A clinical trial comparing BiVap (Richard Wolf®) saline vaporization of the prostate vs. TwisterTM Diode Laser System in the treatment of benign prostatic obstruction between prostate volume 90 to 150 ml

Introduction To evaluate the efficacy, safety and postoperative outcomes of the BiVap and Twister systems with benign prostatic obstruction (BPO) in prostate volüm between 90–150 ml. Methods In total, we included 131 patients treated with BiVap system (n = 68) and Twister system (n = 63). Postoperative complications including urinary tract infection, transient hematuria, severe dysuria and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Results Preoperative demographic characteristics were similar in the 2 groups. There was observed significant improvement for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. Maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 12, 3 and 12th months respectively in group 1. In group 2 maximum improvement in the same parameters were achieved at postoperative 6, 3, 6, 6 and 12th months, respectively. Conclusions BiVap and Twister systems are safe, effective, and useful technique, which can be used in the surgical treatment of BPO between 90–150 ml.

Usual acinar adenocarcinoma and osteoblastic lesion in the distal middle third of the femur, an unusual finding: a case report / Adenocarcinoma acinar usual e lesão osteoblástica no terço médio distal do fêmur, um achado incomum: relato de caso

A patient with prostate cancer may initially be asymptomatic, compromising early diagnosis and treatment. A 42-year-old male patient on a routine examination had a PSA of 4.18 ng / ml. Prostate biopsy revealed usual Gleason 7 stage T2a acinar adenocarcinoma. Magnetic resonance imaging revealed a nodule in the prostate. Bone scintigraphy showed osteoblastic lesion of the left femur, considered a possibility of a secondary lesion to adenocarcinoma, but his biopsy showed tissue without significant histological changes, ruling out malignancy. The patient was submitted to a radical prostatectomy and bilateral lymphadenectomy, evolving without complications. Follow-up tests showed reactive Protein C negative, alkaline phosphatase, lactate dehydrogenase and total testosterone without changes, total PSA 0.011; Free PSA less than 0.01. The total PSA 0.3 indicated a possible recurrence after 3 years. Magnetic resonance imaging showed no suspicious lesions, PET / CT was performed, which showed molecular hyperexpression of specific membrane antigen for the prostate, confirming local recurrence. Therefore, he was submitted to 36 radiotherapy sessions in the prostate bed from July to August. In October, the total PSA was performed, which decreased sharply. The early stage of prostate cancer may show only benign prostate growth, while the advanced stage may reveal bone pain. Bone tissue often develops a metastatic lesion, resulting in a worse prognosis. In this patient, a link between prostate carcinoma and bone lesion was ruled out by biopsy, which demonstrated the absence of spread of the disease.

SIGNIFICANCE OF DETECTION OF FREE/TOTAL PSA RATIO AND OTHER BIOCHEMICAL PARAMETERS IN PATIENTS WITH BPH, CARCINOMA PROSTATE AND ITS CLINICOPATHOLOGIC CORRELATION

Background. Benign prostatic hyperplasia (BPH) can raise prostate-specific antigen (PSA) levels two to three times higher than the normal level. An increased PSA level does not indicate Prostate Cancer (PCa), but the higher the PSA level, the higher the chance of having PCa. Detection and treatment have been profoundly affected by the advent of Free/Total PSA ratio testing. Objectives. The aim of the study was to estimate free, total PSA levels and its ratio for serum levels of calcium, acid phosphatase and alkaline phosphatase in patients with BPH and PCa; to correlate clinical, biochemical and histopathological findings in the above patients. Methods. PSA levels were detected by Chemiluminescent assay; serum calcium – by Modified Arsenazo method; serum acid phosphatase – by Doumas et al method; and Alkaline phosphatase – by Lowry et al method. Results. Present study found high levels of total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa rate. Free/Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were considerably higher in PCa as compared to BPH. Serum calcium levels did not show significant difference in control and study groups. Conclusions. It was established that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in those without PCa. Therefore, in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary. Objectives: The study was carried out with the following objectives: to estimate free, total PSA levels and calculate Free/Total PSA ratio in patients with BPH and Carcinoma Prostate, to study the serum levels of calcium, acid phosphates, and alkaline phosphatase in patients with BPH and PCa. and to correlate clinical, biochemical and histopathological findings in the above patients. Methods. Free and total PSA levels were detected by Chemiluminescent assay; Serum Calcium was detected by Modified Arsenazo method. Serum acid phosphatase was detected by Doumas et al method and Alkaline phosphatase were detected by Lowry et al method Results: Present study found high levels of Total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa ate. Free /Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were slightly raised in PCa as compared to BPH. Serum calcium levels did not show a significant difference in control and study groups. Conclusion: We concluded that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in men without PCa. There was a negative correlation found between the free/total PSA ratio and the histopathologic findings. The lower the ratio higher is the grade of malignancy. Therefore in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary

