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COVID-19 led to changes in the way blood samples are collected. As societies were isolated to control viral spread, access to facilities became limited. Remote sample collection with a volumetric microsampling approach, using Mitra® devices based on VAMS® technology, proved to be highly effective. It allowed people to collect high-quality samples at home and post them to a laboratory. This enabled scientists to conduct large serosurveillance studies, with results showing that seroprevalence of COVID-19 was higher than initially expected. Furthermore, remote microsampling studies by several institutions were conducted to measure the relationship between antigen levels and antibody response and duration. VAMS technology was also used in COVID-19 clinical trials. In summary, the independent research reviewed in this paper proved that VAMS is an effective sample collection alternative.

Coagulation Factor XI (FXI) is a plasma glycoprotein composed of four apple (Ap) domains and a serine protease (SP) domain. FXI circulates as a dimer and activates Factor IX (FIX), promoting thrombin production and preventing excess blood loss. Genetic variants that degrade FXI structure and function often lead to bleeding diatheses, commonly termed FXI deficiency. The first interactive FXI variant database underwent initial development in 2003 at https://www.factorxi.org. Here, based on a much improved FXI crystal structure, the upgraded FXI database contains information regarding 272 FXI variants (including 154 missense variants) found in 657 patients, this being a significant increase from the 183 variants identified in the 2009 update. Type I variants involve the simultaneous reduction of FXI coagulant activity (FXI:C) and FXI antigen levels (FXI:Ag), whereas Type II variants result in decreased FXI:C yet normal FXI:Ag. The database updates now highlight the predominance of Type I variants in FXI. Analysis in terms of a consensus Ap domain revealed the near-uniform distribution of 81 missense variants across the Ap domains. A further 66 missense variants were identified in the SP domain, showing that all regions of the FXI protein were important for function. The variants clarified the critical importance of changes in surface solvent accessibility, as well as those of cysteine residues and the dimer interface. Guidelines are provided below for clinicians who wish to use the database for diagnostic purposes. In conclusion, the updated database provides an easy-to-use web resource on FXI deficiency for clinicians.

The gold immunochromatography assay (GICA), a new immunochromatography technique, uses a nitrocellulose membrane as a carrier and a colloidal gold-labeled antigen or antibody as a tracer (bioreceptor). This technology has many advantages over other immunoassays, including its simplicity, rapidity, cheapness, and the lack of a requirement for special training or expensive equipment, and it can be used to detect either antigens or antibodies. Therefore, we chose to develop this method for the diagnosis of candidiasis in Indonesia. The objective of the present study was to develop a diagnostic test for Candida albicans in rats using the GICA method. GICA bioreceptors were developed from biofilm antigens isolated from biofim Candida albicans grown on the surface of nitrocellulose membranes. The formation of biofilms was confirmed using scanning electron microscopy. Antigen levels as bioreceptors were optimized by using the immuno dot method. The samples to be analyzed were antibody serum, in the form of blood serum samples from heart mice that have been induced to become candidiasis. To this end, we optimized the antigen and antibody volumes necessary to make this diagnosis. The results show that the optimum concentration of antigen to be used in the test is 2.5 µg/µL and the optimum volume of antibody is 10 µL. The control rats produced a single red stripe on the control line and the candidiasis rat samples produced a double red stripe, with the bottom line being the control line and the upper line the test line. The test chip was successfully used for the diagnosis of candidiasis in rats and given the name “Candiday Kit.”. We anticipate that this test will be suitable for the diagnosis of candidiasis in humans Keywords: candidiasis; rat; gold immunochromatography assay; antigen; biofilm; Candida albicans.

Background The Hepatitis B virus (HBV) affects over 250 million people worldwide and can lead to cirrhosis and hepatocellular carcinoma. HBV surface antigen (HBsAg) quantification is increasingly used to predict disease activity and treatment response. As there is no virologic cure, clinicians are seeking a “functional cure”, or HBsAg loss, as a guide to safely stopping nucleos(t)ide analogue therapy. Tenofovir Disoproxil Fumarate (TDF) and Entecavir (ETV) are first line therapy but require prolonged treatment to achieve HBsAg clearance. Aims To assess the association between nucleos(t)ide therapy and decline in quantitative HBsAg (qHBsAg) in patients with HBV from Calgary, Alberta. Methods A retrospective review of adult patients with chronic HBV, followed at the University of Calgary Liver Clinic, was conducted between January 2012 and October 2020. Patients were excluded if treatment was discontinued or changed, only had a single qHBsAg measurement, or were co-infected with hepatitis C virus, hepatitis delta virus, or HIV. Patients were stratified according to therapy with TDF, ETV, or no treatment. To identify associations between mean changes in qHBsAg by medication exposure, one-way ANOVAs and t-tests were performed. Results were reported as means and 95% confidence intervals (CI). The median time from initial qHBsAg to most-recent was calculated. Results 187 patients were included in the final analysis (Table 1). 77 were excluded for being on more than one medication over the study period, 10 were excluded due to discontinuation of treatment, and 195 were excluded for single qHBsAg measurements. The mean qHBsAg decline was -750.04 IU/mL (95% CI -1311.58, -188.50) in the TDF group (n=45) and -309.20 IU/mL (95% CI -600.90, -17.50) in the ETV group (n=35) (p=0.20). In the no treatment group (n=107), the mean qHBsAg increased by 711.29 IU/mL (95% CI -600.78, 2023.80)(Figure 1). The median time from initial qHBsAg to most-recent was 980 days. Conclusions Quantitative HBsAg levels declined in patients on TDF and ETV, but increased in untreated patients. Although HBsAg levels showed a trend for greater decline in TDF-treated patients, results failed to reach statistical significance, and may be affected by overall treatment duration. Future studies will explore medication use as a time-varying covariate to identify how change in treatment influences changes in HBsAg over time. Funding Agencies None

Background and Design: The role of androgens in androgenetic alopecia (AGA) patogenesis is well known. Studies set forth that ultrasensitive serum prostate specific antigen (PSA) analysis could be a biochemical marker of hyperandrogenism in women with hirsutism. Serum PSA levels in women with AGA can be used as an indicator of the effect of androgens in target organs. The aim of this study was to investigate serum PSA levels in women with AGA. Materials and Methods: A total of 100 female patients and a voluntary group of 67 healthy women were evaluated in this research. The diagnosis of AGA was established through history, dermotological evaluation and hair pull test. The degree of hair loss was categorized using the Ludwig scale. Total and free PSA were measured by an “Roche Cobas e 601 immunoassay analyser using the electrochemiluminescence immunoassay” method. Results: Twenty-nine patients (29%) had Ludwig 1, 64 (64%) had Ludwig 2, and 7 (7%) had Ludwig 3 hair loss. Total testosterone level was significantly higher in patient group than in control group (p=0.03). The levels of free PSA, total PSA, prolactin, ferritin, cortisol, folliclestimulating hormone, luteinizing hormone, and estradiol were within the normal limits in both patient and control groups and there was no statistically significant difference between the groups (p>0.05). Conclusion: In our study, there was no statistically significant difference in serum free PSA (p=0.084) and total PSA (p=0.285) levels. However, further large-scale studies are warranted.

