Christiaan Frederik Heyns

Clinical (non-histological) diagnosis of advanced prostate cancer: Evaluation of treatment outcome after androgen deprivation therapy

Evaluation of the visual prostate symptom score in a male population with great language diversity and limited education: A study from Namibia

A visual prostate symptom score (VPSS) compared with the international prostate symptom score (IPSS) for evaluation of lower urinary tract symptoms (LUTS) can be completed without physician assistance by a significantly larger proportion of men with limited education. We aimed to evaluate the correlation of the VPSS and IPSS with uroflowmetry parameters. Men with LUTS were requested to complete the IPSS and VPSS, consisting of pictograms to evaluate urinary frequency, nocturia, force of the stream and quality of life. The maximum (Qmax) and average urinary flow rate (Qave), voided volume (VV) and post-void residual (PVR) urine volumes were measured. Statistical analysis was performed using the Mann-Whitney and Spearman's tests. The study included 93 men (mean age 64 years, range 33 - 85), with VV >150 ml in 66 (71%) and 150 ml there were significant negative correlations between the IPSS and Qmax (r=-0.30, p=0.016), the IPSS and Qave (r=-0.29, p=0.018), the VPSS and Qmax (r=-0.38, p<0.002) and the VPSS and Qave (r=-0.37, p<0.003). The VPSS question on the subject's assessment of his urinary stream showed a significant negative correlation with the Qmax (r=-0.37, p=0.002) and Qave (r=-0.31, p=0.011), but the IPSS question on the subject's urinary stream did not correlate significantly with the Qmax or Qave. The VPSS is equivalent to the IPSS in terms of correlation with Qmax and Qave and can therefore be used instead of the IPSS to evaluate LUTS in men with limited education.

Background: The objectives were to investigate the aetiology and clinical features of urinary retention and to analyse differences between acute urinary retention (AUR) and chronic urinary retention (CUR). Method: We analysed the clinical data of 558 men admitted to our institution with urinary retention between September 1998 and June 2007. Statistical analysis was performed with Student's t-test, Mann-Whitney and Fisher's exact tests, where appropriate. Results: The mean age of the men was 66.4 years (range 12.8–94.7). AUR was present in 90.7% and CUR in 9.3%. The most common causes were benign prostatic hyperplasia in 36.6%, adenocarcinoma of the prostate (ACP) in 36.0% and urethral stricture in 14.3%. Mean prostate volume was 56.6 cc (range 15–262). Comparing the groups with AUR versus CUR, a positive urine culture was significantly more common in the group with AUR (34.1% vs. 8%), whereas anaemia (15.9% vs. 34.1%), renal failure (9.1% vs. 46.2%) and hydronephrosis (23.9% vs. 53.9%) were significantly more common in the group with CUR. There was no significant difference in prostate volume or the proportion of men with histological prostatitis (29.5% vs. 23.1%). Conclusion: The prevalence of ACP and urethral stricture as aetiology of retention was higher than reported in the literature. The prevalence of anaemia, renal failure and hydronephrosis was significantly greater in patients with CUR compared to AUR. There was no significant difference in prostate volume or the prevalence of histological prostatitis, indicating that factors other than prostate size or histological prostatitis determine the development of AUR rather than CUR.

We aimed to evaluate the presenting features and treatment outcome of prostate cancer in men aged 50 years, had a siginificantly greater proportion with poorly differentiated adenocarcinoma (53%), locally advanced (stage T3-4) tumours (56%), haematogenous metastases (75%), significantly higher serum PSA at diagnosis (mean 621, median 74 ng/ml) and shorter survival. Men aged 50 years. To diagnose prostate cancer at a potentially curable stage in men aged 20-25 years.