Free/total prostate-specific antigen ratio can prevent unnecessary prostate biopsies.

OBJECTIVES: To evaluate the ability of free/total prostate-specific antigen (PSA) ratio to improve specificity of prostate cancer detection, compare Diagnostic Products Corporation (DPC) Immulite and Ciba Corning ACS 180 total (t)PSA assay, and define an assay-specific cutoff point and reflex range for DPC PSA ratio (PSAR). METHODS: In a prospective study, 206 men were enrolled with measurement of both assays. Group 1 consisted of 173 men with a suspicion of prostate cancer (PCA). Thirteen men with known PCA (group 2) and 20 men younger than 32 years (group 3) were used as control groups. RESULTS: Our results in group 1 (115 with benign prostatic hyperplasia [BPH], 58 with PCA) revealed a sensitivity of 82.7%, a specificity of 45.2%, and an accuracy of 57.8% for the DPC tPSA assay (cutoff point more than 4.0 ng/mL) within the entire PSA range. tPSA values of the ACS 180 assay were 1.97-fold higher. Within the tPSA gray zone of 2.5 to 10 ng/mL (66 BPH, 23 PCA), specificity and accuracy of DPC tPSA can be improved by using the DPC PSAR (cutoff point less than 19%) from 33.3% to 71.2% and 42.7% to 70.8%, respectively, maintaining the same sensitivity level of 69.6%. CONCLUSIONS: By combining tPSA testing with PSAR within the gray zone, 39.7% (25 of 63) of unnecessary biopsies can be saved, without missing any additional cancers compared with tPSA testing alone. The optimal reflex range for DPC PSAR is 2.5 to 10 ng/mL and the best PSAR cutoff point for biopsy criterion is less than 19% in our high-risk population, with a cancer yield of 34%. Because we still do not have an international PSA standard, it is important to use assay-specific "normal values" and PSAR cutoff points.

[Preoperative T-staging of prostatic carcinoma: endorectal magnetic resonance tomography compared with other imaging and clinical methods]. / Präoperatives T-Staging des Prostatakarzinoms: Endorektale Magnetresonanztomographie im Vergleich zu anderen bildgebenden und klinischen Methoden.

PURPOSE: The diagnostic value of endorectal magnetic resonance imaging (MRI) in comparison to clinical information and other imaging modalities was analysed in order to define the most accurate preoperative staging method. METHODS: 54 patients with biopsy proven prostate carcinoma, who underwent subsequent prostatectomy, were examined with an endorectal surface coil. The results were compared to body coil MRI, digital rectal examination and prostate specific antigen levels. In 37 patients, results of endorectal ultrasound were available. RESULTS: Staging accuracy, sensitivity and specificity of endorectal coil MRI were 83.3%. For body coil MRI, staging accuracy was 59.2%, sensitivity 43.3% and specificity 82.6%, for transrectal ultrasound 59.5%, 36.4% and 91.7% and for the digital rectal examination 55.6%, 26.7% and 91.7%, respectively. Staging accuracy of endorectal MRI was significantly (p < 0.05) superior to that of the other imaging modalities. CONCLUSION: Endorectal coil MRI allows reliable distinction between localised and advanced tumour stages and is superior to other imaging techniques in this regard. It can thus be recommended for staging in patients with prostate carcinoma.

[Urinary incontinence]. / Urininkontinenz.

In spite of its high incidence the urinary incontinence remains a taboo subject, which people generally avoid speaking about. In this paper we describe the different forms of urinary incontinence with special stress on its pathophysiology, the diagnostics and therapeutical modalities.

[Screening of prostate carcinoma]. / Screening des Prostatakarzinoms.

Taking into consideration the height costs of screening healthy men from general population at risk for prostate cancer, we do not recommend prostate cancer screening except for scientific reasons in prospective random trials. To diagnose prostate cancer we know the following methods for patients with prostatic problems: DRE = (digital rectal examination) PSA = (prostate-specific antigen) TRUS = (transrectal ultrasonography) The possible validity of DRE, PSA and TRUS are discussed. The best and most economic way of diagnosing prostate cancer is a combination of DRE and PSA.

[Staging in prostate carcinoma]. / Staging beim Prostatakarzinom.

A correct staging of clinically localized prostate cancer should nowadays consist of: digital rectal examination (DRE) (+/- -transrectal ultrasound [TRUS]) bone scan abdominal computed tomography or body coil magnetic resonance imaging (+/- laparoscopic lymph node dissection according to the PSA level) endorectal surface coil MR imaging (if available) The above-mentioned methods are discussed with preference to the new technology of endorectal surface coil magnetic resonance imaging (E-MRI) of the prostate.

[Ultrasound examination of the urogenital tract: indications and limits]. / Ultraschall-Untersuchung am Urogenitaltrakt: Indikationen und Grenzen.

