Tumour marker report | Figure 1

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Internal Medicine

Tumour marker report

58 year old male with

  1. Grade 2 prostrate enlargement (with little to no urinary symptoms)
  2. BMI of 28

With no other clinical symptoms nor presentations came with this report (self referred) in view of his enlarged prostate.

Is this anything alarming since oncology is not my forte.

What should I recommend this patient if at all anything?

Any and all suggestions are welcome.

The author made an update to this case

Update 1

Thank you all for your valuable inputs.

Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction

Review question
How does surgery using bipolar technology compare with traditional monopolar technology for men with an enlarged prostate causing difficulty with urination?

Background
People with an enlarged prostate can experience difficulty passing urine. This occurs because the enlarged prostate compresses the urinary tube from which urine leaves the bladder. One option for treatment of this condition is telescopic surgery, which acts to remove prostate tissue and relieve the blockage. This is traditionally performed using a technology called monopolar TURP (short for 'transurethral resection of the prostate'). In recent times, a technique called bipolar TURP has been developed. This approach uses saline instead of other watery fluids and may put men at lower risk for a problem called TUR syndrome, which is a rare but potentially serious complication caused by fluid absorption, but it is unclear how the two procedures compare overall.

Study characteristics
We searched the medical literature for clinical trials up to 19 March 2019. We found 59 randomised trials that compared BTURP with MTURP. These studies included a total of 8924 patients. The longest period of follow‐up for the outcomes of interest was 12 months after treatment.

Key results
Compared to MTURP, BTURP probably results in similar reduction in urinary symptoms and bother.
It probably slightly reduces both the risk of TUR syndrome and the need for blood transfusion.
Erectile function is probably similar after both procedures, as is the risk of urinary incontinence and the need for a repeat procedure.

Quality of evidence
The quality of evidence for the outcomes of ability to pass urine, patient bother, TUR syndrome, need for blood transfusion, and erectile function was considered to be moderate. The quality of evidence for the outcomes of urinary leakage after the procedure and need for a repeat procedure was low.

Convective radiofrequency water vapour thermal therapy for lower urinary tract symptoms in men with benign prostatic hyperplasia

Review Question
What are the effects of convective radiofrequency water vapour thermal therapy in men with bothersome urinary symptoms because of an enlarged prostate?

Background
Prostate enlargement is common in older men, and can cause bothersome urinary symptoms, such as having to pass their water (voiding) often, a weak stream while voiding, or dribbling. If lifestyle changes and medications don't help, a variety of surgical procedures, including transurethral resection of the prostate (TURP), can improve these symptoms. They may also cause unwanted effects, such as problems with ejaculation or erections. Recently, a new procedure called 'convective radiofrequency water vapour thermal therapy' has become available. It is unclear how it compares to other treatments, such as TURP.

Study characteristics
We found a single study, with 197 men, that compared convective radiofrequency water vapour thermal therapy to a sham procedure (men were made to believe they received treatment, while in reality, they did not), funded by the device company. The men's average age was 62.9 years, and most had a moderate degree of bothersome urinary symptoms.

Key results
Compared to a sham procedure, and with a three‐month follow‐up, convective radiofrequency water vapour thermal therapy may improve urinary symptoms (low certainty of evidence). Convective radiofrequency water vapour thermal therapy also likely improves quality of life (moderate certainty of evidence). We are very uncertain whether serious unwanted side effects are more common or not (very low certainty of evidence). Men's erections and ejaculations may be similar in men who have convective radiofrequency water vapour thermal therapy and those who receive the sham procedure (low certainty of evidence).

Certainty of the evidence
We judged the certainty of the evidence for the outcomes to be moderate, low or very low. Reasons for not being so confident had to do with the study design and the study size.

Clinical Case Presentations

  1. 69 y Male attended the clinic c/o a skin discolouration
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    Patient PMH: HTN, hipercholesterolemia, prostate enlargement, Arteriosclerosis.
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