A STUDY ON CORRELATION OF SERUM PROSTATE SPECIFIC ANTIGEN WITH CLINICAL AND PATHOLOGICAL VARIABLES IN PATIENTS OF PROSTATOMEGALY

Background: In clinical practice, biopsies are generally performed only when the results ofprostate specific antigen (PSA) test or digital rectal examination (DRE) are abnormal. This leads to misdiagnosis of most small prostatic cancers present in many older men. Patients with lower urinary tract infection (LUTS) who have serum PSA levels higher than 4ng/ml are primarily advised to undergo prostate biopsy to rule out cancer. However, PSA is organ specific not disease specific, so the presence of other prostate diseases such as benign prostatic hyperplasia (BPH) and prostatitis may influence its effectiveness for cancer detection. Hence, the PSA based prostate cancer detection is fraught with high false positive rate. Aim:To evaluate the utility of PSA assay as a method of investigation in diagnosis of prostatic lesion. Objectives: The use of Serum PSA levels for the early detection of prostate cancer and evaluate its role with other modalities for diagnosis of prostate cancer and to diagnose different diseases of prostate, i.e. prostatitis, BPH in prostatomegaly, and its correlation with Serum PSA levels. Materials and Methods: This prospective descriptive study was conducted in Index Medical College, Hospital & Research Centre, Indore, M.P,India in the period of August 2019 to July 2021. The patients were selected from the outdoor Department of General Surgery. Results: A total of 80 male patients presenting with LUTS were included. Their mean age was 68.66 years. The majority i.e. 41 of the study group were in the age group of 61-70 years. 42 of patients had Serum PSA < 4ng/ml. Biopsy proven adenocarcinoma cases 34% of the cases are in the age group of 61-70 years. Out of the biopsy proven adenocarcinoma cases, DRE was suspicious of malignancy in 89%. Conclusion: Serum PSA levels have a significant correlation with the age group, with the increase in age there is rise in Serum PSA levels. Transabdominal ultrasound, DRE and Serum PSA has high sensitivity in diagnosis of prostatomegaly but it was found that none of the screening tool has got much efficacy in differentiating carcinoma prostate from benign hypertrophy, but the combination of DRE and Serum total PSA or DRE, Serum total PSA and ultrasound abdomen showed higher efficacy in diagnosis of carcinoma prostate. Increase in Serum PSA is directly related to carcinoma, but there is no absolute cut-off for Serum PSAfor diagnosis of carcinoma. Key-Words: Prostate specific antigen, Prostatomegaly, Benign Prostatic Hypertrophy, Digital Rectal Examination, International Prostate Severity Score, Carcinoma Prostate.

Endogenous testosterone density predicts unfavorable disease at final pathology in intermediate risk prostate cancer

Objective To test the hypothesis that endogenous testosterone (ET) density could be associated with tumor load (TL) in patients with intermediate risk (IR) prostate cancer (PCa). Materials and methods Endogenous testosterone density (ETD, ratio between ET and prostate volume [PV]), biopsy positive cores density (BPCD, the ratio between the number of positive cores and PV) and prostate-specific antigen density (PSAD, ratio between total PSA and PV) were retrospectively evaluated on a prospectively collected data on 430 patients with IR PCa submitted to radical prostatectomy (RP). Tumor load (TL) was measured as the percentage of prostatic volume occupied by cancer at final pathology. Unfavorable disease (UD) was defined as tumor upgrading (ISUP grading group 4, 5) and/or upstaging (pT3a or 3b) in prostate specimens. Associations were assessed by the logistic regression and linear regression models. Results Overall, UD, which was detected in 122 out of 430 IR patients (28.4%), was predicted by BPCD (odd ratio, OR = 1.356; 95% CI 1.048–1.754; p = 0.020) with a sensitivity 98.4% and overall accuracy 71.9%. On multivariate analysis, BPCD was independently predicted by PSAD (regression coefficient, b = 1.549; 95% CI 0.936–2.162; p < 0.0001), ETD (b = 0.032; 95% CI 0.023–0.040; p < 0.0001) and TL (b = 0.009; 95% CI 0.005–0.014; p < 0.0001). As BPCD increased, ETD and ET levels increased accordingly, but patients with BPCD > 1.0%/mL had significantly lower ET levels. Conclusions As ETD increased, BPCD and TL increased, accordingly; furthermore, patients with lower ET levels were more likely to have occult UD. The influence of tumor load, and unfavorable disease on ET and ETD needs to be addressed by further studies.

