Re-examining Prostate-specific Antigen (PSA) Density: Defining the Optimal PSA Range and Patients for Using PSA Density to Predict Prostate Cancer Using Extended Template Biopsy.

OBJECTIVE: To compare the predictive accuracy of prostate-specific antigen (PSA) density vs PSA across different PSA ranges and by prior biopsy status in a prospective cohort undergoing prostate biopsy. MATERIALS AND METHODS: Men from a prospective trial underwent an extended template biopsy to evaluate for prostate cancer at 26 sites throughout the United States. The area under the receiver operating curve assessed the predictive accuracy of PSA density vs PSA across 3 PSA ranges (<4 ng/mL, 4-10 ng/mL, >10 ng/mL). We also investigated the effect of varying the PSA density cutoffs on the detection of cancer and assessed the performance of PSA density vs PSA in men with or without a prior negative biopsy. RESULTS: Among 1290 patients, 585 (45%) and 284 (22%) men had prostate cancer and significant prostate cancer, respectively. PSA density performed better than PSA in detecting any prostate cancer within a PSA of 4-10 ng/mL (area under the receiver operating characteristic curve [AUC]: 0.70 vs 0.53, P < .0001) and within a PSA >10 mg/mL (AUC: 0.84 vs 0.65, P < .0001). PSA density was significantly more predictive than PSA in detecting any prostate cancer in men without (AUC: 0.73 vs 0.67, P < .0001) and with (AUC: 0.69 vs 0.55, P < .0001) a previous biopsy; however, the incremental difference in AUC was higher among men with a previous negative biopsy. Similar inferences were seen for significant cancer across all analyses. CONCLUSION: As PSA increases, PSA density becomes a better marker for predicting prostate cancer compared with PSA alone. Additionally, PSA density performed better than PSA in men with a prior negative biopsy.

Liposuction and lipofilling for treatment of symptomatic silicone toxicosis of the gluteal region.

BACKGROUND: Silicone injection can cause numerous posttreatment complications-including debilitating pain, cellulitis, abscesses, overlying skin compromise, and siliconomas distorting overlying tissues-that can be difficult to manage. OBJECTIVES: The authors evaluate liposuction as a treatment for patients experiencing complications from silicone injections to the gluteal region, to both preserve aesthetic appearance and minimize further risk of complication from these procedures. METHODS: Eight patients (7 women and 1 man) who presented consecutively to us between 2010 and 2013 with complications from silicone injections to their gluteal region were enrolled in this study. Each patient was evaluated by computed tomography scan and a 0 to 6 visual analog scale for pain. Emergency room (ER) visits, previous hospital admissions, and cellulitis requiring antibiotics in the 12 months prior to treatment were recorded. Patients were treated with ultrasonic and standard liposuction followed by lipotransfer into the gluteal musculature. A Student t test was used for statistical comparison of pre- and postoperative values. RESULTS: Average patient age was 36 years (range, 25-43 years). All patients initially presented with intense pain as assessed by a visual analog scale; by the 12th week postoperatively, the entire cohort experienced remission in pain. At 1 year postoperatively, no patients had infections (vs 75% preoperatively; P = .028), visited the ER (vs 50% preoperatively; P = .058), or were hospitalized (vs an average of 1.5 hospitalizations per patient preoperatively; P = .066). CONCLUSIONS: Liposuction with immediate intramuscular fat transfer for buttock augmentation appears to be a safe surgical option that preserves aesthetic appearance for patients with gluteal silicone toxicosis.