A cohort of 448 men were seen and evaluated at the Urol- ogy Clinic of Texas Tech Physicians in Lubbock, TX, USA, from 2008 to 2013. Patients who never had a biopsy with PSA levels of > 4 ng/mL or with suspicious findings on digital rectal examination (DRE) were included in our study. For each patient prior to performing a warranted prostate biopsy, a complete history was collected and physical examination was performed. The prostate volume for each patient was estimated by DRE and confirmed by transrectal ultrasound (TRUS). Patients who underwent prior biopsies or prior surgeries were excluded from our study. For each prostate, 12-core TRUS-guided biopsies were performed bilaterally, including at the apex, base, and middle portion of the gland. A minimum of six biopsies were performed in each lobe in addition to biopsies obtained if suspicious lesions were encountered. PSA density data were obtained by dividing the PSA serum level by the TRUS-confirmed prostate volume.
included 40 participants, who only suffered from BPH and the second group involved 45 participants suffering from both MetS and BPH. BPH patients were having international prostate symptom scores (IPSS) equal or greater than 13 and prostate volume (PV) were equal or greater than 25ml. In the second group, five parameters were addressed, patients have three out of five parameters regarded as MetS. These parameters included body mass index (BMI >25kg/m 2 ), dyslipidemia
In 1992, the concept of PSA density (PSAD) was introduced to correlate PSA and prostate volume. This was based on the knowledge that most PSA is produced by prostate epithelial cells and cancer cells produce more PSA per unit volume than benign cells. Prostate specific antigen density (PSAD) was obtained by dividing the total serum PSA with prostate volume, as determined by transrectal ultrasound measurement using the formula; volume = length x width x depth x 0.52. xiii Benson et al xiv
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possibly optimal surgical modalities to resect sufficient prostatic tissue to relieve or improve LUTS. Moreover, the prostate volume is of utility in prostate cancer detec- tion and management as it can be used in conjunction with serum prostatic specific antigen (PSA) to define the PSA density, a clinically relevant parameter for decision- making . In addition, the measurement of prostatic volume is also required in other fields such as radiation oncology, as patients might not be deemed candidates for brachytherapy or stereotactic body radiotherapy (SBRT) if prostate volumes are > 60 cc and > 80 cc, re- spectively. Hence, estimating the actual prostate volume with accuracy is required for proper medical and surgi- cal management of prostatic diseases as well as for abla- tive procedures.
Ung and colleagues took 6 to 18 core biopsies from 750 patients and reviewed the effect of the association of the increasing core number with prostate volume on the cancer detection rates. They showed that the cancer detection rate decreased from 40% to 27% as long as prostate volume increased; moreover, the cancer detection rate was not dif- ferent as long as the number of cores increased (p = 0.77). Authors, however, had a very wide PSA range in this study (0.3 to 67 ng/mL). 17
Between the PCa group and the non-PCa group, the initial PSA level, the last PSA level, the age, the prostate volume, the PSAD, the PSAV and the follow-up period were compared by Mann-Whitney U test (Table 1). To identify the predictive factors for PCa, univariate and multivariate logistic regression analysis with enter selection were conducted (Table 2). Odds ratios (ORs) and 95% confidential intervals for all covaria- tives were calculated. Predictive accuracy was quantified us- ing the area under the curve (AUC) of the receiver operator characteristic (ROC) analysis (Fig. 1). 10 SPSS 12.0 (SPSS
We assessed 68 men between the ages 45 to 85 who presented with acute urinary retention. Initial assessment included detailed clinical history, International Prostate Symptom Score (IPSS) and Quality of Life assessments and a transabdominal ultrasonogram to measure Prostate Volume (PV) and Intravesical Prostatic Protrusion (IPP). The degree of IPP was determined by the distance from the tip of the protrusion to the circumference of the bladder at the base of the prostate gland. Patients with IPP >10mm were taken have significant IPP and those ≤ 10mm was taken to be insignificant. Statistical analysis included descriptive analysis and Pearson’s correlation coefficient.
