Suchergebnisse

Prostate cancer is the most frequent malignant disease in men in United States, Western Europe and in Lithuania. Due to ageing population incidence of prostate cancer will rise even more in the future. Since the year 2003 prostate cancer became the most common form of cancer diagnosed in men in Lithuania (more than 1500 new prostate cancer cases a year). There were 2005 of new prostate cancer cases diagnosed in the year 2005. According to Lithuanian Cancer Registry data during the years 1995-2005 the prevalence of prostate cancer was increasing 14.5 percent annually. Prostate cancer was detected in 24.3 percent of all cancer cases in men in the year 2005 in Lithuania and in 48.3 percent of them disease was detected in the stages I and II. In the year 2005 the prevalence of prostate cancer in Lithuanian men was 125.9 per 100000 population and mortality was 31 per 100000 population. Prostate cancer is a second common form of death after lung cancer in cancer-associated mortality group in Lithuania. Prostate cancer mortality ranged between 19 and 55 per 100000 in Europe and it was 23.2 per 100000 populations in the year 2006 in European Union. Many authors stress that it is important to diagnose prostate cancer in the early stages in order to reduce prostate cancer mortality rate. The aim of the study was to optimize investigation and follow-up of the high prostate cancer risk patients, and to define the relation between prostate cancer risk factors and prostate cancer detection. The objectives of study: 1. To estimate the rate of prostate cancer detection by the first and repeat laterally directed sextant transrectal ultrasound guided prostate biopsies, and to evaluate efficacy of repeat laterally directed sextant prostate biopsies. 2. To evaluate the influence of age, smoking, alcohol use, obesity, elevated cholesterol and prostate cancer history in relatives for prostate cancer detection in high risk patients. 3. To analyze the relevance of PSA, digital rectal examination and transrectal ultrasound examination for prostate cancer detection in high risk patients. 4. To evaluate the importance of prostate volume and transition zone prostate volume for prostate cancer detection in high risk patients. To estimate the relevance of transition zone index (TZI) and to detect TZI cutoff value for prostate cancer detection. 5. To predict the development of prostate cancer using free and total PSA, free/total PSA ratio, PSA density, transition zone PSA density. 6. To optimize indications and frequency for repeat biopsies in high prostate cancer risk patients. Prospective study was performed in Urology department of Kaunas University of Medicine during the years of 2003-2007. 195 men with high risk (elevated prostate specific antigen test (PSA >4 ng/ml) and/or pathological digital rectal examination) for prostate cancer were included into the study. The patients were followed up to 4 years. Conclusions: 1. We detected prostate cancer in 30.3% of patients after the first, 13.1% after the second, 10.3% after the third and 7.7% after the fourth laterally directed sextant transrectal ultrasound guided prostate biopsy. Of all prostate cancer cases detected in our study 78.7 percent were found after the first biopsy. After the second biopsy we found additional 14.6% of cancer cases and together with the first biopsy detected 93.3% of all prostate cancers. 2. The patients with prostate cancer had more malignant diseases in the past than benign prostate hyperplasia group. Patient's age, smoking, alcohol use, familial cancer anamnesis, obesity and elevated cholesterol concentration did not differ between cancer and benign groups. 3. PSA test and digital rectal examination are important in suspecting prostate cancer. Transrectal ultrasound test allows to evaluate prostate volume, transition zone prostate volume and to calculate secondary values (PSA density, transition zone PSA density, transition zone index) which enable to determine indications for repeat prostate biopsies. 4. Prostate volume and transition zone prostate volume were significantly smaller in prostate cancer group as compared to benign group. Patients with benign prostate hyperplasia had statistically significant increment of prostate volume and transition zone prostate volume with every subsequent biopsy. Transition zone index was also lower in prostate cancer group as compared to benign. We estimated a cutoff value of transition zone index for prostate cancer detection: transition zone index 0.17 ng/ml/cm3 increased prostate cancer detection risk by 5 fold, free/total PSA ratio 0.17 ng/ml/cm3 and transition zone index 0.17 ng/ml/cm3.

