Latest Articles

A Practical Algorithm for Evaluation of Men With persistently Raised PSA: Is the Role of DRE Underestimated?

Krishna Rao Gurugubelli, Bharat Kumar, Sachin Bhagwan Dhakare, Atul Vishwanath Domakuntla, Arun Kumar SM, Lal Darsan, H Krishna Moorthy*

Background: Symptomatic men with elevated prostate-specific antigen (PSA) pose a diagnostic challenge due to overlap between benign and malignant conditions. A structured, algorithm-based approach integrating clinical examination, imaging, and appropriate biopsy modality may improve diagnostic accuracy while reducing unnecessary procedures.

Objective: To evaluate an algorithm-based diagnostic approach for symptomatic men with elevated PSA, stratified by clinical palpability, and to assess the diagnostic performance of finger-guided transrectal biopsy and multi parametric MRI-directed TRUS (trans rectal ultrasound) cognitive fusion biopsy.

Materials and Methods: This prospective observational study included 78 symptomatic men with persistently elevated PSA of >4ng/ml who underwent prostate biopsy. Patients were stratified based on digital rectal examination (DRE) into clinically palpable and non-palpable prostate groups. Patients with palpable lesions underwent finger-guided transrectal biopsy, while those with non-palpable prostates underwent multiparametric MRI (mpMRI), followed by TRUS-guided cognitive fusion biopsy for PI-RADS ≥ III lesions. Final diagnosis was confirmed by biopsy, TURP histopathology when performed, or serial PSA follow-up when treatment is inconclusive of malignancy.

Results: Among 56 patients with clinically palpable lesions, finger-guided biopsy detected carcinoma prostate in 36 patients, with one false-negative identified on TURP. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 97.2%, 100%, 100%, 95%, and 98.2%, respectively. Among 22 patients with clinically non-palpable prostates and PI-RADS ≥ III lesions, TRUS-guided cognitive fusion biopsy detected malignancy in 13 patients, with 100% sensitivity, specificity, and diagnostic accuracy. No statistically significant difference in cancer detection was observed between groups (p = 1.00).

Conclusion: An algorithm-based approach integrating DRE, mpMRI, and tailored biopsy techniques provides excellent diagnostic accuracy in men with persistently elevated PSA. Finger-guided biopsy remains effective in clinically palpable lesions, while mpMRI-directed TRUS biopsy is highly reliable in clinically non-palpable cases.

Keywords: Prostate-Specific Antigen; Prostatic Cancer Diagnostic Algorithm; Digital Rectal Examination; Multiparametric MRI; TRUS-Guided Biopsy.

Behavioral Variables, Dreaming, and an Inferred Association with Dopamine Modulation

Yuejia Zhuang*, Nicole Jurdak

Dreams, mental experiences occurring during REM sleep, are closely connected with the regulation of dopamine. The study aimed to investigate the association between dopamine and dreaming activity through proxy variables such as aerobic exercise and sugary consumption, both demonstrated to affect dopamine levels. A sample of n=64 participants ranging from 13 to 71 years old with a mean age of 29.9 were asked researcher-developed questions through surveys on SurveyMars. All data was analyzed through Pearson Product Moment correlation using SPSS software. The r and p values were calculated and correlational scatter plots were created. In total, 64 responses were collected in part 1 of the survey and 307 responses were collected in part 2 of the survey. The �indings of the study revealed that there is a signi�icant positive correlation between higher sugary substance consumption and dream vividness. Additionally, there was a positive correlation between the amount and intensity of exercise and dream vividness. However, there was only a non-signi�icant correlation between sugary substance consumption and higher amount and intensity of exercise and dream recall frequency. Future directions and limitations are discussed.

Minimally Invasive Surgery for Resection of Appendiceal Mucocele: A Single-Center Experience Case Series

Abdullah S. Al-Darwish, MD1*, Abdullah Z. Alsaif, MD1, Sami AlHawassi, MD1, Hisham AlKhalidi, MD, PhD2,3, Youssuf AlSuhaibani, MD1, Nahar A. AlSelaim, MD, MPH1,4,5, Abdulrahman Al-Balla, MD1

Introduction: Appendiceal Mucocele is a rare medical condition, sometimes it is discovered incidentally but occasionally it could mimic acute appendicitis. Laparoscopic resection of appendiceal mucocele recently has been reported, but the safety and efficacy are still controversial.
Presentation of Cases: We will present four cases of laparoscopic resection of appediceal mucocele. The First, second, and fourth cases were treated by laparoscopic appendectomy only; While the third case was treated by laparoscopic right hemicolectomy.
Discussion: We elected to do our cases using a Laparoscopic approach. Laparoscopic resection is achievable with expert surgeons, despite the risk of malignancy, but necessary precautions should be taken. The four cases’ final histopathology reports showed the same result: Low-Grade Appendiceal Mucinous Neoplasm (LAMN) .
Conclusion: A Laparoscopic resection of appendiceal mucocele can be done by expert surgeons if the necessary precautions were taken to prevent spillage.