There is a trend of minimally invasive surgery in the treatment of benign prostatic hypertrophy (BPH). Studies have examined levels of prostate specific antigen (PSA) in patients after open prostatectomy or transurethral resection of prostate (TURP) and noted reset of PSA to lower values after surgery. We reviewed PSA levels in patients after minimally invasive procedures to determine if levels were reset. There were 120 patients (age 45–70) enrolled in the study. Fifty patients underwent laser ablation, 20 patients had electrovaporization (TVP) and 50 patients underwent TURP. PSA measurements were obtained prior to and after surgical procedures in a three-year follow-up. Mean pre-operative PSA was 2.8 (±0.34) ng/ml for laser cohort, 3.2 (±0.31) ng/ml for the TURP group and 2.3 (±0.42) ng/ml for TVP patients (P=0.33). At 1 y follow-up, mean PSA decreased 32% for laser patients, 46% for the TURP cohort and 8% for TVP group. The largest mean decrease in PSA velocity was−1.5 (±0.31) ng/ml per y for TURP followed by 0.9 (±0.29) ng/ml per y for laser patients and−0.1 (s.d.±1.2) ng/ml per y for TVP group in y 1. The TURP group maintained the largest decrease in PSA velocity in y 2,−0.6 (±0.26) ng/ml per y. Three patients (2-TURP, 1-TVP) were diagnosed with prostate cancer during follow-up. In conclusion, serum PSA levels were reset at lower levels following different surgical interventions. This lower level of PSA remained decreased for 2 y post-procedure. Urologists should be cognizant of this reset level and monitor PSA levels for possible increases to screen for prostate cancer in this patient population.

In the sickle cell syndromes, Hb A2 measurements aid in the differential diagnosis of sickle cell anemia from sickle-beta-thalassemia. The purpose of this study is to assess the Hb A2 levels in samples containing sickle hemoglobin (Hb S) by the use of an automated high performance liquid chromatography system (HPLC-Variant beta-thalassemia Short Program). The blood samples analyzed were from individuals of African descent living in the state of Tennessee who had either sickle cell trait (Hb AS), sickle cell disease (Hb SS), or sickle cell-hemoglobin C disease (Hb SC). Interestingly, the Hb A2 levels determined by HPLC were found elevated in samples containing Hb S. The Hb A2 mean in Hb AS samples (n=146) is 4.09% (SD +/- 0.42, range 2.20 to 5.20%); in Hb SS samples (n=33) it is 3.90% (SD +/- 1.08, range 0.60 to 5.90%); and in Hb SC samples (n=27) it is 4.46% (SD +/- 0.70, range 2.30 to 5.91%). The Hb A2 mean by HPLC in normal individuals (Hb AA, n=70) is 2.57% (SD +/- 0.25, range 2.1 to 3.0%), and the Hb A2 range in beta-thalassemia carriers is 4 to 9%. Our results show that the Hb A2 levels in Hb S-containing samples partially overlap with those expected from beta-thalassemia carriers. The hemoglobinopathy laboratory should be aware of this apparent elevation in Hb A2 levels determined by HPLC in individuals carrying Hb S. Other factors, such as family history and clinical symptoms, should be taken into account before a diagnosis of sickle cell trait, sickle-beta-thalassemia, or sickle cell anemia is made.

