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Purpose: The incidence of prostate cancer, benign prostatic enlargement and serum level of prostate-specific antigen (PSA) increase with patient age. Intermediate elevation of PSA in elderly populations is apt to be considered insignificant. We evaluated the impact of PSA and prostate volume on the presence of non-palpable prostate cancer in elderly men with an intermediate level of PSA. Materials and methods: Clinical records of 154 men 70 years or older, with non-cancerous digital rectal examination findings and with serum PSA levels of 2.0–10.0 ng/mL, who underwent initial 6- to 10-core transrectal prostate biopsy, were reviewed for prostate volume, number of biopsy cores, PSA and associated parameters. Stepwise logistic regression and receiver operating characteristic (ROC) models were used to determine the impacts of the parameters on the biopsy results. Results: Overall cancer detection rate was 40/154 or 26.0%. Prostate-specific antigen showed no significant association with the presence of prostate cancer ( P = 0.59, Mann–Whitney U-test), while prostate volume did ( P < 0.0001). On stepwise logistic regression analysis, prostate volume ( P = 0.024, 95% CI 1.008–1.116) and biopsy core density ( P = 0.017, 95% CI 4.76–7.12 × 106) were independently associated with a cancer diagnosis, whereas PSA density was not an independent factor for a positive biopsy result. The area under the ROC curve for prostate volume was significantly superior to that of PSA (0.802 vs. 0.529; P = 0.012). Conclusions: In men 70 years or older with gray zone PSA, prostate cancer patients are equally distributed over any PSA range. Although PSA has less impact on cancer presence than mere prostate volume, prostate cancer would be detected in a substantial proportion of older patients with PSA levels of 2.0–10.0 ng/mL. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate, in a retrospective review, whether the concept of effective core volume is useful for predicting the volume of a tumor focus identified by transrectal needle biopsy of the prostate gland. Methods: The tumor volume range was estimated according to the concept of an effective core volume using the numbers of total and positive biopsy cores from the peripheral zone and peripheral zone prostate volume in 32 patients with prostate cancer with one to three cancer-positive cores who only underwent radical prostatectomy after transrectal prostate biopsy. The estimated tumor volume was compared with the actual tumor volume as determined by pathologic examination of whole mount sections of the prostatectomy specimens. Results: In the 32 patients, the actual tumor volume was within the range determined by the effective core volume concept in 24 patients (75.0%), although 4 (12.5%) had a smaller focus and 4 (12.5%) a larger focus than estimated. Overall accuracy improved up to 84.4% (27 of 32) if 5% safety margins were applied to the range determined by the effective core volume concept. In particular, the accuracy was 87.5% (14 of 16) in patients with one positive core after transrectal systemic biopsy. Conclusions: The effective core volume can be used to predict the volume of prostate cancer with acceptable accuracy. It can provide an assumed maximal tumor volume and valuable information for clinical decision making of the treatment strategy, particularly in cases with one positive core. [Copyright &y& Elsevier]

Abstract: Objectives: To examine whether an association exists between body mass index (BMI) and prostate cancer detection rates or pathologic features of cancer in Japanese urologic patients. Methods: We studied the age, BMI, and biopsy results of 481 patients who underwent transrectal prostate biopsy. They were stratified by BMI into three groups according to the cutoffs recommended for Asian populations: normal, BMI less than 23.0 (n = 248); overweight, BMI 23.0 to 25.0 (n = 116); and obese, BMI greater than 25.0 (n = 117). We then compared the cancer detection rates and pathologic features among the three groups. Multivariate logistic regression analysis was also performed. Results: No significant differences in the cancer detection rate were found among the three groups (40.2% to 43.1%, P = 0.87) on univariate analysis. Multivariate logistic regression analyses revealed significant associations between the BMI and cancer detection (P = 0.029, 95% confidence interval [CI] 0.85 to 0.99), but no significant associations were observed between BMI and the presence of Gleason components 4 or 5 (P = 0.061, 95% CI 0.79 to 1.01), poor cell differentiation (P = 0.174, 95% CI 0.96 to 1.24), or clinically organ-confined disease (P = 0.45, 95% CI 0.84 to 1.08). Conclusions: BMI seems to have a significant impact on prostate cancer detection rates, although it seems difficult to apply the BMI directly to the management of patients at risk of prostate cancer in urologic clinics. [Copyright &y& Elsevier]

