PURPOSE: The aim of this study was to analyze the prognostic significance of pre- and post-treatment serum prostate-specific antigen (PSA) level, together with a variety of other clinicopathological parameters, in patients with metastatic prostate cancer receiving maximal androgen blockade (MAB). MATERIALS AND METHODS: The PSA levels before and during MAB, together with various clinicopathological parameters, were measured in 65 patients with newly diagnosed metastatic prostate cancer. The prognostic significance of these parameters, including the PSA level two and six months after MAB (PSA2MO and PSA6MO), a 50% reduction in the pretreatment PSA level after MAB (PSA50), the extent of disease (EOD), performance state, Gleason score and pretreatment hemoglobin, were analyzed by both univariate and multivariate tests. RESULTS: Of the forty-nine patients with a pretreatment PSA level of > or =50ng/ml, twenty-four (24/49, 48.9%) showed normalized (< or =4ng/ml) PSA2MO, and three of these (3/24, 12.5%) died of metastatic prostate cancer. Twenty-five patients (25/49, 51.1%) showed no normalization of the PSA2MO, and sixteen of these (16/25, 64%) died of metastatic prostate cancer. Of the patients with a pretreatment PSA level > or =50ng/ml, patients with a normalized PSA2MO showed a higher survival rate than those with a non-normalized PSA2MO from the univariate analysis using the Log-Rank test (p=0.0001), and PSA2MO was revealed as the most useful prognostic factor (p=0.022) from the multivariate analysis using the Cox proportional hazards regression model. CONCLUSIONS: A normalized (< or =4ng/ml) PSA level 2 months after MAB (PSA2MO) in metastatic prostate carcinoma was found to be the most useful prognostic factor in metastatic prostate cancer patients with a pretreatment PSA level of > or =50ng/ml.
Androgen Antagonists ; Humans ; Multivariate Analysis ; Neoplasm Grading ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Survival Rate

PURPOSE: The purpose of this study was to investigate the value of hypoechoic lesions on transrectal ultrasound (TRUS) as a prognostic factor for patients with localized prostate cancer. MATERIALS AND METHODS: The patients consisted of 71 patients with pT2N0M0 disease following radical prostatectomy between 2002 and 2008. The group with hypoechoic lesions was labeled group 1, whereas the group without hypoechoic lesions was labeled group 2. The presence of hypoechoic lesions on preoperative TRUS was analyzed as a prognostic factor along with several parameters, including preoperative factors and pathologic factors. The biochemical progression-free survival (BPFS) rate was compared between the two groups according to the presence of hypoechoic lesions on TRUS. RESULTS: A total of 35 patients had hypoechoic lesions on TRUS, whereas 36 had no hypoechoic lesions. Preoperative baseline characteristics were not significantly different between the two groups. In the univariate analysis, BPFS showed significant differences according to the presence of hypoechoic lesions on TRUS and the preoperative prostate-specific antigen level. The BPFS rates over the first 24 months were 97.0% in group 1 and 97.1% in group 2; however, the difference in the BPFS rate over 48 months significantly widened to 75.3% compared with 91.7%, respectively. Despite this finding, no significant independent prognostic factor for BPFS was found on multivariate analysis in this patient cohort. CONCLUSIONS: The presence of hypoechoic lesions on TRUS may suggest worse prognostic characteristics in pT2 prostate cancer. Further studies involving larger subject populations are needed to corroborate the significance of the presence of hypoechoic lesions as a prognostic factor.
Disease-Free Survival ; Humans ; Multivariate Analysis ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms

PURPOSE: Pretreatment knowledge of prostate gland histology may help to select medical therapy for men with benign prostatic hyperplasia(BPH). Our objective was to determine whether prostate-specific antigen density(PSAD) correlated to the relative amount of epithelium in BPH tissue. MATERIALS AND METHODS: We evaluated 32 men with pathologically proven BPH who underwent transurethral resection of the prostate. All clinical findings which were age, symptom scores, maximal flow rate, total serum PSA, PSAD, prostate volume, transitional zone volume, transitional zone ratio were correlated with mean epithelial score(MES), which measures semi-quantitatively to represent the relative amount of epithelium in the resected BPH tissues. RESULTS: Prostatic size, serum PSA and PSAD showed significant correlation with MES in univariate analysis, but multivariate analysis showed that only PSAD was statistically significant(p<0.05). CONCLUSIONS: These data suggest that PSAD be related to the histological composition of the prostate in men with BPH. Therefore it might be useful as an evaluation to direct BPH therapy.
Epithelium ; Humans ; Male ; Multivariate Analysis ; Prostate ; Prostate-Specific Antigen* ; Prostatic Hyperplasia*

