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  • Yang et al reported PSA triggered TRUSP biopsy

    2019-06-11

    Yang et al. reported PSA triggered TRUSP biopsy in Korea. This study included 75 patients younger than 40 years of age, with PSA > 4.0 ng/mL; the PCa detection rate was 1.3% in the Korean study. In comparison, there were substantially more abnormal DRE findings and significant LUTS findings in our study. The results suggested that nitric oxide synthase inhibitor PSA alone was not an effective mechanism for detecting PCa for young men, and the detection rate of PCa from PSA screening was very low. This is consistent with the result of our investigation, which suggested that PSA triggered TRUSP biopsy detected no PCa in men under 40 years of age. The AUA guidelines recommend against PSA-based screening in men less than 40 years of age. However, for high-risk men (i.e. those with a strong family history of prostate cancer or Afro-American ethnic group) aged 40–54 years, and all men from 55 to 69 years of age, individualized discussion of PSA detection of prostate cancer was suggested. In our cohort, all PCa patients had no family history, while the 5 patients with a family history of prostate cancer had negative TRUSP biopsy. The EAU guidelines recommended baseline PSA measurement at a young age. It was a robust predictor of aggressive PCa, metastasis, and PCa-specific mortality years later. Thus, the baseline PSA testing for young men could be useful for risk stratification, and to individualize protocols for early detection of PCa. With the primary purpose being risk assessment and the establishment of a baseline PSA or PSA velocity, initial PSA checkup provides important prognostic information. TRUSP biopsy triggered by PSA or PSA velocity had higher AUC (area under curve) on ROC (receiver operating characteristic) analysis for PCa detection in men in their 40s than those in their 50s, which has been reported in multiple studies. In 1994, Epstein et al. first reported criteria-based prostate-specific antigen and needle biopsy pathology for identifying potentially insignificant CaP, that might be safely managed by active surveillance. These criteria are associated with a significantly lower risk of adverse findings upon surgery than those with low-risk disease (stage T1c/T2, PSA ≦10 ng/mL, and Gleason score ≦6). The Epstein criteria have been used prospectively in a trial with more than 700 men to aid in selecting patients suitable for active surveillance rather than early intervention. Bill-Axelson et al. have shown the survival advantage of radical prostatectomy over watchful waiting for male patients younger than 65 years old. The younger PCa patients also have lower treatment-related morbidities such as incontinence and erectile dysfunction. Previous reports have also shown a better biochemical progression-free survival after prostatectomy, and less advanced disease at prostatectomy for younger males. Younger men have fewer comorbid conditions that might complicate treatment course. These findings suggest that in younger men, active treatment may be more effective, with fewer associated complications. In our study, 2 (2.60%) TRUSP biopsies were complicated by post biopsy fever. There was no AUR, anal bleeding or sepsis shock after the TRUSP biopsy. There were a number of potential detriments caused by PCa screening, which include hematuria, hematochezia, hematospermia, dysuria and retention, pain and infection. Our group reported on a nationwide study analyzing complications after TRUSP biopsy in Taiwan. The most frequently seen complication of prostate biopsy was voiding difficulty (9.76%), followed by infection (6.59%), and significant bleeding (1.14%). Age was a significant factor in infection requiring treatment. These findings supported the present study that severe complication such as infection following TRUSP biopsy in young men was not higher than the average in Taiwanese patients.
    Introduction Our previous research indicated that Chinese medicine and acupuncture demonstrated a similar efficacy for treatment of obesity as Western antiobesity drugs, but with fewer reported effects. Meridian and acupoint are the unique systems recorded in The Yellow Emperor\'s Internal Classic or Canon of Medicine, and are considered to be energy channels with acupoints being the nodes in modern medicine. Body temperature closely relates to energy metabolism, and it is generally understood that a quick evaluation of a person\'s health can be accomplished by measuring oral or axillary temperatures. However, single temperature reading is not always reliable. A patient with furunculosis may have a normal core body temperature, but the skin temperature around furunculosis may be feverish. A patient with lower extremity varicose veins may have normal axillary temperature, but the feet may feel almost icy to the touch. Owing to the properties of meridian and acupoint, we conjecture that skin temperature of meridian acupoint may be a good parameter to help evaluate health condition. Some studies have described some acupoint skin temperatures, but they merely focused on only one or two meridians. There is no standard of meridian acupoint temperature and no clear digitalized indicator to evaluate health associated with meridians to date. In this study, we have summarized the characteristics of 14 main meridians acupoint temperatures and have established a meridian acupoint temperature map. In addition, meridian theory is the foundation of traditional Chinese medicine (TCM) and acupuncture. Skin temperature of meridian acupoint may also provide clearly valuable information for TCM formula modification and acupoint combination for the treatment.