Jannicke Frugård

Transurethral microwave thermotherapy in the management of lower urinary tract symptoms from benign prostatic obstruction: follow-up after five years.

Objective: This study reports on a 5-year follow-up after transurethral microwave thermotherapy (TUMT) from benign prostatic obstruction using a lower power treatment protocol. Material and methods: Ninety-one patients with uncomplicated benign prostatic obstruction were treated in a 1-h session using the PRIMUS U + R device. Results: Twenty-nine (32%) of the patients were evaluable after 5 years, while 42 had received additional treatment for their lower urinary tract symptoms. In the 29 patients without additional therapy after TUMT, the decrease in the International Prostate Symptom Score was 37% compared with the pretreatment value. A moderate increase in peak uroflow, seen 1 year after TUMT, was not confirmed in an extended follow-up. Patients still on TUMT monotherapy after 5 years had smaller prostates from the outset than the group receiving additional treatment. No serious side-effects were observed. Conclusion: Lower power TUMT has a symptomatic effect of limited duration in most cases; in the long-term perspective only a minority of patients will benefit from this treatment.

A positive real‐time elastography is an independent marker for detection of high‐risk prostate cancers in the primary biopsy setting

To evaluate the performance of real‐time elastography (RTE) in an initial biopsy setting.

Interstitial laser coagulation in the management of lower urinary tract symptoms suggestive of bladder outlet obstruction from benign prostatic hyperplasia: long‐term follow‐up

The first two papers in this section are on the topic of laser therapy for BPH. This is obviously a much‐visited topic, but these papers help to throw further light on the subject. Is the laser the best way of treating this condition? We need more evidence to answer this question, and hopefully we will be able to give our patients the correct response when they ask us, based on papers such as these.

Three-year Follow-up after Transurethral Microwave Thermotherapy (TUMT) for Benign Prostatic Hyperplasia using the PRIMUS U + R Device

OBJECTIVE We report long-term (3 years) follow-up data of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) using a lower-power treatment protocol. MATERIAL AND METHODS Ninety-one patients were treated in a 1-h session with the PRIMUS U + R device. RESULTS Forty-five of the patients were still on TUMT monotherapy at 3-year follow-up, while 32 received additional therapy for their lower urinary tract symptoms. In patients with monotherapy there was a 45% decrease in international prostate symptom score (IPSS) when compared to pretreatment values. The moderate increase in peak uroflow seen early after TUMT could not be observed after 3 years. No serious side-effects were seen. CONCLUSION Three years after lower-power TUMT, 49% of patients treated were on TUMT monotherapy, while 35% received additional therapy for their voiding symptoms. Symptom score decreased 45% in patients with TUMT monotherapy concomitant with unchanged uroflow.

Combination of real-time elastography and urine prostate cancer gene 3 (PCA3) detects more than 97% of significant prostate cancers

Abstract Objective. The prostate cancer gene 3 (PCA3) score in urine is a promising biomarker for prostate cancer. Real-time elastography (RTE) is a well-documented ultrasound modality. The objective of this study was to evaluate the ability to detect significant cancer foci in the prostate with these methods alone and in combination. Material and methods. From September 2009 to September 2010, 40 patients planned for radical prostatectomy underwent a PCA3 urine test and RTE before operation. A Hitachi EUB-8500 with prostate end-fire transrectal probe was used. The PCA3 score was evaluated with a standard cut-off value of 35. RTE was evaluated in correlation with whole-mount section pathology. Three patients fulfilled the criteria for insignificant prostate cancer and were excluded from the study. Results. The PCA3 score was increased in 26 patients (70%). RTE identified at least one tumour in 33 out of 37 patients (89%). RTE detected the largest tumour in 27 out of 37 patients (73%). More than one cancer was present in 29 patients and RTE identified more than one tumour in 13 of these. The RTE was false positive in four patients. The PCA3 score was increased in three out of four false-negative RTE patients. By combining both methods, 36 out of 37 patients (97%) with significant prostate cancer were detected. Conclusions.The combination of PCA3 score and RTE detected 97% of significant prostate cancers. The combinative use of RTE and PCA3 will be further investigated in an unselected series of men with suspected prostate cancer.

The potentially curable prostate cancer patient and the pathways leading to diagnosis and treatment

Objective: Potentially curable prostate cancer is a diagnostic challenge for the general practitioner (GP). In a defined catchment area we wanted to discover why patients consulted their GPs and the reasons for their referral to the urologist. Material and Methods: Patients remitted to our “early prostate cancer clinic” with suspected potentially curable prostate cancer between January 1997 and December 2000 were included in the study. Patient information was registered according to a prospectively designed protocol. Results: Of the 872 patients examined, prostate cancer was diagnosed in 41.3% (360/872). Median age was 63.1 years and median total prostate‐specific antigen (PSA) level was 8.6 μg/l. The main reason for referral to a urologist was elevated PSA alone. However, the majority of the patients had no urological symptoms when they consulted their GP. As no local or national screening recommendations existed, we believe that opportunistic PSA screening has been common. Conclusions: The most important reason for referring patients to our specialist clinic was elevated PSA, often detected by means of opportunistic PSA screening. This study shows the effect of PSA testing in real‐life practice.

