Higher Serum Endothelial-Specific Molecule-1 (ESM-1/Endocan) Levels are Associated with Poor Pathological Outcomes in Primary Bladder Cancer: A Non-randomized, Prospective, Case-Control Study.

AIM: To compare serum endothelial-specific molecule-1 (ESM-1 or endocan) levels between individuals with primary bladder cancer (BC) who have various pathological features of BC and healthy volunteers. MATERIALS AND METHODS: 154 consecutive patients with primary BC (Group-1) and 52 healthy volunteers (Group-2) were accepted into this prospective, non-randomized, observational research between January 2017 and December 2018. Peripheral blood samples were obtained from each participant to measure serum ESM-1/endocan levels. Group-1 was further divided into subgroups as Group-1A (pTa), Group-1B (pT1) and Group-1C (pT2) based on the transurethral resection of bladder tumour (TURBT) histopathological results. In addition Group-1 was divided into other subgroups based on pathological features of BC including tumor grade, tumor volume and muscle-invasive status. Groups were compared statistically regarding ESM-1/endocan levels. RESULTS: Median age of the individuals was 63 (22) years in Group-1 and 66 (11) years in Group-2 (p = 0.051). There were 140 (90.9%) males and 14 (9.1%) females in Group-1 and 30 (57.7%) males and 22 (42.3%) females in Group-2 (p < 0.001). The serum ESM-1/endocan measurements were lower in Group-2 than in Group-1 (p = 0.018). Of the patients in Group-1, 62 (40.3%) had low-grade tumors and 92 (59.7%) had high-grade tumors. When Group-1 was further divided into other subgroups according to different pathological features of BC such as tumor stage, grade, muscle-invasive status and tumor volume it was detected that there was a statistically meaningful difference between all subgroups of Group-1 and Group-2 in terms of serum ESM-1/endocan levels (p < 0.05 for each). The serum ESM-1/endocan cut-off value (3.472 ng/mL) had a specificity of 57.7%, sensitivity of 59.1%, NPV (negative predictive value) of 32.3% and PPV (positive predictive value) of 80.5% for predicting the presence of BC with an AUC (Area Under the Curve) of 0.609 (95% confidence interval (CI) 0.524-0.694; p = 0.018). CONCLUSIONS: The serum ESM-1/endocan levels can be considered a potentially useful predictor for BC. Higher serum ESM-1/endocan levels are related with poor pathological outcomes in BC.

Flexible fibre optic vs digital ureteroscopy and enhanced vs unenhanced imaging for diagnosis and treatment of upper tract urothelial carcinoma (UTUC): results from the Clinical Research Office of the Endourology Society (CROES)-UTUC registry.

OBJECTIVES: To compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing kidney-sparing surgery (KSS) with fibre-optic (FO) vs digital (D) ureteroscopy (URS). To evaluate the oncological impact of image-enhancement technologies such as narrow-band imaging (NBI) and Image1-S in patients with UTUC. PATIENTS AND METHODS: The Clinical Research Office of the Endourology Society (CROES)-UTUC registry is an international, multicentre, cohort study prospectively collecting data on patients with UTUC. Patients undergoing flexible FO- or D-URS for diagnostic or diagnostic and treatment purposes were included. Differences between groups in terms of overall survival (OS) and disease-free survival (DFS) were evaluated. RESULTS: The CROES registry included 2380 patients from 101 centres and 37 countries, of whom 401 patients underwent URS (FO-URS 186 and D-URS 215). FO-URS were performed more frequently for diagnostic purposes, while D-URS was peformed when a combined diagnostic and treatment strategy was planned. Intra- and postoperative complications did not differ between the groups. The 5-year OS and DFS rates were 91.5% and 66.4%, respectively. The mean OS was 42 months for patients receiving FO-URS and 39 months for those undergoing D-URS (P = 0.9); the mean DFS was 28 months in the FO-URS group and 21 months in the D-URS group (P < 0.001). In patients who received URS with treatment purposes, there were no differences in OS (P = 0.9) and DFS (P = 0.7). NBI and Image1-S technologies did not improve OS or DFS over D-URS. CONCLUSIONS: D-URS did not provide any oncological advantage over FO-URS. Similarly, no differences in terms of OS and DFS were found when image-enhancement technologies were compared to D-URS. These findings underline the importance of surgeon skills and experience, and reinforce the need for the centralisation of UTUC care.

