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We report a 76-year old man who had cerebellar hemorrhage and recurrent subdural hematoma. Investigations revealed that these were metastases from cancer of the prostate. We discuss the need for annual prostate cancer assessment in our environment Key Message: The indications for annual examination of the prostatic specific antigen in elderly men should be appreciated.

Primary prostatic lymphoma is a rare prostate malignancy that accounts for 0.09% of prostate cancer and 0.1% of lymphoma. Clinical misdiagnosis is common as majority of cases present with non-specific urinary symptoms like other prostatic diseases or prostatic cancer. Early diagnosis is of significant paramount as prognosis is dependent on histological type and tumour staging at the time of diagnosis. Urologists should remain aware of rare histological types of prostate cancer as delayed diagnosis of primary prostate lymphoma can be detrimental and lead to advanced disease causing serious sequelae i.e renal failure in addition to the primary pathology. [ABSTRACT FROM AUTHOR]

Background: Tumor-associated macrophages (TAM) are the main component of inflammation along with leukocytes, endothelial cells and fibroblasts together form a tumor microenvironment, with immune cells representing its vital component. Many studies suggested that TAMs cumulating in tumors correlate with a poor prognosis. In prostate cancer, TAMs can increase cancer cell invasion by stimulating tumor angiogenesis, degrading the extracellular matrix, and also suppresses the antitumor functions of cytotoxic T cells resulting in poor prognosis. Aims and Objectives: 1. To determine the expression of M1 (CD68) and M2 (CD163) in prostate carcinoma (Pca). 2. To find the association between M1, M2 macrophage with Gleason's score and stage of Pca. Materials and Methods: This is a retrospective observational study. All transurethral resection prostatic (TURP) chips positive for Pca and the clinical details were collected. Radiologic findings with respect to stage of disease, size of lesion, were noted. Results: Among the 62 cases studied, majority of the cases were in-between the age of 61-70 years. Highest cases were seen in Gleason's score 8, 9, and 10 (62%), prostatic specific antigen (PSA) levels 20-80 ng/mL (64%), tumor size 3-6 cm (51.6%), T3 stage (40.3%), N1 lymph node stage (70.9%). M1 stage of (31%). CD68 and CD163 expression was analyzed with Gleason's score, TNM stage and PSA levels. CD68 score 3 correlated with low distant and nodal metastasis 6.2% and 6.8%, respectively. CD163 score 3 correlated with high metastasis to lymph nodes and distant metastasis of 86.3% and 25%, respectively. On further analysis, statistically convincing association between the CD163 expression and Gleason's score, PSA levels, nodal and distant metastasis was found. Conclusion: CD68 expression was correlated with good prognosis with less nodal and distant metastasis and Cd163 expression has poor outcome with increased chances of nodal and distant metastasis. Further exploration of TAM mechanisms and immune checkpoints in the prostate tumor microenvironment can furnish new light and motives for the treatment of Pca. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate thiol/disulphide homeostasis as an additional serum marker to prostate specific antigen (PSA) in the diagnosis of prostate cancer. Patients and Methods: Prospective study was conducted among 174 patients with PSA levels of 2.5–20 ng/mL without suspicion of malignancy in rectal examination and who underwent prostate needle biopsy. A total of 75 patients were included in our study after exclusion criteria. Serum PSA, thiol, and disulphide levels of the patients were recorded prior to biopsy. In this study, 25 patients with pathology results indicating prostate cancer, 25 randomly selected patients with pathology results indicating chronic prostatitis, and 25 randomly selected patients with pathology results indicating benign prostate hyperplasia (BPH) were included. Results: Total and native thiol levels were higher in prostate cancer group than in BPH and chronic prostatitis groups; however, no statistically significant difference was observed (p> 0.05). When prostate cancer sub-groups were investigated, total and native thiol levels were noted to be higher in patients with a Gleason score of 7, 8, and 9 than in those with a Gleason score of 6; however, no statistically significant difference was observed (p> 0.05). Conclusions: Thiol levels were higher in prostate cancer group than in benign disease (BPH and chronic prostatitis) groups; these levels were also higher in group with high Gleason scores (Gleason 7, 8, or 9) than in group with a low Gleason score (Gleason 6); however, these differences were not statistically significant.

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Objectives: To evaluate the effect of different urological manipulations on the serum PSA level in patients with benign prostatic hyperplasia. Study Design: Quasiexperimental study. Setting: Department of Urology, Nawaz Sharif Social Security Hospital, Lahore. Period: January 2018 to December 2018. Material & Methods: A series of 60 patients were included in the study who fulfill the inclusion criteria. All the patients were above 50 years of age and presented with symptoms of benign prostatic hyperplasia. These patients were divided into four groups equally. In group A digital rectal examination, in group B transurethral resection of prostate, in group C Foley's catheterization and in group D Trans rectal ultrasound guided prostatic biopsy was done. Pre-manipulation and post-manipulation blood samples for serum PSA were taken after 30 minutes, 72 hours and one week. Results: Trans urethral resection of prostate, Foley's catheterization and trans rectal ultrasound guided prostatic biopsy caused a statistically significant rise in serum PSA level (p < 0.05) while digital rectal examination did not raise serum PSA level significantly. Conclusion: Different manipulations do cause alteration in the serum PSA level which may change the management plan. [ABSTRACT FROM AUTHOR]

Background: Anogenital distance is often used as biomarker of intra uterine androgen levels. The androgen may influence the benign prostatic hypertrophy and lower urinary tract symptoms subsequently. This was mainly undertaken to study the relation between the anogenital distance and the lower urinary tract symptoms. Material and methods: A comparative study was undertaken among 50 LUTS patients and 50 controls in Urology department of a tertiary care hospital. All the cases were studied for International Prostate Symptom Score (IPSS), Prostate volume, Maximum flow rate (Qmax), Prostate specific antigen (PSA), testosterone levels, height, weight were recorded. Two types anogenital distance was obtained AGDAP (from the centre of the anus to the cephalad insertion of penis) and AGDAS (from the center of the anus to the posterior base of the scrotum) were measured. Results: The maximum flow rate was significantly higher in controls. This study had shown that the AGD was higher in cases than controls. The PSA levels were significantly higher in LUTS patients and also testosterone levels. The BMI adjusted values of AGD (AS) also was significantly lower in LUTS group than the controls. Conclusion: The anogenital distance can be a marker for benign prostatic hyperplasia and this knowledge can be used for prevention. [ABSTRACT FROM AUTHOR]

