Lucas Nogueira - Academia.edu (original) (raw)

Papers by Lucas Nogueira

Journal of Urology, 2009

Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is as... more Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is associated with malignant histology and/or nuclear grade.

Urology, 2010

To analyze our experience with laparoscopic partial nephrectomy (LPN) to detail postoperative adv... more To analyze our experience with laparoscopic partial nephrectomy (LPN) to detail postoperative adverse events and identify factors that may contribute to adverse surgical outcomes. Complications from LPN result from a variety of factors, both technical and inherent.Single-center review of 144 consecutive LPN (4 surgeons) performed between November 2002 and January 2008 was conducted. Identified complications were graded using standard reporting criteria. Univariate and multivariate statistical analysis of variables and their association with complication event and blood loss was performed.A total of 39 complications occurred in 29 (20%) cases. Of these, 20 (51%) were urologic and 19 (49%) were nonurologic. Individual adverse events by grade were as follows: grade I, 6 (15.4%); grade II, 19 (48.7%), grade III, 11 (28.2%), and grade IV, 3 (7.7%). No grade V complications occurred. The median tumor size and ischemia time were 2.7 cm and 35 minutes, respectively. Univariate analysis identified increased American Society of Anesthesiologists risk score (odds ratio 2.99, 95% confidence interval [CI] 1.28, 6.94) and ischemia time (odds ratio 1.31; 95% CI 1.00, 1.71) as associated with complication risk. On multivariate analysis, longer ischemia time was associated with increased estimated blood loss (95% CI 3, 57; P = .03). Hospital readmission and reintervention was required in 15 (10.4%) and 9 (6.2%) patients, respectively.Complications from LPN occur in a meaningful proportion of procedures although the majority does not require reintervention and half are not urologic. Increasing ischemia time and American Society of Anesthesiologists score are associated with risk for unfavorable surgical outcomes.

Urology, 2010

Objectives-Focal treatment is a curative option for localized prostate cancer (PCA), but appropri... more Objectives-Focal treatment is a curative option for localized prostate cancer (PCA), but appropriate selection of patients hasn't been established. We analyzed patients who had undergone radical prostatectomy (RP), with preoperative disease features considered favorable for focal treatment, to test the hypothesis that they would be accurately characterized with transrectal biopsy and prostate MRI.

Journal of Urology, 2009

Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is as... more Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is associated with malignant histology and/or nuclear grade.

Urologia Internationalis, 2010

To assess the role of short-term antibiotic therapy (ABT) in preventing urinary tract infection (... more To assess the role of short-term antibiotic therapy (ABT) in preventing urinary tract infection (UTI) after catheter removal following laparoscopic radical prostatectomy (LRP). 729 consecutive patients underwent LRP by one of two surgeons. One surgeon systematically prescribed a 3-day course of ABT (ciprofloxacin) starting the day before catheter removal; the other surgeon did not. The groups were compared for the incidence of symptomatic UTI occurring within 6 weeks after catheter removal. ABT was given to 261 of 713 patients (37%), while the remaining 452 patients (63%) did not receive ABT. After catheter removal, UTI was observed less frequently among patients receiving ABT: 3.1 vs. 7.3% in those not receiving ABT (p = 0.019). A number needed to treat to prevent 1 UTI is 24. Hospital readmission for febrile UTI was observed only in patients who did not receive ABT (n = 5, 1.1 vs. 0%, p = 0.16). One would need to prescribe ABT for 91 LRP patients to prevent 1 case of febrile UTI. ABT at the time of catheter removal reduced the risk of postoperative UTI after LRP. One would need to prescribe ABT to 24 patients to prevent 1 case of UTI.

Journal of Urology, 2009

INTRODUCTION AND OBJECTIVES: To describe the additional risk for complications and the potential ... more INTRODUCTION AND OBJECTIVES: To describe the additional risk for complications and the potential benefits of extending the indications and anatomical limits of laparoscopic pelvic lymph node dissection (PLND).

European Urology, 2010

Background: Although oncologic outcomes appear to be similar after laparoscopic partial nephrecto... more Background: Although oncologic outcomes appear to be similar after laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN), data on renal function are lacking. Objective: To evaluate the change over time in renal function after LPN and OPN. Design, setting, and participants: We identified 987 patients with a single sporadic tumor and a normal contralateral kidney who were treated by LPN (n = 182) and OPN (n = 805) between January 2002 and July 2009. Intervention: All patients underwent LPN or OPN at Memorial Sloan-Kettering Cancer Center. Measurements: Estimated glomerular filtration rate (GFR) was calculated using the abbreviated Modification of Diet in Renal Disease formula. We created a multivariable generalized estimating equations linear model that predicted GFR based on the time from surgery, preoperative GFR, tumor size, American Society of Anesthesiologists score, and ischemia time. Results and limitations: Mean patient age, tumor size, and ASA score were similar between LPN and OPN patients. The baseline preoperative GFR was lower in the laparoscopic group (67 ml/min per 1.73 m 2 vs 73 ml/min per 1.73 m 2 ; p < 0.001). The mean ischemia time was shorter after LPN than OPN (35 min vs 40 min, respectively; p < 0.001). In a multivariable model, the interaction term between time from surgery and approach was statistically significant ( p = 0.045), indicating that there was a differential effect on recovery of renal function over time by approach. Laparoscopically treated patients maintained a slightly higher renal function than those treated via an open approach. The 2-mo and 6-mo predicted GFR for a typical patient increased slightly from 65 ml/min per 1.73 m 2 to 67 ml/min per 1.73 m 2 , respectively, for those treated laparoscopically but remained constant at 62 ml/min per 1.73 m 2 after OPN. Conclusions: Our data suggest that the surgical approach has a small effect on the recovery of renal function after partial nephrectomy. Laparoscopically treated patients maintained slightly higher renal function.

