Medico-Legal Update

Amal A. Hussein ¹, Rayah S. Baban ², Alaa G. Hussein ³, Saif H. Mohammed ⁴

Affiliations
1 Laboratory of Biochemistry /AL-Imamain AL-Kadhimain Medical City,, IQ
2 Department of Chemistry and Biochemistry /College of Medicine / AL-Nahrain University, IQ
3 Department of Pathology /College of Medicine / ALNahrain University, IQ
4 Department of Surgery, Al-Nahrain University/College of Medicine, IQ

Abstract

There is widespread of PSA using as a Prostate Cancer biomarker (threshold of 4ng/ml),but there is no single PSA value that avoids missing serious cancers at a treatable phase, avoids false-positives and unnecessary prostate biopsies.The evaluation of the clinical significant of[-2]proPSA and the Prostate Health Index(PHI) in diagnosis of Prostate Cancer was done in this research to enhance the correct prediction of the prostate cancer.The aim, of this study is to improve the method of testing by using newer PSA biomarkers in the subject sera for evaluating the diagnostic significance of[-2]proPSA and Prostate Health Index(PHI)in the detect of prostate cancer in early stages.A case-control researchcomprising54 patients over 50 years old age having Prostate Cancer and Benign Prostatic Hyperplasia recruited from Iraqi urological clinics unit and AL-Amal National Hospital for Cancer Management during the period from July 2018 to March 2019. There was a significantly high difference (P<0.001) ofserumPSA,P2PSA and PHI levels among all the study groups. The cut-off values of[-2]proPSA and Prostate Health Index (PHI)based on the ROC curve results in current study were >322 pg/ml and >578 respectively for Prostate cancer patients , while their values range between 322-89 pg/ml,and 578-209 respectively for BPH patients,and<89 pg/ml and<209for apparently healthy men respectively, the area under curve(AUC)of(P2PSAg)and PHI were0.968,0.960 for PCa group against noncancerous group respectively,0.85 and 0.796 for BPH group against control group respectively. Their levels show significant increase in PCa patients in comparison with noncancerous group and in BPH patients when compared with control group.

Keywords

(-2)proPSA;prostate cancer; Prostate Health Index; prostate-specific antigen

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Firas Alquraishi ¹, Saif H. Mohammed ¹, Yasser Al-Hakeem ¹

Affiliations
1 Lecturer, PhD. surgery Department, Al-Nahrain University/College of Medicine, IQ

Abstract

Background: men with benign prostate hyperplasia suffer from urinary tract infection especially in lower part of the tract and common manifestation of this infection is nacturia. Treatment of nocturia depends mainly on α-blockers; however, these drugs have limited success in relieving this symptom. Aims: This study aims to assess the efficacy of desmopressin (0.2mg) as an add-on therapy with α-blockers in relieving refractory nocturia for men with BPH. Patients and Methods: Inclusion criteria for this prospective, nonrandomized, open-label trial included men ≥60 years old with LUTS due to BPH; a total IPSS of ≥14 points; and persistent nocturia with ≥2 voids/night despite using α-blockers for at least 10 weeks prior to inclusion. Patients with diabetes mellitus, known neurogenic bladder dysfunction, uncontrolled hypertension, congestive heart failure, and those using diuretics were excluded from the study. Fifty one patients were included and categorized into two groups; those who continued on α-blocker treatment (n=22), and those for whom oral desmopressin (0.2 mg) was used as an add-on therapy (n=29). After four weeks of treatment, the International Prostate Symptom Score (IPSS), storage and voiding subs-scores, nocturia episodes, maximal flow rate (Q_max) and bother score were measured and compared with their respective baseline values. Results: there were no difference significantly between the two groups in all measured demographic and clinical parameters (all p-values >0.05). After four weeks of treatment, the total IPSS, storage sub-score, nocturia episodes, and bother score were all significantly better in the group were desmopressin add-on ( P-values ≤0.05). No significant differences were observed in the voiding sub-score and Q_max value between the two groups (both p-value >0.05). Conclusion: adding desmopressin to α-blockers is active therapy for men with BPH and suffering nocturia and no initial response to α-blockers

Keywords

nocturia, desmopressin, benign prostate hyperplasia, lower urinary tract infection

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