Introduction: Prostate cancer is the second most common neoplasm among men around the world. Two routinely used immunocytochemical markers for prostatic epithelium are Prostatic Acid Phosphatase (PAP) and Prostatic Specific Antigen (PSA). Various other markers like Prostate-Specific Membrane Antigen (PSMA), androgen and progesterone receptors, HER2- neu, low molecular weight keratin, etc., are also used. HER2-neu overexpression has been implicated in tumorigenesis and has been correlated with a poor prognosis for patients with breast cancer, ovarian cancer, and gastric cancer. Use of Trastuzumab for the treatment of breast carcinoma has improved prognosis in HER2-neu positive cases. Recent studies have suggested the correlation of HER2-neu overexpression with higher grades of prostate cancer. Aim: To study HER2-neu expression in different histopathological grades of prostatic carcinoma. Materials and Methods: A prospective study was carried out on 41 histopathologically proven cases of prostatic carcinoma in Pathology Department of SRMSIMS, Bareilly over a period of one year and six months (November 2017 to April 2019). Gleason grading and HER2-neu Immunohistochemistry was applied on every case and then correlated. Statistical tests were applied, statistical software Statistical Package for the Social Sciences (SPSS) version 21. Results: A 92.7% (38/41) cases were reported as Prostatic Adenocarcinoma of Non-Mucinous type. Total of 42.5% (17/40) were grouped under Grade group 5, 27.5% (11/40) cases under Grade group 3 and 10% (4/40) under Grade groups 1,2 and 4 each. Out of total, 14.6% (6/41) cases were considered as positive and 80.5% (33/41) cases were considered as negative for HER2-neu expression and 4.9% (2/41) cases were considered as equivocal (Fluorescence In Situ Hybridization (FISH) conformation required). In cases with positive HER2-neu expression, mean group grade was calculated to be 4.83±0.40 and in patients with negative HER2-neu expression, it was 3.38±1.40 (it was calculated to find correlation between group grade and HER2-neu expression). There was a significant statistical difference (p=0.00003668) found between the Gleason Group Grade in HER2-neu positive and negative patients as HER2-neu positivity is seen in higher group grades. One case was reported as neuroendocrine carcinoma in which Gleason grading was not done. Conclusion: Compared to low Gleason Group Grade carcinoma, higher percentage of HER2-neu expression was seen in high Gleason Group grade carcinoma.

Purpose: The aim of the study is to correlate between the value of digital rectal examination (DRE), serum prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) as predictors for diagnosing prostate cancer in patients with voiding symptoms. Materials and Methods: A total of 1610 male patients seen over a period of 10 years in a single institution had prostate-related voiding problems. Routine studies including DRE and serum PSA were done to all patients. TRUS and TRUS biopsy were performed for patients with suspected prostatic cancer based on abnormal DRE findings and/or serum PSA levels. Results: TRUS biopsy revealed prostate cancer in 206 out of 1610 patients with prostate-related voiding problems (13%), 40% had abnormal PSA and 28% had abnormal DRE. Combined abnormal PSA and DRE revealed cancer in 63% of patients. This percentage increased to 90% when TRUS was also abnormal, but dropped to 54% when TRUS was normal. Conclusions: DRE together with serum PSA and TRUS have the highest predictable values for diagnosis of prostate cancer among patients with voiding symptoms. In the absence of abnormal TRUS, PSA and DRE together are more predictable than either alone. Serum PSA alone is more predictable than DRE. Random prostate biopsies should be performed in the presence of high serum PSA, and/or abnormal findings by DRE in male patients with urinary symptoms suggestive of the prostate disease.

Introduction and objectives: PSA elevation is associated with prostate cancer and it is used in screening programs for its diagnosis. It is one of the most common indications for referral to an urologist. There’s no consensus about what to do in PSA elevation management. Antibiotics, nutraceuticals or anti-inflammatories are commonly prescribed in daily practice. Our objective was to verify the effect on the PSA value of a short 30-day trial of a curcuma extract, than to discuss the implications in terms of reducing the number of prostate biopsies performed. Patients and methods: We enrolled 50 consecutive patients admitted at our attention for a first PSA over the level of 4 ng/ml or for a suspected PSA rising defined as PSA velocity (PSAv) > 0.75 ng/ml/years. They received treatment with curcuma extract, 2 tablets per day for 30 day. All patients received a second PSA measurement and TRUS within 6 days from the end of the therapy. In case of PSA reduction below 4 ng/ml, patients were reassured and invited to repeat a PSA control over the time. When PSA level were persistently high over 4 ng/ml or in case of any rising, patients underwent a transrectal ultrasound guided 12-core prostatic biopsy (TRUSbx). Results: Mean age of the patients was 64.56 ± 8.88 (range, 42- 81 years). Prostate volume was 48.34 ± 15,77 ml (range, 18-80 ml). At visit 1, PSA value was in mean 6,84 ± 3.79 ng/ml (range 2.93-21ng/ml). Consequently, mean PSA density value was 0.16 ± 0.16 (range 0.05-1.11). PSA free and PSA total ratio at baseline was 16.85 ± 3.9% (range 8-26%). At visit 2, the prostate volume did not change. Total PSA was 4.65 ± 2,67 ng/ml (range 1-16.82 ng/ml). PSA free and PSA total ratio (PSAF/T) after treatment was 19.68 ± 5.35 % (range 7.8-29%). The differences of total PSA and PSAF/T between visit 1 and visit 2 were < 0.0001 and p < 0.0036, respectively. We performed 26 TRUSbx. Prostate cancer was diagnosed in 6 cases, PIN HG in 2 cases and non neoplastic findings in the remnants 18 patients. Conclusions: Use of the Curcuma extract is able to lower the PSA value after a 30-day intake period. We are not able to state that the reduction of PSA after intake of this Curcuma extract may exclude a prostate cancer. We need further studies to evaluate that.