The impact of IV contrast enhanced 18F-FDG PET/CT on the staging of bladder cancer.

OBJECTIVE: The aim of this retrospective study was to compare the diagnostic accuracies of conventional radiological imaging (CI) methods magnetic resonance imaging or computed tomography (MRI or CT) and intra venous (IV) contrast enhanced (CE) fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) for the staging of bladder cancer (BC). MATERIALS AND METHODS: The 18F-FDG CE-PET/CT results of 35 consecutive patients with BC were analyzed. Diagnostic value of CE-PET/CT and CI are compared for their accuracy in revealing primary tumors, nodal-distant metastasis, and the final tumor staging. The imaging results were compared with the gold standard, including of histopathology and clinical follow-up. We also investigated the effect of maximum standardize uptake value (SUVmax) and lymph node metastasis on survival. RESULTS: The CE-PET/CT had a diagnostic accuracy of 89% (31/35), compared to 57% (19/35) for CI. The results of CE-PET/CT imaging lead to upstaging in 37% (13/35) patients compared to CI staging. For primary tumor detection, the sensitivity of CE-PET/CT was 97% (34/35). Contrast enhanced-PET/CT detected nodal metastases in 19 (54%) patients, whereas CI detected in 9 (26%) patients. Contrast enhanced-PET/CT detected distant metastases in 14 (40%) patients, while conventional methods showed distant metastases in 9 (26%) patients. Maximum SUV of primary tumor does not have a significant effect on survival, whereas the median survival time of patients without lymph node metastasis is longer than patients who have lymph node metastasis (P=0.038). CONCLUSION: These data suggest that 18F-FDG CE-PET/CT had good diagnostic performance compared to conventional imaging for detecting primary tumor, nodal and distant metastasis in BC. Upstaging by CE-PET/CT changed the management of patients.

Neutrophil gelatinase-associated lipocalin is an early marker of renal damage in lower urinary tract obstruction in rats. / NGAL es un marcador precoz de daño renal en la obstrucción del tracto urinario inferior en ratas.

OBJECTIVES: To compare the urinary NGAL levels with serum creatinine levels as an early biomarker for renal injury in rats with bladder outlet obstruction (BOO). METHODS: Twenty male Wistar Albino rats dividedin to 4 groups. In each group basal serum creatinine and urinary NGAL levels were evaluated. In Group 1 (Sham/Control group) only laparotomy was performed.In Group 2 (14th day partial BOO) and Group 3 (28th day partial BOO) partial obstruction and in Group 4(Complete BOO) complete obstruction was performed. Serum creatinine levels and urinary NGAL levels were evaluated in Group 4 on the third day of the study, in Group 2 on the 14th day and in Group 3 and Group 1 on the 28th day. Urethra, ureters and kidneys were excracted by laparotomy and evaluated for histopathologic examination. RESULTS: The increase in plasma creatinine levels after obstruction was statistically significant in Group 4 ( p <0.005). There was significant difference between the groups in urinary NGAL levels after obstruction (p<0.005). Post-obstruction urinary NGAL level was highest in Group 4 and it was statistically significant when compared to beginning levels (p<0.005). In Group 3, increase in urinary NGAL levels were higher (p<0.005) with no increase in plasma creatinine level after obstruction. CONCLUSIONS: It can be concluded that urinary NGAL levels might be an early biomarker for renal dysfunction in partial bladder outlet obstruction which may cause renal impairment through upper urinary tract injury.Therefore, urinary NGAL may play role during the treatment choice and follow-up in BOO patients.

