Prostate disorders diagnosis and management review with an osteopathic component

Physicians commonly encounter disorders of the prostate in the primary care setting, where shared decision making for prostate cancer screening should also occur. Hence, it is important for physicians to understand and differentiate the diagnoses of prostate disease. Initial evaluation should include a thorough history, physical examination, laboratory examination and imaging, if necessary. This article aims to provide a diagnostic and management approach for prostate disease.

Prostate Cancer: Early Detection and Assessing Clinical Risk Using Deep Machine Learning of High Dimensional Peripheral Blood Flow Cytometric Phenotyping Data

Detecting the presence of prostate cancer (PCa) and distinguishing low- or intermediate-risk disease from high-risk disease early, and without the need for potentially unnecessary invasive biopsies remains a significant clinical challenge. The aim of this study is to determine whether the T and B cell phenotypic features which we have previously identified as being able to distinguish between benign prostate disease and PCa in asymptomatic men having Prostate-Specific Antigen (PSA) levels < 20 ng/ml can also be used to detect the presence and clinical risk of PCa in a larger cohort of patients whose PSA levels ranged between 3 and 2617 ng/ml. The peripheral blood of 130 asymptomatic men having elevated Prostate-Specific Antigen (PSA) levels was immune profiled using multiparametric whole blood flow cytometry. Of these men, 42 were subsequently diagnosed as having benign prostate disease and 88 as having PCa on biopsy-based evidence. We built a bidirectional Long Short-Term Memory Deep Neural Network (biLSTM) model for detecting the presence of PCa in men which combined the previously-identified phenotypic features (CD8+CD45RA-CD27-CD28- (CD8+ Effector Memory cells), CD4+CD45RA-CD27-CD28- (CD4+ Effector Memory cells), CD4+CD45RA+CD27-CD28- (CD4+ Terminally Differentiated Effector Memory Cells re-expressing CD45RA), CD3-CD19+ (B cells), CD3+CD56+CD8+CD4+ (NKT cells) with Age. The performance of the PCa presence ‘detection’ model was: Acc: 86.79 ( ± 0.10), Sensitivity: 82.78% (± 0.15); Specificity: 95.83% (± 0.11) on the test set (test set that was not used during training and validation); AUC: 89.31% (± 0.07), ORP-FPR: 7.50% (± 0.20), ORP-TPR: 84.44% (± 0.14). A second biLSTM ‘risk’ model combined the immunophenotypic features with PSA to predict whether a patient with PCa has high-risk disease (defined by the D’Amico Risk Classification) achieved the following: Acc: 94.90% (± 6.29), Sensitivity: 92% (± 21.39); Specificity: 96.11 (± 0.00); AUC: 94.06% (± 10.69), ORP-FPR: 3.89% (± 0.00), ORP-TPR: 92% (± 21.39). The ORP-FPR for predicting the presence of PCa when combining FC+PSA was lower than that of PSA alone. This study demonstrates that AI approaches based on peripheral blood phenotyping profiles can distinguish between benign prostate disease and PCa and predict clinical risk in asymptomatic men having elevated PSA levels.

Ethnopharmacological application of common agrimony (Agrimonia eupatoria) in the Pirot County (Serbia)

Agrimonia eupatoria is perennial herbaceous plant from family Rosaceae, characterized by pinnate leaves, and yellow spike-like racemose inflorescences. It flowers from June to September, and above ground part of plants are collected for medicinal purposes. Survey on participants' knowledge and use of medicinal plants in the Pirot County was carried in the form of interviews in four municipalities: Pirot, Babušnica, Bela Palanka and Dimitrovgrad. Out of the total number of respondents, which amounted to 631, it was noted that 34 people knew the use of common agrimony. The largest number of respondents mentioned common agrimony against the group of urinary diseases (19 reports). A small number of respondents have mentioned the use against prostate disease (6 reports) and treatment of wounds (5 reports). Five reports against the group of digestive tract diseases were recorded. The results were compared with other ethnopharmacological studies from Serbia and the Balkan Peninsula. The following applications of common agrimony were not mentioned in previous ethnopharmacological investigations in Serbia and Balkan Peninsula: for circulation, for the heart, against varicose veins, catarrh of the stomach, for colon, for the stomach, bile, liver, prostate disease, against kidney and urinary tract sand, and diseases of internal organs.