Objective. To identify the possibility of multiparametrical magnetic resonance imaging (mpMRI) in the diagnosis of clinical recurrence of prostate cancer, with the aim of optimizing salvage radiation therapy (SLT).Material and methods. In this prospective study, the results of 89 patients with marker relapse (PSA) of prostate cancer (PCa) after radical prostatectomy was examined. mpMRI of the pelvis was performed before the SLT and 6 months later. Separately, in 44 patients, the data of dynamic contrast enhancement (DCE) with different contrast agents (gadobutrol, gadodiamide and gadoversetamide) were analyzed.Results. According to the model of multiple linear regression, the area of the substrate of clinical recurrence is statistically significantly correlated with the PSA level (R=0.74, p

Introduction: Prostate cancer is the second most common neoplasm among men around the world. Two routinely used immunocytochemical markers for prostatic epithelium are Prostatic Acid Phosphatase (PAP) and Prostatic Specific Antigen (PSA). Various other markers like Prostate-Specific Membrane Antigen (PSMA), androgen and progesterone receptors, HER2- neu, low molecular weight keratin, etc., are also used. HER2-neu overexpression has been implicated in tumorigenesis and has been correlated with a poor prognosis for patients with breast cancer, ovarian cancer, and gastric cancer. Use of Trastuzumab for the treatment of breast carcinoma has improved prognosis in HER2-neu positive cases. Recent studies have suggested the correlation of HER2-neu overexpression with higher grades of prostate cancer. Aim: To study HER2-neu expression in different histopathological grades of prostatic carcinoma. Materials and Methods: A prospective study was carried out on 41 histopathologically proven cases of prostatic carcinoma in Pathology Department of SRMSIMS, Bareilly over a period of one year and six months (November 2017 to April 2019). Gleason grading and HER2-neu Immunohistochemistry was applied on every case and then correlated. Statistical tests were applied, statistical software Statistical Package for the Social Sciences (SPSS) version 21. Results: A 92.7% (38/41) cases were reported as Prostatic Adenocarcinoma of Non-Mucinous type. Total of 42.5% (17/40) were grouped under Grade group 5, 27.5% (11/40) cases under Grade group 3 and 10% (4/40) under Grade groups 1,2 and 4 each. Out of total, 14.6% (6/41) cases were considered as positive and 80.5% (33/41) cases were considered as negative for HER2-neu expression and 4.9% (2/41) cases were considered as equivocal (Fluorescence In Situ Hybridization (FISH) conformation required). In cases with positive HER2-neu expression, mean group grade was calculated to be 4.83±0.40 and in patients with negative HER2-neu expression, it was 3.38±1.40 (it was calculated to find correlation between group grade and HER2-neu expression). There was a significant statistical difference (p=0.00003668) found between the Gleason Group Grade in HER2-neu positive and negative patients as HER2-neu positivity is seen in higher group grades. One case was reported as neuroendocrine carcinoma in which Gleason grading was not done. Conclusion: Compared to low Gleason Group Grade carcinoma, higher percentage of HER2-neu expression was seen in high Gleason Group grade carcinoma. [ABSTRACT FROM AUTHOR]

A 74-year-old man was suffering from nine months of perineal pain and progressive worsening of urinary symptoms including nocturia and urgency. His prostate-specific antigen (PSA) levels were 1.48 ng/mL at the time of referral. Initially, a differential diagnosis of prostatitis or seminal vesicle inflammation was made, and four weeks of antibiotics were prescribed, which were later extended to six weeks due to failure of symptoms to resolve. Magnetic resonance imaging (MRI) of the prostate was then conducted. The impression was that there was ejaculatory duct obstruction caused by enlarged seminal vesicles with no evidence of significant prostate cancer. The prostate-specific antigen density (PSAd) was 0.04, and the prostate imaging reporting and data system (PIRADS) score was I-II. A CT chest with contrast was conducted for further investigation of pulmonary nodules found on the CT urogram. It revealed multiple calcified pulmonary nodules which were suspicious of malignancy. A CT-guided biopsy of one of the pulmonary nodules was taken, and histopathological analysis revealed a mucinous adenocarcinoma. A transurethral resection of the prostate (TURP) was then performed. Histopathological analysis of the prostatic surgical specimen revealed invasive mucinous adenocarcinoma. Based on the findings, a diagnosis of mucinous adenocarcinoma of the prostate with atypical lung metastasis without osseous or regional lymph node involvement was made, stage T4 N0 M1a. The patient is currently on a treatment regimen consisting of carboplatin, pemetrexed, and pembrolizumab., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khokhar et al.)

This study investigated the application of crude methanol extract (CME) of Zapoteca portoricensis root and its methanol (MF) and ethyl acetate (EAF) fractions in managing benign prostatic hyperplasia (BPH). Forty-five albino rats (180-200 g) were divided into nine groups of five rats each: Group 1 served as normal control. BPH was induced in groups 2-9 using dihydrotestosterone and estradiol. Group 2 served as BPH-control and group 3 was dutasteride-treated. Groups 4 and 5, 6 and 7, and 8 and 9 were respectively treated with 200 and 400 mg/kg/d b.w. of CME, 200 and 400 mg/kg/d b.w. of MF, and 200 and 400 mg/kg/d b.w. of EAF, respectively for 14 days orally. The effects of the extracts on the hematological and biochemical indices of the rats were assessed. At 400 mg/kg/d b.w, p.o. using a gavage, CME, MF and EAF decreased prostatic specific antigen by 55.91%, 57.54% and 56.75%, respectively comparable to 58.80% by dutasteride (an indication of improved prostate status). The extracts also restored BPH-modified hematological and biochemical status of BPH-induced-extracts-treated rats compared to BPH-control. These findings suggest that Z. portoricensis root extracts normalize aberrations associated with BPH and may justify the plant's folkloric use in the management of BPH. [ABSTRACT FROM AUTHOR]

Prostate cancer is the second most common form of cancer in men in Europe. The primary treatment of this type of cancer is radical prostatectomy, which has shown good oncological results. Radical prostatectomy (open, laparoscopic or robotic) has high success and low morbidity rates in patients with localized prostate cancer. The life expectancy is >10 years after radical prostatectomy. Studies have shown that ~20%-30% of the patients who have undergone radical prostatectomy can develop biochemical recurrence, which is monitored by using the value of the prostate-specific antigen (PSA). In some cases (patients with high-risk prostate cancer), adjuvant therapy after radical prostatectomy, such as radiotherapy or androgen deprivation therapy, can significantly reduce the risk of biochemical recurrence. The optimal management of recurrent disease remains uncertain. Recent literature was systematically reviewed regarding the management of biochemical recurrence and to compare clinical experience in literature studies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study is to correlate between the value of digital rectal examination (DRE), serum prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) as predictors for diagnosing prostate cancer in patients with voiding symptoms. Materials and Methods: A total of 1610 male patients seen over a period of 10 years in a single institution had prostate-related voiding problems. Routine studies including DRE and serum PSA were done to all patients. TRUS and TRUS biopsy were performed for patients with suspected prostatic cancer based on abnormal DRE findings and/or serum PSA levels. Results: TRUS biopsy revealed prostate cancer in 206 out of 1610 patients with prostate-related voiding problems (13%), 40% had abnormal PSA and 28% had abnormal DRE. Combined abnormal PSA and DRE revealed cancer in 63% of patients. This percentage increased to 90% when TRUS was also abnormal, but dropped to 54% when TRUS was normal. Conclusions: DRE together with serum PSA and TRUS have the highest predictable values for diagnosis of prostate cancer among patients with voiding symptoms. In the absence of abnormal TRUS, PSA and DRE together are more predictable than either alone. Serum PSA alone is more predictable than DRE. Random prostate biopsies should be performed in the presence of high serum PSA, and/or abnormal findings by DRE in male patients with urinary symptoms suggestive of the prostate disease. [ABSTRACT FROM AUTHOR]