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The study is limited by the lack of prostatectomy on most patients. Even in men with prostatectomy, only one individual had prostate volume recorded. Correlation to prostate volume by prostatectomy sample should be per- formed on future studies. Another limitation is the un- known affect of the presence of an endorectal coil in volume determinations. The prostate is known to deform with the presence of the endorectal coil. Additional trials should be performed in a screening population to deter- mine of PSAd may be helpful in this more standard pa- tient population. PSAd may be helpful in prediction al- gorithm to be combined with other parameters to assess prostate cancer risk, as suggested by Kubota . This study is useful in that is reports results from a moderate sized sample, tests the added resolution of 3.0 T MRI, and shows cancer sensitivity in addition to high grade cancer differentiation.
No consensus has yet been reached as to whether it is necessary to add more punctures for patients with larger prostate volume. It is recommended that individualized puncture scheme can be applied to patients according to their prostate volume . Specifically, it was believed to be advisable to use 8-punctures biopsy for patients with prostate volume less than 40 ml, 10-core biopsy for those with a vol- ume from 40 ml to 60 ml, and 12-punctures biopsy for those with a volume more than 60 ml . However, other literature does not support increasing the number of biopsy punctures for patients with larger prostate . As was shown in Table 2, positive detection rate dif- fered significantly among groups with different prostate volumes P = 0.000) and was decre- ased with increasing prostate volume. It should therefore be considered to increase the num- ber of punctures for patients with larger pros- tate volume, especially for those with prostate volume more than 100 ml. For patients with similar prostate volume, 13-and 10-core biop- sies were comparable in the detection rate of prostate cancer (P = 0.354). Therefore, increas- ing the number of punctures from 10 to 13 should not be advised, especially when consid- ering the increased hematuria complication in the 13-core scheme.
IL) version 19.0 software. Continuous pretreatment vari- ables (age, prostate volume) were expressed as means and compared between the prostate volume groups by one-way analysis of variance with Bonferroni multiple comparisons testing. Categorical pretreatment variables (clinical stage, total Gleason score, alpha-adrenergic blocking therapy, hor- monal therapy, prior transurethral resection of the prostate or transurethral microwave thermotherapy, IMRT prescription dose) and CTCAE genitourinary toxicities were expressed as percentages and compared between volume groups by Chi-square test. Univariate logistic regression analysis was used to assess the impact of prostate volume as a continu- ous variable and other pretreatment factors on prevalence of CTCAE genitourinary toxicity. Before and after volume stratification, repeated-measures one-way analysis of vari- ance was used for comparison of absolute mean IPSS values across measured time points within each group, and the significance of IPSS differences between any two time points was assessed using the paired t-test. The Kruskal–Wallis test was used to compare IPSS and ∆ IPSS (post-treatment minus pretreatment IPSS) medians between the volume groups, and the Mann–Whitney test was used for multiple comparisons of IPSS measures reaching significance on the Kruskal–Wallis test. The Pearson correlation was used to measure the strength of linear dependence between two variables. All reported P values are two-sided. Statistical significance was considered at P , 0.05.
The results of this post-hoc analysis of data from the two silodosin Phase III studies and the OL extension study show that silodosin provides statistically significant and clinically meaningful symptom relief in patients with BPH-related symptoms, irrespective of prostate size. Decreases in IPSS from baseline to week 12 in each silodosin subgroup (defined by EPV) were significantly greater than the IPSS decreases in the corresponding placebo subgroups. Mean change in IPSS in each silodosin subgroup was similar to that previ- ously observed for the entire silodosin-treated population of the double-blind studies ( − 6.4). 10 Most importantly, over the
small changes (as little as 3 % of a volume as small as ~10 mm 3 ) in the mouse prostate under various physiological and pathological conditions. Figs. 1, 2 and 3 demonstrate that our use of the VisualSonics instrumentation and Amira 3D software for reconstruction allows very reproducible measurements of VP volume in intact mice (Fig. 1), mice undergoing castration induced regression (Fig. 2) and mice undergoing DHT supplementation induced re-growth (Fig. 3). In these imaging sessions the VP volumes varied from ~20 mm 3 for intact animals to ~5 mm 3 for regressed animals, emphasizing the high degree of accuracy in measuring very small glands. Because image processing involves operator- dependent segmentation of the raw US images, we per- formed blinded intra- and inter-operator assessments of reproducibility (Fig. 4) and found excellent agreement (CV ~3 %). We should note that assessment does not re- quire extensive training in mouse anatomy, as individuals who had no prior experience were able to readily master the segmentation protocol within weeks. We also applied our methodology to two pathological animals models: prolactin transgene-driven benign prostatic hyperplasia (Fig. 5) and orthotopic implantation of human prostate cancer xeno- grafts (Fig. 6). In both cases, we were able to detect patho- logical changes which increased the volumes by as little as 10 % ( c.f. Fig. 6b, W3). In addition, the small size of the nor- mal anterior prostate host site for implantation leads to vari- ability when injecting tumor cells to establish prostate orthotopic xenografts, impairing reproducibility in the either the microenvironment or mis-location of the implantation and concomitant dissemination of the tumor in the periton- eum . Thus, in contrast to other imaging modalities, which require large volume changes to be appreciated, this methodology reveals the magnitude of morphological changes more typically seen in human pathology, where the volumetric alterations are a small fraction of the original organ volume. Fi- nally, in data not shown here, we have use the same protocol to image tumor formation in PTEN deficient mouse models of human prostate cancer and can similarly detect presumptive tumor which represents less than 10 % of prostate volume.