Objective: We planned to examine the connection between serum uric acid (UA) values and prostatic calculi (PCal) presence and to evaluate the relation between PCal and other etiological factors. Methods: Patients between 20 and 60 years of age who were referred to the clinic with any reason and had non-contrast abdominal tomography (NCACT) for PCal were included in the study. While the patients were separated into 2 groups based on their serum UA level as ≥7 mg/dL (Group 1) and < 7 mg/dL (Group 2), NCACT was also divided into 2 groups as PCal presence (PCal+) and lack (PCal–) serum UA, calcium, phosphorus, sodium, prostate-specific antigen levels and urinary analysis results of the patients were evaluated and compared. Results: PCal were detected in 38 of 169 patients (22%). PCal presence was detected to be significantly high in Group 1 (p = 0.015). While Type A localization PCal were present both in Groups 1 and 2. Based on PCal presence, UA level was detected to be significantly high in PCal+ patients (p = 0.01). No significant difference was detected among the groups in biochemical parameters and urine-related parameters other than UA. Conclusion: A significant relation was found between high UA value and PCal in this study. These results may show that UA plays an active role in PCal etiology.

Coagulopathy causes morbidity and mortality in patients with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Yet, the mechanisms are unclear and biomarkers are limited. Early in the pandemic, we observed markedly elevated factor V activity in a patient with COVID-19, which led us to measure factor V, VIII, and X activity in a cohort of 102 consecutive inpatients with COVID-19. Contemporaneous SARS-CoV-2-negative controls (n = 17) and historical pre-pandemic controls (n = 260-478) were also analyzed. This cohort represents severe COVID-19 with high rates of ventilator use (92%), line clots (47%), deep vein thrombosis or pulmonary embolism (DVT/PE) (23%), and mortality (22%). Factor V activity was significantly elevated in COVID-19 (median 150 IU/dL, range 34-248 IU/dL) compared to contemporaneous controls (median 105 IU/dL, range 22-161 IU/dL) (P .001)-the strongest association with COVID-19 of any parameter studied, including factor VIII, fibrinogen, and D-dimer. Patients with COVID-19 and factor V activity150 IU/dL exhibited significantly higher rates of DVT/PE (16/49, 33%) compared to those with factor V activity ≤150 IU/dL (7/53, 13%) (P = .03). Within this severe COVID-19 cohort, factor V activity associated with SARS-CoV-2 load in a sex-dependent manner. Subsequent decreases in factor V were linked to progression toward DIC and mortality. Together, these data reveal marked perturbations of factor V activity in severe COVID-19, provide links to SARS-CoV-2 disease biology and clinical outcomes, and nominate a candidate biomarker to investigate for guiding anticoagulation therapy in COVID-19.

Introduction Alpha2-plasmin inhibitor (α2-PI) has a heterogeneous composition in the plasma. Both N- and C-terminal cleavages occur that modify the function of the molecule. C-terminal cleavage converts the plasminogen-binding form (PB-α2-PI) to a non-plasminogen-binding form (NPB-α2-PI). N-terminal cleavage by soluble fibroblast activation protein (sFAP) results in a form shortened by 12 amino acids, which is more quickly cross-linked to fibrin. The p.Arg6Trp polymorphism of α2-PI affects N-terminal cleavage. In this work, we aimed to investigate the association between α2-PI heterogeneity and the risk of venous thromboembolism. Materials and methods Two hundred and eighteen patients with venous thromboembolism (VTE) and the same number of age and sex-matched healthy controls were enrolled. Total-α2-PI, PB-α2-PI and NPB-α2-PI antigen levels, α2-PI activity, sFAP antigen levels and p.Arg6Trp polymorphism were investigated. Results Total-α2-PI and NPB-α2-PI levels were significantly elevated in VTE patients, while PB-α2-PI levels did not change. Elevated NPB-α2-PI levels independently associated with VTE risk (adjusted OR: 9.868; CI: 4.095–23.783). Soluble FAP levels were significantly elevated in the VTE group, however, elevated sFAP levels did not show a significant association with VTE risk. The α2-PI p.Arg6Trp polymorphism did not influence VTE risk, however, in the case of elevated sFAP levels the carriage of Trp6 allele associated with lower VTE risk. Conclusion Our results showed that the elevation of total-α2-PI levels in VTE is caused by the elevation of NPB-α2-PI levels. Elevated sFAP level or p.Arg6Trp polymorphism alone did not influence VTE risk. However, an interaction can be detected between the polymorphism and high sFAP levels.

Background None of the current guidelines recommend antiviral therapy for inactive hepatitis B virus (HBV) carriers (IHCs). Methods In this real-world, multicenter, nonrandomized study, 32 participants meeting the inclusion criteria were enrolled 1:1 for treatment with peginterferon α-2b or monitoring without treatment based on participant preference. The expected treatment duration was 48 weeks. The primary end point was hepatitis B surface antigen (HBsAg) loss. The HBV vaccine could be injected after HBsAg loss. Results All patients had HBsAg levels of Conclusions This study provides justification for further studies of short-course peginterferon α-2b for the functional cure of IHCs with low HBsAg levels. Additionally, HBV vaccine injection is beneficial after interferon-induced HBsAg loss.

This review evaluated prostate cancer studies from around the world and investigated the causes of differences among them. Prostate cancer incidence and mortality rates showed significant discrepancies between countries and ethnicities. In North America as well as in other western countries, the most common cancer was found to be prostate cancer; however, it appears to be not as prevalent among men in the Middle East and North Africa. Statistics show that screening of prostate-specific antigen levels should be applied depending on ethnicity and age. Other environmental aspects such as dietary and androgenic factors are believed to have caused these differences.