Large total prostate volumes (TPVs) or high serum prostate-specific antigen (PSA) levels indicate high-risk clinical progression of benign prostatic hyperplasia. This prospective study investigated the treatment outcome of combined 5α-reductase inhibitor and α-blocker in patients with and without large TPVs or high PSA levels. Methods: Men aged ≥ 45 years with International Prostate Symptom scores (IPSS) ≥ 8, TPV ≥ 20 mL, and maximum flow rate ≤ 15 mL/s received a combination therapy (dutasteride plus doxaben) for 2 years. Patients with baseline PSA ≥ 4 ng/mL underwent prostatic biopsy for excluding malignancy. The changes in the parameters from baseline to 24 months after combination therapy were compared in those with and without TPV ≥ 40 mL or PSA levels ≥ 1.5 ng/mL. Results: A total of 285 patients (mean age 72 ± 9 years) completed the study. Combination therapy resulted in significant continuous improvement in IPSS, quality of life index, maximum flow rate, and postvoid residual (all p

Nearly all men who reach average life expectancy have prostate disease. The most common is benign prostatic hyperplasia (BPH). Peroxisome proliferator‐activated receptor alpha (PPARα) had protective effect in different models, but still, there are no studies explain its role in BPH. So that we investigated the effect of fenofibrate (FEN) on induced BPH by testosterone propionate (TP) (3 mg/kg/day for 4 weeks) subcutaneous injection followed by FEN (300 mg/kg/day) was given orally for 4 weeks. We measured prostate weights changes, prostatic tissue superoxide dismutase (SOD), and malondialdehyde (MDA) levels. Prostate‐specific antigen (PSA), dihydrotestosterone (DHT), and total antioxidant capacity (TAC) in serum were determined. The mRNA gene expressions of proliferating cell nuclear antigen (PCNA), PPARα, and glutathione peroxidase (GPx) in prostatic tissue were also measured by quantitative real‐time polymerase chain reaction. In addition, the histopathological changes and activated caspase3 immunoexpression were evaluated. Our results showed that TP succeeded in induction of BPH, which was detected by significant increase in prostate weights, prostatic tissue MDA, serum levels of DHT, PSA, and mRNA gene expression of PCNA but significant decrease in PPARα and GPx gene expression. Moreover, TAC in serum and SOD level in prostate tissue decreased. The histopathological examination showed typical changes of BPH with dysplastic changes with marked decrease in activated caspase3 immunoexpression indicating marked suppression of the apoptotic process. FEN significantly improved all disturbed parameters of BPH model. Moreover, there are no dysplastic changes with co‐administration of FEN to BPH induced group. [ABSTRACT FROM AUTHOR]

Signal-amplified ratiometric electrochemiluminescence (Sa-RECL) provides an attractive approach to maximize signal-to-noise ratio through enhancing signals and eliminate interferences. In this work, we prepared a novel metal-organic framework (MOF)/Au/G-quadruplex as both quenchers and enhancers to fabricate a target-triggered ratiometric ECL sensor for high sensitive and accurate detection of prostatic specific antigen (PSA). The ratiometric ECL sensor using the dual-potential-dependent ECL emitters (quantum dots (QDs) and luminol) and MOF/Au/G-quadruplex not only achieved signal self-calibration but also realized cooperative amplification. After the sequential hybridization among of complementary DNA-QDs, PSA aptamer and pDNA-Au-Hemin-MIL-DNAzyme and the further competition of PSA, the pDNA-Au-Hemin-MIL-DNAzyme probe would keep away from the electrode surface, causing a switchover of their ECL signals from “off-on” state to “on-off” state. The ratiometric ECL aptasensor exhibits high-sensitive and accurate analytical performance toward PSA with a linear detection range from 0.5 to 500 ng mL −1 and a detection limit of 0.058 ng mL −1 (S/N = 3). The novel ratiometric ECL biosensor has been successfully applied to determine different serum samples of PSA, indicating its potential application in the clinical diagnosis. [ABSTRACT FROM AUTHOR]

Prostatic hyperplasia is benign tumor occur in prostate. Benign prostatic hyperplasia is common disease in old men. The incidence of disease arises with increase in age. The patient with benign prostatic hyperplasia are estimated 20% of men in 40s old, and 90% in of men in 80s old, and main causes of prostatic hyperplasia are unknown but there is evidence referring to genetic and hormonal disorders that may cause the disease. This study includes 60 patients with prostatic hyperplasia with an average age of 64 years old and 30 samples as a control with same age group. The study obtained that there was significant association (P ∁ 0.05) between PSA (KLK3) and prostatic hyperplasia. Result also mentions that there was significant decrease in testosterone level and significant increase in dihydrotestosterone level. The present study for KLK2 and KLK3 genes showed molecular variation in both genes, varied between polymorphism and allele polymorphism. PCR amplification of specific primers of KLK2 gene showed polymorphisms ranged between 14%, 8%, 10%, and 6% in each KLK2a, KLK2b, KLK2c, and KLK2d primers respectively, while the allele polymorphism in KLK2c amplification with primer reaches 18% of patient. PCR amplification of specific primers of KLK3 gene showed polymorphisms ranged between 10%, 6%, 2%, and 4% in each KLK3a, KLK3b, KLK3c, and KLK3d primer respectively, and allele variation was not detected in amplification product of KLK3. [ABSTRACT FROM AUTHOR]

