BackgroundAny non-invasive test that can predict the absence of prostate cancer (PCa) or absence of clinically significant PCa (CSPCa) is necessary, as it can reduce the number of unnecessary biopsies in patients with gray zone prostate-specific antigen (PSA, 4 - 10 ng/mL). This study evaluated the diagnostic performance of free PSA% and PSA density (PSAD), and Prostate Imaging Reporting and Data System (PIRADS) score (version 2.0) alone and combined in predicting CSPCa in patients with PSA between 4 and 10 ng/mL.MethodsThis prospective study included a total of 104 consecutive patients with lower urinary tract symptoms (LUTS) and serum PSA between 4 and 10 ng/mL, with or without abnormal digital rectal examination (DRE) findings or any hypoechoic lesion on ultrasound sonography of prostate and without prior transrectal ultrasound (TRUS) biopsy of prostate. PIRADS score was calculated using multi-parametric magnetic resonance imaging (mp-MRI) before TRUS biopsy of prostate. Relationships among PIRADS score, PSAD, free PSA% and presence of CSPCa in TRUS biopsy were statistically analyzed.ResultsIn patients with CSPCa, significantly higher median age (P = 0.001), PSA level (P < 0.001), PSAD (P < 0.001) and significantly lower prostate volume (P < 0.001) and free PSA% were observed as compared to patients with non-CSPCa. Significantly higher proportion of patients with CSPCa showed PIRADS positive test compared to those with non-CSPCa (86.4% vs. 53.3%, P < 0.001). Cut-off values for PSAD and free PSA% were 0.12 ng/mL2 and 25%, respectively. Age, PSAD and free PSA% were significant predictors of PCa, while age and PSAD were significant predictors of CSPCa. Criteria 2, 3 and 4 demonstrated higher specificity and positive predictive value (PPV) in predicting CSPCa as compared to criterion 1. The overall accuracies of criterion 1, 2, 3 and 4 were 64.42%, 85.58%, 80.77% and 79.81%, respectively. The area under the curve (AUC) values of criterion 2, 3 and 4 were higher (0.827, 0.732 and 0.792) than criterion 1 (0.665).ConclusionUsing PIRADS score for predicting CSPCa as a screening test, criteria 2, 3 and 4 have much higher diagnostic performance and present accuracy of mp-MRI to predict CSPCa can be increased with addition of PSAD and free PSA%.

Background: Radiation cystitis is a well-known complication arising from radiation therapy in pelvic malignancies. Haematuria is usually the main presenting symptom of radiation cystitis, which can range from mild to severe refractory and life-threatening forms. There are various forms of treatment ranging from intravesical instillations like alum, formalin, prostaglandins and pentosan sulphate; hyperbaric oxygen therapy to surgical treatment like cystoscopic fulguration, arterial ligation and cystectomy.Here authors aimed to find the efficacy of 1% alum irrigation in controlling haematuria due to radiation cystitis and to correlate its use with change in clinical status and biochemical parameters.Methods: This   retrospective study was done for a period from July 2010 to July 2017 which included all female cervical cancer patients with intractable haematuria due to radiation cystitis. Only patients with normal renal function were included. Irrigation with 0.9% NS, hem coagulase and subsequently 1% alum irrigation were given. Failed cases underwent cystoscopic fulguration.Results: Average age of presentation was 59.79 years. Of the 34 patients 20 (64.51%) patients showed complete response, 4 (12.9%) patients showed partial response and 7 (22.58%) patients had no response to alum irrigation and cystoscopic fulguration were done in these cases. There was no significant change in vital parameters and biochemical parameters except increased prothrombin time (<0.001).Conclusions: No standard of care therapy is presently available for patients with hematuria following radiation cystitis although there is big armamentarium of therapies. Authors found that 1% alum irrigation is safe and efficacious for these patients although normal renal function is a prerequisite.

Background: There is a dearth of reliable blood and urine markers for transitional cell carcinoma of urinary bladder. CA 19-9 is a well-known marker for gastrointestinal malignancies and is being investigated for other malignancies including carcinoma bladder. In this prospective study, we evaluated the role of serum CA 19-9 as a tumor marker and correlated its level with tumor grade and stage.Methods: One hundred and fifteen patients with transitional cell carcinoma of urinary bladder and 69 healthy volunteers, as controls were included in the study. Preoperative blood sample was analysed for level of CA 19-9 using ELISA kit (normal - 0 U/ml to 37U/ml) and were correlated with grade and TNM stage of tumor.Results: The range of the control group is 2-38U/ml (mean: 17.67±9.68U/ml); TCC group is 1-94U/ml (mean: 37.12±31.52U/ml) (p=0.304). When CA 19-9 level >37IU/ml was taken as cut-off for a positive test, sensitivity of detecting T3 disease, T4 disease, MIBC, presence of node and high grade tumour were 80%, 75%, 70.3%, 78% and 57.8% respectively. However, there was a statistically significant increase in levels of CA19-9 in relation to higher grade (<0.001), presence of muscle invasion (<0.001), T stage (<0.001) and N stage (<0.001).Conclusions: Serum CA19-9 is almost invariably raised in patients with high grade and invasive disease. Thus, it has a place as a prognostic marker rather than as a diagnostic tool due to its low sensitivity for TCC bladder.

Background: Epidermal growth factor receptor (EGFR) has demonstrated over expression in bladder tumours and correlation with stage and grade of tumours. The aim of present study was to find the relation between score of the EGFR in Transitional Cell Carcinoma (TCC) of bladder and its various prognostic variables.Methods: This is a retrospective study conducted in Dept of Urology, Gauhati Medical College Hospital between Dec 2016 and July 2017. Forty cases of TCC bladder that were operated either by TURBT or radical cystectomy have been taken. However, patients with CKD, pre-existing systemic disease and UTI were excluded from the study. Presence of EGFR and its score were analysed. The rating was done as 0 (non-immunoreactive), 1+ (weak), 2+ (moderate) and 3+ (strong). The correlation between EGFR score and the various factors like age, sex, stage, size of tumour, presence of CIS, tumour grade, muscle invasion, number of tumours and type of stalk were evaluated statistically using chi square tests.Results: Average age is 59.825 years and male to female ratio is 5.6:1. EGFR score is not significantly related with age, sex, stage of disease, muscle invasiveness or number of tumours whereas size of tumour, presence of CIS changes, grade of TCC and type of tumour stalk bears statistically significant relation with EGFR score.Conclusions: Studies have shown EGFR positivity to be associated with high tumour stage, tumour progression, and poor clinical outcome. Authors have found size >3cm, CIS changes, high grade tumours and broad-based stalks to be significantly associated with higher EGFR scores among patients with TCC of bladder.