PSA, Gleason score and epidemiology of prostate cancer (PC) in Grenada

OBJECTIVE: To assess (1) the incidence and survival rates of PC, (2) the distribution of prostatic-specific antigen (PSA) and Gleason score in Grenada. DESIGN AND METHODS: A PC hospital-based series from the only urologist in the island was assembled. Age-adjusted incidence rates, PSA levels and Gleason scores for Grenada were analyzed and compared with US-Blacks and incidence rates from “International Agency for Research on Cancer (IARC)-contributing” Caribbean registries. RESULTS: 601 new cases of PC diagnosed between 1997-2013 equate to an annual age-adjusted incidence rate of 69.3 per 100,000 in Grenada. This is similar to the Jamaica rate of 77.3, but much inferior to those of US-Blacks 197.7 and Martinique 177.8. The median PSA level in Grenada was 18.0 ng/ml compared to 7.0 among US-Blacks (P<0.05). 47% of Grenadians with PC were in the high risk PSA category (>20ng/ml), compared to only 17% US-Blacks. Lower tract urinary infection and positive digital rectal examination were both significantly associated with high risk PSA and high risk Gleason score (Gleason sum ≥ 8). CONCLUSION: The lower PC incidence in Grenada and Jamaica is likely a reflection of lower prevalence of PSA-testing. Thus, PSA levels fall more substantially in the high risk category.

Aspiration biopsies: a good diagnostic tool

Aspiration biopsies were introduced for the diagnosis of human malignancies in the 1930s. Because of the high degree of safety of the transcutaneous aspirations, virtually every organ in the body has become a target for this procedure. The advantages are: 1. It is an office procedure readily accepted by the patient. 2. There is no interference with further therapeutic procedures. 3. There is not sufficient trauma to produce haemorrhage of dissemination of the tumour. The simple instruments required are a 20 ml syringe and an assortment of needles of varying sizes and gauges from 23 to 26. Palpable lesions that are aspirated most commonly are those in the breast, thyroid, prostate, salivary glands and lymph nodes. The most common non-palpable lesions are usually found in the liver, pancreas and soft tissues. Fine needle aspiration of the breast is easy and highly accurate, diagnosing benign and malignant lesions. Oestrogen and progesterone assays can be performed on specimens obtained by this procedure. Needle aspirations of the thyroid have reduced surgical procedure by about 40 percent. They serve to identify cold nodules with no nucleotide uptake. Moreover 30 percent of cold nodules are cysts, and aspiration therefore provide immediate cures in these cases. Prostatic aspirates are easily performed on male patients if a prostatic nodule is palpable and/or if there is an elevated prostate specific antigen level. The overall accuracy of these aspirates is 97 percent and compares well with tissue core biopsies. Lymph node aspirations are indicated for persistent enlargement and are used primarily to rule out primary or metastatic malignancies. In the latter case they provide the best, least traumatic and quickest way to diagnose inoperable malignancies, and they are also useful for detecting tumour recurrences and, therefore for assessing the effects of adjuvant therapy. Aspiration requiring imaging assistance is usually for deep seated lesions that are not palpable. It is especially useful in diagnosing small (oat) cell carcinoma of the lung, that is not treated surgically. Liver cancers can be most easily assessed by this procedure and the distinction between carcinoma and endocrine tumours of the pancreas is readily made. It is evident that aspiration biopsy is a method of diagnosis with potentially significant benefits. In competent hands, it is safe and reliable.(AU)

The incidence of prostate cancer-trends in two ethnic groups in Trinidad: a nine year study - abstract

Data on prostate cancer patients were obtained from the Pathology Department, General Hospital, San Fernando (before 1993) and, after 1993, prospectively collected for all admissions to that hospital for all patients with prostate cancer. Additonal data was collected from the hospital theatre registers and medical records. 365 prostate patients' data over the nine year period 1987-1995 were analysed for tends in the disease. In the population served by the hospital there are equal numbers of East Indians and Africans in the age range > 60 years. There was a rapid rise in the incidence of prostate cancer in males > 60 years starting in 1993, when PSA became widely available. This rise was maintained and seen mainly in the African population though there was a lesser rise among the East Indians. In most years, prostate cancer was more frequent in African than East Indian men. These data emphasize the value of PSA in detecting prostate cancer in both races but there is need for more education and systematic screening programmes to detect the asymptomatic male who can be offered curative therapy. The significantly higher frequency of prostate cancer in Africans (87.2 percent) than East Indians (12.8 percent) may be associated with differences with genetic and dietary factors and not with environment which is the same for both races. (AU))