Resumen Objetivo Investigar la asociación entre el nivel del antígeno prostático específico (PSA) en el mismo momento de la realización de PET/TC con 68 Ga-PSMA y el volumen tumoral metabólico (MTV) en pacientes con cáncer de próstata en progresión bioquímica. Métodos En este análisis retrospectivo se estudió a 84 pacientes sometidos a PET/TC con 68 Ga-PSMA, a quienes se midieron los niveles de PSA en la misma semana (Trigger-PSA). Se calculó el MTV a partir de la suma de las lesiones metastásicas. Para determinar las relaciones entre el nivel de Trigger-PSA y los hallazgos de PET/TC utilizamos la correlación de Spearman. Resultados El MTV medio de la enfermedad ósea (mBD) fue significativamente superior al valor encontrado en los ganglios metastásicos (mLN) (139,5 frente a 17,7; p < 0,05). La enfermedad se limitó a la próstata en 8 pacientes (9,5%), mLN en 21 pacientes (25%), mBD en 32 pacientes (38,1%) y las 3 localizaciones (próstata, mBD y mLN) en 17 pacientes (20,2%). En 6 pacientes (6,14%), la PET/TC con 68 Ga-PSMA no fue capaz de detectar la enfermedad. Los niveles medios de Trigger-PSA en los pacientes con enfermedad limitada a próstata (2,8 ng/ml), mLN (6,8 ng/ml) y mBD (16,8 ng/ml) fueron estadísticamente significativos (p < 0,05). Los pacientes positivos tuvieron un Trigger-PSA medio de 4,3 ng/ml frente a 1,5 ng/ml en los pacientes negativos (p < 0,05). Establecimos 3 puntos límite para la tasa de detección del nivel de Trigger-PSA: ≤ 1 ng/ml (47,3%), 1-4 ng/ml (68,4%) y ≥ 4 ng/ml (96,7%). Cuando el Trigger-PSA excedió de 4 ng/ml, el MTV fue superior (p < 0,001). Conclusión Los resultados evidencian la correlación de MTV con Trigger-PSA, lo cual puede tener impacto sobre el tratamiento. Sin embargo, los niveles de Trigger-PSA no permitieron distinguir entre la enfermedad localizada o a distancia. La estadificación precisa de la enfermedad podría permitir planificar la mejor estrategia terapéutica. Objective To investigate the association between prostatic-specific antigen (PSA) levels and molecular tumor volume (MTV) measured in the 68 Ga-PSMA PET/CT, both done in a short period of time, in prostate cancer patients with biochemical failure. Methods Eighty-four patients who underwent 68 Ga-PSMA PET/CT and measurement of PSA levels in the same week (trigger-PSA) were studied in this retrospective analysis. MTV was calculated from the sum of the metastatic lesions. To determine the association between trigger-PSA level and PET/CT findings, Spearman rank correlation was used. Results The median MTV of metastatic bone disease (mBD) was significantly higher than in metastatic lymph-nodes (mLN) (139.5 versus 17.7; P < .05). Disease was limited to the prostate in 8 patients (9.5%), mLN in 21 patients (25%), mBD in 32 patients (38.1%) and the 3 sites (prostate, mLN, and mBD) in 17 patients (20.2%). In 6 patients (6.14%), 68 Ga-PSMA-PET/CT was not capable of detecting disease. The median trigger-PSA levels of patients with disease limited to the prostate (2.8 ng/mL), mLN (6.8 ng/mL), and for mBD (16.8 ng/mL) was statically significant ( P < .05). Positive patients had a mean trigger-PSA of 4.3 ng/mL vs 1.5 ng/mL in negative patients ( P < .05). We established 3 threshold-points for trigger-PSA level detection rate: ≤ 1 ng/mL (47.3%), 1-4 ng/mL (68.4%) and ≥ 4 ng/mL (96.7%). When trigger-PSA exceeded 4 ng/mL, the MTV was higher ( P < .001). Conclusion The correlation of MTV with trigger-PSA is demonstrated, which may have an impact on management. However, trigger-PSA levels were not capable of distinguishing between localized or distant disease. An accurate detection of disease can lead to a better therapeutic strategy. [ABSTRACT FROM AUTHOR]

Introduction and objectives: PSA elevation is associated with prostate cancer and it is used in screening programs for its diagnosis. It is one of the most common indications for referral to an urologist. There's no consensus about what to do in PSA elevation management. Antibiotics, nutraceuticals or anti-inflammatories are commonly prescribed in daily practice. Our objective was to verify the effect on the PSA value of a short 30-day trial of a curcuma extract, than to discuss the implications in terms of reducing the number of prostate biopsies performed. Patients and methods: We enrolled 50 consecutive patients admitted at our attention for a first PSA over the level of 4 ng/ml or for a suspected PSA rising defined as PSA velocity (PSAv) > 0.75 ng/ml/years. They received treatment with curcuma extract, 2 tablets per day for 30 day. All patients received a second PSA measurement and TRUS within 6 days from the end of the therapy. In case of PSA reduction below 4 ng/ml, patients were reassured and invited to repeat a PSA control over the time. When PSA level were persistently high over 4 ng/ml or in case of any rising, patients underwent a transrectal ultrasound guided 12-core prostatic biopsy (TRUSbx). Results: Mean age of the patients was 64.56 ± 8.88 (range, 42-81 years). Prostate volume was 48.34 ± 15,77 ml (range, 18-80 ml). At visit 1, PSA value was in mean 6,84 ± 3.79 ng/ml (range 2.93-21ng/ml). Consequently, mean PSA density value was 0.16 ± 0.16 (range 0.05-1.11). PSA free and PSA total ratio at baseline was 16.85 ± 3.9% (range 8-26%). At visit 2, the prostate volume did not change. Total PSA was 4.65 ± 2,67 ng/ml (range 1-16.82 ng/ml). PSA free and PSA total ratio (PSAF/T) after treatment was 19.68 ± 5.35% (range 7.8-29%). The differences of total PSA and PSAF/T between visit 1 and visit 2 were < 0.0001 and p < 0.0036, respectively. We performed 26 TRUSbx. Prostate cancer was diagnosed in 6 cases, PIN HG in 2 cases and non neoplastic findings in the remnants 18 patients. Conclusions: Use of the Curcuma extract is able to lower the PSA value after a 30-day intake period. We are not able to state that the reduction of PSA after intake of this Curcuma extract may exclude a prostate cancer. We need further studies to evaluate that. [ABSTRACT FROM AUTHOR]