Objective This study was performed to evaluate the 1-year survival rate and functional outcomes of 20 patients who underwent intersphincteric resection (ISR) for low rectal cancer. Methods Twenty patients who underwent ISR for low rectal cancer were followed up for 1 year. Complications, functional outcomes objectified by the Wexner score, and oncological outcomes were assessed. Results The short-term survival rate was 100%. The median Wexner score was ≤10 in all patients at 12 months after surgery. Signs of local recurrence were absent, and antigen levels remained within the reference ranges 1 year postoperatively. Conclusions ISR is a feasible alternative in highly selected patients who primarily refuse a colostomy bag and present with type II or III tumors. In the present study, patient-reported continence was satisfactory, and the absence of a colostomy bag increased patients’ quality of life. The oncological outcomes were satisfactory at 1 year postoperatively.

Studies have reported that the G505A nonsynonymous (ns)-SNP encoding the Ala147Thr amino acid substitution in TAFI, is associated with a reduction in risk of venous thrombosis and myocardial infarction. Interestingly, homozygosity for the A-allele (AA) of G505A is associated with increased TAFI antigen (TAFI:Ag) levels in plasma. In our study of the genetic determinants of cardiovascular disease (CVD) in Mexican Americans of South Texas, we performed an exome-wide scan in relation to plasma TAFI antigen levels in 784 individuals. While accounting for age, sex, and their interactions as confounders in linear mixed model, we found a heritability of 59% for TAFI:Ag levels (p=1.4E-19), and that ns-SNP G505A was the only variant showing exome-wide significance (p=3.5E-14; Figure A). Figure B shows the quantile-quantile distribution of the p-values from all the exome-wide tests. Clearly, the p-value distribution reveals that there is no systematic bias that may act to skew the p-values, and that the lone exception¾in agreement between observed and expected quantiles¾is due to this TAFI SNP, which strongly suggests a truly significant effect. Consistent with previous reports, the regression coefficient for G505A as a predictor of TAFI:Ag levels showed them to be increasing from the homozygous for the major G-allele (GG), to the heterozygous individuals (GA), to the individuals homozygous for the minor A-allele (AA) (Figure B). We also investigated if G505A is associated with our CHD variable. Using a statistical genetic model for the liability to disease conditional on a threshold, which is equivalent to a probit mixed model, we found that the G505A ns-SNP in TAFI, encoding TAFI Ala147Thr, is significantly associated with a reduction in the risk of CHD (p=0.002). As observed in existing literature, potential limitations of this study include the ELISA assay used for the quantification of TAFI levels. Some ELISA assays measure proTAFI, TAFIa, and TAFIi. However, recent evidence suggests that there may be cross reactivity between TAFIa and TAFIi. This can result in measuring ongoing TAFI activation peptides and elevated levels of TAFIa which ultimately goes on to make resistant fibrin. This is likely the marker that results in the increased risk of venous thromboembolism. To mitigate this confounding factor, an ELISA assay specific to measuring TAFI antigen is needed. In conclusion, we found that TAFI G505A is pleiotropically associated with TAFI:Ag levels and risk of CHD. Figure 1 Figure 1. Disclosures DeFronzo: AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees; Boehringer-Ingelheim: Membership on an entity's Board of Directors or advisory committees, Research Funding; Intarcia: Membership on an entity's Board of Directors or advisory committees; Merck: Research Funding.

Even though most tumors located in the prostate derive from prostatic glands, there is a long list of malignant and nonmalignant causes for prostatic growths that clinicians should be aware of. Tumors of the prostate can be grouped in epithelial, neuroendocrine, stromal, mesenchymal, hematolymphoid, and miscellaneous. Solitary fibrous tumor of the prostate (SFT), is an extremely rare mesenchymal tumor (only about 20 cases reported in the literature). Histologic features resemble those of the more common variant pleural SFT. Of all, 10%-20% of SFTs, also known as malignant SFTs, behave aggressively. Herein, we describe a case of prostatic SFT in a 66-year-old patient that presented with obstructive urinary symptoms and normal prostate-specific antigen levels.

von Willebrand factor (VWF) is synthesised in vascular endothelial cells and released into the plasma as unusually large VWF multimers (UL-VWFMs). Sinusoidal endothelial cells are a major target of ischaemia-reperfusion injury due to liver surgery. This study aimed to clarify the effect of hepatectomy on UL-VWFMs.Thirty-five patients who underwent hepatectomy were eligible for the study. Plasma ADAMTS13 activity and VWF antigen levels were measured by enzyme-linked immunosorbent assay and multimer analysis of plasma VWF was performed according to Ruggeri and Zimmerman's method. For analyses, patients were categorised according to UL-VWFM positivity after hepatectomy.Plasma ADAMTS13 activity significantly decreased from 61.0% (27.7%-126.2%) before operation to 37.4% (20.2%-71.4%) on postoperative day 7 (p 0.001). Plasma VWF antigen levels significantly increased from 172.1% (80.5%-412.8%) before operation to 361.0% (154.7%-745.8%) on postoperative day 2, which remained high until postoperative day 7 (p 0.001). Seven patients remained UL-VWFMs-negative and 22 patients became UL-VWFMs-positive after operation. Pringle's maneuver duration was significantly longer and blood loss volume was significantly higher in the UL-VWFMs-positive group (p = 0.001 and p = 0.003, respectively). By multivariable analysis, Pringle's maneuver duration [odds ratio 1.049, 95% confidence interval (CI) 1.001-1.098; p = 0.043] was significantly associated with increased UL-VWFMs level after hepatectomy. UL-VWFMs index was significantly correlated with Pringle's maneuver duration (r = 0.444, p = 0.017).Plasma UL-VWFMs levels increased after hepatectomy due to ischaemia-reperfusion injury with Pringle's maneuver.

The objective of the study was to identify a subset of men who can avoid systematic multisite biopsy (SyB) among those undergoing magnetic resonance imaging (MRI)-targeted transperineal 4-core biopsy (TgB) without missing clinically significant cancer (SC).From April 2013 to December 2017, 304 men with elevated prostate-specific antigen levels (20 ng/mL) or abnormal digital rectal examination and positive MRI findings underwent transrecta ultrasound and MRI-targeted transperineal 4-core with 14-core systematic biopsy. MRI findings were prospectively collected and evaluated using Prostate Imaging-Reporting and Data System version 2 (PI-RADS), and scores ≥3 were considered positive. SC was defined as Gleason score ≥3 + 4 or maximum cancer length ≥5 mm. We evaluated the diagnostic performance of TgB and SyB to detect SC and characterized men who could avoid SyB without missing SC.Detection rates of any cancer and SC for TgB/SyB/their combination were 59%/63%/68% and 51%/52%/61%, respectively. TgB alone missed 14% (29/207) of any cancer and 16% (29/184) of SC detected using TgB with SyB. In uni- and multivariable analyses, PI-RADS scores of 3 to 4 were independent predictors for missing SC using TgB alone. When restricted to 81 men with PI-RADS scores of 5 (27%), SC was missed using TgB alone only in 3 (4.6% vs. 22% for the remaining 223 men; P = .007).SC was missed using TgB alone in a non-negligible proportion of men who underwent TgB and SyB. SyB might be safely avoided in men with PI-RADS score 5 lesions with reduced risks of missing SC.