OBJETIVOS: Comparar los niveles urinariosde NGAL con la creatinina sérica como marcador precoz de daño renal en ratas con obstrucción del tracto urinario inferior. MÉTODOS: 20 ratas Wistar Albino masculinas fueron divididas en 4 grupos. En cada grupo se midió el nivel basal de creatinina en suero así como los niveles urinarios de NGAL. En el grupo 1 (Sham/Grupo Control) solo se realizó laparotomía. En el grupo 2 (14 días después de una obstrucción tracto urinario inferior parcial) y el grupo 3 (28 días después de una obstrucción tracto urinario inferior parcial) se realizó una obstrucción parcial y en el grupo 4 (obstrucción completa) una obstrucción completa. Los niveles de creatinina sérica y NGAL urinario fueron evaluados en el grupo 4 en el 3er día del estudio; en el grupo 2 en el día 14 del estudio y en el grupo 1 en el día 28. Uretra, uréteres y riñones se quitaron por laparotomía y se hizo un análisis histológico. RESULTADOS: El incremento en la creatinina sérica después de la obstrucción fue estadísticamente significativo en el grupo 4 (p<0,05). Hubo suficiente diferecia entre los grupos en términos de NGAL urinario después de la obstrucción (p<0,005). Los niveles de NGA post-obstructivos fueron superiores en el grupo 4 y fue estadísticamente significativo en comparación con los niveles iniciales. En el grupo 3, el incremento en los niveles de NGAL urinario fue superior (p<0,005) sin incrementeo en los niveles de creatinina en plasma después de la obstrucción. CONCLUSIONES: Se puede concluir que los niveles de NGAL urinarios podrían ser un marcador de lesión renal en caso de obstrucción parcial del tracto urinario inferior. Por tanto, NGAL urinario debe jugar un papel durante la elección de tratamiento y seguimiento de pacientes con obstrucción del tracto urinario inferior.

Is cystoscopy follow-up protocol safe for low-risk bladder cancer without muscle invasion?

OBJECTIVE: The applicability of cystoscopy follow-up protocol that is indicated for low-risk nonmuscle-invasive bladder cancer (NMIBC) in the guidelines was investigated for our population. MATERIALS AND METHODS: Patients who underwent transurethral resection with a diagnosis of primary bladder tumor in our clinic within 10 years with low grade of pathology pTa and follow-up periods of at least 5 years were retrospectively reviewed. Fifty-one patients (39 males and 12 females) who were diagnosed with a low-risk NMIBC, had no recurrence at the 3-month control cystoscopy, and followed up for the first 2 years on 3-month basis with cystoscopy were included in the study. RESULTS: The mean age of the patients was 57.37 ± 12.21 years (range: 29-80 years), and the mean duration of recurrence was 25.76 ± 32.45 months. In the cystoscopy follow-ups of 51 patients, up to the 6th month, a total of 12 (24%); up to the 9th month, a total of 21 (41%); up to the 12th month, a total of 30 (59%); up to the 15th month, a total of 36 (71%); up to the 18th month, a total of 36 (71%); up to the 21st month, a total of 39 (77%); and up to the 24th month, a total of 41 (80%) patients were reported to have recurrence. In the case of patients with no recurrence at the 9th month cystoscopy, it was determined that 50% of the patients had recurrence in the first 6 months and 67% in the first 2 years. CONCLUSION: The majority (80%) of recurrences in low-risk NMIBC occurred in the first 2 years. If the follow-up protocol described in the guidelines had been applied, patients with relapses would have a delay of at least 6 months of diagnosis. Therefore, even if there is no recurrence in the low-risk NMIBC at the 3rd and 9th months, it may be more appropriate to follow the cases in the first 2 years with follow-up cystoscopy every 3 months.

Evaluation of Nephrolithometric Scoring Systems to Predict Outcomes of Retrograde Intrarenal Surgery.

PURPOSE: The aim of the study was to evaluate the predictive value of nephrolithometric scoring systems used to predict the complexity of renal stones for the outcomes of retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: A total of 81 patients who underwent RIRS for nephrolithiasis between January 2013 and October 2017 were reviewed in this retrospective study. Guy's Stone Score (GSS), the S.T.O.N.E., Clinical Research Office of the Endourologic Society (CROES), and Seoul National University Renal Stone Complexity (S-ReSC) nephrolithometry scores were assessed by same researcher for each patient from preoperative non-contrast enhanced computed tomography scans. These nephrolithometric scores, stone characteristics and complications were compared in patients with/without residual stone. RESULTS: The median (IQR) age of patients (37 female/44 male) was 45 (20) years. The median (IQR) stone burden was 139.4 (125.4) mm2 and the mean Hounsfield unit (HU) value was 1034.46 ± 239.56. The stone burden, S.T.O.N.E. and S-ReSC scores were statistically significantly higher and the CROES score was significantly lower in patients with a residual stone (p < 0.001, for all). The incidence of residual stones was statistically significantly higher in patients with Grade 3 GSS (p = 0.018). While S.T.O.N.E., S-ReSC and CROES were significantly correlated with stone-free rates, GSS failed to correlate with stone-free status. According to the receiver operating characteristic (ROC) curve analysis, the predictive value of stone burden was higher for residual stones, compared to S-ReSC scoring (p < 0.05). CONCLUSION: Nephrolithometric scoring systems nomograms used to predict the PCNL success were not superior to stone burden in predicting the RIRS success.