Usefulness of the prostate health index in predicting the presence and aggressiveness of prostate cancer among Korean men: a prospective observational study

Background We aimed to evaluate the usefulness of the Beckman Coulter prostate health index (PHI) and to compare it with total prostate-specific antigen (PSA) levels and related derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) in the Korean population. Methods A total of 140 men who underwent their first prostate biopsy for suspected PCa were included in this prospective observational study. The diagnostic performance of total PSA, free PSA, %free PSA, [–2] proPSA (p2PSA), %p2PSA, and PHI in detecting and predicting the aggressiveness of PCa was estimated using the receiver operating characteristic curve (ROC) and logistic multivariate regression analyses. Results Of 140 patients, PCa was detected in 63 (45%) of participants, and 48 (76.2%) of them had significant cancer with a Gleason score (GS) ≥ 7. In the whole group, the area under the curve (AUC) for ROC analysis of tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.63, 0.57, 0.69, 0.69, 0.72, and 0.76, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p = 0.005). For PCa with GS ≥ 7, the AUCs for tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.62, 0.58, 0.41, 0.79, 0.86, and 0.87, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p < 0.001). In the subgroup with tPSA 4–10 ng/mL, both %p2PSA and PHI were strong independent predictors for PCa (p = 0.007, p = 0.006) and significantly improved the predictive accuracy of a base multivariable model, including age, tPSA, fPSA and %fPSA, using multivariate logistic regression analysis. (p = 0.054, p = 0.048). Additionally, at a cutoff PHI value > 33.4, 22.9% (32/140) of biopsies could be avoided without missing any cases of aggressive cancer. Conclusions This study shows that %p2PSA and PHI are superior to total PSA and %fPSA in predicting the presence and aggressiveness (GS ≥ 7) of PCa among Korean men. Using PHI, a significant proportion of unnecessary biopsies can be avoided.

364 The Cycling Urologist: Effect on PSA, Haematuria, Pudendal Nerve Entrapment and Cyclists Nodules

Aim Cycle use has vastly increased over the last few years in the UK. The aim of this review was to evaluate the effect of cycling on the common conditions presenting to the urology clinic, in particular those of raised PSA, haematuria, soft tissue lesions (“cyclist nodules”) and pudendal nerve entrapment syndromes. Method A PUBMED search of the literature on cycling and genitourinary disorders was performed. The keywords included “Bicycling” AND “Prostate-specific antigen”, “Bicycling” AND “Haematuria”, “Bicycling” AND “Cyclist Nodules”, “Bicycling” AND “Pudendal Nerve Entrapment”. Results The literature suggests no significant change in total PSA levels after a bout of cycling, regardless of age. The type of cycling (mountain biking vs. road cycling) does not influence PSA levels. It is possible that the saddle used in cycling may displace the pressure across the perineal and gluteal region to effectively alleviate pressure on the prostate. Haematuria appears to be rare with cycling but has been described. Perineal nodular induration is a very rare - although possibly under diagnosed condition. It is thought to be caused by repetitive micro trauma from contact between the perineum and saddle. Pudendal nerve entrapment (PNE) represents the most common bicycling associated urogenital problem. Numbness in the perineum, penis, scrotum or the buttocks is the most common and most recognised symptom. Genital numbness may occur unrelated to erectile dysfunction (ED) although cycling related ED is invariably associated with genital numbness. Conclusions Urology Trainees and Consultants should be aware of how recreational and high-level cycling may result in presentation to the Urology clinic.

Peripheral Lymphocyte Count, Free/Total PSA Ratio, LUTS Predict The Severity of Prostatic Inflammation in BPH Patients

Objective To study the correlation between peripheral blood lymphocytes, f/t PSA and LUTS symptoms, and prostatic inflammation in BPH patients.Materials and Methods From May 2020 to October 2020, 120 patients (aged 56-85 years) with BPH undergoing elective transurethral resection of the prostate (TURP) were selected. Peripheral blood lymphocyte counts and f/t PSA values were measured preoperatively, and IPSS scores were assessed. Postoperative prostate tissues were sent for pathological examination, and the relationship between peripheral blood lymphocyte count, TPSA, f/t PSA values, relevant clinical laboratory parameters, and relevant LUTS symptoms and the distribution of prostate tissue inflammation was analyzed.Results with the aggravation of prostatic inflammation, IPSS score and TPSA value were lower, while f/t PSA value and lymphocyte count were lower. Multivariate logistic regression analysis of 120 BPH patients showed that age (> = 60) [odds ratio (OR) = 0.29, 95% CI = 0.31-2.10; P = 0.02], IPSS score [OR = 1.24, 95% CI = 1.13-1.37; P < 0.01], TPSA [OR = 1.10, 95% CI = 1.02-1.19; P = 0.02], f/t PSA [OR = 1.03, 95% CI = 0.01-0.15; P = 0.02], and lymphocytes [OR = 1.70, 95% CI = 0.78-3.77; P = 0.04] were related to the formation of prostatic inflammation in BPH patients. Conclusion Peripheral blood lymphocyte count, TPSA, LUTS severity, and f/t PSA ratio can predict the severity of prostatic inflammation, which may be used as diagnostic markers for BPH patients with LUTS symptoms who have prostatitis and promote the development of drug treatment for LUTS symptoms in BPH patients with prostatitis.