The current study was applied to evaluate the significance of serum Prostate- Specific Antigen (PSA) as a screening tool for the PCa and the role of percent free - to- total PSA ratio in the discriminating between BPH and PCa. Prostatic biopsies and blood were collected from (62) patients aged between (50-89) years. Eleven healthy men with negative digital rectal examination, (median age, 60.6yr) were enrolled in this study as a control group. The common diseases encountered were BPH (59.7%), BPH with prostatitis (19%), adenocarcinoma (17.7%), and transitional cell carcinoma (3.2%). 54% of BPH cases had tPSA level < 4 ng/ml as well 13.5% of them having tPSA>10, while 15.3% of malignant cases had tPSA level < 4 ng/ml and 84.7% of them having tPSA>10. The statistical analysis showed a significant difference between (BPH and PCa); (PCa and control cases) and (prostatitis and control) in regard to tPSA. Regarding to % cPSA the entire case of PCa showed levels >60% aligned with only 75%, 27%, 16% in prostatitis, control and BPH groups successively. The mean comparison showed statistically significant differences between the PCa patients and control cases and between prostatitis and control cases, while no significant differences between BPH and control group. Regarding to % FPSA, 53.8 % of PCa cases showed ≤15, along with 16.6 % of prostatitis showed ≤15, while no cases of both BPH and control revealed FPSA ≤15. Comparison of the means showed a statistically large difference between the (PCa and BPH), (PCa and control) and (prostatitis and control) cases. While no significant differences between (BPH and control) cases. In conclusion, combinational use of tPSA with other molecular forms of PSA especially proportion of FPSA provide higher diagnostic and differentiative accuracy than the tPSA alone.

Background: Multifocality, multicentricity and extension beyond the prostate capsule are all characteristics of prostatic adenocarcinoma that may escape diagnosis by conventional CT scanning or MRI. This study was designed to assess the diagnostic value of magnetic resonance spectroscopy (MRS) in prostatic carcinoma and its compatibility with prostatic specific antigen (PSA) as the conventional method.Methods: In this cross-sectional study, we recruited 139 patients with previous radical prostatectomy referring to Radiology department of Hazrate-e-Rasul Hospital during the first half of 2011 for the evaluation of local recurrence. Traditionally, local recurrence is defined as serum PSA concentration >0.2 ng/dl. We used 1.5-tesla Siemens Avanto MRI unit with endorectal coil and measured creatine, choline and citrate levels before calculating choline-creatine/citrate ratio. Correlation between MRS findings with PSA concentration was evaluated in regards to the multiple levels of the previously mentioned ratio.Results: Local recurrence was found in 107 (77%) patients based on PSA levels. The mean values for serum PSA levels and creatine-choline/citrate ratio were significantly different in patients with and without local recurrence. Creatine-choline/citrate ratios greater than 50, 100 and 150 (as different cut-off points of recurrence) were respectively seen in 104, 102 and 97 patients and agreement ratio between MRS and PSA in these levels were 94.1%, 94.4% and 85.1%, respectively. Correlation coefficient between these two methods was 0.481.Conclusion: MRS is a valuable tool for evaluating recurrence inpatients with prostate cancer treated by radical prostatectomy and it is in good agreement with serum PSA levels.

OBJECTIVE: We compared the safety and efficacy of the 12-core biopsy with those of the conventional systematic 6-core biopsy with PSA levels between 4.1 and 20.0 ng/mL. MATERIALS AND METHODS: This study included 428 patients who underwent a 6-core biopsy and 128 patients who underwent a 12-core biopsy. Biopsies were performed transrectally under ultrasound guidance. The 12-core biopsy scheme involved obtaining 6 far lateral cores. RESULTS: For patients with PSA level between 4.1 and 10.1 ng/mL, 47 of the 265 patients who underwent 6-core biopsy and 32 of the 91 patients who underwent a12-core biopsy were diagnosed with prostate cancer (p = 0.0006). Among the patients with a PSA level between 10.1 and 20.0 ng/mL, 48 of 163 patients who underwent the 6-core biopsy and 16 of 37 patients who underwent the 12-core biopsy were diagnosed with prostate cancer (p = 0.0606). Three of the 95 patients who were diagnosed with prostate cancer through the 6-core biopsy and 12 of the 48 patients who were diagnosed through the 12-core biopsy had cancer located in the anterior apex. The 12-core biopsy increased the diagnostic rate in the apex (p = 0.001). No statistically significant differences were found in incidence of complications. CONCLUSION: We concluded that the 12-core biopsy is a safe and more effective procedure for increasing the diagnostic rate of prostate cancer than the 6-core biopsy in patients with PSA level between 4.1 and 10.0 ng/mL, and the most useful anatomical area to be added was found to be cores from the anterior apex.

Serum and urinary prostatic acid phosphatase (PAP) and prostatic specific antigen (PSA) from 20 dogs were measured. PAP and PSA tests were carried out in authomatized equipment with commercial kits used for humans. Mean PAP serum value was 0.7U/l and urinary 0.1U/l. Mean serum and urinary PSA were 0.005ng/dl and 0.004ng/dl, respectively. In vivo determination of these two biomarkers in dogs is a new form of diagnosis in veterinary medicine and these values should be correlated with the morphological lesion of the prostate gland.Realizaram-se mensurações sérica e urinária de fosfatase ácida prostática (PAP) e antígeno prostático específico (PSA) de 20 cães. Os testes de PAP e PSA foram feitos em um equipamento automatizado, com o uso de kits comerciais para humanos. A média de PAP sérico foi de 0,7U/l e urinário 0,U/l. As médias do PSA sérico e urinário foram 0,005ng/dL e 0,004ng/dl, respectivamente. A determinação do dois biomarcadores in vivo é uma nova opção de diagnóstico na medicina veterinária e os valores obtidos devem ser correlacionados com a lesão morfológica da próstata.