Improving the diagnosis of high grade and stage bladder cancer by detecting increased urinary calprotectin expression in tumor tissue and tumor-associated inflammatory response.

Purpose: To investigate whether measurement of urinary calprotectin can serve as a biomarker in the diagnosis of primary bladder cancer and to confirm its diagnostic role in determining high grade and stage disease. Materials and Methods: Urinary calprotectin was measured in spot urine samples from patients with primary bladder cancer and control subjects. To confirm levels in urine, tissue samples were also obtained from bladder tumor and healthy trigone of bladder by transurethral resection in both groups. Finally, calprotectin levels in tissue and urine of the patients and control subjects were compared and their diagnostic potential was investigated in high grade and stage bladder cancers. Results: Of 82 participants, 52 were patients with bladder cancer and 30 were control subjects. The two groups were comparable in terms of age, smoking status, and comorbidities. Tissue and urinary calprotectin levels were significantly higher in the bladder cancer group. In subgroup analyses, urinary calprotectin levels were significantly higher in patients with high-grade, muscle-invasive tumors. After receiver operating characteristic analyses, the sensitivity and specificity of urinary calprotectin was 100% and 96.7%, respectively, in the diagnosis of primary bladder cancer. High grade and stage bladder cancers were detected with sensitivity and specificity of 70% and 74.2%, and 80% and 84.8%, respectively. Conclusions: Urinary calprotectin may be a valuable parameter in the diagnosis of primary bladder cancer with high sensitivity and specificity. Furthermore, it may be useful in the prediction of high grade and stage disease. However, more investigations are needed.

The Effect of Platelet-Rich Plasma on Peyronie's Disease in Rat Model.

PURPOSE: The objective of this study was to evaluate the effects of intratunical injection of platelet rich plasma (PRP) for the treatment of Peyronie's disease (PD) in a rat model. MATERIALS AND METHODS: Twenty male Sprague-Dawley rats (300-350 g) were randomly divided into 4 groups: sham, PD, PD + PRP, and PRP. The PD + PRP groups received intratunical injections with 0.1 mL PRP on day 15 (treatment) or day 0 (PRP effect). Forty-five days following transforming growth factor-beta 1 injection, rats underwent pathological examination. Tissues were evaluated histologically for fibrosis grade (Haematoxylin & Eosin staining), collagen/smooth muscle ratio (Masson Trichrome staining) and type III/type I collagen ratio (Picro-sirius red staining). Statistical analysis was performed by Kruskal-Wallis and chi-square followed by the Mann-Whitney U test for post hoc comparisons. RESULTS: Significant changes were found in all 3 groups compared to the sham group (p < 0.0001 for fibrosis, p = 0.001 for collagen/smooth muscle ratio and p = 0.003 for type III/type I collagen ratio). The values in the PRP group and the findings in the PD group are similar (p = 0.122 for fibrosis, p = 0.221 for collagen/smooth muscle ratio and p = 1.0 for type III/type I collagen ratio). CONCLUSION: This is the first study of PRP on PD. As a result of pathological examinations, PRP shows PD-like effects in rats. PRP may be a cheap, easily accessible, and an effective disease model for PD treatment research.

Role of contrast-enhanced 18F-FDG PET/CT imaging in the diagnosis and staging of renal tumors.

PURPOSE: The objectives of this prospective study are to compare intravenous contrast-enhanced (CE) fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CE F-FDG PET/CT) with conventional methods (CT/MRI) and to evaluate the relationship of maximum standardized uptake value (SUVmax) with Fuhrman grade in patients with renal tumors. PATIENTS AND METHODS: A total of 62 patients [35 males and 27 females; mean age 55.8±12.7 (range: 27-81) years] were enrolled in the study. CE F-FDG PET/CT scanning included whole-body (early) and abdominal imaging (late) 1 and 2 h after intravenous F-FDG administration, respectively. SUVmax was calculated for primary tumors. CE F-FDG PET/CT and CT/MRI findings were compared with respect to primary tumors and staging. RESULTS: The sensitivity of CE F-FDG PET/CT in primary tumor detection was 98%, which was very close to that of CT/MRI (100%). CE F-FDG PET/CT resulted in correct staging in 84% of the cases, compared with 68% of the cases with conventional methods (52 vs. 42 patients). SUVmax values of early PET for the primary tumors were significantly correlated with the Fuhrman grades (P<0.001). CE F-FDG PET/CT enabled the detection of synchronous tumors in four patients, one of which was incorrectly diagnosed as having metastasis by CT. Distant metastases were detected in 16 patients with CE F-FDG PET/CT and in 13 patients with routine conventional methods. CONCLUSION: CE F-FDG PET/CT showed similar results compared with CT/MRI in the detection of primary tumors, but it was superior to conventional methods in the detection of metastasis and staging. Given the highly significant correlation between SUVmax values and the Fuhrman grading, CE F-FDG PET/CT may play a significant role in the evaluation of patient prognosis.

