No abstract

Background: Human prostate-specific antigen (PSA) is a glycoprotein with approximately 7% (wt/wt) carbohydrate. The PSA assay, along with other diagnostic parameters, is considered the most useful early malignancy marker to confirm the diagnosis of prostate disease. Benign prostatic hyperplasia (BPH) and prostatic cancer are the most common prostate diseases. Objecive:The study was designed to assess the diagnostic sensitivity of PSA with different prostate volume (PV) in Iraqi men aged (40 to 88) to define better predictions for early detection of prostatic cancer. Method:The subjects involved in this study were 119 consecutive male aged (40-88) years with BPH. Prostate volume (PV) (measured by transrectal ultrasound: TRUS) and PSA density (PD) data distribution were evaluated. Variables of the clinical and laboratory display were expressed as mean ± SD. ANOVA were used for the comparison of variables. Pearson correlation coefficients were calculated for the whole study.Result: Mean (± SD) age of the subjects included in this study was 63.23±11.12 years (p<0.01).The PSA values in different age groups (40-54, 55-69, 70+), were: 5.71±4.47, 7.87±4.55 and 10.22±7.26 ng/mL respectively. There was a significant increase between the second and third group (P < 0.05), while there was a highly significant increase between the first and third age groups (P < 0.01). The correlation between PV and tPSA was (+0.305) based on the Pearson's correlation co efficient (P<0.01). Conclusion:Increase in prostate volume is associated with increased serum PSA level. A PSA level depicts approximate prostate volume and may have clinical potential in the management of BPH patients where PSA and prostate volume were significantly correlated in BPH patients.

No abstract

Background: Extracorporeal shock wave lithotripsy (ESWL) is currently considered one of the main lines of treatments for urolithiasis. The effectiveness of pharmacologic therapies in facilitating stones expulsion after ESWL has been reported. Objectives: To evaluate the effect of Tamsulosin and terpenes combination (Rowatinex) on the clearance of stone gravels after extracorporeal shock wave lithotripsy (ESWL) of renal stone. Methods: From May 2010 to June 2011 (84) patients with single radio opaque renal stone presented to urologic consultation department at Al-Ramadi teaching hospital/Iraq were included in this prospective, case-control study. All patients were examined by ultrasonography, and intravenous urography. Their age ranged from 19 to 62 years. All patients underwent ESWL and randomly divided into three groups, group A, of 28 patients, received conservative medical therapy alone and served as the control group, group B, of 28 patients, received tamsulosin 0.4 mg once daily in addition to conservative medical treatment and group C, of 28 patients, received Rowatinex capsules, 1 capsule before food 3 times daily in addition to conservative medical therapy. All patients were followed up by clinical examination, urine analysis, ulrasonography and abdominal radiograph (KUB) at 4 and 8 weeks and the number of patients with clinical success was recorded. Clinical success defined as stone-free status or clinically insignificant stone . Results: The age of patients ranged from 19 to 60 years in group A (mean 35.7±6), 20-62 years in group B (mean 36.6±13.25) and 20-61 years in group C (mean 36.2±13.02), there was no significant statistical difference between the age, gender and site and size of renal stones among the three groups (p value > 0.05). The percentage of patients with clinical success after ESWL at 4 weeks was 23% in group A, 44% in group B and 40% in group C and increased to 46%, 80% and 76% in group A, B and C respectively at 8 weeks. The clinical success was statistically more significant in group B and C compared to group A at both 4 and 8 weeks ( p value < 0.05). There was no statistically significant difference in the clinical success between group B and C (p value > 0.05). Although the incidence of drugs side effects in group B and C occurred more than in group A, but no significant side-effect was detected so as to require exclusion of a patient from the study and medical intervention was not performed in any of the patients because of side-effects. Conclusion: The use of medical expulsion in this study by tamsulosin or terpenes combination (Rowatinex) was well tolerated and it demonstrated that it is clinically meaningful and statistically it has significant improvement in the clearance of stone fragments after ESWL of renal stone. The effect on tamsulosin and terpenes combination (Rowatinex) is comparable.

Objective: To determine the consequence of recognizing high grade prostatic intraepithelial neoplasia (HGPIN) & its extent on initial sextant prostatic biopsy then identifying its associated risk of finding prostate cancer on subsequent biopsy. Patients and methods: Seventy-one men were subjected to transrectal ultrasound guided sextant prostate biopsy due to elevated serum prostate specific antigen (S.PSA) > 4 ng /ml, an abnormal digital rectal examination (DRE) and/or transrectal ultrasound (TRUS) findings. The number, percentage, as well as bilateral and multifocal involvement of specimens positive for HGPIN were recorded in every patient. The percentage of cancer detected in these patients on repeat biopsy within 1 year of the initial biopsy was also recorded. Results: The mean age and mean S.PSA level of our patients was 59.9 years and 7.9 ng/ml respectively. Of the 71 patients studied, initial biopsy revealed that (32.4%) had benign prostatic hyperplasia (BPH), (36.62%) had carcinoma, (25.35%) had HGPIN and (5.63%) had chronic prostatitis. On repeat biopsy within 1 year of initial biopsy cancer of the prostate was detected in 33.3% of our patients who were diagnosed with HGPIN on 1 st biopsy. All of them had multifocal involvement on the initial biopsy. Conclusion: Recognizing HGPIN on 1 st biopsy (particularly multifocal involvement) is associated with great risk of prostate cancer development on subsequent biopsy, thus comprehensive follow-up of these patients is necessary.