ◽  
Detection Rates ◽  
Uncommon Presentation ◽  
Imaging Results ◽  
Second Year

Introduction: Hematospermia is an uncommon presentation of prostate cancer. Following the introduction of MRI for patients with hematospermia we evaluated its use and effect on prostate biopsy and cancer detection rates. Materials and Methods: Analysis of patients attending our outpatient department over 2 years was undertaken. Diagnostic workup included digital rectal examination and PSA. Those with abnormal findings or persisting symptoms were offered prostate biopsy. In the second year MRI became available for patients with hematospermia. Abnormal MRI or persisting symptoms were offered biopsy. We compared the frequency of prostate biopsy and cancer detection in patients undergoing MRI and those not having imaging. Results: Forty-seven patients were referred with hematospermia. Nineteen patients did not undergo MRI; four received prostate biopsy with one adenocarcinoma found. Twenty-four patients had an MRI with 17 biopsies undertaken. Three biopsies revealed adenocarcinoma. In the MRI group 71% of patients underwent prostate biopsy but only 21% from the non-MRI group (p < 0.05). Prostate cancer detection rate in the MRI group was 18% whilst in the non-MRI group was 25% (p = 0.7). Conclusions: Our findings indicate that caution should be used with MRI as it can lead to an increase in prostate biopsy with no change in cancer detection rate.

scholarly journals The Detection of Clinically Significant Prostate Cancer in Chinese Biopsy Naïve Men. The Role of Mpmri and Targeted Biopsy and Risk Stratification Using PSA Density

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Kai Zhang ◽  
Zijian Song ◽  
S. Remmers ◽  
Rui Chen ◽  
Gang Zhu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Stratification ◽  
Prostate Biopsy ◽  
Digital Rectal Examination ◽  
Psa Density ◽  
Medical Centers ◽  
Chinese Cohort ◽  
Detection Ratio ◽  
Clinically Significant

Objective To evaluate the performance of the systematic (SBx) and targeted prostate biopsy (TBx) in detecting prostate cancer (PCa) and significant prostate cancer (csPCa) and including upfront risk stratification with PSA Density (PSAD) in a biopsy naïve cohort of Chinese men. Methods A total of 348 men from two medical centers were available for analyses. All men underwent a mpMRI scan based on an elevated PSA and/or abnormal digital rectal examination (DRE). A total of 150 men received both SBx and TBx prostate biopsy (PIRADS >= 3). In these men the detection ratio was calculated as the PCa and csPCa prevalence of the TBx strategy divided by the prevalence of PCa and csPCa of the SBx + TBx strategy. For PSAD analyses the percentage missed csPCa were plotted against the clinically relevant thresholds of PSAD (range 0.01 – 0.20). Results In the men with PIRADS >= 3, a total of 89 PCa cases (59 being csPCa) were detected. The TBx alone strategy detected 74 of all PCa, leading to a detection ratio of 0.83 (95% CI 0.74-0.90). For csPCa these numbers were 48 of the total 59 csPCa cases, i.e a detection ratio of 0.81 (95% CI 0.69-0.90).With the focus on avoiding missing csPCa diagnoses a cut-off of PSA D 0.10 seemed optimal in this cohort, leading to a reduction of 15% of all referrals, missing 6% of all PCa and 2% of csPCa. A similar cut-off of PSAD holds if also men with PIRADS >= 2 were included. Conclusion In this Chinese cohort of biopsy naïve men a TBx approach can aid in improved detection of csPCa. Omitting SBx would results in missing csPCa cases. An upfront risk stratification step with the use of PSAD is advised although the optimal PSAD cut-off in Asian men most likely differs from the generally advised cut-off of 0.15 ng/ml/ml.

scholarly journals Analysis of risk factors for determining the need for prostate biopsy in patients with negative MRI

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Linghui Liang ◽  
Feng Qi ◽  
Yifei Cheng ◽  
Lei Zhang ◽  
Dongliang Cao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Efficiency ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Multivariable Logistic Regression Analysis ◽  
Detection Rates ◽  
Prostate Biopsies ◽  
Clinically Significant ◽  
Definition Of ◽  
Medical University

