Интегральная оценка параметров повторной трансректальной мультифокальной биопсии в диагностике рака предстательной железы

Materials and Methods. The results of transrectal multifocal prostatic rebiopsy made under ultrasound guidance at the Clinic of Urology, Military Medical Academy, in 1998 to 2004 were studied.A total of 2352 males were examined; of them, 125 patients underwent rebiopsy. The patients’ age was 54 to 87 years (mean age 60.3 years). The patients were divided into 4 age groups: 1) 51-60 years [11% (14/125)]; 2) 61-70 years [47% (59/125)]; 3) 71-80 years [35% (44/125)]; 4) > 81 years [0.3% (4/125)]. There were 6 to 14 biopsy probes.Results. The study showed that rebiopsy of the prostate identified its cancer in 23% of the patients having a negative primary histological result. It was also established that the patients in whom primary biopsy revealed prostatic intraepithelial neoplasia (PIN) and/or an increase in PSA of > 0.75 ng/ml per year and its density > 0.15 ng/ml/cm3 should be referred to a repeated histological study within 6 to 12 months. When these rules were observed, there were the most favorable prognostic signs: no capsular invasion, lower Glisson scores, and none metastasis.Conclusion. The study has provided the following indications for rebiopsy:— a continually elevating PSA level or its preservation after primary negative biopsy;— abnormal findings on rectal examination and transrectal ultrasound study;— high-grade PIN in the prior biopsy specimen.

Возможности применения новых диагностических индексов при выявлении рака предстательной железы

Introduction and Objectives. The low specificity of PSA for the early diagnosis of prostate cancer was a reason for elaboration of new diagnostic methods. The aim of the study was to create novel diagnostic indices of random mathematic combinations of numeric clinical patient parameters and to estimate these values as a diagnostic tool for the detection of prostate cancer.Material and Methods. A total of 326 male patients aged 47—83 years (mean age was 65.56.5 years) who had undergone TRUS-guided 12-core systematic transrectal prostate biopsy were included in the study. The detection rate of prostate cancer was 43,6%. To compare the accuracy of the diagnostic indices, receiver-operator characteristic (ROC) curves were plotted for any of the indices and the areas under ROC curves were calculated. Age, prostate volume, transition zone volume, peripheral and central zone volume, concentration of PSA, and biopsy result were recorded in the patients.Results. A total of 37 indices were generated. The maximal accuracy equal to 0,664 was in «PSA Density in Transition Zone (PSAD-TZ) × Age». «PSAD × Age» and «PSAD-TZ» with an accuracy equal to 0,656 and 0,655 were on 2nd and 3rd rank positions, respectively. PSA with an accuracy of 0,583 was on 31st rank position only. With 90% specificity, the sensitivity of «PSAD × Age», «PSAD-TZ × Age», and «PSA» were 24, 22, and 19%, respectively. With 80% specificity, the sensitivity of «PSAD-TZ × Age», «PSAD × Age», and «PSA» were 47, 40, and 30%, respectively. With 90% sensitivity, there were no differences in the reduction in unnecessary biopsies. At the same time, with 80% sensitivity, «PSAD-TZ*Age» showed a 17% reduction in unnecessary biopsies as compared with «PSA» (р = 0,001).Conclusions. The indices «PSAD-TZ × Age» and «PSAD × Age» may be used in counseling patients with suspected prostate cancer. Further multicenter studies may be required to evaluate the effectiveness of the novel indices widely used in clinical practice.

Зомета в терапии рака предстательной железы с метастатическим поражением костей на фоне андрогенной депривации (результаты Российского многоцентрового исследования)

Introduction: Hormonal therapy is the method of choice in treating disseminated prostate cancer. Chronic androgenic suppression causes a reduction in bone mineral density. The most common complications of bone metastases are pathological fractures, spinal cord compression, pain, etc.Methods: A multicenter study (11 clinics of Russia) assessing the efficacy of Zometa in preventing skeletal complications of bone metastases was conducted in 2004—2005. Zometa was administered intravenously at a dose of 4 mg every 3Р4 weeks with androgenic deprivation. Its objective effect was evaluated in 70 patients. Changes in bone mineral density were evaluated by densitometry.Results: Complete pain relief was achieved in 73% of the patients; after therapy 86% of the patients had 0—1 WHO activity status score, 97% of the patients had no bone complications. The level of bone resorption marker β-Cross-Laps decreased to the normal values in 51% of the patients.Conclusion: The study has provided an evidence of the efficacy of Zometa and the necessity of using this drug in complex therapy for bone metastases of prostate cancer.Introduction: Hormonal therapy is the method of choice in treating disseminated prostate cancer. Chronic androgenic suppression causes a reduction in bone mineral density. The most common complications of bone metastases are pathological fractures, spinal cord compression, pain, etc.Methods: A multicenter study (11 clinics of Russia) assessing the efficacy of Zometa in preventing skeletal complications of bone metastases was conducted in 2004—2005. Zometa was administered intravenously at a dose of 4 mg every 3Р4 weeks with androgenic deprivation. Its objective effect was evaluated in 70 patients. Changes in bone mineral density were evaluated by densitometry.Results: Complete pain relief was achieved in 73% of the patients; after therapy 86% of the patients had 0—1 WHO activity status score, 97% of the patients had no bone complications. The level of bone resorption marker β-Cross-Laps decreased to the normal values in 51% of the patients.Conclusion: The study has provided an evidence of the efficacy of Zometa and the necessity of using this drug in complex therapy for bone metastases of prostate cancer

The informative value of preoperative prostate-specific antigen in determination of the likelihood of recurrent prostate cancer after radical prostatectomy

