Bone Metastases and Bone Loss Medical Treatment in Prostate Cancer Patients

Prostate cancer is a malignancy in urology with the highest incidence metastasize to the bone up to 70%. The incidence of skeletal related event (SRE) by 46.1% such as severe pain, pathologic fractures, spinal compression syndrome and hypercalcemia, with a consequence of higher inpatient care and worsen the patient’s prognosis. Androgen deprivation therapy (ADT) as a metastatic prostate cancer treatment itself causes an osteopenia or osteoporosis. Bisphosphonate inhibits normal and pathologic osteoclast-mediated bone resorption by several mechanisms. Denosumab is the latest treatment option in bone metastases. Multi-study shows the efficacy of denosumab is better than zoledronic acid for SRE prevention. Adverse events between denosumab and bisphosphonate are comparable. Key words: prostate cancer, bone metastases, bone loss, treatment

Prostatektomi Radikal: Morbiditas Dan Mortalitas Di RSUP Dr. Hasan Sadikin, Bandung

Kanker prostat merupakan salah satu jenis keganasan tersering pada pria. Prostatektomi radikal merupakan terapi pilihan pada kanker prostat yang masih organ confined. Tindakan ini merupakan tindakan operatif dengan derajat kesulitan tinggi, sehingga risiko morbiditas atau mortalitas harus menjadi perhatian. Tujuan penelitian ini adalah mengevaluasi morbiditas, mortalitas pasien, dan faktor yang berperan.Penelitian ini dilakukan secara retrospektif dengan mengumpulkan data dari rekam medis dan status khusus pasien kanker prostat yang telah menjalani operasi prostatektomi radikal dari 2005 sampai 2011 di RS Hasan Sadikin. Analisis univariat dilakukan dengan Chi-square untuk menilai faktor yang berperan terhadap morbiditas dan mortalitas.Sebanyak 90 pasien sebagai subjek penelitian. Usia rerata subjek 62,99 + 5,32 tahun, nilai PSA 31,89 + 29,13 ng/ml, volume prostat 53,24 + 29,13 ml, skor Gleason paling banyak ditemukan pada rentang 2-6 sebesar 58,9%. Rerata lama operasi 236,74 + 89,78 menit dengan jumlah perdarahan sebanyak 874,22 + 573,46 ml dan transfusi 318,11 ml.Morbiditas mayor ditemukan pada 8 kasus (0,08%); 6 kasus termasuk klasifikasi modikasi Clavien derajat 3 dan 2 kasus derajat 5. Analisis statistik tidak menunjukkan adanya kaitan antara usia, PSA, volume prostat, skor Gleason, dan stadium T terhadap terjadinya morbiditas dan mortalitas.Kesimpulannya, morbiditas pada penelitian ini sebesar 0,06% dan mortalitas 0,02%. Faktor usia, PSA, volume prostat, skor Gleason, dan stadium T tidak bermakna secara statistik. Penapisan pra-operasi yang baik akan mencegah terjadinya morbiditas dan mortalitas, selain faktor pengalaman operator

Bacterial and Antibiotic Sensitivity Patterns in Patient Urine after Percutaneous Nephrostomy

Percutaneous nephrostomy (PN) is a urine diversion procedure using a tube, stent, or catheter. Knowledge of bacterial sensitivity to antibiotics can guide the establishment of an appropriate and safe treatment to reduce the incidence of percutaneous nephrostomy-related infection (PNCI). The purpose of this study was to determine the suitability of antibiotics medication based on the results of bacterial culture and bacterial sensitivity test. This study was a retrospective descriptive observational study on medical records of patient diagnosed with obstructive uropathy who underwent PN in the period January 2017 to December 2019. A total of 20 bacterial isolates were classified as gram-positive bacteria isolates (16.53%) and 101 isolates presented gram-negative bacteria (83.47%). The most frequent gram-negative bacteria identified in these isolates were E. coli (n=42), Pseudomonas aeruginosa (n=22), and Klebsiella pneumonia (n=20). Meanwhile, Staphylococcus aureus was seen in ten isolates with gram-positive bacteria. Vancomycin antibiotics had the best sensitivity to gram-positive bacteria based on the antibiotic sensitivity tests. On the other hand, meropenem and amikacin had the best sensitivity to gram-negative bacteria (83.2%). This study showed that the most common bacteria identified from nephrostomy patients is E. coli with meropenem and amikacin as the most sensitive antibiotic for these patients. Thus, antibiotic therapy before and after PN procedure should be considered wisely to prevent resistant PNCI

