This paper evaluates the use of prostate-specific antigen (PSA) as a screening tool for prostate cancer. A current and contentious issue in both public and medical spheres, we are still lacking clear evidence and guidelines. Here, the Wilson and Jungner screening criteria are used as a framework to suggest that PSA-testing is not yet a proven tool for population screening. Additionally, the conflicting results of two recent randomised controlled trials are compared. The European Randomised trial of Screening for Prostate Cancer (ERSPC) found that PSA screening reduced prostate cancer-related deaths by 20% (adjusted p=0.04). Meanwhile the North American Prostate, Lung, Colon and Ovarian cancer trial (PLCO) found no significant impact of screening on mortality. The reasons for these differing outcomes are discussed in greater detail under the categories of methodology, study size, screening interval, cause of death and tumour demographics. The authors of this article conclude that PSA screening, at best, has a moderate impact on prostate cancer mortality. PSA-screening does, however, pose a high risk of over-diagnosis and over-treatment with its associated morbidity. Furthermore, economic and quality of life evaluations are lacking at present. Data are awaited from the UK Department of Health- funded ProtecT study,as well as longer-term outcomes of the ERSPC.
OBJECTIVES: To determine the effectiveness and safety of saturation biopsies for prostate cancer detection of and to identify predictive variables for cancer.METHODS: We conducted a retrospective transversal study in which we analyzed 144 saturation biopsies (January ‘06 - July ‘09). Inclusion criteria: at least two sets of biopsies without evidence of malignancy and Prostate Specific Antigen (PSA) levels >10ng/ml or PSA kinetics suggestive of malignancy (rate >0.75ng/ml/year) and patients with atypia in a previous biopsy.The variables analyzed were: age, abnormal digital rectal examination (DRE), total PSA, free/total PSA ratio, prostate volume, PSA density, previous histopathology, number of cylinders obtained and complications. Statistical analysis was performed using the Chi-square test, Student’s t-test and logistic regression.RESULTS: Mean age was 66 years (SD ± 6.4), mean total PSA 14.4 ng/ml (SD ± 12.6), mean free/total PSA ratio 0.09 (SD ± 0.09), mean prostate volume 61.6 cc (SD ± 27.4), mean PSA density 0.27 (SD ± 0.26) and mean number of cylinders obtained 30.45 (SD ± 3.8).We diagnosed 32% of the patients with prostatic adenocarcinoma. We observed PSA density was higher in the prostate cancer group, 0.39 (SD ± 0.36), compared to 0.21 (SD ± 0.18) in patients without cancer (p=0.003). Adenocarcinoma was found in 58% of the biopsies in patients with suspicious DRE, compared to 28% with normal DRE (p=0.009). Mean prostate volume in the prostate cancer group was 52.5 (SD ± 24.7) compared to 66.0 (SD ± 27.7) in the group without cancer (p=0.006). In the multivariate analysis, the PSA density (p=0.02; 95% CI 1.36 - 37.36) was the only variable that independently predicted the presence of adenocarcinoma. No statistically significant differences were found in either univariate or multivariate analysis for the remaining variables analyzed. The incidence of complications was similar to that described in the literature for other series.CONCLUSIONS: Saturation biopsy is safe and effective for detection of prostate cancer. PSA density was the only factor that was shown to be independent predictive variable for tumor diagnosis.
OBJECTIVES: The increased incidence of transitional cell carcinoma (TCC) of the bladder in men is known, generally attributed to greater exposure to the effect carcinogenic products. Although it has been reported that cancer-specific outcome can be particularly adverse in women due to socioeconomic or biological factors, clinical-pathological differences of TCC at the time of diagnosis have not been sufficiently studied. The aim of this study is to analyze whether there are genderrelated differences in grade and tumor stage in primary bladder TCC.METHODS: All consecutive primary bladder TCC diagnoses made in our institution between 1990 and 2009 have been included. We retrospectively analyzed age, smoking, symptoms at presentation, tumor grade (WHO 1973), tumor size and number, and TNM stage, comparing men and women. Statistical analysis was conducted using the Mann-Whitney U test as non-parametric test and Chi-squared test to compare frequencies.RESULTS : We analyzed 1196 patients (992 males and 204 females) with a 5:1 ratio. We found significant differences in age (69 years vs. 73 years), smoking (46.5% vs. 11.2%) and muscle-invasive stage (12.1% vs. 18.1%). Correcting by tobacco consumption, neversmoker women have larger and more aggressive tumors with a frequency of muscle-invasive disease three times higher than male never-smokers and equaling to male current-smokers.CONCLUSION: TCC of the bladder is more frequent in males than females. In this series, women are older at the time of diagnosis and most often affected by muscle-invasive disease particularly in never-smokers. We need studies to analyze the potential impact of passive smoking to justify these results.