AbstractTo analyze the clinical characteristics of patients with negative biparametric magnetic resonance imaging (bpMRI) who didn’t need prostate biopsies (PBs). A total of 1,012 male patients who underwent PBs in the First Affiliated Hospital of Nanjing Medical University from March 2018 to November 2019, of 225 had prebiopsy negative bpMRI (defined as Prostate Imaging Reporting and Data System (PI-RADS 2.1) score less than 3). The detection efficiency of clinically significant prostate cancer (CSPCa) was assessed according to age, digital rectal examination (DRE), prostate volume (PV) on bpMRI, prostate-specific antigen (PSA) and PSA density (PSAD). The definition of CSPCa for Gleason score > 6. Univariate and multivariable logistic regression analysis were used to identify predictive factors of absent CSPCa on PBs. Moreover, absent CSPCa contained clinically insignificant prostate cancer (CIPCa) and benign result. The detection rates of present prostate cancer (PCa) and CSPCa were 27.11% and 16.44%, respectively. Patients who were diagnosed as CSPCa had an older age (P < 0.001), suspicious DRE (P < 0.001), a smaller PV (P < 0.001), higher PSA value (P = 0.008) and higher PSAD (P < 0.001) compared to the CIPCa group and benign result group. PSAD < 0.15 ng/ml/cm3 (P = 0.004) and suspicious DRE (P < 0.001) were independent predictors of absent CSPCa on BPs. The negative forecast value of bpMRI for BP detection of CSPCa increased with decreasing PSAD, mainly in patients with naive PB (P < 0.001) but not in prior negative PB patients. 25.33% of the men had the combination of negative bpMRI, PSAD < 0.15 ng/ml/cm3 and PB naive, and none had CSPCa on repeat PBs. The incidence of PB was determined, CSPCa was 1.59%, 0% and 16.67% in patients with negative bpMRI and PSAD < 0.15 ng/ml/cm3, patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and biopsy naive and patients with negative bpMRI, PSAD < 0.15 ng/ml/cm3 and prior negative PB, separately. We found that a part of patients with negative bpMRI, a younger age, no suspicious DRE and PSAD < 0.15 ng/ml/cm3 may securely avoid PBs. Conversely PB should be considered in patients regardless of negative bpMRI, especially who with a greater age, obviously suspicious DRE, significantly increased PSA value, a significantly small PV on MRI and PSAD > 0.15 ng/ml/cm3.

scholarly journals Integrated predictive model for prostatic cancer using clinical, laboratory and ultrasound data

2016 ◽  
Vol 43 (6) ◽  
pp. 430-437
Author(s):  
GUSTAVO DAVID LUDWIG ◽  
HENRIQUE PERES ROCHA ◽  
LÚCIO JOSÉ BOTELHO ◽  
MAIARA BRUSCO FREITAS
Keyword(s):  
Prostate Cancer ◽  
Predictive Model ◽  
Prostate Biopsy ◽  
Clinical Laboratory ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Roc Curves ◽  
Rectal Examination ◽  
Psa Density

ABSTRACT Objective: to develop a predictive model to estimate the probability of prostate cancer prior to biopsy. Methods: from September 2009 to January 2014, 445 men underwent prostate biopsy in a radiology service. We excluded from the study patients with diseases that could compromise the data analysis, who had undergone prostatic resection or used 5-alpha-reductase inhibitors. Thus, we selected 412 patients. Variables included in the model were age, prostate specific antigen (PSA), digital rectal examination, prostate volume and abnormal sonographic findings. We constructed Receiver Operating Characteristic (ROC) curves and calculated the areas under the curve, as well as the model's Positive Predictive Value (PPV) . Results: of the 412 men, 155 (37.62%) had prostate cancer (PC). The mean age was 63.8 years and the median PSA was 7.22ng/ml. In addition, 21.6% and 20.6% of patients had abnormalities on digital rectal examination and image suggestive of cancer by ultrasound, respectively. The median prostate volume and PSA density were 45.15cm3 and 0.15ng/ml/cm3, respectively. Univariate and multivariate analyses showed that only five studied risk factors are predictors of PC in the study (p<0.05). The PSA density was excluded from the model (p=0.314). The area under the ROC curve for PC prediction was 0.86. The PPV was 48.08% for 95%sensitivity and 52.37% for 90% sensitivity. Conclusion: the results indicate that clinical, laboratory and ultrasound data, besides easily obtained, can better stratify the risk of patients undergoing prostate biopsy.

scholarly journals Clinical Utility of miRNA-1, miRNA-29g and miRNA-133s Plasma Levels in Prostate Cancer Patients With High-Intensity Training After Androgen-Deprivation Therapy

