Indonesian Andrology and Biomedical Journal

A Comparative Review of PSA, PSMA PET, and PCA3 Biomarkers in Prostate Cancer Diagnosis: Effectiveness, Cost, and Safety Analysis

Jesselyn Wijaya — 2024-12-20

ABSTRACT

Background: Prostate cancer is the third most common urological cancer among men in Indonesia, with an incidence rate of 14.8 per 100,000 population in 2012. PSA has been a cornerstone of diagnosis, however its low specificity in distinguishing prostate cancer from other urological malignancies, is followed by study of other biomarkers such as PSMA and PCA3. PSMA and PCA3, either as a single marker or in combination with PSA, has the potential to enhance diagnostic accuracy, aid in risk assessment, and support treatment decision-making.

Results : The overall diagnostic accuracy, as indicated by the AUC integrating sensitivity and specificity, shows that PCA3 and PSMA have higher AUC values compared to PSA. Combining PSA with PSMA, PCA3, or both demonstrated promising potential for prostate cancer diagnosis when compared to PSA alone. PSA shows slightly higher sensitivity, supporting its role as a screening tool, while PSMA PET offers better specificity than conventional imaging for detecting advanced prostate cancer, albeit at a higher cost. Meanwhile, PCA3, a urinary biomarker, surpasses PSA in specificity, effectively reducing unnecessary biopsies with a safer, non-invasive approach.

Summary : PSA remains the standard diagnostic biomarker for prostate cancer screening. Its low specificity may result in unnecessary biopsies. Other biomarkers like PSMA and PCA3 may be more appropriate for specific patient situations than PSA, with PCA3 being the least invasive procedure and PSMA PET being the most expensive. A multimodal approach combining PSA with PSMA or PCA3 shows significantly higher accuracy than PSA alone, improving diagnostic chances and reducing the risk of overdiagnosis.

Chronic inflammation and gut microbiota at a glance: Insights into fertility barriers

Bondan Winarno — 2024-12-20

Background: The acrosome reaction (AR) is a crucial step in fertilization, enabling sperm to penetrate the oocyte's protective layers, but various elements can hinder AR.

Reviews: Fertilization is a fundamental process in mammalian reproduction, involving the fusion of a sperm with oocyte. To achieve this, sperm must undergo capacitation, a series of biochemical changes that prepare them for fertilization. Once capacitated, sperm can penetrate the protective layers of the oocyte, after capacitation, sperm bind to receptors on the zona pellucida (ZP), a protective layer surrounding the egg. This binding triggers the acrosome reaction (AR), releasing enzymes that help the sperm penetrate the protective layers. Once the sperm has penetrated, it fuses with the oocyte's plasma membrane, delivering its genetic material. Anti-sperm antibodies (ASA) can directly bind to sperm, hindering their function and ability to undergo AR. Chronic inflammation, often associated with conditions like diabetes and obesity, with chronic hyperglycemia producing advanced glycation end products (AGEs) can create a pro-inflammatory environment that negatively impacts sperm parameter and function. Additionally, gut microbiota (GM) dysbiosis has been linked to chronic inflammation and may contribute to infertility.

Summary: Proper AR is essential for successful fertilization, but presence of ASA, GM dysbiosis, and chronic inflammation may hinder fertility. The evidence suggests improving inflammation by proper GM symbiosis may improve sperm parameter and fertility.

Effect of Intermittent Fasting on Decreased Interleukin-6 Genes mRNA Expression in Mice (Mus Musculus)

Sriyana Herman — 2024-12-25

Nowadays, the development of various degenerative diseases is very rapid. The rapid development of the disease has encouraged the wider community to understand the impact. Intermittent fasting can help prevent the emergence of cancer (one of the degenerative diseases) because during fasting the body's cells are in protective mode so as to protect the body from disease. Intermittent fasting reduces the body's inflammatory status by inhibiting the expression of proinflammatory cytokines, especially interleukin-6 (IL-6).

This study aims to examine the effect of intermittent fasting on IL-6 gene mRNA expression. This study is an experiment with Pretest-Posttest with Control Group design to examine the effect of intermittent fasting on the of IL-6 genes mRNA expression. The subjects of this study were 10 mice divided into 2 groups: the intermittent fasting group and the control group. The research was carried out at the Laboratory of Molecular Biology and Immunology Department, Faculty of Medicine, Universitas Hasanuddin, Makassar, as a place for the maintenance and care of experimental animals as well as examination of IL-6 genes mRNA expression. The study was conducted for 30 days.

The results showed a decrease in the average value of IL-6 mRNA expression of subjects before and after intermittent fasting with the value of ρ = 0.003 (ρ <0.05) showed that there is a significant effect between intermittent fasting on the decrease in IL-6 genes mRNA expression.

In conclusion, there is a decline in the IL-6 genes mRNA expression after intermittent fasting.