With more recent modalities of immunosuppression, splenectomy is now rarely considered in refractory/relapsed thrombotic thrombocytopenic purpura (TTP). However, the surgical approach had shown convincing evidences of high efficacy in the pre-rituximab era and therefore may still represent a lifesaving option in selected challenging cases. To define the characteristics of subjects who may benefit from splenectomy may ease clinical decision making. In this paper we describe the clinical and laboratory data of 2 multiple relapsing TTP cases who successfully underwent splenectomy in the pre-rituximab era. Whereas high anti-ADAMTS13 antibody titre and low ADAMTS13 activity never correlated with remission and relapse, a drop in the ADAMTS13 antigen level was always associated with the acute phase, whereas levels consistently returned to normal following splenectomy, heralding long term remission. Splenectomy may therefore be considered in refractory TTP cases associated with increased ADAMTS13 antigen clearance, irrespective of persistence of inhibitory antibodies.

Low risk prostate cancer patients enrolled in active surveillance (AS) programs commonly undergo biopsies on a frequent basis for examination of cancer progression. AS programs employ a fixed schedule of biopsies for all patients. Such fixed and frequent schedules, may schedule unnecessary biopsies for the patients. Since biopsies have an associated risk of complications, patients do not always comply with the schedule, which increases the risk of delayed detection of cancer progression. Motivated by the world's largest AS program, Prostate Cancer Research International Active Surveillance (PRIAS), in this paper we present personalized schedules for biopsies to counter these problems. Using joint models for time to event and longitudinal data, our methods combine information from historical prostate-specific antigen (PSA) levels and repeat biopsy results of a patient, to schedule the next biopsy. We also present methods to compare personalized schedules with existing biopsy schedules., Comment: 16 pages, 5 figures, 1 table. Supplementary materials available at https://goo.gl/jpPtL8

The present study investigated the association between radical prostatectomy (RP) and the risk of herpes zoster (HZ). Male patients aged ≥ 40 years and diagnosed with prostate cancer (PCa) between 2000 and 2005 were included in this study. Patients who underwent RP for the first time during 2000-2006 were included in the RP group. Randomly selected individuals from among the remaining patients with PCa who did not undergo RP were included in the non-RP group. Univariate and multivariate Cox regression models were used to analyze the association between PCa and HZ. In addition, the association between RP and the risk of HZ in different subgroups was evaluated after stratification by age, comorbidities, and hormone therapy (HoT) status. Furthermore, the combined effect of RP and HoT on the risk of HZ was evaluated. This study included 1,380 patients with PCa who newly underwent RP and 1,371 patients with PCa who did not undergo RP. During follow-up, 96 and 104 patients in the RP and non-RP groups, respectively, developed HZ. Patients who underwent both RP and HoT showed a significantly reduced risk of HZ, compared with patients who did not undergo both RP and HoT. RP is not associated with an increased risk of HZ. However, prostate-specific antigen levels should be monitored routinely during follow-up to detect PCa recurrence.

The density of malaria parasites is a key determinant of whether an infected individual develops fever. While the pyrogenic threshold for malaria parasite density has been well studied, there are no analogous data on the antigen levels associated with fever during infection. Samples from 797 afebrile and 457 febrile outpatients from two provinces in Angola with known concentrations of histidine-rich protein 2 (HRP2), aldolase, and lactate dehydrogenase (LDH) antigens were analyzed by Bayesian latent class modeling to attribute malarial etiology to the fevers and to estimate the sensitivity and specificity of different antigen thresholds for detection of malaria fevers. Among patients with aldolase or LDH levels detectable with a bead-based assay, the concentrations of these two antigens did not differ between afebrile and febrile patients. In contrast, the concentrations of HRP2 were substantially higher in febrile HRP2-positive patients than in afebrile HRP2-positive patients. When HRP2 concentrations were considered, the malaria-attributable fractions of fever cases were 0.092 in Huambo Province and 0.39 in Uige Province. Diagnostic tests detecting HRP2 with limits of detection (LODs) in the range of 3,000 to 10,000 pg/µl would provide ideal sensitivity and specificity for determination of malarial etiology among febrile persons.

A 70-year-old gentleman underwent prostatectomy for bladder outlet obstruction due to enlarged prostate and was found to have primary extragastrointestinal stromal tumour (EGIST). He has been started on imatinib therapy and is presently on follow-up. Prostatic EGIST should be one of the differential diagnoses in patients with enlarged prostate with normal prostate-specific antigen levels.Key words: Prostate, gastrointestinal stromal tumour, PSA

We aimed to describe a case series of robot-assisted bladder diverticulectomy followed by radical prostatectomy for prostate cancer in a single surgical procedure. Three cases of robot-assisted bladder diverticulectomy and radical prostatectomy were completed between 2013 and 2016. Charts of the three cases were reviewed and analyzed for perioperative and postoperative outcomes. All patients presented with lower urinary tract symptoms, and bladder diverticulum or diverticula was revealed after further evaluation of the patients. In addition, elevated prostate-specific antigen levels were noted. All patients were diagnosed with prostate carcinoma on the basis of subsequent multiparametric MRI studies and biopsies. Three patients underwent da Vinci robot-assisted diverticulectomy followed by radical prostatectomy using a transperitoneal approach. All patients had Foley catheters removed postoperatively after negative cystogram, and no substantial complications were noted. Sequential robot-assisted bladder diverticulectomy—radical prostatectomy is an effective and safe procedure.

Anticoagulation therapy is administered to patients to prevent or stop thrombin generation in vivo. Although plasma tests of in vivo thrombin generation have been available for more than 2 decades, they are not routinely used in clinical trials or practice to monitor anticoagulation therapy. We observed a fall in one such marker, the D-dimer antigen, in patients receiving anticoagulation therapy. We therefore conducted a systematic review of the medical literature to document the change in serum biomarkers of thrombin generation following the initiation of anticoagulation therapy. Using a defined search strategy, we screened PubMed and Embase citations and identified full-length articles published in English. Eighteen articles containing serial changes in 1 of 3 markers of thrombin generation (D-dimer antigen, thrombin–antithrombin complexes, and prothrombin fragment 1+2 antigen levels) in the 14 days following the initiation of anticoagulation were identified. Even though the assays used varied considerably, each of the 3 markers of thrombin generation declined in the initial period of anticoagulation therapy, with changes evident as early as 1 day after beginning therapy. These observations provide a rationale for further exploration of these markers as measures of the adequacy of anticoagulation using classic as well as novel anticoagulants. Particular patient groups that would benefit from additional means of monitoring anticoagulation therapy are discussed.