To prospectively compare the prevention of tumour recurrence by four intravesical adjuvant administration protocols, and thus elucidate the efficacy of early and high total dose instillations of epirubicin to prevent superficial bladder tumour recurrence after transurethral resection of bladder tumour (TURBT). In all, 69 patients with Ta/T1 bladder cancer were randomly assigned to four intravesical administration protocols: A, delayed instillation (first instillation 7 days after TURBT) and low-dose (30 mg once every 2 weeks, six times): B, early instillation (three instillations before 7 days after TURBT) and low-dose; C, delayed and high-dose (30 mg once weekly 12 times) instillation; D, early and high-dose. The influence of the instillation protocols and tumour characteristics on the probability of recurrence-free survival was examined using Kaplan-Meier analysis and a Cox regression hazard model. The early-instillation and high-dose groups had relatively lower recurrence rates after 6 months (A, 30%; B, 25%; C, one of 12; and D, none) and 1 year (50%, 35%, four of nine and one of eight, respectively). Patients who received 360 mg epirubicin (C and D) had a significantly better recurrence-free survival than those receiving 180 mg (A and B; P = 0.012). Preoperative urine cytology and tumour multiplicity were significantly associated with recurrence. However, multivariate analysis of the risk of recurrence using a Cox proportional hazard model showed that urine cytology (hazard ratio 3.11, 95% confidence interval 1.08–8.94, P = 0.04) and total dose (0.32, 0.11–0.92, P = 0.03) were independent prognostic factors for recurrence. Patients who received a high-dose epirubicin instillation had a significantly lower recurrence rate but the benefit of early instillation was not confirmed, as the study group was too small. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate functional and oncological outcomes in patients who underwent unilateral or bilateral nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer. Methods: The cohort comprised 2683 patients with clinical stage T1-4, N0M0 high-risk prostate cancer who underwent RARP in Japanese tertiary care centers from August 2011 to April 2023. High risk was defined using the European Association of Urology risk stratification criteria. Patients were classified as high risk if they had clinical stage T2c–T4, a serum prostate-specific antigen concentration (PSA) of > 20 ng/dL, or an International Society of Urological Pathology (ISUP) grade of 4–5. Patients were grouped into NS and non-NS surgery groups. Propensity score matching was performed (1:1 ratio) to reduce confounding bias. The primary outcome was biochemical recurrence (BCR)-free survival (BCR-FS). The impact of NS surgery on BCR-FS was examined in the propensity score-matched cohort using Cox proportional hazards regression. Results: The propensity score-matched cohort comprised 1722 patients. In the matched cohort, median follow-up was 31.9 months. The 5-year BCR-FS was 70.2% in the NS group and 71.9% in the non-NS group (HR 1.05; 95% confidence interval, 0.85–1.29). NS surgery did not increase the risk of BCR in subgroups of patients stratified according to ISUP grade, T stage, percent cancer core involvement, and PSA. Conclusion: Neurovascular bundle preservation during RARP for high-risk prostate cancer appears feasible without increasing the BCR rate. However, the retrospective study design carries the potential influence of selection bias. [ABSTRACT FROM AUTHOR]

Assesses the virulent characteristics of Escherichia coli strains that cause acute prostatitis. Genes fond to have prostatitis from pyelonephritis isolates; Higher proportion of genotype in prostatitis strains; Pathogenic mechanisms of urinary tract infections significant in the study's findings.