Transrectal ultrasound-guided prostate rebiopsy: How many core sampling should be applied to which patient?

BACKGROUND: We investigated the correlation between the sampled number of cores in rebiopsy and the cancer detection rate (CDR). MATERIALS AND METHODS: Two hundred and twelve patients with normal rectal examination who had undergone rebiopsy in the past 5 years were examined retrospectively. Moreover, 68% of them had undergone 12 cores (Group 1) while 32% had undergone 20 cores (Group 2). Both groups were compared with respect to the CDR. RESULTS: There was no difference between groups in terms of age, total prostate-specific antigen, and prostate volume (P > 0.05). Forty-one (19%) of 212 patients were diagnosed with cancer, and the CDR was significantly higher in Group 2 (30.9% vs. 13.9%, P = 0.004). This rate increased from 6.5% to 20% (P = 0.025) and from 0% to 33.3% (P = 0.023), respectively, with 12-core and 20-core rebiopsies in patients whose initial pathology indicated benign and high-grade prostatic intraepithelial neoplasia (HGPIN). Furthermore, cancer was detected in 24 (40%) of 60 patients who were diagnosed with atypical small acinar proliferation (ASAP) in the initial biopsy. However, despite being higher in 20-core biopsy group (47.6% vs. 35.9%), this was not statistically significant (P = 0.377). CONCLUSIONS: At least 20 cores should be sampled in rebiopsy, especially in the patients diagnosed with benign and HGPIN. However, we believe that standard systematic sampling will be sufficient for the patients diagnosed with ASAP.

Effect of Stone Composition on the Outcomes of Semi-Rigid Ureteroscopy Using Holmium: Yttrium-Aluminum-Garnet Laser or Pneumatic Lithotripsy.

OBJECTIVE: To compare the effectiveness of laser lithotripsy (LL) and pneumatic lithotripters (PL) in calcium oxalate (CaOx) and calcium phosphate (CaP) stones and assess whether these stone compositions affect the outcomes of LL and PL. STUDY DESIGN: Comparative, descriptive study. PLACE AND DURATION OF STUDY: Istanbul Training and Research Hospital, Turkey, from August 2010 to August 2015. METHODOLOGY: A total of 114 patients underwent ureteroscopy using LL and PL. Fifty-eight (50.9%) had CaOx stones and 56 (49.1%) had CaP stones. The lithotripters were compared in stone composition groups, and stone compositions were compared in lithotripter groups. Patient characteristics, perioperative parameters, and postoperative complications were compared. RESULTS: The baseline patient and stone characteristics were similar in all groups. The operation time of the PL and LL for the patients with CaP stones (68.75 ±32.88 and 44.48 ±34.37 minutes, respectively) was significantly shorter than the operation time of the PL and LL for the patients with CaOx stones (91.56 ±30.54 and 65.75 ±37.74 minutes, (p=0.012 and p=0.009, respectively). Moreover, the patients with CaOx or CaP treated with LL 65.75±37.74 and 44.48 ±34.37 minutes, respectively) had significant shorter operation time than the PL (91.56 ±30.54 and 68.75 ±32.88 minutes, (p=0.046 and p=0.01, respectively). Stone-free rates were similar in all groups. The PL for the patients with CaP stones caused more postoperative fever and infection than the other groups (p=0.050). CONCLUSION: Though both PL and LL are effective in the treatment of CaOx and CaP stones, LL had a significantly shorter operation and hospitalization time and complication rates in patients with CaOx and CaP stones. So LL is a more feasible and safer modality in the treatment of recurrent CaP stones.

Age-related prevalence of diabetes mellitus, cardiovascular disease and anticoagulation therapy use in a urolithiasis population and their effect on outcomes: the Clinical Research Office of the Endourological Society Ureteroscopy Global Study.

