dc.contributor.author | Zackrisson, Björn 1958- | en |
dc.date.accessioned | 2008-08-11T10:19:27Z | |
dc.date.available | 2008-08-11T10:19:27Z | |
dc.date.issued | 2003 | en |
dc.identifier.isbn | 91-628-5644-8 | en |
dc.identifier.uri | http://hdl.handle.net/2077/15890 | |
dc.description.abstract | Problems: Description of transrectal ultrasound (TRUS) anatomy in selected healthy men is lacking. Is the prostate gland involved in febrile urinary tract infection (UTI)? Is one negative prostate sextant-biopsy enough to rule out prostate cancer (PC)? What is the risk of diagnosing insignificant PC in men subjected to long-term PSA-screening?Methods: I) 125 healthy men (20-69 years) were investigated by TRUS. II-III) 70 and 55 men, respectively, with febrile UTI were followed 12 months with physical examinations, repeated PSA-testing and TRUS. IV-V) 10.000 men (50-65 years) were randomized to biennial PSA-screening. If elevated PSA digital rectal examination and TRUS-led prostate biopsies were recommended. In 457 men with one set of negative prostate-biopsies, the outcome from two subsequent screening-occasions was studied. The rate of low-volume PC (evaluated in prostatectomy- or biopsy-specimen) was studied in 544 men diagnosed at one of 4 biopsy-occasions. Results: I) Prostate volume (PV) increased with age (19.2-35.5cm3). Sonographic changes were common in all age-groups. II-III) 83% had elevated PSA (>4ng/ml) during febrile UTI. PV and decreased significantly (31%) the infection. Free-PSA normalized after one month. Complexed-PSA slowly decreased during 12 months. Up to six months free-to-total-PSA was similar to PC-values (11-16%). IV) Three groups were found: PC (26%), three negative biopsies (56%) and normalized PSA (17%). In cases with PV <20cm3 either PC or normalized PSA was found. Only follow-up identified the normalized-PSA group. V) Biopsies and cancers detected at four biopsy-rounds were; 1593/389, 571/120, 252/33 and 78/6, respectively. The risk of detecting low-volume cancer was constant (5-7%) at the different sets of biopsies, but the relative ratio of low-volume cancer doubled from 24% (19%) at primary biopsy to 48% (36%) at third biopsy. Conclusions: Various TRUS-findings are common among healthy men. The prostate gland is commonly involved in febrile UTI, with PSA and TRUS-findings during follow-up mimicking PC. Causes for PSA elevation in men with one negative sextant prostate-biopsy are PC, BPH and probably inflammation. The chance of finding significant cancer decreases with the number of previous sets of benign biopsies, while the risk of detecting low-volume cancer is constant. | en |
dc.subject | Male | en |
dc.subject | normal anatomy | en |
dc.subject | prostate gland | en |
dc.subject | transrectal ultrasound (TRUS) | en |
dc.subject | urinary tract infection (UTI) | en |
dc.subject | prostate-specific antigen (PSA) | en |
dc.subject | prostate cancer | en |
dc.subject | re-biopsy | en |
dc.subject | prostate cancer screening | en |
dc.title | Investigation of the prostate gland in different clinical conditions | en |
dc.type | Text | en |
dc.type.svep | Doctoral thesis | en |
dc.gup.origin | Göteborgs universitet/University of Gothenburg | eng |
dc.gup.department | Department of Urology | eng |
dc.gup.department | Avdelningen för urologi | swe |
dc.gup.defenceplace | Aulan, bruna stråket 5, Sahlgrenska Universitetssjukhuset/SU, Göteborg, kl. 13.00 | en |
dc.gup.defencedate | 2003-05-28 | en |
dc.gup.dissdbid | 5835 | en |
dc.gup.dissdb-fakultet | MF | |