Objective. To evaluate the process of hormonal recovery after cessation of luteinizing hormone-releasing hormone (LHRH) agonist treatment in patients who had received long-term LHRH agonist therapy for prostate cancer. Material and methods. Men who had successfully undergone androgen deprivation therapy with only monthly LHRH agonist therapy for > 30 months were enrolled and the administration of LHRH agonist was discontinued. Serum total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prostate-specific antigen (PSA) were measured before the cessation of LHRH agonist therapy and every 4 weeks thereafter, and the administration of LHRH agonist remained suspended until the total testosterone level recovered to > 50 ng/dl. Results. Ten patients were enrolled in the study. The median (range) castration period and the levels of serum LH, FSH, total testosterone and PSA at cessation of therapy were 39 (30–56) months, 50 ng/dl in all cases. There were large variations in the times required for recovery of LH and FSH (30–100 days) and serum testosterone (30–330 days). PSA began to increase at various testosterone levels, and there was a large variation (0–83%; median 41%) in the ratio of the androgen suppression (testosterone [ABSTRACT FROM AUTHOR]

Objectives: To evaluate and minimize the duration of clean intermittent catheterization (CIC) required after interstitial laser coagulation of the prostate in patients with benign prostatic hyperplasia.Methods: Patients who did not show sufficient improvement in lower urinary tract symptoms or voiding dysfunctions with alpha-1 adrenergic blockers, and who agreed to undergo interstitial laser coagulation of the prostate, were enrolled in this study. Postoperatively, the indwelling Foley catheters were removed by the next morning. Patients were then required to undertake CIC with alpha-1 adrenergic blockade therapy until the postvoid residual urine volume decreased to less than 100 mL.Results: Seventy-nine patients underwent interstitial laser coagulation of the prostate, and 70 underwent catheter-free trials by postoperative day 1. The mean age and preoperative prostate volume of these 70 patients was 70.3 years (SD 8.7) and 49.6 cm3 (SD 34.8), respectively. Forty-three patients experienced postoperative urinary retention, and 37 of these underwent CIC. The median postoperative catheterization time was 3 days (range 0 to 31), and all patients eventually became catheter free. Univariate analysis showed that postoperative urinary retention was associated with a preoperative prostate volume of 30 cm3 or larger, a maximal flow rate of less than 6 mL/s, and a postvoid residual urine volume of 100 mL or greater. Multivariate analysis showed that a preoperative prostate volume of 30 cm3 or larger was the most significant predictor of postoperative urinary retention.Conclusions: More than 60% of the patients experienced urinary retention after interstitial laser coagulation of the prostate. However, the results of the present study suggested that CIC and alpha-1 adrenergic blockade therapy could manage post-treatment urinary retention with a relatively short catheterization time. [Copyright &y& Elsevier]

A characteristic clinical course of a patient with micropapillary bladder cancer, a rare histological variant with high metastatic potential, is presented. An 80-year-old woman had locally advanced high-grade bladder cancer with a focal micropapillary variant identified which was treated with intra-arterial chemotherapy with radiation therapy. Standard follow-ups involving cystoscopy with cold-cup biopsies and computed tomography could not detail the bladder carcinoma; however, the patient died of carcinomatosis 20 months after treatment. At autopsy, carcinomas proliferated under benign mucosa and infiltrated diffusely in the retro peritoneum. This behavior differs from the normal pattern of invasive transitional cell carcinoma, which usually proliferates forming a mass lesion. Thus, it may be difficult to detect micropapillary bladder cancer by computed tomography which demonstrates only increased tissue density in retroperitoneal fascia; therefore, care should be taken in the follow-up of micropapillary bladder cancer. [ABSTRACT FROM AUTHOR]

Purpose: To examine value of prostate-specific antigen (PSA) adjusted by prostate volume measured using transabdominal ultrasonography in prostate cancer detection among men with elevated PSA. Methods: 238 men aged 79 years or younger with serum PSA levels of 2.0–20.0 ng/mL and normal digital rectal examination findings were studied in terms of total and free PSA, prostate volumes with transrectal (TRUS) and transabdominal (TAUS) ultrasonography and transition zone volumes with TRUS prior to transrectal 10-core biopsy. In addition to sole PSA values and the free-to-total PSA ratio, volume-adjusted PSA values, PSA densities determined by TRUS (PSADTRUS), and TAUS (PSADTAUS), and PSA transition zone densities (PSATzD) were compared using receiver operating characteristic (ROC) analysis. Results: Prostate cancer was diagnosed in 58 (24.4%) of the 238 men who underwent prostate biopsies. Of the areas under ROC curves (AUC) of studied parameters, PSATzD (AUC 0.751) was the best and significantly superior to PSADTAUS (AUC 0.664, P = 0.007). However, PSADTAUS exceeded PSA (AUC 0.559, P = 0.004) and showed potential capability of a one-fourth reduction in unnecessary biopsies without spoiling sensitivity (90%). Cancer detection rate was only 4.2% in the 48 patients whose prostate volume in TAUS was > 50 mL and PSADTAUS was < 0.075. Conclusions: Since PSADTRUS and PSATzD were significantly superior to PSADTAUS, TRUS is feasible as the standard fashion to determine prostate volume in the diagnosis of prostate cancers. However, TAUS is also worthwhile as it can improve the prostate cancer detection using sole PSA, and primary use of TAUS has the potential to reduce the substantial number of unnecessary biopsy safely. [ABSTRACT FROM AUTHOR]