OBJECTIVES: The aim of the study is to compare the use of PSA testing among general practitioners (GPs).METHODS: The number of PSA tests ordered by general practitioners in the years 2008-2009 was examined in a cross-sectional study of nine health districts of Spain. The percentage of PSA ordered to men younger than 50 (PSA< 50/PSAtotal) and 40 years (PSA< 40/PSAtotal) was calculated. The percentage of men over 50 years who were attended was also calculated and this data was compared with the number of PSA ordered to this population. For two of the departments, these data were also compared between GPs and urologists.RESULTS: PSA testing in 2009 is higher than 2008 in seven health districts. PSA testing in men younger than 50 years was increased along the period of the study and in men younger than 40 years remained steady. The differences between the values of the indicators for urologists and GPs are significant.CONCLUSIONS: The number of PSA tests and the percentage performed to men younger 50 years has been increasing and the variability is high. These data are suggestive for interventions focused on PSA testing and prostate cancer screening in primary care settings.
Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself.In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success.OBJECTIVES: To update and review, according to recent literature, the evaluation of renal transplant candidates.METHODS: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant.RESULTS: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up.Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution.Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation.CONCLUSION: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations.Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients` specific conditions, by a multidisciplinary approach before proceeding to transplantation.
OBJECTIVE: Retrocaval ureter is a rare disease which is due to a abnormal development of the inferior cava vein. It usually presents with ureteral obstruction, and surgery is needed for symptomatic cases.METHOD: We present a case of retrocaval ureter and a revision of the literature.RESULTS: A 9 year-old boy who had consulted for macroscopic hematuria. The intravenous urography (IVU) suggested the diagnosis of retrocaval right ureter, which is confirmed by magnetic resonance imaging (MRI). Make us resection of the retrocaval segment and relocation of the ureter anterior to the inferior vena cava. Follow-up IVU showed good resolution of hydronephrosis.CONCLUSIONS: Retrocaval ureter is a rare disease, with easy diagnostic and effective treatment. Other associated anomalies could be associated.
OBJECTIVE: To report a new case of bladder hernia. We reviewed the clinical features, diagnosis and treatment of this disease.METHODS: Case report of a patient diagnosed with bladder hernia.RESULTS: We expose the clinical picture and the most common form of diagnosis and the more effective treatment.CONCLUSIONS: Bladder hernia is rare disorder that is diagnosed clinically and whose treatment is surgical, with very good results.
OBJECTIVE: We present a case of X-Y translocation with male phenotype (46,XX testicular disorder of sex development) and review the literature.METHODS: Disorders of sex development with mismatch of genetic, gonadal and phenotypic sex are quite rare, and some are due to genetic or chromosomal abnormalities. The karyotype was investigated by a cytogenetic study of peripheral blood (phytohemagglutinin-stimulated lymphocyte culture over 72 hours). G-banding analysis of 25 metaphases showed a 46,XX chromosome constitution (46 chromosomes with XX sexual composition). Fluorescence in situ hybridization (FISH) analysis with probes for X centromeres and the sex-determining region of the Y chromosome (SRY) (testis-determining factor gene) showed two X chromosomes. The analysis also showed the SRY signal in the telomeric region of the short arm of one of the chromosomes.RESULTS: In recent years, a number of other genes involved in disorders of sex development in animals and humans have also been identified.Genetic defects in the peptide hormone receptors, members of the steroid receptor superfamily, and other transcription factors, as well as any of a series of enzymes and cofactors involved in steroid biosynthesis can cause abnormal determination and differentiation.CONCLUSIONS: Although chromosomal abnormalities are rarely present in patients with apparently normal external genitalia, they should be considered in urology consultations by adolescents and adults, particularly in the investigation of gynecomastia or infertility.
OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate.METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection.CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation.