Penile haemodynamic changes in post-radical cystectomy patients.

The aim of this study was to assess the penile vascular changes in post-radical cystectomy patients. A prospective assessment took place between January 2003 and January 2005 of 45 potent men who underwent radical cystectomy and diversion for invasive bladder cancer. Nerve sparing (NS) technique was applied in 21 cases, while others were not subjected to NS (non-nerve sparing group; NNS = 24 cases). All patients were comparable in preoperative clinical and pathological parameters. A control arm was the preoperative normal indices of the same patients. Preoperative penile duplex ultrasounds (PDU) for all cases were carried out, and then follow-up 2, 6 and 12 months thereafter. On first postoperative visit, none of NS cases showed any arterial insufficiency, while two cases of NNS (8.3%) had peak systolic velocity (PSV) < 30 cm/sec. Moreover, all cases of both groups showed early increase of end diastolic velocity (EDV) > 5 cm/sec. In NS cystectomy group, the PSV showed statistically insignificant change [p > 0.05 (mean: 53.6, cm/sec)]. Shortly after surgery, the EDV values increased, followed by gradually significant improvement (decrease in EDV values) in comparison with control state (mean: 5.9 cm/sec). On the other hand, the NNS cases showed statistically insignificant changes in PSV (mean: 49.3 cm/sec), with deterioration in EDV that did not improve with time, in contrast to NS cases (mean: 13.15 cm/sec). The main significant penile vascular changes were in EDV (venogenic mechanism) in post-cystectomy patients. There was a gradual progressive improvement in venogenic competence mechanism in NS cases with insignificant deterioration of arteriogenic mechanism in both groups (NS/NNS).

Obesity-PSA relationship: a new formula.

To clinically apply the inverse PSA-body mass index (BMI) correlation and enhance PSA sensitivity in obese cases, a new formula is warranted. An innovated BMI-PSA equation is designed. PSA-BMI adjusted formula (named Hekal's equation): measured total PSA (ng ml(-1)) multiplied by age (years) and divided by BMI of the patient. The formula is applied over a randomly chosen 1000 cases of different PSA, BMI, age and trans-rectal ultrasound biopsy results, the yield of new PSA is correlated with pathology and age-specific PSA adjustment values. Among the 988 cases with complete data, obesity (BMI: 30-35 kg m(-2)) in 236 cases (23.8%) and 79 cases (7.9%) have BMI>35 kg m(-2). Mean PSA was 5.8 ng ml(-1) (s.d.+/-8.4 ng ml(-1)). Cases stratified based on their age (every 10 years). The new equation was applied. Obesity is detected in 33.5 and 43.6% of fifth and sixth decade of life respectively (P=0.02), with low measured PSA values (2.1, 3.8 ng ml(-1), respectively). By such PSA measurement biopsy may be omitted, missing 53.3% of malignant cases. In contrast, PSA adjusted were 4 and 9.3 ng ml(-1) within the same group of patients. With such values, the decision of a biopsy could not be missed for the targeted groups. Specificity and sensitivity of adjusted PSA values at cutoff point 4 ng ml(-1) was 41.7 and 70%, respectively. Based on our results, the new PSA-BMI adjusted formula is reproducible, easy applied formula. With such a formula the higher sensitivity of PSA in obese patients could be achieved. The misleading low PSA in obese cases in the fifth and sixth decade will be corrected.

The patients less than 50 years: is there a need to lower the PSA cutoff point?

The aim of this study was to study the incidence and possibility of prostate cancer detection in patients <50 years with prostate-specific antigen (PSA) <4 ng ml(-1). Between January 2006 and January 2008, 355 men were subjected to radical cystoprostatectomy for bladder cancer. Among 162 cases without pathological prostatic invasion, random selection of two groups with serum PSA <4 ng ml(-1) was carried out. According to the age, 56 pairs in group A (< or =50 years) and group B (>50 years) were selected randomly. The resected prostate glands of each group were examined pathologically for evidence of prostatic adenocarcinoma. Correlation of the age groups with pathological findings, PSA, digital rectal examination (DRE) and body mass index (BMI) was carried out. The mean age of the groups (A and B) was 46.17+/-4.3 and 58.42+/-4.4 years, respectively. Mean PSA was 1.9+/-1.6 ng ml(-1) in group A and 2+/-1.6 ng ml(-1) in group B. Prostatic adenocarcinoma was detected in 1.8 and 10.7% in groups A and B, respectively (P=0.051). High-grade prostatic intraepithelial neoplasia (PIN) was higher in group A than in group B, 11 cases versus 4 (P=0.079). DRE was not significantly associated with pathological findings in those groups of patients. BMI was directly correlated with PSA in patients of group A (mean: 27.8+/-4.4, CC: 0.5, P=0.015), but not with that of group B (mean: 27.5+/-4.8, CC: 0.16, P=0.239). A new PSA cut-off point for younger patients (<50 years) is warranted. Serum PSA 2 ng ml(-1) is recommended as a cut-off point to screen and biopsy advice for nonsymptomatic patients <50 years. High-grade PIN was higher among the younger patients with low serum PSA, which indeed needs a meticulous follow-up.