Prostate cancer is the most frequent malignant disease in men in United States, Western Europe and in Lithuania. Due to ageing population incidence of prostate cancer will rise even more in the future. Since the year 2003 prostate cancer became the most common form of cancer diagnosed in men in Lithuania (more than 1500 new prostate cancer cases a year). There were 2005 of new prostate cancer cases diagnosed in the year 2005. According to Lithuanian Cancer Registry data during the years 1995-2005 the prevalence of prostate cancer was increasing 14.5 percent annually. Prostate cancer was detected in 24.3 percent of all cancer cases in men in the year 2005 in Lithuania and in 48.3 percent of them disease was detected in the stages I and II. In the year 2005 the prevalence of prostate cancer in Lithuanian men was 125.9 per 100000 population and mortality was 31 per 100000 population. Prostate cancer is a second common form of death after lung cancer in cancer-associated mortality group in Lithuania. Prostate cancer mortality ranged between 19 and 55 per 100000 in Europe and it was 23.2 per 100000 populations in the year 2006 in European Union. Many authors stress that it is important to diagnose prostate cancer in the early stages in order to reduce prostate cancer mortality rate. The aim of the study was to optimize investigation and follow-up of the high prostate cancer risk patients, and to define the relation between prostate cancer risk factors and prostate cancer detection. The objectives of study: 1. To estimate the rate of prostate cancer detection by the first and repeat laterally directed sextant transrectal ultrasound guided prostate biopsies, and to evaluate efficacy of repeat laterally directed sextant prostate biopsies. 2. To evaluate the influence of age, smoking, alcohol use, obesity, elevated cholesterol and prostate cancer history in relatives for prostate cancer detection in high risk patients. 3. To analyze the relevance of PSA, digital rectal examination and transrectal ultrasound examination for prostate cancer detection in high risk patients. 4. To evaluate the importance of prostate volume and transition zone prostate volume for prostate cancer detection in high risk patients. To estimate the relevance of transition zone index (TZI) and to detect TZI cutoff value for prostate cancer detection. 5. To predict the development of prostate cancer using free and total PSA, free/total PSA ratio, PSA density, transition zone PSA density. 6. To optimize indications and frequency for repeat biopsies in high prostate cancer risk patients. Prospective study was performed in Urology department of Kaunas University of Medicine during the years of 2003-2007. 195 men with high risk (elevated prostate specific antigen test (PSA >4 ng/ml) and/or pathological digital rectal examination) for prostate cancer were included into the study. The patients were followed up to 4 years. Conclusions: 1. We detected prostate cancer in 30.3% of patients after the first, 13.1% after the second, 10.3% after the third and 7.7% after the fourth laterally directed sextant transrectal ultrasound guided prostate biopsy. Of all prostate cancer cases detected in our study 78.7 percent were found after the first biopsy. After the second biopsy we found additional 14.6% of cancer cases and together with the first biopsy detected 93.3% of all prostate cancers. 2. The patients with prostate cancer had more malignant diseases in the past than benign prostate hyperplasia group. Patient's age, smoking, alcohol use, familial cancer anamnesis, obesity and elevated cholesterol concentration did not differ between cancer and benign groups. 3. PSA test and digital rectal examination are important in suspecting prostate cancer. Transrectal ultrasound test allows to evaluate prostate volume, transition zone prostate volume and to calculate secondary values (PSA density, transition zone PSA density, transition zone index) which enable to determine indications for repeat prostate biopsies. 4. Prostate volume and transition zone prostate volume were significantly smaller in prostate cancer group as compared to benign group. Patients with benign prostate hyperplasia had statistically significant increment of prostate volume and transition zone prostate volume with every subsequent biopsy. Transition zone index was also lower in prostate cancer group as compared to benign. We estimated a cutoff value of transition zone index for prostate cancer detection: transition zone index 0.17 ng/ml/cm3 increased prostate cancer detection risk by 5 fold, free/total PSA ratio 0.17 ng/ml/cm3 and transition zone index 0.17 ng/ml/cm3.