PURPOSE: This study examined the prevalence of risk factors for urological stone surgery and their possible influence on outcome and complications following ureteroscopy (URS). METHODS: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study collected prospective data on consecutive patients with urinary stones treated with URS at centers around the world for 1 year. The prevalence of common comorbidities and anticoagulation therapy and their relationship with complications and age were examined. RESULTS: Of 11,719 patients, 2,989 patients (25.8%) had cardiovascular disease, including 22.6% with hypertension, and 1,266 patients (10.9%) had diabetes mellitus. Approximately six percent of patients were receiving oral anticoagulation therapy, including aspirin (3.7%) and clopidogrel (0.8%). The prevalence of hypertension and diabetes mellitus and the proportion of patients receiving anticoagulant medication and/or antidiabetes treatment increased with age. Elderly were more likely to develop a postoperative complication when they had diabetes, a cardiovascular disease or received anticoagulation therapy. Post-operative bleeding was higher in patients receiving anticoagulants than those not receiving them (1.1 vs. 0.4%; p < 0.01). Patients with risk factors for stone formation had more complications than those without (4.9 vs. 3.0%, p < 0.001). CONCLUSIONS: This is the first study confirming in a global population that URS can effectively and safely be performed in a population with high comorbidity. The risk of a complication was highest among elderly patients presenting with comorbidities.

Novel technique of cytolithotripsy for large bladder stones.

INTRODUCTION: We evaluated a minimally invasive surgical technique involving a single percutaneous access with a laparoscopic trocar under video-cystoscopic vision for managing large bladder stones. All patients were candidates for open surgery. MATERIALS AND SURGICAL TECHNIQUE: Fourteen patients with bladder stones larger than 3 cm in diameter or multiple stones were treated with this technique. The procedure involved the percutaneous placement of a laparoscopic trocar under cystoscopic control and the introduction of a rigid nephroscope into the bladder. Stones were cleansed via fragmentation or direct removal. DISCUSSION: The technique was successful in all cases, resulting in controlled, stone-free bladders; there were no surgical complications. The mean operation time was comparable to that of standard management. All patients discharged uneventfully. None reported urethral stricture during the 24-month follow-up period. Percutaneous cystolithotripsy under endoscopic control is easy to perform and should be considered as an alternative for large or multiple bladder stones as it decreases the risk of urethral stricture.

The effect of antibiotherapy on prostate-specific antigen levels and prostate biopsy results in patients with levels 2.5 to 10 ng/mL.

PURPOSE: This controlled prospective study aims to investigate the possible effects of antibiotic treatment on prostate-specific antigen (PSA) and its derivatives, and consequently on the transrectal biopsy rates, in the diagnosis of prostate cancer. PATIENTS AND METHODS: One hundred and forty patients aged 45 to 70 years old, with a PSA level between 2.5 and 10 ng/mL and normal digital rectal examinations (DRE), were included in this study between June 2009 and November 2010. The patients were randomly assigned into two groups. The first group received oral levofloxacin 500 mg 1*1 for 21 days; the second, the control group, was given no treatment. Initially, total PSA, free PSA, a DRE, urinary ultrasonography (including prostate volume, postvoiding residual urine), uroflowmetry, International Prostate Symptom Score, National Institutes of Health Chronic Prostatitis Symptom Index, and International Index of Erectile Function tests were performed. All of these were repeated at the end of 3 weeks of antibiotic treatment. An additional PSA measurement was also performed at day 10 of the treatment. All patients underwent transrectal ultrasonography (TRUS) guided prostate biopsy at day 21, just the day after the final (third) PSA sampling. RESULTS: The mean age of the patients was 59.6 years. Overall, in 23 patients, prostate cancer was detected, including those found in the rebiopsies. Statistically, there were significant changes in values of PSA and its derivatives in the treatment group (from 5.31 to 4.69 and 4.58 ng/mL, consecutively). Focusing on prostate cancer patients in both the treatment and control groups, however, we did not detect any significant change in the same parameters. CONCLUSION: Antibiotic treatment given to the patients with a PSA level between 2.5 and 10 ng/mL can be beneficial, before a decision for TRUS guided prostate biopsy, just in a limited subgroup, by reducing the PSA levels below the threshold value. Considering the large population of patients in the gray zone, however, it still does not provide clear solid evidence for avoiding unnecessary prostate biopsies.