The present single-center retrospective clinical real-world study aimed to assess the feasibility and outcomes of patients who underwent simultaneous prostate biopsy and general urological surgeries. The medical records of 49 patients who underwent prostate biopsy and general urological surgeries simultaneously from October 2016 to June 2019 were retrospectively reviewed. Patients' outcomes were evaluated 3 days, 1 month and 6 months after biopsy. Of the 49 biopsy cases, 41 were treated by transurethral prostatectomy, two by ureteroscopic lithotripsy, two by laparoscopic renal cyst decortication, two by cystostomy and two by ureteral stent extraction. The overall detection rate of clinically significant prostate cancer was 22.4%. The rate in patients with a prostate imaging reporting and data system (PI-RADS) score of 4-5 was 100%, while in cases with a PI-RADS score of <3 it was 7.1%. Postoperative complications within 3 days included hematuria in 39 (79.6%) cases, fever in three (6.1%) cases and hematochezia in two (4.1%) cases. There was no significant difference in the incidence of hematuria between the transrectal and transperineal approaches; however, the overall incidence of complications was significantly reduced after switching from a transrectal approach to a transperineal approach. No complications were observed after 1 or 6 months. In summary, combining simultaneous prostate biopsy to general urological surgeries is a safe and feasible approach. The transperineal approach has a lower incidence of complications. This method may benefit certain patients who are concurrently undergoing general urological surgeries and are under suspicion of prostate cancer in real-world clinical practice. [ABSTRACT FROM AUTHOR]

Background/Purpose Large total prostate volumes (TPVs) or high serum prostate-specific antigen (PSA) levels indicate high-risk clinical progression of benign prostatic hyperplasia. This prospective study investigated the treatment outcome of combined 5α-reductase inhibitor and α-blocker in patients with and without large TPVs or high PSA levels. Methods Men aged ≥ 45 years with International Prostate Symptom scores (IPSS) ≥ 8, TPV ≥ 20 mL, and maximum flow rate ≤ 15 mL/s received a combination therapy (dutasteride plus doxaben) for 2 years. Patients with baseline PSA ≥ 4 ng/mL underwent prostatic biopsy for excluding malignancy. The changes in the parameters from baseline to 24 months after combination therapy were compared in those with and without TPV ≥ 40 mL or PSA levels ≥ 1.5 ng/mL. Results A total of 285 patients (mean age 72 ± 9 years) completed the study. Combination therapy resulted in significant continuous improvement in IPSS, quality of life index, maximum flow rate, and postvoid residual (all p < 0.0001) regardless of baseline TPV or PSA levels. However, only patients with baseline TPV ≥ 40 mL had significant improvements in IPSS-storage subscore, voided volume, reduction in TPV, transitional zone index, and PSA levels. In addition, patients with baseline TPV < 40 mL and PSA < 1.5 ng/mL had neither a reduction in TPV nor a decrease in serum PSA level. Conclusion A high TPV indicates more outlet resistance, whereas elevated serum PSA level reflects glandular proliferation. Thus, patients with TPV<40 mL and low PSA levels has less benefit from 5α-reductase inhibitor therapy. The therapeutic effect of combined treatment may arise mainly from the α-blocker in these patients. [ABSTRACT FROM AUTHOR]

To assess total testosterone and prostatic-specific antigen (PSA) kinetics among diverse chemical castrations, advanced-stage prostate cancer patients were randomized into three groups of 20: Group 1, Leuprolide 3.75 mg; Group 2, Leuprolide 7.5 mg; and Group 3, Goserelin 3.6 mg. All groups were treated with monthly application of the respective drugs. The patients’ levels of serum total testosterone and PSA were evaluated at two time periods: before the treatment and 3 months after the treatment. Spearman’s rank correlation coefficient was utilized to verify the hypothesis of linear correlation between total testosterone and PSA levels. At the beginning the patients’ age, stage, grade, PSA, and total testosterone were similar within the three groups, with median age 72, 70, and 70 years in Groups 1, 2, and 3, respectively. Three months after the treatment, patients who received Leuprolide 7.5 mg presented significantly lower median total testosterone levels compared with Goserelin 3.6 mg and Leuprolide 3.75 mg (9.5 ng/dL vs. 20.0 ng/dL vs. 30.0 ng/dL, respectively; p = .0072), while those who received Goserelin 3.6 mg presented significantly lower PSA levels compared with Leuprolide 7.5 mg and Leuprolide 3.75 mg (0.67 vs. 1.86 vs. 2.57, respectively; p = .0067). There was no linear correlation between total testosterone and PSA levels. Overall, regarding castration levels of total testosterone, 28.77% of patients did not obtain levels ≤50 ng/dL and 47.80% did not obtain levels ≤20 ng/dL. There was no correlation between total testosterone and PSA kinetics and no equivalence among different pharmacological castrations. [ABSTRACT FROM AUTHOR]

We investigated the association between cadmium in blood and the concentration of the prostate specific antigen (PSA) in semen, including the modifying effects of zinc or the CAG polymorphism in the androgen receptor (AR). Blood and semen samples were collected from 504 partners of pregnant women in Greenland, Poland and Ukraine. We found an inverse trend between cadmium and PSA (log( β ) = −0.121, 95% confidence interval (CI): −0.213; −0.029, P = 0.0103) in Greenlandic men. Similar results were observed in men with a high number of CAG repeats (CAG 24) (log( β ) = −0.231, 95% CI: −0.363; −0.098, P = 0.0009). Inverse trends between cadmium and PSA were found when semen zinc concentrations were below the median value for men from Ukraine and Greenland. These outcomes suggest that cadmium may impair prostate function, as measured by PSA in semen, while high zinc levels and a low number of CAG repeats protects against this action. [ABSTRACT FROM AUTHOR]

Metastatic prostate cancer found within the hernia sac contents is a rare clinical manifestation. We report a 64-year-old male patient who presented with rare clinical features of prostate cancer. A focal metastasis of prostate cancer was incidentally found in an incised inguinal hernia sac 5 years after radical prostatectomy. The serum prostate specific antigen (PSA) level remained undetectable (< 0.01 ng/mL) prior to herniorrhaphy without any adjuvant therapy. In addition, serial studies performed right after herniorrhaphy disclosed no evidence of overt clinical metastasis. However, his serum PSA level started rising 12 months later and bladder invasion as well as a mass in the cul-de-sac was identified subsequently. The serum PSA level was 2.45 ng/mL at his latest visit, which was 5 years after herniorrhaphy. This case implies that physicians should be more alert in patients with a low preoperative serum PSA level during the period of follow-up. Both serum PSA and digital rectal examination may be important in patients with low preoperative PSA level after radical prostatectomy.