Transurethral resection of the prostate (TURP) in Antigua - abstract

Twenty-nine TURPs performed over an 18-month period in Antigua by a general surgeon with specialised training in the technique are presented. Ages ranged from 47 to 84 years with a mean of 66 years. Most presented with frequency, nocturia and other outflow problems and a prostatic cause was confirmed by pre-operative cystoscopy. A rack-and-pinion resectoscope was used with 1.5 per cent glycine as irrigation fluid. Resection time varied from 55 to 150, with an average of 78.7 minutes. Average hospital stay was 4.3 with a range of 3-14 days. There was a 1.16 per cent complication rate with 2 procedures converted to open prostatectomy because of bleeding and loss of landmarks, 1 DVT, 1 calculus and 1 clot retention. Transfusion was necessary in only 1 case. In response to a follow-up questionnaire, 27 patients indicated satisfaction with the results of the procedure. In the smaller islands, surgeons should be encouraged to seek procedural training in order to provide services which would be covered by the specialty services in the larger territories (AU)

Immunohistochemistry of lymphocyte B-cell lymphoma of the prostate gland

A case of small lymphocytic B-cell lymphoma occurring in the prostate gland of a 68-year-old man is reported. These tumours are rarely encountered in surgical specimens, and may be confused with an undifferentiated carcinoma. Differentiation is readily made, using immunohistochemical techniques

The anaesthesia penile tumescence test - abstract

A simple method of differentiating organic from psychogenic impotence is important if appropriate therapy is to be offered. Prostatic massage under light anaesthesia was consistently found to produce penile tumescence in ten controls. Tumescence usually started within one minute of the onset of prostatic massage, and progressed to a stage adequate for penetration within three minutes. The penile erection was maintained at least until the patient reached the recovery room. Eleven patients being investigated for impotence were subjected to the procedure in conjunction with hormonal and blood flow studies. All patients had nocturnal penile tumescence (NPT) stamp tests and two of those who failed this and the anaesthesia penile tumescence (APT) test, had nocturnal penile tumescence (NPT) strain gauge tests in the U.S.A. Seven patients had good APT results, two fair and two poor. The four patients who had fair and poor results also failed the NPT stamp tests and the NPT strain gauge test where this was done. APT testing therefore correlates well with the accepted standard NPT test, requires no special expensive equipment and allows polaroid documentation of rigidity instead of increase in circumference as in the NPT test. Polaroid documentation also allows patients to realise their potential and facilitates treatment of psychogenic impotence (AU)

Open prostatectomy: a study on 132 cases done at two hospitals in Port of Spain

Clinical data on 132 patients who received open prostatectomy during a 9-year period at two institutions in Port-of-Spain, Trinidad, are presented. There were 104 patients from the Port-of-Spain General Hospital and 28 from a private institution. The overall mortality was 38 percent, wound infection contributing to death in most of these cases. The majority of complications which followed prostatectomy performed under the conditions which exist in these two institutions were infective in origin. These can be prevented by performing early prostatectomies when the need for catheterization arises. It is concluded from the results of this study that, despite the conditions which exist at the Port-of-Spain General Hospital, open prostatectomy in old men is a safe procedure. (AU)

Pharmaceutical care for benign prostatic hyperplasia

From birth to mid forties, the prostate moves from the size of a bean to 4cm. It then begins to enlarge through a process of cell multiplication called benign prostatic hyperplasia or hypertrophy (BPH) which is a synonym for Nodular Hyperplasia of the Prostate (the medically correct term). BPH is an important male health issue. Pharmacists must keep themselves informed about this condition. Treatment requires a team approach. Patients must be informed of the symptoms of this condition and lifestyle habits that can prevent or control it (AU)