The Correlation between Hypogonadism and Coronary Heart Disease in Men at RSUP Prof. Ngoerah

Jovita Theodora Liu — 2024-12-25

Background : Hypogonadism is a clinical syndrome associated with aging, characterized by low levels of testosterone in a man's body. Hypogonadism can lead to various diseases, one of which is coronary heart disease. Coronary heart disease is a cardiovascular disease caused by the buildup of plaque in the coronary arteries.

Objective : This research aims to examine the relationship between hypogonadism and coronary heart disease in men at RSUP Prof. Ngoerah.

Methods : The research was conducted analytically with a case-control design. Hypogonadism was measured using the ADAM score questionnaire, which consists of 10 questions. The research sample comprised men who were coronary heart disease patients and men who were non-coronary heart disease patients aged 35–45 years in the Gedung Pelayanan Jantung Terpadu RSUP Prof. Ngoerah. The sample was determined using a consecutive sampling technique, with a total of 50 participants.

Results : The research results found that 28 participants (56%) tested positive for hypogonadism, and 22 participants (44%) tested negative for hypogonadism. A p-value of 0.004 indicated a significant relationship (p ≤ 0.05) between hypogonadism and coronary heart disease. The calculated Odds Ratio (OR 95% CI) between hypogonadism and coronary heart disease was 5.6 (1.648 – 19.232). Among the research participants, 19 (76%) were both positive for hypogonadism and coronary heart disease. Meanwhile, 16 participants (64%) were negative for both hypogonadism and coronary heart disease. The lower the testosterone levels in men, the higher the risk of developing coronary heart disease. Coronary heart disease patients with hypogonadism were 5.6 times more likely to have the condition compared to those without hypogonadism.

Conclusion : There is a significant correlation between andropause and coronary heart disease in men at RSUP Prof. Ngoerah.

The Association of E-Cigarettes with Hypogonadism in Adult Men in Denpasar

Louis Felix Djuanda — 2024-12-25

Background : A decrease in testosterone level can cause a set of symptoms forming a clinical syndrome called hypogonadism. One of the factors that is known to disrupt testosterone levels is smoking habits. Currently, the use of e-cigarettes as an alternative product to conventional cigarettes is increasing rapidly in many countries, including Indonesia. The amounts of harmful substances in e-cigarette aerosols are similar to the smoke produced by conventional cigarettes, but the health hazards of e-cigarettes are still not well known.

Objective : This study was conducted to determine the relationship between e-cigarettes and hypogonadism in adult men in the city of Denpasar.

Method: This study uses a descriptive-analytical method in the form of a cross-sectional study. The research sample consisted of 49 e-cigarette users collected using consecutive sampling techniques. The data were then analyzed using SPSS^® version 26.

Results : Based on the research obtained from the ADAM score from a total of 49 samples, the prevalence of hypogonadism is higher in the group of people who smoked e-cigarettes, about 35,3%. Overall, this study found a fairly high prevalence of hypogonadism (26.5%) in Denpasar. The chi-square test shows a p-value of 0,032 and a prevalence ratio (PR) of 5.294.

Conclusions : Active use of e-cigarettes showed a significant association with the incidence of hypogonadism experienced by adult men in Denpasar. Based on the PR calculation, the risk of hypogonadism in active e-cigarette users was 5.294 times higher than that of adult men who were not active e-cigarette users.

Non-obstructive azoospermia in male with Y-chromosome microdeletion: a case report

Jesselyn Angellee — 2024-12-25

Background: Male factors have contributed to at least 50% of all infertility cases worldwide. Numerous factors causing male infertility have been identified, one of which is azoospermia due to genetic defects. The detection of Y-chromosome microdeletion may assist in diagnosing male infertility as well as predicting the success rate of testicular sperm extraction.

Case: A man in his mid-thirties visited the Andrology outpatient clinic at Dr. Soetomo General Hospital accompanied by his wife. They have been married for eight years and have had regular unprotected sexual intercourse, but pregnancy has never been achieved. The patient’s semen analyses showed azoospermia in three examinations conducted at different times. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were significantly increased, and genetic screening showed microdeletion in the Azoospermia Factor b (AZFb) subregion.

Discussion: Y-chromosome microdeletion is the second most common genetic defect causing azoospermia after Klinefelter syndrome. The AZF region in the distal part of the Y chromosome plays a key role in regulating spermatogenesis. Mutation or loss of any subregions in this factor may affect spermatogenesis, with the worst outcome being azoospermia.

Conclusion: Detailed examinations are important to determine the cause of azoospermia, which may assist a physician in choosing the appropriate management for this condition. Infertile men with Y-chromosome microdeletion face challenges in reproducing naturally. They may also need genetic counseling regarding the possibility of passing on this genetic defect to their offspring and information on how to prevent it.