Materials and Methods. The results of examination and treatment of 163 males who had undergone radical retropubic prostatectomy (RRP) with bilateral pelvic lymphadenectomy for clinically locally advanced prostate cancer (PC) (T1aN0M0-to-cT2bN0M0) were studied. The patients’ mean age was 63.5 years and ranged from 41 to 74 years. After RRP, the duration of a follow-up averaged 46.6±2.7 months and ranged from 24 to 81 months. Digital rectal study, determination of serum prostate-specific antigen (PSA) and its density, transrectal multifocal prostate biopsy under ultrasound guidance, and, if required (PSA more than 20 ng/ml or a total of above 7 Glisson scores), computed tomography and scintigraphy of skeletal bones were performed in all the patients. The postoperative examination involved postmortem examination and measurement of serum PSA levels over time.Results. The study has revealed that there is an clear tendency for an increase in the frequency of other poor signs with elevated preoperative PSA levels.Conclusion. The findings have indicated that there is a direct and statistically significant correlation between the preoperative values of total PSA, its density, and the possible outcomes of RRP

Integral estimate of the parameters of transrectal multifocal rebiopsy in the diagnosis of prostate cancer

Materials and Methods. The results of transrectal multifocal prostatic rebiopsy made under ultrasound guidance at the Clinic of Urology, Military Medical Academy, in 1998 to 2004 were studied.A total of 2352 males were examined; of them, 125 patients underwent rebiopsy. The patients’ age was 54 to 87 years (mean age 60.3 years). The patients were divided into 4 age groups: 1) 51-60 years [11% (14/125)]; 2) 61-70 years [47% (59/125)]; 3) 71-80 years [35% (44/125)]; 4) > 81 years [0.3% (4/125)]. There were 6 to 14 biopsy probes.Results. The study showed that rebiopsy of the prostate identified its cancer in 23% of the patients having a negative primary histological result. It was also established that the patients in whom primary biopsy revealed prostatic intraepithelial neoplasia (PIN) and/or an increase in PSA of > 0.75 ng/ml per year and its density > 0.15 ng/ml/cm3 should be referred to a repeated histological study within 6 to 12 months. When these rules were observed, there were the most favorable prognostic signs: no capsular invasion, lower Glisson scores, and none metastasis.Conclusion. The study has provided the following indications for rebiopsy:— a continually elevating PSA level or its preservation after primary negative biopsy;— abnormal findings on rectal examination and transrectal ultrasound study;— high-grade PIN in the prior biopsy specimen

Possibilities of using novel diagnostic indices to detect prostate cancer

Introduction and Objectives. The low specificity of PSA for the early diagnosis of prostate cancer was a reason for elaboration of new diagnostic methods. The aim of the study was to create novel diagnostic indices of random mathematic combinations of numeric clinical patient parameters and to estimate these values as a diagnostic tool for the detection of prostate cancer.Material and Methods. A total of 326 male patients aged 47—83 years (mean age was 65.56.5 years) who had undergone TRUS-guided 12-core systematic transrectal prostate biopsy were included in the study. The detection rate of prostate cancer was 43,6%. To compare the accuracy of the diagnostic indices, receiver-operator characteristic (ROC) curves were plotted for any of the indices and the areas under ROC curves were calculated. Age, prostate volume, transition zone volume, peripheral and central zone volume, concentration of PSA, and biopsy result were recorded in the patients.Results. A total of 37 indices were generated. The maximal accuracy equal to 0,664 was in «PSA Density in Transition Zone (PSAD-TZ) × Age». «PSAD × Age» and «PSAD-TZ» with an accuracy equal to 0,656 and 0,655 were on 2nd and 3rd rank positions, respectively. PSA with an accuracy of 0,583 was on 31st rank position only. With 90% specificity, the sensitivity of «PSAD × Age», «PSAD-TZ × Age», and «PSA» were 24, 22, and 19%, respectively. With 80% specificity, the sensitivity of «PSAD-TZ × Age», «PSAD × Age», and «PSA» were 47, 40, and 30%, respectively. With 90% sensitivity, there were no differences in the reduction in unnecessary biopsies. At the same time, with 80% sensitivity, «PSAD-TZ*Age» showed a 17% reduction in unnecessary biopsies as compared with «PSA» (р = 0,001).Conclusions. The indices «PSAD-TZ × Age» and «PSAD × Age» may be used in counseling patients with suspected prostate cancer. Further multicenter studies may be required to evaluate the effectiveness of the novel indices widely used in clinical practice

Zometa in therapy for bone metastases of prostate cancer during androgenic deprivation (Results of Russian multicenter study)

Introduction: Hormonal therapy is the method of choice in treating disseminated prostate cancer. Chronic androgenic suppression causes a reduction in bone mineral density. The most common complications of bone metastases are pathological fractures, spinal cord compression, pain, etc.Methods: A multicenter study (11 clinics of Russia) assessing the efficacy of Zometa in preventing skeletal complications of bone metastases was conducted in 2004—2005. Zometa was administered intravenously at a dose of 4 mg every 3Р4 weeks with androgenic deprivation. Its objective effect was evaluated in 70 patients. Changes in bone mineral density were evaluated by densitometry.Results: Complete pain relief was achieved in 73% of the patients; after therapy 86% of the patients had 0—1 WHO activity status score, 97% of the patients had no bone complications. The level of bone resorption marker β-Cross-Laps decreased to the normal values in 51% of the patients.Conclusion: The study has provided an evidence of the efficacy of Zometa and the necessity of using this drug in complex therapy for bone metastases of prostate cancer