Prostatic-specific antigen (PSA) is a biomarker that has been broadly used in aiding the diagnoses of benign prostatic hyperplasia (BPH) and prostate cancer. The incidence of both, which are, in part, androgen-driven diseases, has increased in men worldwide over the past 40 years...

Fluciclovine is a radiotracer indicated for positron emission tomography (PET) imaging in men with suspected prostate cancer recurrence based on elevated blood prostate-specific antigen levels treated by hormone therapy or castrate-resistant prostate cancer. Fluciclovine is effective as part of a whole-body PET/MR imaging protocol and aids in the detection of local, lymph node, and bone relapse of metastatic prostate cancer.

Little is known about aging in von Willebrand disease (VWD). It is uncertain whether VWD patients experience an age-related increase in von Willebrand factor (VWF) levels, and if so, it is unknown whether normalization of VWF levels with aging ameliorates bleeding risk. We aimed to determine the association of age with VWF levels and bleeding risk in patients with type 1 VWD. This is a retrospective chart review of patients with type 1 VWD presenting to the Hemophilia Clinic of Western Pennsylvania for regularly scheduled clinic visits. Data collected included VWF antigen level and condensed molecular and clinical markers for the diagnosis and management of Type 1 (MCMDM-1) VWD bleeding assessment tool (BAT) bleeding score based on bleeding symptoms during the previous 3 years. Thirty-nine patients participated in the study, and 32 were female. The average age of participants was 41.8 ± 18.0 years. The mean VWF antigen level was 0.83 ± 0.37 IU/mL, and the mean bleeding score was 2.51 ± 2.90. The bleeding score was inversely associated with age, β = −0.080 (SE = 0.023), P < .01. There was a nonsignificant association between VWF antigen levels and age. To our knowledge, this is the first report showing an association between aging and decreased bleeding symptoms in patients with type 1 VWD. Determining whether or not bleeding risk is reduced in older patients with type 1 VWD is essential for optimal clinical management. Moreover, VWF concentrate is costly, and unwarranted use represents a significant waste of health-care dollars. These findings warrant further investigation.

Background The association of plasma factor XIII (FXIII) level with venous thromboembolism (VTE) is still controversial and the effect of sex and FXIII B subunit (FXIII-B) polymorphisms in this respect have not been explored. Objectives 1/ To determine FXIII activity and antigen levels in patients with a history of VTE and how they are influenced by sex and FXIII-B polymorphisms. 2/ To explore the association of FXIII levels and FXIII-B polymorphisms with the risk of VTE. Methods 218 VTE patients and equal number of age and sex matched controls were enrolled in the study. FXIII activity was measured by ammonia release assay; FXIII-A2B2 and FXIII-B levels were determined by ELISAs. FXIII-B polymorphisms were identified by RT-PCR using melting point analysis. Results Adjusted FXIII activity and FXIII-A2B2 antigen levels were significantly higher in females with a history of VTE than in the respective controls. FXIII-B levels were significantly lower in male VTE patients than in controls. FXIII-A2B2 antigen levels in the upper tertile increased the risk of VTE in females (adjusted OR: 2.52; CI: 1.18–5.38). Elevated FXIII-B antigen level had a protective effect only in males (adjusted OR: 0.19; CI: 0.08–0.46). FXIII-B Intron K c.1952 + 144 C > G polymorphism significantly lowered FXIII activity, FXIII-A2B2 and FXIII-B antigen levels in both groups. FXIII-B polymorphisms did not influence the risk of VTE. Conclusions In VTE patients the changes of FXIII level and their effect on the risk of VTE show considerable sex-specific differences. Intron K polymorphism results in decreased FXIII levels, but does not influence the risk of VTE.

Background Red blood cells (RBCs) with D antigen levels only detected by anti-D adsorption-elution and an antiglobulin test express a DEL phenotype. For two DEL types, including RHD(1227G>A), immunization of D– recipients has been reported. This study's aim was to measure the prevalence of DEL-associated RHD alleles in a cohort of Australian D– donors to develop a model to estimate alloimmunization risk. Study Design and Methods D–, C+ and/or E+ blood donors were screened for RHD exons using quantitative polymerase chain reaction. Donors with RHD signals were DEL phenotyped with MCAD6 anti-D. RHD alleles were characterized via single-nucleotide polymorphism array or sequencing. Extended DEL phenotyping was performed with an anti-D panel. Results Among 2027 donors, 39 carried RHD alleles that have been previously reported to associate with either the DEL or the weak D phenotype. An additional five donors carried previously unreported RHD alleles and exhibited the DEL phenotype: RHD(IVS2-2delA), RHD(IVS1+5G>C), RHD(ex9:del/CE), and RHD(ex8:del/CE) represented twice. In total, DEL/weak D–associated RHD alleles were detected in 44 of 2027 donors or 2.17% (95% confidence interval, 1.54%-2.81%). The RHD(1227G>A) DEL allele was the most frequent (n = 16). The risk of transfusing D– females not more than 40 years of age with an RHD(1227G>A) DEL RBC unit (when managed as D–) is estimated to be one in 149,109 transfusions (range, 100,680-294,490). Conclusion DEL/weak D–associated RHD alleles were found in 2.17% of Australian D–, C+ and/or E+ blood donors. This differs from previous European reports in that the clinically significant RHD(1227G>A) DEL allele is the most prevalent.

Ethnic evaluation of the pharmacokinetics and safety of new drugs is required in Japan before implementing bridging or joining global studies. As therapeutic monoclonal antibodies (mAbs) show limited ethnic differences, their pharmacokinetics and safety in Japanese individuals could be estimated from prior non-Japanese studies. Therefore, there is potential to re-evaluate the development program for mAbs in Japan. We reviewed the pharmacokinetics of mAbs approved in Japan. Although some differences had been observed in pharmacokinetics of mAbs between Japanese and non-Japanese populations (mainly Caucasians), these differences were attributed to differences of body weight and/or antigen levels. Moreover, the influential factors can be estimated without conducting regional pharmacokinetic/safety studies. The pharmacokinetics of some mAbs is presumably non-linear and show differences between healthy volunteers and patients because of differences in antigen levels. However, for 10/24 mAbs approved in Japan, Japanese healthy volunteer studies were conducted before the patient studies. Additionally, for the mAbs that showed ethnic differences in pharmacokinetics, the doses selected in subsequent patient studies were the same as the doses approved in the United States. In this review, we discuss new drug development strategies in various regions, and assess the need for regional pharmacokinetics/safety studies before joining global studies.

