Gerald N. Collins

Correlation between prostate size estimated by digital rectal examination and measured by transrectal ultrasound

OBJECTIVESnTo correlate prostate size estimates performed by single or multiple examiners through digital rectal examination (DRE) with volume measured by transrectal ultrasound (TRUS) and to propose measures for predicting prostate volume using DRE estimates in clinical settings.nnnMETHODSnData from four sources were analyzed: (1) the Olmsted County community study of 397 patients examined by a single urology nurse, with TRUS measurements done by multiple examiners; (2) a community study in Stirling, Scotland, involving 480 patients with DRE and TRUS performed by one urologist; (3) baseline data from the Veterans Affairs Cooperative Study No. 359 in 1222 patients with DRE and TRUS measurements by multiple personnel at 31 centers; and (4) a clinical series of 100 men with DRE and TRUS by a single urologist.nnnRESULTSnDRE estimates and TRUS volumes were significantly correlated (r = 0.4 to 0.9), but prostate size was underestimated by 25% to 55% for men with a prostate volume over 40 mL, depending on the study, with greater variability for studies involving multiple examiners. In one study that assessed prostate dimensions by DRE, posterior surface area (SA) correlated with overall TRUS volume (r = 0.4). According to receiver operating characteristic curves, SA showed a 70% and 76% chance of correctly identifying men with prostate volume greater than 30 or 40 mL, respectively; those with larger prostates were best distinguished by SA greater than 7 cm2 (sensitivity greater than 0.74, specificity greater than 0.50).nnnCONCLUSIONSnDRE underestimates prostate size, particularly if TRUS volume is greater than 30 mL. However, DRE estimates may help identify prostates likely to be larger than certain cutpoints by TRUS. Posterior SA may be useful as a preliminary assessment when prostate size is an important predictor of therapeutic response.

Periprostatic nerve block gives better analgesia for prostatic biopsy.

Objective u2002To prospectively compare two local anaesthetic techniques for prostatic biopsies, which are usually taken with no anaesthesia; because multiple biopsy techniques are becoming more common and there is an increasing need for analgesia/anaesthesia during the procedure.

Early prostate cancer – which treatment do men prefer and why?

Study Type – Preference (prospective cohort)u2028Level of Evidenceu20031b

Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience

Objective To evaluate prospectively the efficacy of extracorporeal shock wave therapy (ESWT) as a conservative treatment for Peyronies disease.

Management of acute urinary retention secondary to benign prostatic hyperplasia in the UK: a national survey.

To analyse current practice in the management of acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) in the UK, and to assess how much of this is evidence‐based.

Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years

To evaluate the incidence and timing of the onset of chronic scrotal pain after vasectomy in two populations at 1 and 10u2003years after surgery.

Urological litigation in the UK National Health Service (NHS): an analysis of 14 years of successful claims

What’s known on the subject? and What does the study add?

Diethylstilboestrol versus Bicalutamide in Hormone Refractory Prostate Carcinoma: A Prospective Randomized Trial

Objective: To compare the efficacy of diethylstilboestrol (DES) with bicalutamide in the treatment of hormone refractory prostate cancer in relation to its effect on prostate-specific antigen (PSA) and survival. Methods: Patients on LHRH analogues for prostate carcinoma with evidence of biochemical or clinical progression were randomized into one of the treatment arms (n = 58). The first group (group A, n = 26) received 1 mg of DES with 75 mg of aspirin per day in addition to the primary hormonal treatment. The second group (group B, n = 32) received bicalutamide at a dose of 50 mg/day in addition to the primary treatment. Patients were followed up every 3 months with their PSA being checked and were also monitored for any clinical progression and adverse effects as a result of treatment. Any adverse event occurring after patients were started on treatment was attributed to the drug and patients were clinically assessed at each visit. Failure of treatment was defined as a 50% or greater increase in PSA after commencing treatment. Once randomized, all patients were followed up for survival regardless of failure of second-line hormonal manipulation. Results: The mean age of the patients was 76.7 years (60–88, SD 7.4) in group A and 76 years (67–86, SD 6.9) in group B. Twelve patients in each group had metastatic disease. The median follow-up periods for both groups were 24 months (range 6–48 in group A, range 3–54 in group B). 65% of the patients in group A (17/26) and 43.5% (14/32) in group B had a fall in their PSA levels (p = 0.08, Fisher’s exact test) with 23% (6/26) and 31% (10/32) having a >50% response respectively (p = 0.34, Fisher’s exact test). Mean PSA nadir in those who responded were 20.6 ng/ml (range 1.6–59.4) and 7.41 ng/ml (range 0.1–42.6) in groups A and B respectively. The median duration of response was 9 months (3–18 months) for group A and 12 months (3–18 months) for group B. Seven patients in group A and 6 in group B experienced adverse events. Three of the 7 in the group A experienced cardiovascular related adverse effects (1 congestive cardiac failure, 1 pulmonary embolism and 1 stroke). At the end of the study period, 14 (54%) of group A patients were alive and 12 (46%) were dead. In group B, 15 (47%) were alive, 16 (50%) were dead and 1 (3%) lost to follow-up. At the completion of the study, 3 patients in each group were still on treatment. Conclusion: Low-dose DES and 50 mg of bicalutamide per day are equally effective in hormone refractory prostate carcinoma with respect to biochemical response, although DES has more severe adverse effects. This is a small sample and larger multicentre trials are needed to give us a definite conclusion.

Prostatic manipulation has a minimal effect on complexed prostate‐specific antigen levels

Objective To assess the effect of prostatic manipulation on complexed prostate‐specific antigen (cPSA), as various forms of prostatic manipulation are known to increase the serum free and total PSA level.

Diethylstilboestrol for the treatment of prostate cancer: past, present and future

Abstract The aim of this review was to discuss the most recent data from current trials of diethylstilboestrol (DES) to identify its present role in advanced prostate cancer treatment as new hormonal therapies emerge. The most relevant clinical studies using DES in castration-refractory prostate cancer (CRPC) were identified from the literature. The safety, efficacy, outcomes and mechanisms of action are summarized. In the age of chemotherapy this review highlights the efficacy of oestrogen therapy in CRPC. The optimal point in the therapeutic pathway at which DES should be prescribed remains to be established.