SENSITIVITY AND SPECIFICITY OF PROSTATIC BIOPSY RESULT BASED ON PROSTATE VOLUME

Objective: To compare the sensitivity and specificity of both types of prostate biopsies, between 6 core biopsy/sextant biopsy with volume based biopsy prostate. Material & method: The subjects were patients that have been performed prostate biopsy in Hasan Sadikin Hospital in 2006 – 2010. The data was divided into two groups, the group A (before 2009) 327 patients had performed 6 cores biopsy, group B (after 2009), the biopsy was performed based on prostate volume (volume < 40 cc : 8 cores, volume 40-60 cc : 10 coresand volume > 60 cc : 12 cores). Biopsy results confirmed by definitive results from surgery, then analyzed specificity and sensitivity between two groups. The analytical statistic test using unpaired T test and Levene’s test. Results: There were 654 patients divided in two groups. The data in both groups were similar based on analytical statistic test using unpaired t test (p = 0.28) and the data was in normal distribution (Levene’s test = p > 0.05). The group A, mean age 67.4 years, mean prostate volume 32.53 cc and mean PSA levels 29.89 ng/dl and at group B, mean age 66.7 years, mean prostate volume 30.89 cc and mean PSA levels 16.92 ng/dl. Volume based cores method in prostate biopsy have higher sensitivity and specificity compared with 6 core biopsy (97.5% vs 94.0%) and (92.2% vs 77.8%). Conclusion: The sensitivity and specificity of prostate biopsy was increased in volume based cores compared to 6 cores biopsy. Keywords: Prostate biopsy, volume based

Accuracy of Urine Cytology In Detecting Bladder Cancer

One of the most prevalent and deadly cancers in men is bladder cancer. To achieve the best possible outcome, physicians need to diagnose it promptly. The gold standard for diagnosis is tissue biopsy, but this method is invasive. There is another option for non-invasive diagnostic using urine cytology. The purpose of this study was to measure the accuracy of urine cytology in diagnosed bladder cancer patients. This study extracted data from patients medical records in a tertiary hospital in Indonesia from 2009–2019. The diagnostic accuracy was then compared between urine cytology and biopsy as the gold standard. Data on subjects’ baseline characteristics and diagnostic accuracy (sensitivity, specificity, PPV, and NPV) were collected. Results were then stratified according to the American Joint Committee on Cancer pathology staging for bladder cancer. Of 124 study subjects, male was more dominant (male,88% versus female, 12%) Seventy-five patients had a T1-tumor stage. Overall, the diagnostic accuracy was as follows:sensitivity, 47.8%; specificity, 90.9%; PPV, 98.2%; and NPV, 14.5%. High-grade tumors were shown to have a higher sensitivity. The highest accuracy was found in the MIBC grade T3, which was 90.68%. For diagnostic accuracy, urine cytology offered high specificity, but low sensitivity. The exploration of other markers is needed to establish a non-invasive but accurate method to diagnose bladder cancer

Five-Year Profiles of Prostate Cancer Patients in A Tertiary Hospital in Indonesia

Prostate cancer is a malignant disease of the urogenital system, which is the second most common cancer in men and one of the leading causes of death in male population. In Bandung City, Indonesia, no data are available regarding the profile of prostate cancer patients. This study aimed to determine the profile of prostate cancer patients treated at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, which is the tertiary hospital in the most populated province in Indonesia, during the period of 2015-2019. This was a a retrospective descriptive study on secondary data from medical records. Results showed that most prostate carcinoma patients were was 67.95 ± 8.946 years old with most of them (n=92, 81.4%) had a history of hypertension and 62 patients (54.9%) did not have any history of smoking. Most patients had 20-40 cc prostate volume with hard consistency and without nodules; a PSA level of > 20 ng/ml; and a gleason score of 8-10 or poorly differentitated. Age affected increased incidence of prostate carcinoma with the highes prostate volume (20-40cc). The  average PSA was 504.66 ± 10.26 and the median gleason score was 8 (6-10). The highest prostate volume is 20-40cc with hard consistency without nodule and the highest PSA value is > 20 ng/ml with a Gleason score of 8-10, showing a poorly differentiated condition

Characteristics of Non-Muscle Invasive Bladder Cancer (NMIBC) in Patients Treated in an Indonesian Tertiary Hospital from 2008 to 2019

Bladder cancer is the 10th most common cancer in both males and females with a ratio of 3:1. About 75% of bladder cancers are non-muscle invasive bladder cancers (NMIBC). The aim of this study was to identify the characteristics of Non-Muscle Invasive Bladder Cancer (NMIBC) patients treated in Dr. Hasan Sadikin General Hospital as one of the tertiary hospitals in Indonesia. This was a retrospective descriptive study that involved reviewing the medical records of patients diagnosed with NMIBC between January 2008 and December 2019. Characteristics reviewed were age, gender, body mass index (BMI), smoking history, urinary tract infection and stone history, intravesical chemotherapy and its side effects, and urinary cytology results. All data were tabulated and charted. Fifty-one out of 773 bladder cancer patients were diagnosed with NMIBC (6.59%). The mean age was 62.94 years old, with the majority of patients were in the 60-69 age group (31.37%). Males constituted the majority of the patients (n=44, 86.27%), with most patients had ideal BMI (66.66%), smoking history (72.54%), urinary tract infection history (56,86%), and urolithiasis history (5.88%). Thirty patients were given intravesical chemotherapy (58.82%), three patients experienced hematuria (10%), and four patients had painful urination (13.33%). Urinary cytology showed atypical cells (92.16%) in the majority of patients. The incidence of NMIBC in bladder cancer patients in our study was 6.59%, which differs from the incidence in developed countries of 75%, as shown in previous literature

TERAZOSIN EVALUATION AS MALE LUTS TREATMENT USING IPSS SUB-SCORING RATIO

Objective: To evaluate the improvement of Lower Urinary Tract Symptoms (LUTS) in males treated with terazosin based on sub scoring ratio of the International Prostatic Symptoms Score (IPSS). Material & Method: Sixty eight male with LUTS subjected to terazosin 1 mg daily and divided into two groups based on IPSS sub scoring ratio. After 3 months improvement of the symptoms were evaluated using the IPSS. Data analysis was done using paired T-test. The conclusion was based on significance level p<0,05. Results: The IPSS score was improving on both failure to void group (IPSS- v/s >1) and failure to store group (IPSS- v/s ≤1) after 3 months of Terazosin therapy (mean= 9,56 versus 6,94). Statistically superior improvement was observed on failure to voiding group (p=0,0003) (95CI:1,30-3,93). Conclusion: Terazosin is best given to male LUTS with IPSS- v/s >1 although both groups respond well.Keywords:International prostatic symptoms score, sub score, failure to voiding, failure to storage, male, lower urinary tract symptoms

A Ten-Year Study on Risk Factors of Orchiectomy in Testicular Torsion

Testicular torsion is a common urological emergency among children, peaking in neonates and pubertal age with an incidence rate of 3.8 in 100.000 (0.004%) annually. This study aimed to explore the characteristics of testicular torsion cases and risk factors for orchiectomy in testicular torsion patients. This was a retrospective study on medical records of patients diagnosed with testicular torsion underwent surgery at the urology department of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from January 2009 to August 2019. Patient characteristics including age, duration of symptom, location, etiology, and degree of torsion were analyzed. A total of 86 cases of testicular torsion were identified, with most cases (54 cases, 62.8%) occured at the mean age 14.67 ± 2.4 years old. Most patients (69 patients, 80.2 %) arrived more than six hours after the onset, and 65 (75.5%) and 4 (4.6%) of them underwent orchiectomy and orchidopexy, respectively. The remaining patients (17 patients, 19.8%) came less than 6 hours after the onset and only 8 (9.3%) and 9 (10.4%) underwent orchiectomy and orchidopexy, respectively. Both duration of torsion (p = 0.000, P<0.05) and degree of torsion (p = 0.006 , P<0.05) were significantly correlated with orchiectomy. In conclusion,  the risk factor for orchiectomy is strongly related to duration and degree of torsion. The chance for testis salvation increases if torsion happens before 4.5 hours and the degree of torsion is below 180 degrees. Prompt diagnosis and treatment is the only key to testicular salvation

Characteristics of Non-Muscle Invasive Bladder Cancer (NMIBC) in Patients Treated in an Indonesian Tertiary Hospital from 2008 to 2019

Bladder cancer is the 10th most common cancer in both males and females with a ratio of 3:1. About 75% of bladder cancers are non-muscle invasive bladder cancers (NMIBC). The aim of this study was to identify the characteristics of Non-Muscle Invasive Bladder Cancer (NMIBC) patients treated in Dr. Hasan Sadikin General Hospital as one of the tertiary hospitals in Indonesia. This was a retrospective descriptive study that involved reviewing the medical records of patients diagnosed with NMIBC between January 2008 and December 2019. Characteristics reviewed were age, gender, body mass index (BMI), smoking history, urinary tract infection and stone history, intravesical chemotherapy and its side effects, and urinary cytology results. All data were tabulated and charted. Fifty-one out of 773 bladder cancer patients were diagnosed with NMIBC (6.59%). The mean age was 62.94 years old, with the majority of patients were in the 60-69 age group (31.37%). Males constituted the majority of the patients (n=44, 86.27%), with most patients had ideal BMI (66.66%), smoking history (72.54%), urinary tract infection history (56,86%), and urolithiasis history (5.88%). Thirty patients were given intravesical chemotherapy (58.82%), three patients experienced hematuria (10%), and four patients had painful urination (13.33%). Urinary cytology showed atypical cells (92.16%) in the majority of patients. The incidence of NMIBC in bladder cancer patients in our study was 6.59%, which differs from the incidence in developed countries of 75%, as shown in previous literature