Is sampling transitional zone in patients who had prior negative prostate biopsy necessary?

OBJECTIVE: To assess the necessity of transitional zone sampling of the prostate during repeat prostate biopsy procedures. METHODS: Patients treated for lower urinary tract symptoms with transurethral resection of the prostate (TURP) from April 2004 to July 2009 whom had at least 1 negative prostate biopsy prior to this treatment were chosen as the study group. A histopathological analysis of surgical specimens was employed to determine cancer detection rates. RESULTS: A total of 72 patients with the mean age of 66.1, mean prostate-specific antigen (PSA) of 10.4 ng/mL and mean prostate volume of 63.2 cc were included. Of the patients, 50 had 1 biopsy set, 17 had 2 sets, 4 had 3 sets and 1 patient had 4 sets of consecutive biopsies. All biopsy results were negative for prostate cancer. After the analysis of surgical specimens obtained during TURP, cancer was detected in 3 patients (4.2%). Transitional zone sampling during prostate biopsies did not significantly improve the cancer detection rate. Transitional zone sampling was performed in 29 biopsies taken from 20 patients, one of whom (5%) had prostate cancer. The remaining 71 biopsies were taken from 52 patients without transitional zone sampling, and cancer was detected in 2 (3.8%) of them. CONCLUSIONS: Since no significant difference was observed between patient groups (those with and those without transitional zone biopsies) in the detection of prostate cancer in the transitional zone, strategies for increasing the number of cores taken from transitional zone during repeat biopsies should be reconsidered.

Protective role of natural antioxidant supplementation on testicular tissue after testicular torsion and detorsion.

OBJECTIVES: To investigate the impact of garlic extract (GE), which is known for its antioxidant activity, on a testicular torsion/detorsion model in animals and to help understand how to prevent both ischemic and reperfusion injuries after testicular torsion and detorsion. MATERIAL AND METHODS: Six groups of rats (n=7 in each group) were used. The animals in the control group (Group I) did not receive any treatment. The animals in the sham group (Group II) underwent scrotal incision and testicular fixation only. The animals in Groups III-VI underwent 720 degrees of left testicular torsion for 2 h; subsequent detorsion was performed for 2h in Groups IV and VI only. Animals in Groups V and VI were treated exactly the same as those in Groups III and IV, respectively except that they were pretreated with oral GE for 5 days at a dosage of 5 ml/kg. Both testicles in all rats were removed and tissue malondialdehyde (MDA) levels and enzymatic activities of xanthine oxidase (XO) were studied, in addition to a histological evaluation after hematoxylin-eosin staining. RESULTS: Testicular MDA levels and XO activities were higher in Group III compared to Group II (p<0.05). Pretreatment with GE prevented these increases. Detorsion caused more damage and resulted in a further increase in MDA levels but MDA levels were not increased in animals pretreated with GE. Histologically, torsion caused some separation between germinative cells in the seminiferous tubules, which became much more prominent in Group IV and was attenuated by GE pretreatment. There were no significant changes in any of the above-mentioned enzymatic activities or histopathologic changes in the contralateral testicle in any of the groups. CONCLUSIONS: We believe that both testicular torsion and detorsion result in testicular tissue damage by means of lipid peroxidation, which is evident by an increase in the tissue levels of MDA. Dietary supplementation with GE seems to attenuate the generation of toxic free radicals, as evidenced indirectly by low tissue MDA levels.