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1.
West Afr J Med ; 32(1): 8-13, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23613288

RESUMO

OBJECTIVE: To evaluate the usefulness of prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of cancer of the prostate (CaP) amongst unscreened patients. PATIENTS, MATERIALS AND METHODS: A prospective study 168 unscreened men who were referred for evaluation for CaP. They all had a 10-core extended transrectal prostatic needle biopsy using size 16 Tru Cut needle for either an elevated serum total PSA of > 4 ng/ml or abnormal DRE findings or both. Overall cancer detection rate was determined and detection rates were determined separately for patients with elevated PSA with normal DRE, abnormal DRE with normal PSA and those with both indications. The performances of each indication were determined separately and in combination in terms of their sensitivity, specificity, predictive values and accuracy. The results were compared amongst patients with different indications for biopsy. RESULTS: The overall cancer detection rate was 44.0%. Detection rates in patients with elevated PSA with normal DRE and abnormal DRE with normal PSA were 30.0% and 17.4% respectively. There was statistically significant increased detection of 61.2% amongst patients with both indications. The overall sensitivities of PSA, DRE and combination of both were 94.6%, 75.7% and 70.3% respectively while the specificities were 20.2%, 44.7% and 64.9% respectively. The accuracies of PSA, DRE and combination of both indications were 53%, 58% and 67.3% respectively while the PPVs were 48.3%, 51.9% and 61.2% respectively. Mean Gleason score was 6.82 while the overall complication rate was 23.2% CONCLUSION: Neither PSA nor DRE is sensitive, specific, predictive or accurate enough on its own to be an ideal screening or diagnostic test for CaP. Therefore, optimal evaluation of patients with suspected CaP is best achieved with both even in unscreened populations.


Assuntos
Exame Retal Digital , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Adenocarcinoma/diagnóstico , Idoso , Biópsia , Hospitais de Ensino , Humanos , Masculino , Programas de Rastreamento/métodos , Nigéria , Valor Preditivo dos Testes , Estudos Prospectivos , Próstata/patologia
2.
Niger Postgrad Med J ; 19(3): 137-42, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23064168

RESUMO

AIMS AND OBJECTIVES: To compare the cancer detection rates of sextant and ten- core biopsy protocol amongst patients being evaluated for prostate cancer. PATIENTS AND METHODS: This is a prospective study involving 125 men with suspicion of prostate cancer. They all had an extended 10-core transrectal digitally-guided prostatic biopsy using Tru-Cut needle. Indications for biopsy were presence of one or more of the following: elevated Prostate Specific Antigen (PSA), abnormal Digital Rectal Examination (DRE) findings and abnormal prostate scan. Sextant biopsies were collected first, followed by four lateral biopsies in all patients. Both groups of specimen were kept and analyzsed separately by the same pathologist. The cancer detection rates of sextant and extended (combination of sextant and lateral) 10-core biopsy protocols were determined and compared. Pearson's Chi square and McNemar tests at two degrees of freedom with level of significance set at 0.05 ( P <0.005) were used to determine the statistical significance. RESULTS: The overall cancer detection rate of 10-core prostate biopsy was 48.8%. Of all positive biopsies, the sextant biopsy protocol detected 52 cancers (85.2%) while the lateral biopsy protocol detected 58 cases (95.1%). Three (3) cancers were detected by the sextant protocol only while the lateral protocol detected nine (9) cancers where sextant technique was negative for malignancy. Ten-core extended protocol showed a statistically significant increase of 14.8% over the traditional sextant. (P=0.046). The overall complication rate of ten-core biopsy was 26.4% and the procedure was well tolerated in most patients. CONCLUSION: We conclude that a ten-core prostate biopsy protocol significantly improves cancer detection and should be considered as the optimum biopsy protocol.