Background and Objective: Current treatment technique for laser prostatectomy involve Nd:YAG wavelength at 60 to 80 W, Use of the KTP wavelength in addition to Nd:YAG allows for vaporization of more tissue, decreasing the amount undergoing coagulation necrosis, In this study, we compared 20 W and 40 W of KTP laser energy in conjunction with the Nd:YAG wavelength for the treatment of benign prostatic hyperplasia (BPH), Patients and Materials: A total of 50 consecutive patients underwent laser ablation of the prostate, with 38 patients (Group I) receiving treatment with 20 W of the KTP and 60 W of the Nd:YAG wavelengths, The other 12 patients (Group II) underwent treatment with 40 W of KTP and 60 W of Nd:YAG laser energy. The patients;had an initial evaluation consisting of American Urological Association (AUA) Symptom Score, uroflowmetry, transrectal ultrasonography for prostate volume measurement, and assay of prostate specific antigen (PSA) serum level. The patients were seen in follow-up at 1, 3, and 6 months. Results: The mean symptom score decreased from 23.4 to 8.9 from Group I and from 18.2 to 3.5 for Group II at the 6-month followup. The mean peak urinary flow rate increased from 8.4 to 15.4 mL/sec Group I and from 8.3 to 16.5 mL/sec in Group II at the 6-month follow-up, Conclusions: The patients treated with the 40 W of KTP laser energy experienced a more rapid and sustained improvement in symptom score than those treated at 20 W, The improvement in peak urinary flow rate was approximately the same in the two groups.

Objectives, To compare the safety and efficacy of laser ablation of the prostate, one of the minimally invasive treatments available for men with benign prostatic hyperplasia, to transurethral resection of the prostate (TURP).Methods. A prospective randomized study of 100 men with benign prostatic hyperplasia, with 50 patients in each:treatment arm, was conducted. All patients met the entry criteria: age older than 45 years, no history of carcinoma of the prostate, a peak flow rate less than 15 mL/s, medical therapy failure, and the ability to undergo regional or general anesthesia. All patients underwent a preoperative evaluation consisting of the American Urological Association (AUA) symptom score, uroflowmetry, pressure-flow study, transrectal ultrasound for prostate volume, and serum prostate-specific antigen determination. Patients underwent either TURF or laser ablation of the prostate using the potassium titanyl phosphate (KTP)/neodymium: yttrium-aluminum-garnet laser. Patients were seen for follow-up at 1, 3, 6, and 12 months.Results. The mean age was 68.2 years (range 45 to 90) for the laser group and 67.4 years (range 54 to 82) for the TURP group. The mean AUA symptom score was 22 for the laser group and 21 for the TURF group. The mean peak uroflow rate was 7.6 +/- 3.4 mL/s for the laser group and 6.5 +/- 4.0 mL/s for the TURF group. At 12 months of follow-up, the mean AUA symptom score had decreased to 7 (-69.5%) for the laser group and to 3 (-80.9%) for the TURF group. The mean peak uroflow rate increased to 15.4 mL/s (+107.8%) for the laser group and to 16.7 mL/s (+150.7%) for the TURP cohort.:Seventy-five percent of the laser group had a 50% or greater decrease in their individual AUA symptom score compared with 93% of the TURF group. Sixty-five percent of the laser cohort had a 50% or greater increase in their peak uroflow rate compared: with 75% of the TURF cohort.Conclusions. Laser prostatectomy produced improvements in the peak flow rate and symptom score similar to those produced by TURF. The patients who underwent laser treatment required a longer period to reach maximum improvement, which probably reflects the lack of:tissue debulking at the time of surgery. Further improvement in laser technology will be required to produce more immediate results. (C) 1999, Elsevier Science Inc.

(1998). Molecular Diagnosis and Characterization of Hb Zurich [β63(E7)His→Arg] Carriers in a Kentucky Family. Hemoglobin: Vol. 22, No. 5-6, pp. 509-515.

PURPOSE:Racial differences were assessed in all cause and disease related actuarial survivals after treatment for localized prostate cancer.MATERIALS AND METHODS:We studied 148 black and 209 white men with clinical stages T1b to 4NXMO prostate cancer treated with surgery or radiation therapy between 1980 and 1991 at a Veterans Affairs medical center.RESULTS:After a median potential followup of 96 months, there were no significant differences in the all cause, cause specific, metastases-free, clinical disease-free or prostate specific antigen disease-free survivals in 109 black and 167 white men with stages T1b to 2 cancer treated with surgery or radiation therapy, or in 39 black and 42 white men with stages T3 to 4 cancer treated with radiation therapy.CONCLUSIONS:Race appears to have no impact on the stage specific actuarial survivals in men with localized prostate cancer treated with surgery or radiation therapy in an equal access health care system.