Objectives• To test the sensitivity, specificity and accuracy of serum prostate-specific antigen isoform [-2]proPSA (p2PSA), %p2PSA and the prostate health index (PHI), in men with a family history of prostate cancer (PCa) undergoing prostate biopsy for suspected PCa.• To evaluate the potential reduction in unnecessary biopsies and the characteristics of potentially missed cases of PCa that would result from using serum p2PSA, %p2PSA and PHI.
Patients and Methods• The analysis consisted of a nested case-control study from the PRO-PSA Multicentric European Study, the PROMEtheuS project.• All patients had a first-degree relative (father, brother, son) with PCa.• Multivariable logistic regression models were complemented by predictive accuracy analysis and decision-curve analysis. Gleason score (r: 0.247, P = 0.038; r: 0.366, P = 0.002; r: 0.464, P < 0.001, respectively).
Results
• Of the 1026 patients included in the PROMEtheuS
Conclusions• %p2PSA and PHI are more accurate than tPSA, fPSA and %fPSA in predicting PCa in men with a family history of PCa.• Consideration of %p2PSA and PHI results in the avoidance of several unnecessary biopsies. • p2PSA, %p2PSA and PHI correlate with cancer aggressiveness.
Numerous surgical procedures have been developed for urinary diversion in patients who have undergone a radical cystectomy for bladder cancer or, less frequently, a benign condition. Because urinary diversion procedures are complex, early and late postsurgical complications frequently occur. Possible complications include alterations in bowel motility, anastomotic leaks, fluid collections (abscess, urinoma, lymphocele, and hematoma), fistulas, peristomal herniation, ureteral strictures, calculi, and tumor recurrence. Computed tomography (CT) is an accurate method for evaluating such events. Multiplanar reformatting and three-dimensional volume rendering of multidetector CT image data are particularly useful for achieving an accurate and prompt diagnosis of complications and obtaining information that is essential for adequate surgical management. In addition, knowledge of urinary diversion procedures, normal postsurgical appearances, and optimal CT technique for postsurgical evaluations is essential for detecting complications and avoiding misdiagnosis.
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