Objectives : To evaluate the distribution of serum prostate-specific antigen (PSA) levels as a function of age in men with no evidence of prostate cancer who visited urological clinics. Methods : Simultaneous measurements of total PSA and PSA-α-1-antichymotrypsin (PSA-ACT) were performed on patients who presented at urological clinics in Japan. After excluding 490 patients because of follow-up biopsy findings indicating prostate cancer, patients’ history of prostatic surgery and medication affecting the serum PSA level, 1520 patients with PSA levels of less than 20.0 ng/mL were available for the study. Results : Medians (95th percentile) of the total PSA levels were 0.9 (4.7), 1.2 (5.6), 1.7 (11.0), 2.1 (9.8) and 2.8 (11.0) ng/mL in men in their 40s ( n = 37), 50s ( n = 211), 60s ( n = 488), 70s ( n = 609) and 80s ( n = 175), respectively, whereas those of PSA-ACT were 0.5 (2.9), 0.7 (3.7), 1.1 (7.4), 1.2 (5.9) and 1.6 (6.4) ng/mL, respectively. Both total PSA and PSA-ACT increase with aging, although comparison between the 10-year age groups showed a significant difference in the two molecular forms only between men in their 50s and 60s. Conclusions : The PSA ranges of men who visited urological clinics were higher than those of men participating in prostate cancer screening programs reported in other published studies. An age-associated increase in PSA similar to screening populations was also observed in urological outpatients. The results of the present study indicate that age-adjusted PSA cut-off levels can be used in outpatient settings, although the PSA reference value derived from the screening population should be carefully applied to symptomatic men of clinical practices. [ABSTRACT FROM AUTHOR]

To assess the utility of prostate-specific antigen (PSA) complexed toα1-antichymotrypsin (PSA-ACT) in prostate cancer screening in Japanese men with a total PSA level of 2.0–4.0 ng/mL, as improving cancer detection in men with these total PSA levels is a challenge for clinical urologists.Total PSA and PSA-ACT were prospectively assessed and prostate biopsy recommended for patients who met either of two thresholds, i.e. a total PSA of≥ 2.0 ng/mL or a PSA-ACT of≥ 1.5 ng/mL. The diagnostic ability of total PSA and PSA-ACT, and free-to-total PSA ratio and prostate volume-adjusted density were evaluated by receiver operating characteristic (ROC) analysis.Of 1003 men enrolled, 547 met the biopsy criteria and a biopsy was taken in 315 (57.6%) patients. The area under the ROC curve for PSA-ACT (0.679) was significantly greater than that for total PSA (0.601,P = 0.04) and equivalent to that for the free-to-total ratio (0.686,P = 0.911) in 116 men, including 27 with cancer with total PSA levels of 2.0–4.0 ng/mL. PSA-ACT was more specific than the free-to-total ratio at a sensitivity of 95% (36% vs 18%,P < 0.05). The best variable for discriminating between cancer and benign disease in men with PSA levels of 2.0–4.0 ng/mL was PSA-ACT density (area under the curve 0.852) which provided 66% specificity at a sensitivity of 90%.PSA-ACT is better than total PSA and equivalent to the free-to-total ratio for detecting prostate cancer in men with PSA levels of 2.0–4.0 ng/mL, and is thus useful for reducing the number of unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the utility of a newly developed three-dimensional (3D) body surface laser scanner and evaluate the body surface image of patients undergoing renal surgery to determine the impact of surgery on body image alterations.Methods: The body surface image in the upright position was obtained using the Bodyline Scanner (Hamamatsu Photonics K.K., Hamamatsu, Japan), a 3D body surface laser scanner, in 27 patients who had undergone renal surgery. We compared the objective results of body image scanning with the subjective results of a self-administered questionnaire on perception and concern about body image alteration.Results: The abdominal body surface area and volume of the operative side was significantly larger than that of the contralateral side in 18 patients undergoing renal surgery using a flank incision (median area 50.7%, P = 0.002; volume 51.2%, P <0.001). A statistically significant difference was not observed in 9 patients undergoing transperitoneal or laparoscopic surgery (median area 50.0%, P = 0.34; volume 49.9%, P = 0.40). The volume alteration measured by the 3D body surface laser scanner correlated with the patients'' perception (P = 0.01) and concern (P = 0.03) about postoperative body image alteration as assessed by the self-administered questionnaire.Conclusions: The 3D body surface scanner is promising as a tool in the medical field in that it enables a computerized body image to be constructed in the upright position that reflects patients'' subjective perceptions well. Using this, we observed that the flank incision causes postoperative changes in body image perceptible to the patient and a cause for concern. [Copyright &y& Elsevier]

