Fumiyasu Endo

Anteroposterior Dissection HoLEP: A Modification to Prevent Transient Stress Urinary Incontinence

OBJECTIVES The prevalence of transient stress urinary incontinence (SUI) after HoLEP has been reported to be as high as 44%. Anteroposterior dissection HoLEP was newly developed to protect the urethral sphincter and therefore lower the incidence rate of SUI. This study was conducted to determine the SUI incidence rate after anteroposterior dissection HoLEP. METHODS Sixty-eight consecutive patients with benign prostatic hyperplasia underwent HoLEP from January to December 2008. The first 31 cases (Surgery 1) underwent HoLEP according to Gillings method. The next 37 cases (Surgery 2) underwent anteroposterior dissection HoLEP, where adenoma was dissected antegradely. This antegrade movement of the cystoscope allows the apical gland to be removed from the sphincter without causing damage. Surgical quality indexes (hemoglobin change, operating time, resected prostate volume) between the 2 groups were compared. All patients were assessed at 2 weeks postoperatively for clinical SUI, international prostate symptom score (IPSS), quality of life (QoL), and peak flow rates (Q(max)). RESULTS Patient characteristics and surgical quality indexes did not differ between the 2 groups. Clinical SUI was found in 25.2% of cases in the Surgery 1 group, but only 2.7% in the Surgery 2 group. IPSS, QoL and Q(max.) were significantly improved postoperatively in both groups. At 2 weeks, the QoL of the Surgery 2 group was significantly improved compared with that observed for Surgery 1 (1.5 ± 1.1 vs 2.4 ± 1.0, P = .02). The Q(max.) of Surgery 2 was significantly higher compared with Surgery 1 (19.8 ± 8.4 vs 13.0 ± 4.7 ml/s, P = .02). CONCLUSIONS These results indicate that our anteroposterior dissection HoLEP is a promising procedure to avoid postoperative SUI and also to substantially improve QoL.

Relationship Between Prostate-specific Antigen and Hematocrit: Does Hemodilution Lead to Lower PSA Concentrations in Men With a Higher Body Mass Index?

OBJECTIVES To examine whether a lower hematocrit was associated with a lower prostate-specific antigen (PSA), when stratifying by body mass index (BMI) in healthy men. PSA test is widely used in screening for prostate cancer. Many studies have found that PSA levels inversely correlate with BMI. It remains unclear whether hemodilution causes this inverse relationship. METHODS We investigated 19,367 men who visited a hospital for a routine health checkup in 2007. We obtained information on age, BMI, PSA, hematocrit, and smoking status. BMI was categorized as < 18.5, 18.5-22.0, 22.0-25.0, 25.0-30.0, and > or = 30.0 kg/m(2). RESULTS In all subjects, older age and lower BMI were weakly correlated with a higher PSA (r = 0.20, P <.001 and r = -0.05, P <.001, respectively). A multiple regression model for predicting PSA was constructed using age, current smoking status, and hematocrit for each BMI category. After controlling for age and smoking, PSA increased significantly with increasing hematocrit in participants with BMIs of 18.5-30 kg/m(2) (all P <.001). For example, in men with a BMI of 22-25 kg/m(2), slight increases (1.4% increase; 95% confidence interval, 1.0%-1.9%) were observed in PSA with a 1-unit increase in hematocrit. CONCLUSIONS In healthy men with a BMI of 18.5-30 kg/m(2), a lower hematocrit was significantly associated with a lower PSA. Hemodilution may explain the lower PSA levels observed in men with a higher BMI, resulting in an inverse relationship between BMI and PSA.

Plasma Volume Changes Affect Prostate Specific Antigen in Healthy Men

PURPOSE Several studies show that prostate specific antigen inversely correlates with body mass index. Hemodilution may be responsible for the lower prostate specific antigen in obese men. Hematocrit is the most popular indicator of plasma volume. We examined the effect of hematocrit changes on prostate specific antigen in healthy men during 2 years. We also investigated the association between prostate specific antigen and plasma volume changes based on combined changes in body weight and hematocrit. MATERIALS AND METHODS We reviewed the records of 8,338 men who visited our institution for routine health assessments in 2005, 2006 and 2007. Using the combination of body weight and hematocrit changes in 1 year we defined hemodilution as weight gain with decreased hematocrit and hemoconcentration as weight loss with increased hematocrit. RESULTS On multiple regression analysis controlling for patient age and weight change the hematocrit change was significantly associated positively with the prostate specific antigen change between 2005 and 2006 (1.2%/1 U), and between 2006 and 2007 (0.7%/1 U, each p <0.001). After controlling for age participants with hemoconcentration showed significantly greater prostate specific antigen changes than those with hemodilution, that is 6.1% between 2005 and 2006, and 4.8% between 2006 and 2007 (each p <0.001). CONCLUSIONS Hematocrit change was positively associated with prostate specific antigen change. Compared to men with hemodilution significantly greater prostate specific antigen changes were observed in men with hemoconcentration. Thus, plasma volume may explain the inverse relationship between body mass index and prostate specific antigen.

Relationship between changes in haemoglobin A1C and prostate-specific antigen in healthy men

BACKGROUND Although many studies have shown an inverse relationship between diabetes and prostate cancer, it still remains unclear why diabetes may reduce the risk of prostate cancer. An inverse association between haemoglobin A(1C) (HbA(1C)) and prostate-specific antigen (PSA) also has been reported in previous studies that assessed the association cross-sectionally. To fully understand the relationship between diabetes and prostate cancer, it is essential to examine the association in a longitudinal design. The effect of plasma volume should also be considered in examining the PSA level. The aim of this study was to determine whether changes in HbA(1C) were associated with PSA levels, independent of plasma volume changes, as indicated by haematocrit and weight. METHODS We investigated 5917 Japanese men aged 50 and over who visited St. Lukes International Hospital, Tokyo for routine health check-ups in 2006 and 2007. We performed a multiple linear regression analysis to examine any association between changes in HbA(1C) and PSA over 1 year. RESULTS Adjusting for age, body mass index at baseline and changes in weight and haematocrit, the increases in HbA(1C) and PSA were concordant (5.7% increase per 1-unit HbA(1C) change; 95% confidence interval, 2.8-8.5%; p<0.001). CONCLUSIONS In contrast to previous cross-sectional observations showing an inverse association between HbA(1C) and PSA, longitudinal observations suggest a positive association between the two. Further studies are needed to investigate the association between diabetes and prostate cancer.

Relationship between Dietary Factors and Prostate-Specific Antigen in Healthy Men

Introduction: There is little evidence indicating whether dietary factors influence prostate-specific antigen (PSA) concentrations. We examined whether nutritional factors, including energy, protein, fat, and carbohydrate intake were associated with PSA in healthy men. Subjects and Methods: We investigated 13,594 men aged 50 years and over who visited a hospital for a routine health checkup between 2003 and 2007. Dietary intake was assessed using a food frequency questionnaire. We performed a multiple linear regression to examine the association between PSA and dietary intake. Results: After controlling for age, body mass index, and physical activity, PSA was significantly negatively associated with percent protein intake (p for trend < 0.001). Compared with the lowest quintile, PSA was 5.8% lower (95% CI: –8.9 to –2.5%) in the highest quintile. We also observed a significant positive association between percent fat intake and PSA concentration (p for trend 0.043). PSA was 3.4% greater (95% CI: 0–6.9%) among men in the highest quintile compared with those in the lowest quintile. Conclusions: Men who had a lower percent protein intake and higher percent fat intake had an elevated PSA level, although the magnitude of these associations was small.