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Many studies have suggested that BMI is one of the strongest determinants for prostate gland volume. Our study found positive association of PV with BMI (r =0.505). The results of our study are in accordance with those of Monawara M et al.  in 2012 who found significant relationship of prostate volume with BMI. Mean PV in this study found to be highest in obese groups (23.1±1.7 mls). However, Jin Ho Park et al.  in 2009also concluded that as BMI increases prostate volume also increases and PV in obese groups was found out to be the greatest. Lee et al. and Xie et al. [15,19] reported that prostatic volume was greater in obese than normal subjects. This study confirmed positive correlation with BMI & WC. However, when we applied multiple linear regression WC was the only factor related to prostatic hyperplasia.
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Patients and methods: Retrospective analysis of data of all men in urinary retention who underwent treatment with the 120W lithium triborate laser PVP by a single surgeon from November 2006 to July 2010 was performed (n = 78), median age 71 years (interquartile range, 64–80), median prostate volume 91 mL (interquartile range, 58–121). Perioperative outcomes and functional outcomes at baseline, and at 3 and 12 months post-operation were examined. Results: Patients managed preoperatively by urethral catheterization (n = 61) and suprapubic catheterization (n = 5) were of greater age (by 8.2 years, P , 0.05) and higher American Society of Anesthesiologists scores (P = 0.000, Fisher’s exact test mid P) than patients managed by inter- mittent self-catheterization (n = 12), but there was no difference in outcomes. There were three Clavien grade III, two Clavien grade IV, and no Clavien grade V complications. There were also no blood transfusions. Fifty-three men (68%) voided successfully post-PVP and went home catheter-free within 24 hours. At 3 months, 62 out of 64 evaluable men (97%) were voiding well without needing any form of catheterization. At 3 months and 12 months, median Inter- national Prostate Symptom Score was 7 and 6; International Prostate Symptom Score Quality of Life Index 1 and 1; peak urinary flow 19 and 22 mL/sec; and post-void ultrasound measured residual urine volume 52 and 60 mL, respectively.
PSA is one of the most used biomarkers that has revolu- tionized the management of prostate cancer, only a destruc- tion of the basement membrane of the epithelial cells of the prostate can cause excessive leakage of PSA into the bloodstream; 28 In our study, there were no differences between the levels of PSA, which contradicts the results of previous investigations where the PSA in the TCN group reached 1.2±0.2 ng/mL (Figure 2), so it was analyzed in a complementary way. The dimensions of the prostate, in various studies an inverse relationship between prostate volume and the incidence of prostate cancer has been demon- strated, we can see a smaller volume in the TCN + H500+ group S40 and TCN + H250+ S40; with several foci of high- grade intraepithelial neoplasia compared to the TCN + H50+ S40 group, which has a higher volume and few focal points of PIN AG (Figure 3), these ﬁ ndings associated with the absence of PIN in the group receiving a tamponade and few centers of BG-PIN in the groups receiving simvastatin, evidence the chemoprotective effect of C. spinosa at low doses (Table 3).
Two relatively experienced urogenital radiologists, who were blinded to patients ’ clinical information, retrospectively and independently interpreted prostatic mpMRI according to PI-RADS v2 guidelines. 5 If a suspicious lesion was found, both the location and PI-RADS score would be recorded. Any disagreement on the interpreted results between the two radiologists was resolved by a third senior urogenital radi- ologist. If multiple lesions were present, the PI-RADS score would be assigned to the lesion with the largest size or the most malignant feature (i.e., extraprostatic extension). The MRI-measured prostate volume (PV) is calculated according to the ellipsoid volume formula (SI 2). PSAD is obtained by dividing total PSA (tPSA) by PV.
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After receiving institutional review board approval, a retrospective review was performed between 2012 to 2016 of patients who were treated with anterior gland cryoablation for clinically localized cancer. All patients had a prostate mpMRI. If a suspicious lesion was de- scribed on mpMRI, patients underwent image-targeted mpMRI-TRUS fusion biopsy to confirm the malignant nature of the lesion. At least 2 cores were obtained from the target lesion followed by a systematic biopsy sam- pling of 6–12 cores, depending on the prostate volume. Patients without lesions seen on mpMRI (n = 1), discord- ance between mpMRI and previous biopsy (n = 2), or due to patient preference (n = 2) underwent 3D transper- ineal template-guided prostate mapping biopsy (TTMB). Our 3D TTMB technique has been previously described . Erectile and urinary functional outcomes were assessed by self-reported standardized instruments using the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS), re- spectively. No patient had received any other primary treatment for their prostate cancer. An smaller cohort was expected given the novelty of the technique. Cryoa- blation was performed by a single provider.
Fourteen patients underwent prostate MPMRI using a Discovery MR750 (GE Healthcare, Waukesha, WI, USA) at 3T using T2W, T1-weighted dynamic contrast- enhanced, and diffusion-weighted sequences (sequence parameters shown in Table 2.1). Pelvic phased array and endorectal receive coils were used simultaneously for these acquisitions. The schematic in Figure 2.3 provides a high level description of the data acquisition and pre-processing we performed for the radical prostatectomy patients. After MPMRI acquisition, a radiologist and radiology resident, each with > 5 years of experience reading > 200 prostate MRI cases, assessed the multi-parametric MRI using guidelines concordant with the prostate imaging and reporting data system (PI-RADS)  and delineated a total of 24 3D tumour volumes on the MRI. All three sequences were used to identify tumours (as in the PI-RADS guidelines), and the tumours were contoured in the coordinate system of the T2W images. These contours were performed using custom software that allowed the operator to manipulate control points defining a 3D tumour surface with subvoxel precision. This approach mitigates segmentation precision issues arising due to the thickness of the MR image planes. This yielded 14 3D label maps in the T2W coordinate system, one for each patient, depicting a total of 24 contoured tumour regions. For each of the 3D contoured tumours, we calculated tumour volume by multiplying the number of voxels within each region by the voxel size in mm 3 . Table 2.1. MRI sequence parameters.
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Screening for prostate cancer remains a contentious issue. As with other cancer screening programs, a key feature of the debate is verification of cancer-specific mortality reductions. Unfortunately the present evidence, two systematic reviews and six randomized controlled trials, have reported conflicting results. Furthermore, half of the studies are poor quality and the evidence is clouded by key weaknesses, including poor adherence to screening in the inter- vention arm or high rates of screening in the control arm. In high quality studies of prostate cancer screening (particularly prostate- specific antigen), in which actual compliance was anticipated in the study design, there is good evidence that prostate cancer mor- tality is reduced. The numbers needed to screen are at least as good as those of mammography for breast cancer and fecal occult blood testing for colo-rectal cancer. However, the risks associated with prostate cancer screening are considerable and must be weighed against the advantage of reduced cancer-specific mortality. Adverse events include 70% rate of false positives, important risks associ- ated with prostate biopsy, and the serious consequences of prostate cancer treatment. The best evidence demonstrates prostate cancer screening will reduce prostate cancer mortality. It is time for the debate to move beyond this issue, and begin a well-informed dis- cussion on the remaining complex issues associated with prostate cancer screening and appropriate management.
As mentioned earlier, we categorized prostate cancer patients into 2 groups: (1) the PS group and the non-PS group. The non-PS group included men who were diag- nosed with prostate cancer in outpatient offices and thus includes those who underwent PSA testing regardless of the symptoms related to the prostate. In the PS group, there were fewer patients with high Gleason scores, high PSA, and metastatic diseases (Table 1). Previous studies in Gunma Prefecture and Sweden reported that mass screening could decrease the proportion of metastatic prostate cancer. 16,17