Contribution of transcutaneous ultrasonography to the evaluation of urethral strictures.

The aim of our study was to investigate the accuracy and sensitivity of ultrasound in detecting urethral strictures. Between 1992 and 1994, 117 patients with stricture of the anterior urethra were evaluated by retrograde urethrography, ultrasonography and urethroscopy.

Influence of digital examination, cystoscopy, transrectal ultrasonography and needle biopsy on the concentration of prostate-specific antigen.

The influence of various prostatic manipulations, including digital rectal examination, cystoscopy, transrectal ultrasonography and transrectal needle biopsy, on the serum prostatic-specific antigen (PSA) levels in 170 men, were examined. We found that digital rectal examination, cystoscopy and transrectal ultrasonography had no significant effect on PSA levels, except for transrectal needle biopsy, which caused an immediate increase of serum PSA in 96.2% of the patients lasting more than 2 weeks in 42.3% of the cases. In conclusion, serum PSA determination after digital rectal examination, after cystoscopy and after transrectal ultrasonography is accurate and reliable. On the other hand, we must wait about 6 weeks after needle biopsy before measuring PSA in the serum of patients with prostatic diseases.

The value of prostatic specific antigen in the early diagnosis of prostatic cancer: a Greek view.

OBJECTIVE: To assess whether it is worthwhile to screen asymptomatic men for prostate cancer using serum prostate specific antigen (PSA) and to determine how many patients could be cured of prostatic carcinoma if detected by screening. PATIENTS AND METHODS: Between June 1992 and January 1994 the serum PSA level of 1400 asymptomatic men over 50-years-old was assessed. Those men with PSA levels < 4 ng/mL were not evaluated further. Those men with PSA levels of 4-10 ng/mL underwent digital rectal examination (DRE) and transrectal ultrasonography (TRUS) and biopsies were taken when there were significant findings on DRE and/or TRUS. If the PSA levels were > 10 ng/mL patients were submitted for DRE and TRUS and, even if both examinations were negative, random biopsies were taken. Where cancer was detected the tumour was staged and if it was a clinically confined tumour a radical retropubic prostatectomy was performed. The pathological and clinical stages of the disease were then compared. RESULTS: The majority of patients (95%) had PSA levels of < 4 ng/mL. Forty-nine men had PSA levels of 4-10 ng/mL and of these 28 were biopsied, which detected 12 (24.5%) carcinomas. There were 20 men with PSA levels > 10 ng/mL and among them 11 (55%) were found to have carcinomas. Combining these figures, among the 1400 men there were 69 cases with PSA levels > 4 ng/mL and, using DRE and TRUS, 23 patients (33%) were diagnosed as having prostatic adenocarcinomas. Among these, one had metastatic disease, three had lymph node micrometastases during surgical exploration and 19 underwent radical prostatectomies. The pathological and clinical stages agreed in only eight patients. CONCLUSION: Only eight patients can be considered as cured because of the screening protocol and even this result is overoptimistic, as the future biological behaviour of these tumours is unknown. Therefore we cannot recommend screening for prostatic carcinoma among asymptomatic men in Greece.