Purpose:Racial differences exist in the incidence of prostate cancer (PCa). Although many studies have looked at the performance of prostate-specific antigen (PSA) and PSA density (PSAD) in the detection of PCa, only a few have looked at it in relation to Indonesian men. The objective of this study is to find out better PSA and PSAD cutoff point in the detection of PCa in Indonesian men.Methods:A total of 404 consecutive Indonesian men underwent prostate biopsy for suspicion of PCa from 2008 to 2011. The biopsy criteria include one or more of the following: serum PSA more than 10 ng/mL, PSAD more than 0.15 if PSA 4–10 ng/mL, hypoechoic lesion during transrectal sonography and/or abnormal digital rectal examination.Results:Forty five out of 404 (11.1%) had positive biopsies. The mean age, prostate volume, PSA and PSAD were respectively 64.06 years, 43.03 mL, 45.59 ng/mL and 1.15. Of the 404, 131 cases (32.4%) were confirmed to be urinary retention. Positive urine culture found in 182 cases (45%). The cutoff point to detect PCa as estimated by the receiver operating characteristics was 6.95 ng/mL for PSA (sensitivity 97.8%, specificity 19.6%) and 0.7072 for PSAD (sensitivity 62.2%, specificity 78.7%). Positive predictive value for this PSA and PSAD cutoff point were 11.6% and 27.5% respectively (P=0.004 and P=0.000). There was a significant correlation between hypoechoic lesion and positive biopsy results (P =0.000). Urinary retention elevates PSA cutoff point to 14.55 (sensitivity 90.9%, specificity 50%), while positive urine culture alters almost no PSA cutoff elevation.Conclusions:PSA and PSAD cutoff point for Indonesian men in this series is relatively different from international consensus. Furthermore, these data show that PSA and PSAD cutoff point must be adjusted to racial variation to discriminate between malignant and benign disease. Urinary retention is a significant factor for PSA cutoff increase.

Background This study aimed to assess the effects of exogenous SOD administration on prostate cancer cell line (PC-3) apoptosis via the intrinsic pathway by examining the expression of manganese superoxide dismutase (MnSOD), caspase-3, and apoptosis index of the PC-3 cell line. Methods We used the prostate cancer cells from secondary prostate cancer cell lines (PC-3) derived from castration refractory prostate cancer (CRPC), cell differentiation grade IV, and had metastasized to the bone from the American Type Culture Collection (ATCC, Rockville, MD, USA). Superoxide dismutase (SOD) is derived from extracts of melon seeds and wheat gliadin biopolymer, and divided into 62.5 mg/mL, 83 mg/mL, 125 mg/mL, and 250 mg/mL doses. Expression of MnSOD was measured by immunohistochemistry (IHC). Expression of caspase-3 was measured using Western Blot method. Apoptotic index is calculated based on the reaction introduction 3OH end of fragmentation of DNA by the enzyme terminal transferase in preparations with TUNEL staining reagents. A one-way ANOVA test and Pearson correlation test were used to determine the relationship between SOD with expression of caspase-3 and apoptotic index. Results SOD extract significantly increased the expression of caspase-3 ( P =0.016) and the apoptotic index ( P =0.000) ( P <0.05). There was a correlation between the increased doses of SOD extract and the apoptosis index ( P =0.015; r=0.679) and between the increased caspase-3 expression and the apoptosis index ( P =0.015; r=0.682). Conclusion Administration of superoxide dismutase (SOD) increased apoptosis in a prostate cancer cell line (PC-3) through the increased expression of caspase-3. Superoxide dismutase (SOD) can be considered as a therapy for late-stage prostate cancer that had been progressed to hormone resistant and metastasized and promote apoptosis in those prostate cancer cells.

