[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine if antibiotic or anti-inflammatory medications lower serum prostate-specific antigen (PSA) in the presence or absence of inflammation in the prostatic secretions of patients with PSA levels between 2.5 and 10 ng/ml and normal digital rectal examinations (DRE).
Patients with PSA levels between 2.5 and 10 ng/ml and normal DRE were candidates for the study. One hundred and eight patients with positive expressed prostate secretion (EPS) were randomized into antibiotics, anti-inflammatory and control groups (groups 1, 2 and 3, respectively), and 108 patients with negative EPS were randomized into similar groups (groups 4, 5 and 6, respectively). Repeat PSA levels of all patients were obtained 6 weeks after randomization and 10 core prostate biopsies were performed.
Median PSA levels in group 1 before and after treatment were 5.2 (4.3-6.4) and 4.0 ng/ml (3.1-4.9), respectively (p < 0.001). The only significant decrease in PSA was observed in group 1. The percent change in PSA levels in group 1 was significantly greater than both in its control group (group 3; p < 0.001) and the EPS- antibiotics group (group 4; p < 0.001).
Antibiotherapy significantly reduces serum PSA only in EPS+ patients, which justifies limiting the use of prebiopsy antibiotics to EPS+ patients with a normal DRE and PSA level between 2.5 and 10 ng/ml, minimizing the major drawbacks of empirical antibiotics usage.
No preview · Article · Mar 2010 · Urologia Internationalis
[Show abstract][Hide abstract] ABSTRACT: Aim: The aim of this study was to investigate the importance of digital rectal examination (DRE), serum total prostate specific antigen (PSA), percent free PSA (fPSA%), and PSA density (PSAD) in the prediction of high radical prostatectomy Gleason's scores (GSs) ≥ 7 in patients with clinically localized prostate cancer. Materials and methods: Two hundred twenty-five patients who underwent radical prostatectomy for clinically localized prostate cancer were included in the study. The patients were grouped with respect to their radical prostatectomy GSs: group 1 including the patients with GSs < 6 (n = 170) and group 2 including the ones with GSs ≥ 7 (n = 55). The groups were compared with respect to potential predictors of a high GS, which were patient age, gland volume (Vp) obtained by transrectal ultrasound, DRE, PSA, fPSA%, and PSAD. Results: The mean age, PSA, fPSA%, and PSAD values of groups 1 and 2 were 65.23 ± 7.7 and 65.05 ± 7.1 years, 11.20 ± 9.2 and 11.09 ± 6.8 ng/mL, 16.2 ± 8.6 and 15.5 ± 8.1, and 0.25 ± 0.20 and 0.28 ± 0.18 ng/mL/cc, respectively. The groups were similar with respect to mean age, PSA, fPSA%, and PSAD (P > 0.05 for all). Mean prostate volume of patients in group 2 was significantly lower than that of patients in group 1 (43.1 ± 17.01 vs. 46.9 ± 17.6 mL, P = 0.043), and group 2 had more patients with abnormal DRE findings (72.7% vs. 51.2%, P = 0.005). DRE was the only independent factor for predicting high GS in multivariate logistic regression analysis. A DRE suspicious of prostate cancer increased the high GS risk by 2.82 times. Conclusion: This study shows that an abnormal DRE is an independent predictor of high grade disease (GS ≥ 7) in patients with clinically localized prostate cancer.
No preview · Article · Oct 2009 · Turkish Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: To evaluate whether upgrading of the biopsy after radical prostatectomy (RP) affects disease outcome in terms of unfavorable pathology and biochemical failure.
We retrospectively evaluated the records of 174 patients who underwent RP. Prostate biopsy and RP specimen Gleason scores (GSs) and correlative clinical data were recorded, and a multivariate analysis was applied.
Overall (138 patients), the disease of 69 men (50.0%) was upgraded, in 19 (13.8%) it was downgraded, and in 50 (36.2%) it had an identical biopsy and pathological GS. Accuracy rates were significantly higher for GS 8-10 compared to low GSs, with a concordance of 50.0 and 12.2%, respectively (p < 0.01). Multivariate analysis revealed the single independent prognostic factor for a non-organ-confined disease as a RP GS 8-10 (p = 0.035). The factors associated with a positive surgical margin were a biopsy GS 8-10 (p < 0.001) and the presence of biopsy score upgrading (p = 0.02). Biopsy GS >or=8 (p < 0.001) and presence of biopsy score upgrading (p = 0.009) were the two independent predictors of relapse after RP.
This study demonstrated that biopsy upgrading was present in almost half of the patients who underwent RP and it was significantly related to positive surgical margins and biochemical relapse after RP.
No preview · Article · Sep 2009 · Urologia Internationalis
[Show abstract][Hide abstract] ABSTRACT: Introduction: There are many reports about the prognostic significance of the pathologic features of radical retropubic prostatectomy specimens in patients with localized prostate cancer. In our study we evaluated the relation between the preoperative free/total prostate specific antigen ratio (f/t PSA) and pathologic features of radical retropubic prostatectomy specimens. Materials and Methods: We retrospectively evaluated the data of 109 radical retropubic prostatectomy patients. Patients were divided into 3 groups according to their PSA levels (<10, 10-15, >15 ng/dl) and f/t PSA ratio (<0.10, 0.10-0.20, >0.20). We investigated the distribution of the patients to the groups according to pathologic features of radical retropubic prostatectomy specimens such as surgical margin positivity (SMP), extracapsular extension (ECE), seminal vesicle involvement (SVI), perineural invasion and pathologic stage. Results: Mean patient age was 61.6±5.9 years, mean PSA level was 10.6±6.7 ng/ml and mean f/t PSA ratio was 0.16±0.13. There was not any statistically significant difference between the PSA groups regarding the pathologic features of radical retropubic prostatectomy specimens (p>0.05). Pathological stage, SMP, ECE and SVI were higher in f/t PSA ratio <0.10 (p<0.05). Conclusion: We think that preoperative f/t PSA ratio could be a useful determinant for estimating the prognosis of radical retropubic prostatectomy patients according to pathological features of surgical specimens. Further studies with larger number of patients are needed to confirm these results.
No preview · Article · Mar 2007 · Turk Uroloji Dergisi