Impact of the European Randomized Study of Screening for Prostate Cancer (ERSPC) on prostate-specific antigen (PSA) testing by Dutch general practitioners.

OBJECTIVE: To determine the impact of the European Randomized Study of Screening for Prostate Cancer (ERSPC) publication in 2009 on prostate-specific antigen (PSA) level testing by Dutch general practitioners (GPs) in men aged ≥40 years. MATERIALS AND METHODS: Retrospective study with a Dutch insurance company database (containing PSA test claims) and a large district hospital-laboratory database (containing PSA-test results). The difference in primary PSA-testing rate as well as follow-up testing before and after the ERSPC was tested using the chi-square test with statistical significance at P < 0.05. RESULTS: Decline in PSA tests 4 months after ERSPC publication, especially for men aged ≥60 years. Primary testing as well as follow-up testing decreased, both for PSA levels of <4 ng/mL as well as for PSA levels of 4-10 ng/mL. Follow-up testing after a PSA level result of >10 ng/mL moderately increased (P = 0.171). Referral to a urologist after a PSA level result of >4 ng/mL decreased slightly after the ERSPC publication (P = 0.044). CONCLUSIONS: After the ERSPC publication primary PSA testing as well as follow-up testing decreased. Follow-up testing seemed not to be adequate after an abnormal PSA result. The reasons for this remain unclear.

Prostate specific antigen testing policy worldwide varies greatly and seems not to be in accordance with guidelines: a systematic review.

BACKGROUND: Prostate specific antigen (PSA) testing is widely used, but guidelines on follow-up are unclear. METHODS: We performed a systematic review of the literature to determine follow-up policy after PSA testing by general practitioners (GPs) and non-urologic hospitalists, the use of a cut-off value for this policy, the reasons for repeating a PSA test after an initial normal result, the existence of a general cut-off value below which a PSA result is considered normal, and the time frame for repeating a test. Data sources. MEDLINE, Embase, PsychInfo and the Cochrane library from January 1950 until May 2011. Study eligibility criteria. Studies describing follow-up policy by GPs or non-urologic hospitalists after a primary PSA test, excluding urologists and patients with prostate cancer. Studies written in Dutch, English, French, German, Italian or Spanish were included. Excluded were studies describing follow-up policy by urologists and follow-up of patients with prostate cancer. The quality of each study was structurally assessed. RESULTS: Fifteen articles met the inclusion criteria. Three studies were of high quality. Follow-up differed greatly both after a normal and an abnormal PSA test result. Only one study described the reasons for not performing follow-up after an abnormal PSA result. CONCLUSIONS: Based on the available literature, we cannot adequately assess physicians' follow-up policy after a primary PSA test. Follow-up after a normal or raised PSA test by GPs and non-urologic hospitalists seems to a large extent not in accordance with the guidelines.

MIB-1 (KI-67) proliferation index and cyclin-dependent kinase inhibitor p27(Kip1) protein expression in nephroblastoma.

PURPOSE: A number of studies have indicated that the tumor proliferation marker MIB-1 and cell cycle inhibitor p27(Kip1) expression are of prognostic importance in a variety of cancers. The present study was performed to evaluate the prognostic value of these molecules in Wilms' tumors. EXPERIMENTAL DESIGN: MIB-1 and p27(Kip1) expressions were investigated by the means of immunohistochemical analysis of 62 Wilms' tumor. Patients were preoperatively treated by chemotherapeutic agents and had a mean follow-up of 5.7 years. RESULTS: MIB-1 and p27(Kip1) were expressed in normal kidney tissues and in the three main components of Wilms' tumor, i.e., the blastemal, epithelial, and stromal cells. In Wilms' tumors, the percentage of MIB-1-positive cells in the blastema ranged between 0 and 42% (mean, 9.4%) and in the epithelial component between 0 and 53% (mean, 19.9%), with a significant difference (P < 0.01). The percentage of blastemal p27(Kip1)-positive cells ranged between 3 and 85% (mean, 55.1%) and for the epithelial component between 1 and 87% (mean, 59%). There was a significant inverse relationship between blastemal MIB-1 and p27(Kip1) expression in Wilms' tumor. Univariate analysis showed that blastemal MIB-1 and p27(Kip1) expression were indicative for clinical progression and tumor-specific survival. In a multivariate analysis, blastemal MIB-1 and p27(Kip1) protein expression proved to be an independent prognostic for clinical progression besides stage. CONCLUSIONS: It was concluded that both MIB-1-based proliferative activity and p27(Kip1) protein expression in the blastema have prognostic impact in Wilms' tumor.

Prenatal testicular torsion: diagnosis and natural course. An ultrasonographic study.

The aim of this study was to demonstrate the ultrasonographic features of prenatal torsion of the testis at presentation and during follow-up, with histological correlation post-orchidectomy. Between January 1985 and December 1999, 13 neonates with antenatal torsion of the testis were examined postnatally, at presentation and during follow-up, with high-resolution ultrasonography, including colour Doppler ultrasonography. Bilateral testis volume was evaluated [lengthxwidthxdepthx(pi/6)]. Ultrasonographic findings were correlated with histological findings (n=8) and findings at surgery. Moreover, in 1 patient the affected testis was postoperatively examined with ultrasonography in vitro. These findings were correlated with preoperative ultrasonography and corresponding histological slices. All patients (n=13) presented with a painless congenital scrotal mass. On the affected side no flow was found with colour Doppler ultrasonography. Testis volume on the affected and normal side showed mean values of 2.1 and 0.5 cc, respectively. On ultrasonography all patients showed scrotal swelling and a heterogeneous testis with hypoechoic central areas (necrosis). The tunica albuginea was thickened in all patients, with focal (n=2) or rim-like (n=11) hyperechoic reflections (calcifications) at the transitional zone between testis and tunica albuginea. In 9 patients follow-up ultrasonography showed progressive testis atrophy on the affected side. In 10 patients a contralateral hydrocele was found. Prenatal torsion shows a characteristic ultrasonographic pattern. In newborns with a scrotal mass, these ultrasonographic findings should suggest this diagnosis and delay in immediate surgery and/or oncological work-up may be appropriate.