Today, ultrasound examination has become an established standard in urological practice. Sonographic imaging has benefited immensely from the dramatic advancements in digital computer technology. We users now receive better, more accurate information and insights into the functional diagnosis of urological disorders. The ultrasound images are generated in real time and the patient is not exposed to any radiation. As far as costs are concerned, ultrasound instruments of good quality are available at affordable prices, even for general practitioners. This is one reason why ultrasound is being used more and more frequently, replacing more invasive, burdensome and expensive diagnostic techniques in multiple indications. The aim of this paper is to outline the growing number of indications for ultrasound examination in urology, while pointing out the specific limitations of this diagnostic method.

[The value of PSA follow-up in recurrent prostate carcinoma after radical prostatovesiculectomy]. / Die Wertigkeit des PSA-Verlaufes beim Prostatakarzinomrezidiv nach radikaler Prostatovesikulektomie.

We report our experience in evaluating PSA-follow-up of patients treated with radical prostatectomy. Also PSA is the most sensitive available screening test for relapse after radical prostatectomy, it is not 100% specific for cancer relapse while this serum marker is not specific for prostate cancer. In our opinion, patients with biochemical relapse (PSA > 0.5 ng/l) should undergo an early restaging including biopsy of the anastomosis. In 57% of our patients with PSA > 1.0 ng/l two months after surgery we found clinical recurrence 27 months later on.

[Mobile extracorporeal piezoelectric lithotripsy (EPL)--suitable for which stones?]. / Mobile extrakorporelle piezoelektrische Lithotripsie (EPL)--für welche Steine geeignet?

We report our experience with the first 42 patients treated with extracorporeal piezoelectric shock wave lithotripsy (mobile Wolf Piezolith 2300, being once a month to our disposition). In our opinion, this fact influences the indication for the treatment with this lithotriptor; large stones should be treated first either by percutaneous litholapaxy or ESWL, with a Dornier-Lithotriptor.

Spontaneous perirenal hemorrhage after rupture of an aneurysm in case of polyarteritis nodosa along with anuric renal failure. Case report and review of the literature.

We report a case of massive perirenal hemorrhage owing to an inferior segmental arterial rupture of an aneurysm, alongside a primarily inapparent polyarteritis nodosa associated with hepatitis B and C. We come to speak of the diagnostic procedure such as angiography, computerized tomography and MRI as well as the intervening measures like catheter embolization and surgical revision.

[Pathologic-anatomic examination of prostatovesiculectomy samples in prostate carcinoma]. / Pathologisch-anatomische Untersuchung von Prostatovesikulektomiepräparaten beim Prostatakarzinom.

The incidence of the prostatic carcinoma as well as the cases treatable by radical prostatovesiculectomy with curative intention is increasing. The exact pathological examination of the specimens defines the stage of disease and subsequently the prognosis and therapeutic consequences. The compatibility of different scientific studies is made difficult by the lack of a standard in the pathological examination of the specimens. Our exactly defined rational method helps eliminate these troubles and ameliorate the interdisciplinary dialogue.

Sonographic and MR findings of an extensive, HIV-related prostatic abscess.

We present findings in a patient positive for the human immunodeficiency virus in whom a prostatic abscess involving the entire gland was diagnosed by transrectal ultrasonography and magnetic resonance imaging (MRI); he was subsequently treated by transurethral resection, drainage, and antibiotics. To our knowledge, this is the first report of a pelvic phased-array coil MRI performed in a patient with prostatic abscess.

Contrast-enhanced endorectal coil MRI in local staging of prostate carcinoma.

OBJECTIVE: Our goal was to evaluate contrast-enhanced MRI using an endorectal coil in detecting and staging prostate carcinoma. MATERIALS AND METHODS: Sixty patients with clinically suspected prostate carcinoma were examined by T1-weighted contrast-enhanced endorectal coil MRI at 1.5 T. Results were compared with T2-weighted images in all cases and with histologic findings following radical prostatectomy in 28 patients. RESULTS: Prostate carcinomas showed no consistent pattern of contrast enhancement. In 27 patients, the tumor enhanced less than the surrounding prostatic tissue; in 10 patients, enhancement was heterogeneous; and in 23 cases, the lesion was hyperintense compared with normal glandular tissue. With respect to tumor delineation, contrast-enhanced sequences were superior to T2-weighted images in 1 case only; in 24 patients, the tumor could not be delineated at all. However, contrast-enhanced sequences provided a higher diagnostic confidence in delineating the seminal vesicles, prostate capsule, and neurovascular bundle in nine, six, and three cases, respectively. In the operated patients, accuracy, sensitivity, and specificity for staging advanced disease were comparable for both sequences. CONCLUSION: The T2-weighted sequences remain mandatory for delineation of prostate carcinoma. Contrast-enhanced T1-weighted sequences do not improve overall staging accuracy and therefore are not warranted routinely, but should be considered in cases requiring clearer delineation of the prostate capsule and/or seminal vesicles.

Value of endorectal coil versus body coil MRI for diagnosis of recurrent pelvic malignancies.