2019 ◽  
pp. S139-S147
Author(s):  
A. GAZOVA ◽  
A. SAMAKOVA ◽  
E. LACZO ◽  
D. HAMAR ◽  
M. POLAKOVICOVA ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Body Composition ◽  
Exercise Training ◽  
Androgen Deprivation Therapy ◽  
Plasma Levels ◽  
Exercise Intervention ◽  
Free Testosterone ◽  
Androgen Deprivation ◽  
Control Group ◽  
The Impact

The randomized trials showed that the addition of training resistance program to androgen-deprivation therapy (ADT) had many beneficial effects for prostate cancer (PC) patients (significant protective effect on the volume of muscle mass) and the studies have revealed a panel of miRNAs, which are deregulate in PC and may serve as promising biomarkers of PC risk. The primary aim of our present study was to investigate the effect of exercise training to changes in body composition (muscle strength) and the secondary endpoint was to investigate the impact of an exercise training program on plasma levels of selected myogenic microRNAs (miRNAs) (miRNA-1, miRNA-29b, and miRNA-133) in PC patients undergoing the ADT. Effect of ADT and exercise intervention showed significant increase (experimental group vs. control group) the changes in body composition, free testosterone levels, IL-6 and plasma levels of myogenic miRNAs and significant reduced insulin serum levels. In conclusion, resistance training with ADT in the treatment of PC significantly changed the physical and metabolic function and the plasma levels of specific myogenic miRNAs. Our data support with the other publicized results.

scholarly journals Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer

2020 ◽  
Vol 42 (2) ◽  
pp. 76-79
Author(s):  
Dinesh Chataut ◽  
Babin Basnet ◽  
Benu Lohani ◽  
Sundar Suwal ◽  
Sharma Paudel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Gold Standard ◽  
Detection Rate ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Elderly Male ◽  
Common Cancer ◽  
In Trans ◽  
Focus Detection

Introduction Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings. MethodsProspective study was done in 66 males of age >40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA >4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings. ResultsTwenty three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%. ConclusionTRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer.

Urinary miR-183 and miR-205 do not surpass PCA3 in urine as predictive markers for prostate biopsy outcome despite their highly dysregulated expression in prostate cancer tissue

2015 ◽  
Vol 53 (7) ◽  
Author(s):  
Carsten Stephan ◽  
Monika Jung ◽  
Silke Rabenhorst ◽  
Ergin Kilic ◽  
Klaus Jung
Keyword(s):  
Prostate Cancer ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Critical Evaluation ◽  
Sample Size Calculation ◽  
Digital Rectal Examination ◽  
Predictive Marker ◽  
Testing Procedure ◽  
Cancer Tissue ◽  
Few Data

AbstractMicroRNAs (miRNAs) have shown to be promising novel biomarkers in various cancers. We aimed to translate the results of an own previous tissue-based miRNA profile of prostate carcinoma (PCa) with upregulated miR-183 and downregulated miR-205 into a urine-based testing procedure for diagnosis of PCa.Urine sediments were prepared from urine samples collected after a standardized digital-rectal examination (DRE) of patients undergoing prostate biopsy with PSA (prostate-specific antigen) values <20 μg/L in consecutive order. According to the sample-size calculation (α=0.05, power=0.95), 38 patients each with PCa and without PCa were randomly enrolled in this study. PCA3 (prostate cancer associated 3) in urine as Food and Drug Administration-approved assay was determined as reference standard for comparison. The miRNAs were measured by RT-qPCR using TaqMan assays and normalized using different approaches.Both miRNAs were correlated to the mRNA PSA concentrations in the sediments indicating a relationship to the released prostate cells after DRE. However, they had no discriminating capacity between patients with and without PCa. In contrast, PCA3 clearly differentiated between these two patients groups. There was also no significant correlation between miRNAs and standard clinicopathologic variables like Gleason score and serum PSA.The data of our study show that miR-183 and miR-205 failed to detect early and aggressive PCa despite their highly dysregulated expression in cancer tissue. Our results and the critical evaluation of the few data of other studies raise serious doubts concerning the capability of urinary miRNAs to replace or improve PCA3 as predictive marker for prostate biopsy outcome.