Assuntos
Adenocarcinoma , Biópsia por Agulha , Protocolos Clínicos/normas , Exame Retal Digital/métodos , Próstata/patologia , Neoplasias da Próstata , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Idoso , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Pesquisa Comparativa da Efetividade/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Nigéria , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Melhoria de Qualidade
3.
Niger J Clin Pract ; 15(3): 315-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22960968

RESUMO

OBJECTIVE: To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance. MATERIALS AND METHODS: We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson's Chi square test with level of significance set at <0.05. RESULTS: The overall cancer detection by the extended technique was 61 (48.8%) cases while the sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04) CONCLUSION: Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/normas , Protocolos Clínicos/normas , Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Exame Retal Digital , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Antígeno Prostático Específico/sangue
4.
Arab J Urol ; 10(4): 394-400, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26558056

RESUMO

OBJECTIVES: To assess the value of percentage free prostate-specific antigen (%fPSA) in the detection of prostate cancer among Nigerian men with an intermediate total PSA level (4-10 ng/mL), and to show if the optimum threshold for biopsy is different from Caucasian values when the widely used (six-core, digitally directed) prostate biopsy protocol in Nigerians is applied. PATIENTS AND METHODS: The study included 105 patients aged >50 years, with a palpably benign prostate gland and intermediate levels of total PSA (4-10 ng/mL). These patients had a free PSA assay and a transrectal digitally directed six-core biopsy of the prostate. The %fPSA was calculated and the optimum threshold value for detecting prostate cancer was determined. RESULTS: The mean (SD) age of the patients was 64.4 (6.6) years and their mean (SD) total PSA level was 6.6 (1.7) ng/mL. Of these men 14 (13.3%) had cancer of the prostate detected by the prostate biopsy. The %fPSA level related directly to sensitivity values but inversely to the specificity and the positive predictive values. The best threshold of %fPSA for detecting cancer in these men was <40%, with a sensitivity of 100%, specificity of 93.4% and a positive predictive value of 70% (P < 0.05). CONCLUSIONS: In evaluating Nigerian patients with a palpably benign prostate gland and within the intermediate total PSA range, when digitally directed biopsy protocol is adopted, a %fPSA threshold of <40% will detect significant percentage of those with prostate cancer, with a minimal number of unnecessary biopsies. This value differs from that reported in western studies in which transrectal ultrasonography-directed biopsy was used.

5.
Niger Postgrad Med J ; 18(1): 30-3, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21445110

RESUMO

AIMS AND OBJECTIVES: To determine if there is any change in the common causes of gross haematuria among adults Nigerians and to determine what proportion of these aetiologies is due to urological malignancies. PATIENTS AND METHODS: Consecutive adults with presenting with gross haematuria seen in our centre were studied prospectively between February 2006 and January 2007. All patients had detailed clinical and diagnostic evaluation including urine cytology, flexible/rigid urethrocystoscopy, ultrasonography and intravenous urography to determine the causes of their haematuria. Other special investigations including CT scan and tissue biopsies were only used in selected patients as indicated. RESULTS: The cause of haematuria was determined in 74 patients (93.7%) while haematuria was of undetermined origin in 5 patients (6.3%). Fifteen different specific diagnoses were made as the causes of haematuria in this study. The three commonest individual causes of haematuria were benign prostatic hyperplasia (30.4%), bladder carcinoma (12.6 %) and carcinoma of the prostate (10.1%). Urological malignancies were diagnosed in 29.1 % of the patients. The Urological malignancies detected were bladder cancers (12.6 %), prostate cancers (10.1%), renal Cell Carcinoma (5.1%) and urethral Carcinoma (1.3%). The incidence of the cancers increased with age; 82.6% of the patients with malignancies were aged 50years and above while only 17.4% were below 50 years of age (P= 0.045). Urological malignancies were also more common in men (73.9 %) than in women (26.1 %) (P < 0.05). CONCLUSION: We conclude that there is changing trend in the aetiologies of gross haematuria among adult Nigerian patients with urological malignancies being now more prevalent than previously reported in our environment.


Assuntos
Carcinoma/complicações , Hematúria/etiologia , Neoplasias Urológicas/complicações , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma/epidemiologia , Feminino , Hematúria/diagnóstico , Hematúria/epidemiologia , Hospitais de Ensino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Prospectivos , Distribuição por Sexo , Neoplasias Urológicas/epidemiologia , Adulto Jovem
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