PSA Density Help to Identify Patients With Elevated PSA Due to Prostate Cancer Rather Than Intraprostatic Inflammation: A Prospective Single Center Study.

The association between PSA density, prostate cancer (PCa) and BPH is well established. The aim of the present study was to establish whether PSA density can be used as a reliable parameter to predict csPCa and to determine its optimal cutoff to exclude increased PSA levels due to intraprostatic inflammation. This is a large prospective single-center, observational study evaluating the role of PSA density in the discrimination between intraprostatic inflammation and clinically significant PCa (csPCa). Patients with PSA ≥ 4 ng/ml and/or positive digito-rectal examination (DRE) and scheduled for prostate biopsy were enrolled. Prostatic inflammation (PI) was assessed and graded using the Irani Scores. Multivariable binary logistic regression analysis was used to assess if PSA density was associated with clinically significant PCa (csPCa) rather than prostatic inflammation. A total of 1988 patients met the inclusion criteria. Any PCa and csPCa rates were 47% and 24% respectively. In the group without csPCa, patients with prostatic inflammation had a higher PSA (6.0 vs 5.0 ng/ml; p=0.0003), higher prostate volume (58 vs 52 cc; p<0.0001), were more likely to have a previous negative biopsy (29% vs 21%; p=0.0005) and a negative DRE (70% vs 65%; p=0.023) but no difference in PSA density (0.1 vs 0.11; p=0.2). Conversely in the group with csPCa, patients with prostatic inflammation had a higher prostate volume (43 vs 40 cc; p=0.007) but no difference in the other clinical parameters. At multivariable analysis adjusting for age, biopsy history, DRE and prostate volume, PSA density emerged as a strong predictor of csPCA but was not associated with prostatic inflammation. The optimal cutoffs of PSA density to diagnose csPCa and rule out the presence of prostatic inflammation in patients with an elevated PSA (>4 ng/ml) were 0.10 ng/ml2 in biopsy naïve patients and 0.15 ng/ml2 in patients with a previous negative biopsy. PSA density rather than PSA, should be used to evaluate patients at risk of prostate cancer who may need additional testing or prostate biopsy. This readily available parameter can potentially identify men who do not have PCa but have an elevated PSA secondary to benign conditions

Overview of the RFX Fusion Science Program

With a program well-balanced among the goal of exploring the fusion potential of the reversed field pinch (RFP) and that of contributing to the solution of key science and technology prob- lems in the roadmap to ITER, the European RFX-mod device has produced a set of high-quality results since the last 2010 Fusion Energy Conference. RFX-mod is a 2 MA RFP, which can also be operated as a tokamak and where advanced confinement states have 3D features studied with stellarator tools. Self-organized equilibria with a single helical axis and improved confinement (SHAx) have been deeply investigated and a more profound understanding of their physics has been achieved. First wall conditioning with Lithium provides a tool to operate RFX at higher density than before, and application of helical magnetic boundary conditions favour stationary SHAx states. The correlation between the quality of helical states and the reduction of magnetic field errors acting as seed of magnetic chaos has been robustly proven. Helical states provide a unique test-bed for numerical codes conceived to deal with 3D effects in all magnetic configura- tions. In particular the stellarator equilibrium codes VMEC and V3FIT have been successfully adapted to reconstruct RFX-mod equilibria with diagnostic input. The border of knowledge has been significantly expanded also in the area of feedback control of MHD stability. Non-linear dynamics of tearing modes and their control has been modelled, allowing for optimization of feedback models. An integrated dynamic model of the RWM control system has been developed integrating the plasma response to multiple RWMs with active and passive conducting structures (CarMa model) and with a complete representation of the control system. RFX has been oper- ated as a tokamak with safety factor kept below 2, with complete active stabilization of the p2, 1q Resistive Wall Mode (RWM). This opens the exploration of a broad and interesting operational range otherwise excluded to standard tokamaks. Control experiments and modelling led to the design of a significant upgrade of the RFX-mod feedback control system to dramatically enhance computing power and reduce system latency. The possibility of producing D-shaped plasmas is being explore