Both multi-parametric MRI (mpMRI) and the Prostate Health Index (PHI) have shown promise in predicting a positive biopsy in men with suspected prostate cancer. Here we investigated the value of combining both tests in men requiring a repeat biopsy. PHI scores were measured in men undergoing re-biopsy with an mpMRI image-guided transperineal approach (n = 279, 94 with negative mpMRIs). The PHI was assessed for ability to add value to mpMRI in predicting all or only significant cancers (Gleason ≥7). In this study adding PHI to mpMRI improved overall and significant cancer prediction (AUC 0.71 and 0.75) compared to mpMRI + PSA alone (AUC 0.64 and 0.69 respectively). At a threshold of ≥35, PHI + mpMRI demonstrated a NPV of 0.97 for excluding significant tumours. In mpMRI negative men, the PHI again improved prediction of significant cancers; AUC 0.76 vs 0.63 (mpMRI + PSA). Using a PHI≥35, only 1/21 significant cancers was missed and 31/73 (42%) men potentially spared a re-biopsy (NPV of 0.97, sensitivity 0.95). Decision curve analysis demonstrated clinically relevant utility of the PHI across threshold probabilities of 5–30%. In summary, the PHI adds predictive performance to image-guided detection of clinically significant cancers and has particular value in determining re-biopsy need in men with a negative mpMRI.

The efficacy of the tourniquets commonly used by Russell's viper bite victims in retarding venom movement from the bite was studied in 37 cases by measuring venom antigen levels by enzyme-linked immunosorbent assay in venous samples taken proximal and distal to the tourniquets and also before and after release of tourniquets. In most cases, the tourniquet did not prevent proximal spread of venom. In 8/37 cases, however, venom antigen assays suggested but did not prove that venom absorption was being delayed by the tourniquet.

Objective: The purpose of this review is to discuss some critical issues of isoflavones protective against the development of prostate cancer (PCa). Data Sources: Data cited in this review were obtained primarily from PubMed and Embase from 1975 to 2015. Study Selection: Articles were selected with the search terms “isoflavone”, “Phytoestrogen”, “soy”, “genistin”, and “PCa “. Results: Isoflavones do not play an important role on prostate-specific antigen levels reduction in PCa patients or healthy men. The effect of isoflavones on sex hormone levels and PCa risk may be determined by equol converting bacteria in the intestine, specific polymorphic variation and concentrations of isoflavones. The intake of various types of phytoestrogens with lower concentrations in the daily diet may produce synergistic effects against PCa. Moreover, prostate tissue may concentrate isoflavones to potentially anti-carcinogenic levels. In addition, it is noteworthy that isoflavones may act as an agonist in PCa. Conclusions: Isoflavones play a protective role against the development of PCa. However, careful consideration should be given when isoflavones are used in the prevention and treatment of PCa.

Aim: Radiotherapy following radical prostatectomy should be considered in men with high risk features who have a life expectancy of more than 10 years. So far no effect on prostate cancer specific survival has been proven by 3 randomized controlled trials (RCTs) on adjuvant radiotherapy. At present the optimal timing of radiotherapy is not defined. Identifying the site of recurrence is difficult at low PSA levels. [C-11] choline PET-CT studies in biochemical recurrent prostate cancer after prostatectomy show a higher frequency of (false) negative cases compared to restaging after EBRT. It is uncertain if this reflects low volume of disease and/or low grade as biopsies fail to prove recurrent cancer in 50% of cases. We followed the clinical course of men with recurrent prostate cancer after radical prostatectomy and investigated treatment and survival. PET-CT data were correlated with clinical data, PSA kinetics and disease specific and overall survival. We also studied relative survival comparing an age matched group from the Central Dutch Statistical Office (CBS).Methods. Sixty-four patients underwent [C-11]choline PET-CT on PSA relapse. All patients were initially treated with radical prostatectomy and reached PSA nadir ofResults. The 64 patients had median PSA of 1.4 ng/mL. Median follow-up period of patients was 50 (6124) months. Ten patients died during the course of follow-up of which 5 due to metastasized disease. No significant differences were seen in age, time to recurrence, total PSA at recurrence and PET-CT results. Patients with abnormal PET had higher PSAVel (median 3.09 ng/mL/yr versus 10.17, P=0.002) and shorter PSADT (med 4.83 months vs. 0.53, P=0.016). Median time to treatment was significantly lower in the PET-CT negative group. Age of patients at death from the whole group did not differ from the age of death in an age matched group. Disease specific survival was significantly higher in the PET-CT negative group (P=0.05).Conclusions. [C-11]choline PET-CT showed that a negative PET/CT correlated with a higher disease specific survival and a lower treatment rate in men with a biochemical recurrence after radical prostatectomy. Overall survival of the total group was equal to the age matched cohort emphasizing the limited effect of a biochemical recurrent prostate cancer on overall survival. The optimum timing (adjuvant or early salvage) must be answered in running trials before adjuvant RT is used as standard of care.

The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated, but a compromise, reflected by “minimal” and “optimal” requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines for the optimal technique and three protocols for “detection”, “staging” and “node and bone” are presented. The use of endorectal coil vs. pelvic phased array coil and 1.5 vs. 3 T is discussed. Clinical indications and a PI-RADS classification for structured reporting are presented. Key Points • This report provides guidelines for magnetic resonance imaging (MRI) in prostate cancer. • Clinical indications, and minimal and optimal imaging acquisition protocols are provided. • A structured reporting system (PI-RADS) is described.

SUMMARY Chronic hepatitis C virus (HCV) infection which is often a silent disease has resulted in a global epidemic. The diagnosis of hepatitis C virus often requires confirmation with molecular techniques such as the polymerase chain reaction for detection of HCV RNA. Following laboratory confirmation of the diagnosis, molecular techniques are routinely used to monitor HCV RNA levels, particularly in those undergoing treatment. Unfortunately, molecular tests are relatively expensive and their cost may be prohibitive in the developing world. Several studies have investigated the applicability of the hepatitis C core Ag (HCVcAg), as a substitute for measuring HCV RNA levels. In this review, we provide an overview of the major findings of these studies focused on the utility of measuring HCVcAg antigen levels in the clinical setting. Overall, measuring HCVcAg levels is associated with several advantages and disadvantages. It may be useful in different clinical settings for monitoring HCV patients after obtaining an initial baseline HCV RNA result. Copyright © 2011 John Wiley & Sons, Ltd.