PURPOSE: The objective was to investigate the clinicopathological characteristics and the prognosis of prostate cancer patients affected by other primary malignancies. MATERIALS AND METHODS: From 1990 to 2008, we retrospectively reviewed the medical records of 1,317 patients who underwent radical prostatectomy (RP) for prostate cancer. We assessed the effect of other primary malignancies on clinicopathological features, biochemical recurrence (BCR)-free survival, cancer-specific survival (CSS), and overall survival (OS). RESULTS: Of 1,317 patients, at least one additional other primary malignancy was detected in 187 patients (14.2%). A comparison of patient groups according to the presence or absence of other primary malignancies showed no significant differences in preoperative serum prostate-specific antigen concentrations, pathological Gleason scores, or pathological staging. Prostate cancer patients with other primary malignancies were older than patients without other primary malignancies (p<0.001). No significant differences in 5-year BCR-free survival (80.2% compared with 77.7%; p=0.656) or CSS (98.9% compared with 98.5%; p=0.733) were found between these groups, respectively. Five-year OS was significantly lower in prostate cancer patients with than in those without other primary malignancies (89.3% compared with 95.4%; p<0.001). Multivariate analysis showed that other primary malignancies diagnosed after RP for prostate cancer were independent predictors of OS (hazard ratio, 4.10; p<0.001) but not of BCR-free survival or CSS. Conversely, other primary malignancies diagnosed before RP for prostate cancer did not independently predict BCR-free survival, OS, or CSS. CONCLUSIONS: Prostate cancer prognosis after RP is not dependent on the presence or absence of other primary malignancies. However, other primary malignancies diagnosed after RP for prostate cancer negatively affect OS.
Humans ; Medical Records ; Multivariate Analysis ; Prognosis* ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Recurrence ; Retrospective Studies

PURPOSE: To determine the efficacy of cognitive targeted prostate biopsy using biparametric magnetic resonance imaging (b-MRI) for patients with prostate-specific antigen levels under 10 ng/mL. MATERIALS AND METHODS: We reviewed data from 123 consecutive patients who underwent cognitive targeted prostate biopsy using prostate MRI. Of these patients, the first 55 underwent prostate biopsy using multiparametric MRI (mp-MRI), and the remaining 68 underwent prostate biopsy using b-MRI. For b-MRI, we generated T2 weighted axial imaging and diffusion-weighted imaging sequences. We found that 62 of the 123 men had suspicious lesions on MRI (32 of the 55 men in the mp-MRI group and 30 of the 68 men in the b-MRI group). We compared the prostate cancer detection rates and the proportions of clinically significant prostate cancer between the different MRI sequences. RESULTS: Between the two MRI groups, there were no statistically significant differences in prostate cancer detection rate and proportions of clinically significant prostate cancer (41.8% vs. 30.9%, p=0.208 and 82.6% vs. 76.2%, p=0.598). Among the 62 men who had suspicious lesions on MRI, the prostate cancer detection rates were 62.5% and 63.3% (p=0.709) in the mp-MRI and b-MRI groups, respectively, and the proportions of clinically significant prostate cancer were 95.0% and 84.2% (p=0.267). CONCLUSION: Prostate biopsy using b-MRI showed similar performance to that using mp-MRI for detecting prostate cancer and clinically significant prostate cancer. Considering the satisfactory performance and cost effectiveness of b-MRI, this technique could be a good option for obtaining intraprostatic information for first round prostate biopsy.
Biopsy* ; Cost-Benefit Analysis ; Humans ; Magnetic Resonance Imaging* ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms

PURPOSE: The factors that predict prostate cancer detection on repeat biopsy were evaluated in patients with atypical small acinar proliferation (ASAP) on the initial biopsy. MATERIALS AND METHODS: From 2003 to 2008, 3,130 men with suspected prostate cancer underwent a prostate needle biopsy, and 244 (7.8%) were diagnosed as having ASAP. One hundred seventy of 244 patients were rebiopsied at least once more. They were classified into a prostate cancer group and a noncancer group according to the final pathological diagnosis. The database of rebiopsied patients included age, initial prostate-specific antigen (PSA), PSA density (PSAD), PSA velocity (PSAV), total prostate volume (TPV), and transitional zone volume of the prostate (TZV). We compared differences in the aforementioned parameters between the 2 groups. RESULTS: A total of 57 patients (33.5%) with ASAP were ultimately shown to have prostate cancer. Univariate analysis showed that PSAD (p=0.002), PSAV (p=0.001), TPV (p=0.035), and TZV (p=0.005) differed significantly between the cancer and noncancer groups. The results of the multivariate analysis showed that PSAD (p=0.022), PSAV (p<0.001), and TPV (p=0.037) had a statistically significant correlation with cancer detection. CONCLUSIONS: PSAD, PSAV, and TPV are predictive factors of prostate cancer in patients with an initial diagnosis of ASAP of the prostate. Although repeat biopsy is mandatory irrespective of PSA values, the follow-up of PSA may help to estimate the probability of cancer in these men.
Biopsy ; Biopsy, Needle ; Follow-Up Studies ; Humans ; Male ; Multivariate Analysis ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms

PURPOSE: Prostate specific antigen(PSA) is present in a 10(6)-fold higher concentration in semen than in plasma, but serum PSA is elevated during inflammatory conditions such as chronic prostatitis. We evaluated the seminal PSA and its effect on sperm motility in inflammatory chronic nonbacterial prostatitis/chronic pelvic pain syndrome(CPPS). MATERIALS AND METHODS: Twenty-three patients with inflammatory CPPS(group P) and 11 normal controls(group NL) were enrolled in this study. The semen analysis was performed with a computerized analyzer, and seminal PSA was measured twice using a ELSA-PSA2 radioimmunometric kit(Cis Biointernational). We compared the result in groups P and NL. The subjects were then re-sorted into two groups according to the seminal PSA concentration, with 3.0 mg/ml as the cutoff value, and sperm motility was compared for the high- and low-PSA groups. Statistical significance was measured using the unpaired t-test. RESULTS: The average concentrations of seminal PSA in groups P and NL were 3.67 mg/ml and 1.79 mg/ml, respectively(p=0.048). Sperm motility was not different in the two groups. However, motility(straight-line velocity and average path velocity) was lower in the patients with high seminal PSA(p<0.05). CONCLUSIONS: Inflammatory chronic non-bacterial prostatitis increases the seminal secretion of PSA, and high seminal PSA is correlated with decreased sperm motility.
Humans ; Pelvic Pain* ; Plasma ; Prostate ; Prostate-Specific Antigen ; Prostatitis ; Semen ; Semen Analysis ; Sperm Motility* ; Spermatozoa*

This study explored a new model of Prostate Imaging Reporting and Data System (PIRADS) and adjusted prostate-specific antigen density of peripheral zone (aPSADPZ) for predicting the occurrence of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The demographic and clinical characteristics of 853 patients were recorded. Prostate-specific antigen (PSA), PSA density (PSAD), PSAD of peripheral zone (PSADPZ), aPSADPZ, and peripheral zone volume ratio (PZ-ratio) were calculated and subjected to receiver operating characteristic (ROC) curve analysis. The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve (AUC). The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves. The AUCs of PSA, PSAD, PSADPZ, aPSADPZ, and PZ-ratio were 0.669, 0.762, 0.659, 0.812, and 0.748 for PCa diagnosis, while 0.713, 0.788, 0.694, 0.828, and 0.735 for csPCa diagnosis, respectively. All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa. The new model significantly improved the diagnostic accuracy of PCa (0.945 vs 0.830, P < 0.01) and csPCa (0.937 vs 0.845, P < 0.01) compared with the base model. In addition, the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold. This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators. Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.
Male ; Humans ; Prostate/pathology* ; Prostate-Specific Antigen/analysis* ; Prostatic Neoplasms/diagnostic imaging* ; Biopsy ; Nomograms ; Retrospective Studies

Aged ; Humans ; Kallikreins ; analysis ; Male ; Middle Aged ; Prognosis ; Prostate-Specific Antigen ; analysis ; Prostatic Neoplasms ; diagnosis

Biomarkers, Tumor ; analysis ; Humans ; Male ; Prostate-Specific Antigen ; analysis ; Prostatic Neoplasms ; metabolism