Background: Urethral reconstruction has been a problem for a long time and is a major challenge for surgeons. Surgical management of urethral defects is still controversial because there is no synthetic material that is considered ideal as a substitute for the urethra. With the development of adipose-derived mesenchymal stem cells, this research aims to observe the difference between the use of dried amniotic membrane as a scaffold with and without mesenchymal stem cells seeding as graft in urethral reconstruction. Methods: This research was a pure experimental research with a post-test only control group design using 24 male New Zealand white rabbits. The samples were divided into 3 groups: one control group, one scaffold (dried amniotic membrane) without stem cell seeding group, and one stem cell-seeded scaffold group. The rabbits were evaluated at 28 days after treatment and the results were analyzed using Chi-Square test. Results: The number of urethras that were healed were higher in stem cell-seeded scaffold compared to scaffold without stem cell seeding group (p < 0.05). Conclusion: Considering the promising result, application of dried amniotic membrane as a scaffold with adipose-derived mesenchymal stem cell seeding could be an option for urethral reconstruction. Highlights:

Objective: To compare the efficacy of combination therapy of 4 mg doxazosin + 15 mg meloxicam with 4 mg doxazosin single therapy for benign prostate hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS). Materials & Methods: A prospective, randomized and double blind study with total of 22 BPH patients with LUTS were randomized to receive 4 mg doxazosin + placebo once daily for 6 weeks or a combination of 4 mg doxazosin + 15 mg meloxicam once daily for 6 weeks. Inclusion criteria included IPSS ≥ 8, age > 50 years, prostate blood flow grade II. Therapeutic efficacy was assessed by comparing changes in IPSS, maximal urinary flow (Q-max) and changes in prostate blood flow between baseline and immediately after 6 weeks of therapy. Results: There was no significant difference in IPSS change between the two treatment groups (delta IPSS 4 ± 1.1 versus 3.7 ± 1.5, p = 0.630). There was a significant difference in Q-max changes between the two groups (delta Q-max 4 ± 1.5 versus 2.1 ± 0.7, p < 0.001). In group therapied with 4 mg doxazosin + 15 mg meloxicam prostate blood flow decreased from grade II to grade I in 9 of 11 patients (81%). Whereas, in the treatment group of 4 mg doxazosin + placebo no reduction was found in prostate blood flow. Conclusion: Combination therapy of 4 mg doxazosin + 15 mg meloxicam once daily for 6 weeks is better than 4 mg doxazosin therapy alone in improving Q-max and decreasing prostate blood flow in BPH patients with LUTS.Keywords: Benign prostate hyperplasia, inflammation, COX-2 inhibitors.

Objective: To identified outcomes and complications of percutaneous nephrolithotomy (PCNL) in patients of various body mass indices (BMI) to determine the safety of this procedure in patients with elevated BMI.Material & methods: The analytic observational prospective study of patients who underwent PCNL between February to July 2015 in the operating room Soetomo General Hospital Surabaya. Specifically, BMI, stone-free rates, difficulties duringsurgery, complications, and Clavien score were assessed. We evaluate the independent contribution of BMI as a predictor of outcomes. Results: There were 35 selected patients with kidney stone and planned to PCNL, 20 patients were included and 15 patients were excluded from this study. The patients consisted of 10 men (50%) and 10 women (50%). Mean age was 47.55 years (range 33-75). There were 4 patients with diabetes (20%), and 10 patients with hypertension (50%). Mean stone size was 23.30 mm. Stone location was 11 patients (55%) in the right kidney, and 9 patients (45%) in the left. There were 12 patients (60%) with a single stone, and 8 patients (40%) with multiple stones. BMI values were distributed as follows,underweight 1 patient (5%), normoweight 7 patients (35%), overweight 6 patients (30%), obesity 6 patients (30%). Mean skin to stone distance (SSD) was 87.56 mm. Stone free rate was 55%, and difficulties during surgery only seen in 1 patient (5%) bleeding profusely and open surgery was performed. Clavien score in these patients were grade I in 11 patients (55%), grade II in 7 patients (35%), and grade IIIB in 2 patients (10%). The BMI had no significant effect with Intra operative and postoperative difficulties (0.390. p <0.05. CI 95%). However the lower stone free rate had significant effect (0.040. p <0.05. CI 95%).Conclusion: BMI had no significant effect with Intraoperative and postoperative difficulties in PCNL.However, the lower stone-free rate risk associated with elevated BMI was significant.