To determine changes in Factor VIII (FVIII) and von Willebrand Factor (VWF) in the first 3 days of the puerperium. A prospective study assessing FVIII clotting activity, VWF activity and antigen levels in 95 women (with singleton uncomplicated pregnancies) during labour and on days 1, 2 and 3 of the puerperium. There were no significant differences in FVIII, VWF:Ag and VWF:CB on days 1 and 2 of the puerperium compared with levels during labour. There was a significant decrease in VWF:Ag (P = 0.009) and VWF:CB (P = 0.04) on day 3. Age, ethnicity, duration of labour and mode of delivery did not have any significant effect on the changes in FVIII and VWF levels. The pregnancy induced increase in FVIII and VWF is maintained in the first 48 h after delivery. VWF levels start to decline on day 3 postdelivery.

Item does not contain fulltext BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) may have a role in detecting clinically significant prostate cancer in men with raised serum prostate-specific antigen levels. Variations in technique and the interpretation of images have contributed to inconsistency in its reported performance characteristics. OBJECTIVE: Our aim was to make recommendations on a standardised method for the conduct, interpretation, and reporting of prostate mpMRI for prostate cancer detection and localisation. DESIGN, SETTING, AND PARTICIPANTS: A consensus meeting of 16 European prostate cancer experts was held that followed the UCLA-RAND Appropriateness Method and facilitated by an independent chair. MEASUREMENT: Before the meeting, 520 items were scored for "appropriateness" by panel members, discussed face to face, and rescored. RESULTS AND LIMITATIONS: Agreement was reached in 67% of 260 items related to imaging sequence parameters. T2-weighted, dynamic contrast-enhanced, and diffusion-weighted MRI were the key sequences incorporated into the minimum requirements. Consensus was also reached on 54% of 260 items related to image interpretation and reporting, including features of malignancy on individual sequences. A 5-point scale was agreed on for communicating the probability of malignancy, with a minimum of 16 prostatic regions of interest, to include a pictorial representation of suspicious foci. Limitations relate to consensus methodology. Dominant personalities are known to affect the opinions of the group and were countered by a neutral chairperson. CONCLUSIONS: Consensus was reached on a number of areas related to the conduct, interpretation, and reporting of mpMRI for the detection, localisation, and characterisation of prostate cancer. Before optimal dissemination of this technology, these outcomes will require formal validation in prospective trials.

Introduction Low levels of C1-esterase inhibitor (C1-INH) and concomitant reduced complement 4 (C4) concentrations have been identified in patients with hereditary angioedema (HAE). C4 constitutes a promising candidate for a biomarker of disease activity. This investigation aims to determine the relationship between C1-INH functional activity levels (C1-INH[f]) and C4 antigen concentrations in patients with HAE treated with subcutaneous (SC) C1-INH, inferring significance for clinical practice. Methods C1-INH(f) and C4 antigen levels were assayed in three clinical studies (NCT01576523, NCT01912456, NCT02316353 [COMPACT Phase 2, 3 and open-label extension studies]). The relationship between these measurements was inspected in an exploratory manner. All measurements were performed at a central laboratory using validated assays and investigated with respect to time after C1-INH(SC) administration and HAE type. C4 antigen concentration over time after C1-INH(SC) administration was characterized, and the correlation with C1-INH(f) evaluated. Results C4 antigen concentration increased gradually following C1-INH(SC) administration until ∼100 hours post-administration when concentrations declined. A linear relationship was observed between C4 antigen concentrations and C1-INH(f) in patients with type I HAE, based on the Loess fit, until C1-INH(f) of ∼50%, at which point signs of saturability became apparent (example figure shown). The relationship in patients with type II HAE was not clear. Conclusions An exploratory analysis showed a linear relationship between C1-INH(f) and C4 antigen levels in patients with type I HAE, consistent with previous reports. The interplay between C1-INH(f) and C4 should be further explored to understand the potential role of C4 monitoring in treatment decision-making.

This study investigated the safety of administration of long-acting parenteral testosterone undecanoate (TU) to 122 hypogonadal, mainly elderly men, aged 59.6 ± 8.0 years (range 18-83 years old), with baseline testosterone levels between 5.8 and 12.1 nmol l(-1) (mean ± SD = 9.3 ± 1.7). Patients were followed for 24 months. Plasma testosterone rose from 9.3 ± 1.7 to 14.9 ± 4.5 nmol l(-1) (P< 0.01) at 3 months, then stabilised at 19.2 ± 4.6 nmol l(-1) after 6 months. International Prostate Symptoms Scores and Residual Bladder Volumes decreased significantly (P

The problem of the quantitative analysis of immunofluorescence histograms “with weak labeling” is considered. In these distributions, the fluorescence intensity mean of labeled cells is slightly above that of unlabeled cells, and therefore there is a considerable overlap between the two populations. The procedure of selecting “by eye” an intensity level that separates labeled from unlabeled cells is evidently inadequate, leading to subjective and not reproducible results. Threshold and subtraction methods, although objective, quick, and easy to use, are also inaccurate. Till now, correct enough estimates of the percentage of labeled cells have been obtained only by applying mathematical modeling methods, that are, however, not very easy to handle. A new method for estimating the labeled cell proportion from immunofluorescence histograms is presented. It relies on the analysis of the ratio of the cumulative distributions associated with the routinely available test and negative control histograms. Since this ratio results in a well-defined “σ-shaped” distribution from a certain channel onwards, a suitable fitting function is used to obtain directly a preliminary estimate of the proportion of labeled cells. Then, an iterative procedure is designed for updating the estimate until it is judged acceptable, according to a suitable criterion. Moreover, to take into account the overall variability in the control data, the estimation process is repeated using the cumulatives associated with replicate negative control histograms. The accuracy of the method was tested with the same set of experimental data analyzed by means of a mathematical modeling method described in a previous article (Lampariello and Aiello, Cytometry 1998;32:241–254). There was a very good agreement between the known and estimated proportions of labeled cells, and the latter were, in many cases, even closer to the true values than those previously obtained. On the basis of the results reported, the method, which is objective, very simple, and much easier to implement than our previously proposed one, appears to be effective in the entire range of the percentage values, and to provide results independent of the acquisition precision. © 2009 International Society for Advancement of Cytometry

We describe a patient who developed Trousseau's syndrome 4-5 years before the diagnosis of symptomatic myeloma. Immunohistochemical study disclosed tissue factor production by the bone marrow plasma cells. Elevated plasma tissue factor antigen levels and the development of Trousseau's syndrome had continued until the patient obtained a complete response 6 months after high-dose therapy. Tissue factor produced by the clonal plasma cells appeared responsible for "Trousseau's syndrome" in this myeloma patient.