To determine whether additional, far lateral cores improve the diagnostic performance of transrectal sextant biopsy in men with large prostate glands. Men with prostate volumes of 50 mL or greater in transrectal ultrasonography who were suspected of prostatic adenocarcinoma were prospectively enrolled. Biopsy criteria were defined as 2.0 ng/mL or greater of serum total prostate-specific antigen and/or abnormal findings on digital rectal examination. Four cores of far lateral biopsies were added to the standard sextant technique. Of 104 patients enrolled in the present study and undergoing biopsy, 14 (13.5%) were diagnosed as having prostate cancer and 27 (26.0%) were diagnosed as having prostatic intraepithelial neoplasia (PIN) or an atypical gland. There were no cases where cancer was only detected in the additional cores, whereas PIN/atypical gland was uniquely detected from the additional, far lateral sites in eight of the 27 patients who were diagnosed with this condition. Although the number of patients diagnosed as having PIN/atypical gland might increase with the addition of far lateral cores, this additional sampling does not improve cancer detection rates in men with large prostate glands. [ABSTRACT FROM AUTHOR]

: ObjectivesTo analyze prospectively whether prostate cancer (CaP) incidence differs between Japanese men with a prostate-specific antigen (PSA) level of 2.0 to 4.0 ng/mL and those with a PSA level of 4.1 to 10.0 ng/mL.: MethodsMen 79 years old or younger who were referred to our clinic were screened for CaP. Individuals with PSA levels of 2.0 ng/mL or greater were recommended for transrectal prostate biopsy. The prebiopsy clinical characteristics, cancer detection rate, and pathologic findings from the needle biopsy and prostatectomy specimen were compared between the low (2.0 to 4.0 ng/mL) and intermediate (4.1 to 10.0 ng/mL) PSA groups.: ResultsOf 858 patients screened for CaP, 440 with benign findings on digital rectal examination met the criteria, and 274 (62.3%) underwent biopsy. Of those undergoing biopsy, 110 and 123 patients had a low or an intermediate PSA level, respectively. Men in the low PSA group had a higher free/total PSA ratio, smaller prostate volume, and lower PSA density compared with those in the intermediate PSA group. CaP was diagnosed in 26 (23.6%) of 110 in the low and 29 (23.6%) of 123 in the intermediate PSA group. No statistically significant difference was found between the two groups in the pathologic findings of needle biopsy, including Gleason score, number of cores per biopsy, percentage of positive cores, and cancer length in the positive cores.: ConclusionsNo statistically significant difference was found in the incidence of CaP (23.6%) between men with low and intermediate PSA levels in a Japanese population. The diagnostic yield was comparable to that reported for both white and black men. [Copyright &y& Elsevier]