BACKGROUND: To compare endorectal coil magnetic resonance imaging (MRI) with body coil MRI in detecting local recurrence of gynecologic tumors and prostate and rectal cancers. METHODS: Forty-six patients with suspected recurrent pelvic malignancies (13 gynecologic, 15 prostatic, and 18 anorectal primaries) were enrolled in the study. Axial T1- and T2-weighted body coil images and T2- and contrast-enhanced T1-weighted axial endorectal coil images were obtained on a 1.5 T system. Results of the MR examinations were compared with histological findings and follow-up examinations with respect to the diagnostic accuracy and diagnostic confidence for assessment or exclusion of local recurrence. RESULTS: Recurrent disease was histologically confirmed in eight patients with primary gynecologic malignancies, seven with suspected prostatic recurrence, and seven with suspected anorectal recurrence. Overall, accuracy of body coil MRI was 67% for gynecologic tumors, 36% for prostatic recurrences, and 59% for rectal recurrences. T2- and contrast-enhanced T1-weighted endorectal sequences yielded similar results, with an accuracy of 73% for depiction of gynecologic recurrence, 77% for prostatic recurrence, and 77% for rectal recurrence. The difference in accuracy between body coil and endorectal coil examinations was statistically significant (p < 0. 05) only for prostatic cancer. Diagnostic confidence was, however, significantly improved (p < 0.05) in all tumors (T2-weighted endorectal coil examination was superior to T2-weighted body coil images in 71% of cases). CONCLUSION: Although the results of endorectal coil MRI are only slightly superior to those of body coil MRI for the detection of recurrent gynecologic and anorectal tumors, diagnosis can be made with greater diagnostic confidence in many cases. For detection of prostatic recurrence, endorectal MRI is highly recommended.

Optimization of prostate carcinoma staging: comparison of imaging and clinical methods.

PURPOSE: The diagnostic value of endorectal coil MRI, body coil MRI, transrectal ultrasound, digital rectal examination and PSA levels were prospectively analysed in order to define the most accurate preoperative staging method. METHODS: 33 patients with prostate carcinoma, who underwent subsequent prostatectomy, were enrolled in the study and examined on a 1.5T system using the body coil as well as the endorectal surface coil before and after the administration of contrast material. The results were compared to digital rectal examination, prostate specific antigen levels and endorectal ultrasound. RESULTS: Staging accuracy of endorectal coil MRI was 87.9% with a sensitivity of 88.9% and specificity of 86.7%. For body coil MRI, the staging accuracy was 75.7%, the sensitivity 66.7% and the specificity 87.9%, for transrectal ultrasound 69.6%, 41.7% and 100% and for the digital rectal examination 56.6%, 33.3% and 100%, respectively. Prediction was improved by combining results of endorectal coil MRI with PSA values. CONCLUSION: Endorectal ultrasound and digital rectal examination both had a tendency to underestimate the extent of the lesion. Endorectal coil MRI proved to be the best preoperative staging method. In combination with PSA values, diagnostic accuracy could be further improved. Therefore, local staging of prostate cancer could be based on these two parameters alone.

Response and palliation in a phase II trial of gemcitabine in hormone-refractory metastatic prostatic carcinoma. Swiss Group for Clinical Cancer Research (SAKK).

BACKGROUND: In a phase II trial, 43 patients with hormone-refractory prostate cancer were treated with gemcitabine at a dose of 1,200 mg/m2 over 2 hours (later decreased to 1,000 mg/m2 due to hematological toxicity) on days 1, 8 and 15 of a 28 day cycle. PATIENTS AND METHODS: Inclusion criteria were proven tumor progression after hormonal treatment and increased PSA levels, a WHO PS < or = 2, adequate bone marrow reserve, liver and renal function and age < or =, 80 years. Response criteria were based on PSA levels (CR: normalization of PSA, PR: > 50% decrease). Quality of life (QL) was assessed with the EORTC QLQ-C30 on day 1 of each treatment cycle and on day 8 of the first cycle (range of scales 0-100). Physician-rated pain intensity and use of pain medication were assessed at the same timepoints. RESULTS: Hematological toxicity of gemcitabine led to a dose-reduction in 48% of all cycles. Three of forty-three patients (RR = 7%) showed a PSA response: one CR and three PR with time to treatment failure of 8.7, 6.6 and > or = 9.3 months. Seven patients (16%) had stable disease (NC) for a median duration of 7.1 months (range 6.1-11.7 months). There was one case with objective regression of lymph node metastases. Patients reported a considerably impaired health status/QL (n = 41, median = 50) and severe fatigue (n = 41, median = 55.6) at baseline, with no change under treatment. Pain (QLQ-C30) was also severe at baseline (N=41, median=50) but was improved at the end of cycles 1 (n = 33, median change = -16.7, P = 0.0002), 2 (n = 19, median change = -33.3, P = 0.0006), 3 (n = 14, median change = -16.7, P = 0.06) and 4 (n = 9, median change = -33.3, P = 0.04). Patient-rated pain and use of analgesics as combined endpoint yielded palliation for at least 8 weeks in 14 patients (32%). Nine of these patients showed at least stable disease (CR/PR or NC by PSA level), five indicated a benefit in spite of progressive disease. CONCLUSIONS: Gemcitabine in the dose and schedule indicated above has a significant beneficial impact on pain in patients with hormone-refractory prostatic carcinoma despite its limited activity in terms of PSA response and considerable, especially hematological, toxicity.