Summary. A total of 143 cerebrospinal and serum samples, from proven and suspected cases of cryptococcosis, were concurrently examined using a recently introduced enzyme immunoassay (EIA Premier, Meridian Diagnostics, Inc., Cincinnati, OH, USA) and three latex agglutination (LA) procedures (Immunomycologics, Inc., Norman, OK, USA; IBL, Inc., Cranbury, NJ, USA and a non-commercial LA test). Of these 143 specimens, 115 were negative for cryptococcal antigen (CrAg) with the EIA and LA tests. The remaining 28 specimens were evaluated by the LA tests, and all were positive for CrAg (with titres ranging from 1:2 to 1:8192). Of these 28 LA-positive specimens, 26 were also tested by the EIA. This procedure detected CrAg in 23 specimens (88.5%), with antigen levels ranging from 1:4 to 1:266,857. There were 3 LA-positive specimens (titres 1:4 to 1:32) which were negative by the EIA procedure (10.7%). One LA-negative specimen demonstrated CrAg (titre 1:30) by the EIA procedure. The sensitivity of the EIA and LA tests was 85.2 and 100%, respectively. The specificity of the LA test was 100%, whereas that of the EIA was 97%. The agreement among laboratories for testing the specimens with the three LA tests was 100%. Zusammenfassung. An 143 Liquor- und Serumproben von Patienten mit bewiesener Cryptococcose oder Cryptococcose-Verdacht wurde ein neu eingefuhrter Enzymimmunoassay (EIA Premier, Meridian Diagnostics, Inc., Cincinnati, OH, USA) zum Cryptococcus-Antigen-nachweis (CrAG) vergleichend mit drei Latex-Agglutinationssystemen (LA; Immunomycologics, Inc., Norman, OK, USA; IBL, Inc., Cranbury, NJ, USA; und ein nicht-kommerzieller LA-Test) bewertet. Von den 143 Proben waren 115 CrAG-negativ im EIA und in den LA-Tests. Die ubrigen 28 Proben waren in den LA-Tests CrAG-positiv rnit Titern von 1:2 bis 1:8192. Von diesen 28 Proben wurden 26 auch im EIA gepruft. Dieses System reagierte bei 23 Proben (88.5%) CrAG-positiv mit Titern von 1:4 bis 1:266 857. Drei Proben, die in den LA-tests mit Titern von 1:4 bis 1:32 CrAG-positiv waren, reagierten im EIA CrAG-negativ (10.7%). Eine in den LA-Tests CrAG-negative Probe reagierte im EIA rnit einem Titer von 1:30 CrAG-positiv. Die Sensitivi-tat des EIA betrug 85.2%, die der LA-Tests 100%. Die Spezifitat der LA-Tests lag bei 100%, die des EIA bei 97%. Die Ubereinstimmung der Ergebnisse der drei LA-Tests zwischen den drei Testlaboratorien betrug 100%.

Studies on the relationship between fibrinolysis and arterial thrombosis have been conflicting. Previously, we demonstrated that hypofibrinolysis, as measured by a plasma-based assay, increased the risk of venous thrombosis. The present study investigated increased clot lysis time (CLT) measured with the same assay as a risk factor for myocardial infarction in a case-control study including 421 men with a first myocardial infarction and 642 controls below 70 years. CLT was strongly associated with body-mass index, lipid levels, blood pressure and C-reactive protein. Overall, risk of myocardial infarction was 1.4-fold (95% confidence interval (CI) 1.0-1.9) increased for CLT in the fourth quartile (longest CLT) compared with the first quartile. After adjusting for cardiovascular risk factors this risk disappeared (OR 1.0, 95%CI 0.6-1.5). In men aged = 50 years, no clear association between CLT and risk of myocardial infarction was found. Our study suggests that hypofibrinolysis increases the risk of a first myocardial infarction in young men, although the causality of this association remains to be determined.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) OBJETIVO: Demonstrar a experiência na implantação de um protocolo de espectroscopia por ressonância magnética do 1H tridimensional (3D 1H MRSI), disponível comercialmente, aplicando-o em pacientes com suspeita de neoplasia prostática e com diagnóstico estabelecido de tumor prostático. MATERIAIS E MÉTODOS: Estudo realizado de forma prospectiva, em 41 pacientes com idades entre 51 e 80 anos (média de 67 anos). Dois grupos foram formados: pacientes com uma ou mais biópsias negativas para câncer e antígeno prostático específico elevado (grupo A) e pacientes com câncer confirmado por biópsia (grupo B). Procurou-se, a partir dos resultados da ressonância magnética e espectroscopia por ressonância magnética, determinar a área-alvo (grupo A) ou a extensão do câncer conhecido (grupo B). RESULTADOS: No diagnóstico de câncer de próstata a espectroscopia por ressonância magnética apresentou especificidade abaixo da descrita pela literatura, cerca de 47%. Já para o estadiamento do tumor diagnosticado, houve correspondência com a literatura. CONCLUSÃO: A implantação e padronização da espectroscopia por ressonância magnética permitiram a obtenção de informações importantes para o diagnóstico presuntivo da existência de câncer de próstata, combinando as imagens por ressonância magnética com os dados metabólicos da espectroscopia por ressonância magnética. OBJECTIVE: To report an experiment involving the introduction of a protocol utilizing commercially available three-dimensional 1H magnetic resonance spectroscopy imaging (3D 1H MRSI) method in patients diagnosed with prostatic tumors under suspicion of neoplasm. MATERIALS AND METHODS: Forty-one patients in the age range between 51 and 80 years (mean, 67 years) were prospectively evaluated. The patients were divided into two groups: patients with one or more biopsies negative for cancer and high specific-prostatic antigen levels (group A), and patients with cancer confirmed by biopsy (group B). The determination of the target-area (group A) or the known cancer extent (group B) was based on magnetic resonance imaging and MRSI studies. RESULTS: The specificity of MRSI in the diagnosis of prostate cancer was lower than the specificity reported in the literature (about 47%). On the other hand, for tumor staging, it corresponded to the specificity reported in the literature. CONCLUSION: The introduction and standardization of 3D 1H MRSI has allowed the obtention of a presumable diagnosis of prostate cancer, by a combined analysis of magnetic resonance imaging and metabolic data from 3D 1H MRSI. Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por Imagem Universidade Federal do Amazonas Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital São Paulo UNIFESP, EPM, Depto. de Diagnóstico por Imagem UNIFESP, EPM, Hospital São Paulo SciELO