Prostate cancer risk calculators for healthy population: A systematic review (Preprint)

2021 ◽  
Author(s):  
Antonio Bandala-Jacques ◽  
Kevin Daniel Castellanos Esquivel ◽  
Fernanda Pérez-Hurtado ◽  
Cristobal Hernández-Silva ◽  
Nancy Reynoso-Noverón
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Systematic Review ◽  
Cancer Risk ◽  
Digital Rectal Examination ◽  
Prostate Cancer Risk ◽  
Individual Risk ◽  
Healthy Population ◽  
Risk Of Cancer ◽  
The Impact

BACKGROUND Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients’ individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to a better discrimination of patients in need of invasive diagnostic procedures and for optimized allocation of healthcare resources OBJECTIVE To systematically review available literature on current prostate cancer risk calculators’ performance in healthy population, by comparing the impact factor of individual items on different cohorts, and the models’ overall performance. METHODS We performed a systematic review of available prostate cancer risk calculators targeted at healthy population. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, the analyzed calculators, the population for which it was calibrated, the included risk factors, and the model’s overall accuracy. RESULTS We included a total of 18 calculators across 53 different manuscripts. The most commonly analyzed ones were they PCPT and ERSPC risk calculators, developed from North American and European cohorts, respectively. Both calculators provided high precision for the diagnosis of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations, which reached diagnostic precisions as high as 0.938. The most commonly included risk factors in the calculators were age, PSA levels and digital rectal examination findings. Additional calculators included race and detailed personal and family history CONCLUSIONS Both the PCPR and the ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic accuracy. Furthermore, designing calculators from scratch considering each population’s sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which was has been calibrated for its intended population and can be easily reproduced and implemented CLINICALTRIAL CRD42021242110

scholarly journals 2057. Outpatient Antibiotic Stewardship “Bundles up” in Winter with Peer Comparison, URI Order Set and Education: Is It Enough to Weather the Storm?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S693-S693
Author(s):  
Okan I Akay ◽  
Rohini Dave ◽  
Amit Khosla ◽  
CherylAnn Kraska ◽  
Brian J Hopkins ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Drug Events ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Control Group ◽  
Upper Respiratory Infection ◽  
Primary Care Clinics ◽  
Ed Visits ◽  
The Impact ◽  
Order Set

Abstract Background Inappropriate antibiotic use is a growing problem in the outpatient setting. Approximately 90% of all antibiotics are prescribed in outpatient practices. Nonetheless, 30–70% of antibiotic prescriptions (ARx) are unnecessary. Outpatient antimicrobial stewardship (AS) is much needed and the best approach is unknown. We used a bundle approach to outpatient AS during the winter months, by implementing a peer comparison (PC) report, upper respiratory infection (URI) order set and broad education. Methods This is a quasi-experimental project during the period October 2018 to March 2019 (FY19) to evaluate the impact of a bundled intervention in primary care clinics at the VA Maryland Health Care System. A historical control group from the same period the previous year (FY18) was used for comparison. The intervention included an AS directed didactic and URI order set followed by an email in 1/2019 with: (1) censored PC report (ARx/1,000 encounters) with outliers defined as above 1.5 × interquartile range, (2) URI order set reminder, and (3) education. The primary outcome was total ARx per 1,000 encounters in primary care clinics. A random sampling of 200 charts was done to compare proportion of antibiotic appropriateness and number of emergency department (ED) visits and adverse drug events (ADEs) in FY19 Q1 and FY19 Q2. Poisson regression was carried out, in addition to Χ2-statistic. Results There were 3,799 vs. 3,429 ARx in FY18 and FY19, respectively, with a rate difference of 3.3 ARx per 1,000 encounters (P = 0.0056). Q1 to Q2 ARx rate increased by 7.8 and 8.0 ARx per 1,000 encounters in FY18 and FY19, respectively. Forty-eight percent (28/58) of the providers confirmed receipt of email. There were 3 and 4 outliers in FY19 Q1 and Q2, respectively. Appropriate ARx for FY19 Q1 and Q2 was found to be 45% and 35% (P = 0.44), respectively. The most common indications were URI (18% vs. 18%), urinary tract infection (13% vs. 21%). ED visits (10% vs. 6%) were uncommon and there were no ADEs. Conclusion E-mail communication with bundled approach had no effect on ARx or antibiotic appropriateness; however general AS presence and URI order set tempered some use. Removing peer censoring, providing face-to-face education and intensifying antibiotic order sets are additional interventions to be implemented. Disclosures All authors: No reported disclosures.

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