Preoperative high levels of serum vascular endothelial growth factor are a prognostic marker for poor outcome after surgical treatment of renal cell carcinoma

Abstract Objective. The aim of this study was to determine whether concentrations of vascular endothelial growth factor (VEGF) in blood taken preoperatively can predict subtype, survival and recurrence in patients with renal cell carcinoma (RCC). Materials and methods. The patient group consisted of 124 patients with an RCC that was surgically removed with nephrectomy or nephron-sparing surgery at Haukeland University Hospital from 2007 to 2010. All subtypes and stages were included. Preoperative blood samples were taken on the day of surgery, and the samples were prepared and frozen at –80°C. The level of VEGF in serum was analysed using Luminex® immunobead technology. The patients were followed until death or to 31 October 2014 (>4.5 years). Results. Patients with higher levels of VEGF were more likely to have clear cell RCC [odds ratio (OR) 2.43, p = 0.046], as were older patients (OR 1.04, p = 0.024). In a multivariate analysis, high VEGF, stage and nuclear grade all had a significant predictive value for cancer-specific survival (OR 4.56, p = 0.017; OR 11.54, p < 0.001; and OR 7.85, p = 0.015, respectively). VEGF, stage and nuclear grade predicted recurrence in patients presumed to have been radically treated (OR 4.37, p = 0.03; OR 5.02, p = 0.011; and OR 6.57, p = 0.008, respectively). Conclusions. Tumour stage and a high level of serum VEGF were predictors for an increased risk of recurrence and cancer-specific death. Furthermore, the study showed that serum VEGF may be used to determine the subtype of RCC preoperatively.

Benign growth of different prostate zones in aging men with slightly elevated PSA in whom prostate cancer has been excluded: a prospective study of 510 patients

OBJECTIVES To study, in a selected series of patients, whether the peripheral/central zone volumes also change with age. The reported normal total prostate volume in the third decade seems not to exceed 25 to 30 cm(3). Benign prostatic hyperplasia is generally accepted to originate in the transition zone and periurethral tissue, which accordingly show substantial growth with age. METHODS From January 1997 through December 2000, we performed transrectal ultrasound volume measurements of the different prostate zones in patients admitted for suspected prostate cancer. The information was registered according to a prospectively designed protocol. A total of 872 patients were examined, of whom 360 shown to have prostate cancer were excluded. Two more patients were excluded because of missing volume data, leaving 510 patients with noncancerous prostates for inclusion in this study. RESULTS The mean age was 62.8 years and the mean total prostate-specific antigen level was 9.8 microg/L. It was found that 64.9% (331 of 510) had a peripheral/central zone volume larger than 30 cm(3), indicating that some form of growth had occurred also in this zone. A weak but significant correlation was found between age and the peripheral/central zone volume. CONCLUSIONS The results of our study indicate that the peripheral/central zone may contribute to the benign growth of the prostate gland in men younger than 70 years old with slightly elevated total prostate-specific antigen levels.

Prostate cancer antigen-3 (PCA3) and PCA3-based nomograms in the diagnosis of prostate cancer: an external validation of Hansen’s nomogram on a Norwegian cohort

Abstract Objective. The aim of this study was to test the ability of prostate cancer antigen-3 (PCA3) and Hansen’s PCA3-based nomogram to predict prostate cancer (PCa) probability in a Norwegian cohort, with the goal of reducing unnecessary biopsies. Material and methods. Altogether, 127 consecutive patients were recruited to this study at Haukeland University Hospital, Norway. Prostate-specific antigen (PSA), PCA3 score, digital rectal examination (DRE), prostate volume (Pvol) and age were determined. All patients had an extended 10-core biopsy. The performance of PCA3 score and Hansen’s nomogram was tested. Results. There were 124 evaluable patients. Among these, 59 patients had PCa on the initial biopsies. Mean PSA, PCA3 score and age were significantly higher and Pvol was significantly lower in patients with PCa. PCA3 scores of 35 and 21 led to a sensitivity of 71% and 81% and specificity of 72% and 55%, respectively. Hansen’s nomogram gave an area under the curve (AUC) of 0.806. The intraclass correlation was 0.959 (Cronbach’s alpha). Applied to this material, PCa would be missed in 15.2% of patients when applying the suggested threshold probability of 30%, among whom 66.7% had high-grade PCa. With a threshold probability of 20% only one patient had PCa and this was low grade. Conclusions. Hansen’s PCA3-based nomogram is valid for this cohort. A threshold probability of 20% seems more adequate than 30% for this less screened cohort. PCA3 score only affects the biopsy indication in some patients and is recommended only for this subset. The results need to be confirmed in a larger study.