Objectives To evaluate the impact of obesity on the biopsy detection of prostate cancer. Methods We retrospectively reviewed data of 1182 consecutive Korean patients (≥50 years) with serum prostate-specific antigen levels of 3-10 ng/mL who underwent initial extended 12-cores biopsy from September 2009 to March 2013. Patients who took medications that were likely to influence the prostate-specific antigen level were excluded. Receiver operating characteristic curves were plotted for prostate-specific antigen and prostate-specific antigen density predicting cancer status among non-obese and obese men. Results A total of 1062 patients (mean age 67.1 years) were enrolled in the analysis. A total of 230 men (21.7%) had a positive biopsy. In the overall study sample, the area under the receiver operator characteristic curve of serum prostate-specific antigen for predicting prostate cancer on biopsy were 0.584 and 0.633 for non-obese and obese men, respectively ( P = 0.234). However, the area under the curve for prostate-specific antigen density in predicting cancer status showed a significant difference (non-obese 0.696, obese 0.784; P = 0.017). Conclusions There seems to be a significant difference in the ability of prostate-specific antigen density to predict biopsy results between non-obese and obese men. Obesity positively influenced the overall ability of prostate-specific antigen density to predict prostate cancer. [ABSTRACT FROM AUTHOR]

Prostate cancer (CaP) is the most common type of tumour disease in men. Early diagnosis of cancer of the prostate is very important, because the sooner the cancer is detected, the better it is treated. According to that fact, there is great interest in the finding of new markers including amino acids, proteins or nucleic acids. Prostate specific antigen (PSA) is commonly used and is the most important biomarker of CaP. This marker can only be detected in blood and its sensitivity is approximately 80%. Moreover, early stages cannot be diagnosed using this protein. Currently, there does not exist a test for diagnosis of early stages of prostate cancer. This fact motivates us to find markers sensitive to the early stages of CaP, which are easily detected in body fluids including urine. A potential is therefore attributed to the non-protein amino acid sarcosine, which is generated by glycine-N-methyltransferase in its biochemical cycle. In this review, we summarize analytical methods for quantification of sarcosine as a CaP marker. Moreover, pathways of the connection of synthesis of sarcosine and CaP development are discussed. [ABSTRACT FROM AUTHOR]

The present single-center retrospective clinical real-world study aimed to assess the feasibility and outcomes of patients who underwent simultaneous prostate biopsy and general urological surgeries. The medical records of 49 patients who underwent prostate biopsy and general urological surgeries simultaneously from October 2016 to June 2019 were retrospectively reviewed. Patients' outcomes were evaluated 3 days, 1 month and 6 months after biopsy. Of the 49 biopsy cases, 41 were treated by transurethral prostatectomy, two by ureteroscopic lithotripsy, two by laparoscopic renal cyst decortication, two by cystostomy and two by ureteral stent extraction. The overall detection rate of clinically significant prostate cancer was 22.4%. The rate in patients with a prostate imaging reporting and data system (PI-RADS) score of 4-5 was 100%, while in cases with a PI-RADS score of <3 it was 7.1%. Postoperative complications within 3 days included hematuria in 39 (79.6%) cases, fever in three (6.1%) cases and hematochezia in two (4.1%) cases. There was no significant difference in the incidence of hematuria between the transrectal and transperineal approaches; however, the overall incidence of complications was significantly reduced after switching from a transrectal approach to a transperineal approach. No complications were observed after 1 or 6 months. In summary, combining simultaneous prostate biopsy to general urological surgeries is a safe and feasible approach. The transperineal approach has a lower incidence of complications. This method may benefit certain patients who are concurrently undergoing general urological surgeries and are under suspicion of prostate cancer in real-world clinical practice., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020, Spandidos Publications.)

Abstract: Introduction: Ideally, there will be reproducible markers easily and non-invasively available to test for malignancy, or alternative procedures when there is no accurate marker available. For prostate cancer, one of the most common cancers in men, levels of prostate-specific antigen (PSA) lack specificity and sensitivity for the determination of malignancy when they fall within a range of values termed the ‘grey zone’. Objective: To examine the predictive value of sialic acid in prostate neoplasms. Study design: In our study of diagnostic accuracy we recruited 70 men complaining of urinary symptoms who presented in the urology department as outpatients or inpatients. All patients were checked with biopsy and pathology in order to relate benign and malignant lesions of the prostate to levels of sialic acid, a member of a family of acetylated products of neuraminic acid, which has so far proved to be a very sensitive and accurate marker of malignancy. Results: The sialic acid level was found to be elevated in patients with prostate cancer (mean 75.06±10.4mg/dl) and reduced in patients with benign prostate hyperplasia (mean 57.086±8.7mg/dl) (p <0.01); it had a sensitivity of 86% and specificity of 84% in diagnosing malignancy. Conclusion: Sialic acid can be used as an adjunct in predicting prostate malignancy when PSA values fall in the grey zone. [Copyright &y& Elsevier]

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Background. We analyzed data gathered from initial and repeated prostate biopsies at the University Hospital in Olomouc, Czech Republic. We evaluated the diagnostic yield of repeated transrectal ultrasound (TRUS) guided biopsies. We also assessed whether the result of the repeated biopsy depended on the benign diagnosis of the previous biopsy. Methods. From June 2006 till December 2008, the total of 794 men underwent a TRUS guided biopsy. The following parameters were recorded for each patient: age, total Prostatic Specific Antigen (PSA) level, free PSA level, digital rectal examination record, total prostate volume, and the histo-pathological evaluation. For patients undergoing a repeated biopsy, the histo-pathological result of the previous biopsy was also available, as well as the total number of previous biopsies and the time since the last biopsy. These data were analyzed using standard statistical methods. Results. Initial biopsy was positive for prostate cancer in 157 out of 566 men (27.7%). The total PSA level was confirmed to be a significant (P < 0.001) predictor of prostate cancer. The ratio of free PSA to total PSA (the socalled PSA index) was found to be significantly lower (P < 0.001) for patients suffering from adenocarcinoma. A total of 191 men underwent a repeated biopsy. The repeated biopsy was positive for adenocarcinoma in 39 cases (20.4%). Although this yield is lower, the significance is at the threshold (P = 0.04700). In the group of rebiopted men, total PSA level and PSA index were again significant (P = 0.0024 and P = 0.0015 respectively) predictive factors for prostate carcinoma. The diagnostic yield of repeated biopsy was assessed with respect to the most common types of the benign findings in the previous biopsy - adenomyomatous hyperplasia, inflammation, high grade prostatic intraepithelial neoplasia, and suspected adenocarcinoma. No significant difference in the diagnostic yield was found (P = 0.38431). Conclusions. Total PSA level and PSA index are the most significant precursors of adenocarcinoma in both initial and repeated biopsy. The histo-pathological result of a repeated biopsy was found to be independent of the type of benign diagnosis of the previous biopsy. A substantial number of prostate cancer is diagnosed in repeated biopsies which advocates for the indication of a repeated biopsy in case of a negative result of the initial one. [ABSTRACT FROM AUTHOR]