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OBJECTIVES To assess the usefulness of measuring testosterone, free testosterone, and the free/total (f/t) prostate-specific antigen (PSA) ratio with the intention of reducing the number of unnecessary biopsies in the patients with PSA values between 2.0 and 4.0 ng/mL. Cancer detection is not rare among patients with PSA values between 2.0 and 4.0 ng/mL. METHODS A total of 171 men with serum PSA levels of 2.0 to 4.0 ng/mL were enrolled in this study. The f/t PSA ratio and total and free testosterone levels were quantified. All patients underwent transrectal ultrasound-guided biopsy. The cancer detection rate, clinical and pathologic features of the cancers detected, and the probability of cancer detection in relation to the f/t PSA ratio and total and free testosterone levels were estimated. Two-step statistical analysis was used for descriptive purposes and in the detection of cancer predictors. Statistical significance was set at P < or = 0.05. RESULTS The mean patient age was 63.3 years. Cancer was detected in 39 (22.8%) of the 171 patients. Only 15.4% of our patients had insignificant cancer. The f/t PSA ratio and total and free testosterone levels were significantly lower in the patients with prostate cancer (19.3%, 13.68 nmol/L, and 28.4 pmol/L, respectively; P < 0.001). The f/t PSA ratio and free testosterone were the strongest predictors of cancer detection (P < 0.001). CONCLUSIONS The results of our study have shown that an important number of cancers could be detected in the PSA range of 2.0 to 4.0 ng/mL. The great majority of cancers detected have the features of medically significant tumors. The combination of the f/t PSA ratio and free testosterone measurements may reveal those patients who require biopsy.

Objectives To correlate the findings of prostate color Doppler sonography (CDS) with those of site-specific transrectal ultrasound-guided core biopsy; to evaluate the significance of two different color presets in detecting prostate cancer compared with gray-scale transrectal ultrasonography; and to compare the accuracy of conventional gray-scale transrectal ultrasound (CGS)-guided biopsy with CDS-guided biopsy. Methods Seventy patients were enrolled in this prospective study. CDS was performed before biopsy. Two color presets were used: CDS-1 (high sensitivity) and CDS-2 (high specificity). The color flow was graded on a scale from 0 to 2+. At the completion of the color grading, color maps were constructed. In each case, CDS-guided biopsy was performed followed by CGS-guided biopsy (six sextant biopsies and focal lesional biopsies). Results The cancer detection rate was 33%, 31%, and 27% for CGS-guided biopsy, CDS-1, and CDS-2, respectively. CDS-1 was more sensitive than CDS-2 (81% versus 60%) but both presets had similar specificities (79% versus 82%). CGS-guided biopsy yielded a sensitivity of 90%, a specificity of 38%, and a positive and negative predictive value of 34% and 83%, respectively. A biopsy strategy combining hypoechoicity with increased color flow increased the specificity to 97%, positive predictive value to 68%, and negative predictive value to 84%, but its sensitivity was low (18%). Conclusions Our experience suggests that low-velocity, high-sensitivity color is superior to all other CDS settings. The presence of focal peripheral zone hypervascularity at CDS is associated with a high likelihood of prostate cancer. However, only a combination of CDS guidance with six sextant biopsies may achieve maximal sensitivity and specificity.

Objectives To use infrared fiberoptic spectroscopy for the analysis of urinary salts in real time and with no sample processing; and to assess the practical role of this method for the quantitative measurement of the composition of urine and for the diagnosis of urolithiasis in patients. Methods Urine samples were obtained from two groups of patients: 24 patients with stone formation after shock wave lithotripsy and 24 normal subjects of similar age. Infrared absorption measurements were performed in real time, using infrared transmitting silver halide fibers. The absorption data were compared with the infrared absorption spectra of aqueous solutions prepared in our laboratory, with known concentrations of known urinary salts. The results were used for the study of the chemical composition of these salts in the urine samples and for a quantitative analysis of the concentration of the salts. Results We determined the composition of the stones in 20 of the 24 patients on the basis of the characteristic absorption peaks for the oxalates, carbonates, urates, and phosphates observed in their urinary samples. Using the method mentioned above, we found the concentration of different salts in urine with an average error of 20%. Conclusions Fiberoptic infrared spectroscopy could be used as a new diagnostic tool for detecting different urinary salts in urine, finding their chemical composition, and determining their concentrations, without any sample preparation.

1Padova University Hospital, Urology Padova, Italy; 2Barzilai Medical Center, Urology, Ashkelon, Israel; 3VA Urology, Urology, Richmond, VA, USA; 4Montefiore Medical Center, Urology, New York City, NY, USA 5University Hospital Schleswig-Holstein, Urology, Lubeck, Germany; 6TASMC, Radiotherapy, Tel Aviv, Israel; 7VA Urology, Radiotherapy, Richmond, VA, USA; 8Montefiore Medical Center, Radiotherapy, New York City, NY, USA; 9University Hospital Schleswig-Holstein, Radiotherapy, Lubeck, Germany; 10Virginia Commonwealth University, Radiotherapy, Richmond, VA, USA; 11Padova University Hospital, Radiotherapy, Padova, Italy. 795

A new diagnostic and therapeutic application of transrectal ultrasonography (TR-US) is described. TR-US demonstrated one or more well-defined hypoechogenic areas in the prostate gland of 6 patients who presented with clinical signs of urinary tract infection and had only partial response to antibiotic therapy. The presence of a collection of pus in the prostate was confirmed in 4 of 6 patients by transperineal aspiration guided by TR-US, and by prostatic massage or transurethral prostatectomy in the other 2 patients. Ultrasonography also confirmed the resolution of abscesses in 5 patients.