Urology, 2010

The role of pelvic lymphadenectomy is often overlooked in prostate cancer surgery, though serious... more The role of pelvic lymphadenectomy is often overlooked in prostate cancer surgery, though serious attention has been paid of late, with improved understanding of the primary zones of lymph node metastases as described by Studer et al. 1 Indeed, much of the published data on the role of lymphadenectomy have suffered not only from the retrospective design of such studies but also from the absence of accepted standards for dissection templates. Despite these noteworthy limitations, there is growing evidence from clinical data to support 2 important concepts that are not foreign to the oncological surgeon: (1) therapeutic benefit is obtained from lymph node dissection, and (2) wider templates of node dissection increase the potential yield for detecting nodal disease. Several studies have indicated that patients with limited LNM can experience long-term survival. 2-5 Allaf et al 2 reported a significantly improved 5-year PSA progression-free rate after wide node dissection compared with limited node dissection (43% vs 10%), among men with LNM involving Ͻ15% of extracted nodes.

Journal of Urology, 2009

INTRODUCTION AND OBJECTIVE: Laparoscopic partial nephrectomy (LPN) is a minimally invasive techni... more INTRODUCTION AND OBJECTIVE: Laparoscopic partial nephrectomy (LPN) is a minimally invasive technique that has been shown to be safe and effective when compared to open partial nephrectomy (OPN). However, LPN is technically difficult and warm ischemia time (WIT) is longer when compared to OPN. The impact of WIT on the operated kidney's differential function have been poorly studied in the litterature, especially when WIT is less than 30 minutes. We evaluated the impact of WIT on the renal differential function assessed by pre-and post-operative renal scintigraphy.

Bju International, 2008

OBJECTIVETo compare haemostasis and other outcomes after the use of bovine-derived or porcine-der... more OBJECTIVETo compare haemostasis and other outcomes after the use of bovine-derived or porcine-derived gelatine matrix-thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN).To compare haemostasis and other outcomes after the use of bovine-derived or porcine-derived gelatine matrix-thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN).PATIENTS AND METHODSBetween October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine-derived GMTS and Group 2 (10 patients) a porcine-derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination.Between October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine-derived GMTS and Group 2 (10 patients) a porcine-derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination.RESULTSIntraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self-limited gross haematuria.Intraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self-limited gross haematuria.CONCLUSIONSBoth the porcine- and bovine-derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.Both the porcine- and bovine-derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.

International Braz J Urol, 2009

Prostate-specific antigen (PSA) has been used for prostate cancer detection since 1994. PSA testi... more Prostate-specific antigen (PSA) has been used for prostate cancer detection since 1994. PSA testing has revolutionized our ability to diagnose, treat, and follow-up patients. In the last two decades, PSA screening has led to a substantial increase in the incidence of prostate cancer (PC). This increased detection caused the incidence of advanced-stage disease to decrease at a dramatic rate, and most newly diagnosed PC today are localized tumors with a high probability of cure. PSA screening is associated with a 75% reduction in the proportion of men who now present with metastatic disease and a 32.5% reduction in the age-adjusted prostate cancer mortality rate through 2003. Although PSA is not a perfect marker, PSA testing has limited specificity for prostate cancer detection, and its appropriate clinical application remains a topic of debate. Due to its widespread use and increased over-detection, the result has been the occurrence of over-treatment of indolent cancers. Accordingly, several variations as regards PSA measurement have emerged as useful adjuncts for prostate cancer screening. These procedures take into consideration additional factors, such as the proportion of different PSA isoforms (free PSA, complexed PSA, pro-PSA and B PSA), the prostate volume (PSA density), and the rate of change in PSA levels over time (PSA velocity or PSA doubling time). The history and evidence underlying each of these parameters are reviewed in the following article.

Bju International, 2010

Prostate-specific antigen (PSA) has been used for detecting prostate cancer since 1994. Although ... more Prostate-specific antigen (PSA) has been used for detecting prostate cancer since 1994. Although it is the best cancer biomarker available, PSA is not perfect. It lacks both the sensitivity and specificity to accurately detect the presence of prostate cancer. None of the PSA thresholds currently in use consistently identify patients with prostate cancer and exclude patients without cancer. Novel approaches to improve our ability to detect prostate cancer and predict the course of the disease are needed. Additional methods for detecting prostate cancer have been evaluated. Despite the discovery of many new biomarkers, only a few have shown some clinical value. These markers include human kallikrein 2, urokinase-type plasminogen activator receptor, prostate-specific membrane antigen, early prostate cancer antigen, PCA3, α-methylacyl-CoA racemase and glutathione S-transferase π hypermethylation. We review the reports on biomarkers for prostate cancer detection, and their possible role in the clinical practice.

Journal of Urology, 2009

Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is as... more Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is associated with malignant histology and/or nuclear grade.

Urology, 2010

To analyze our experience with laparoscopic partial nephrectomy (LPN) to detail postoperative adv... more To analyze our experience with laparoscopic partial nephrectomy (LPN) to detail postoperative adverse events and identify factors that may contribute to adverse surgical outcomes. Complications from LPN result from a variety of factors, both technical and inherent.Single-center review of 144 consecutive LPN (4 surgeons) performed between November 2002 and January 2008 was conducted. Identified complications were graded using standard reporting criteria. Univariate and multivariate statistical analysis of variables and their association with complication event and blood loss was performed.A total of 39 complications occurred in 29 (20%) cases. Of these, 20 (51%) were urologic and 19 (49%) were nonurologic. Individual adverse events by grade were as follows: grade I, 6 (15.4%); grade II, 19 (48.7%), grade III, 11 (28.2%), and grade IV, 3 (7.7%). No grade V complications occurred. The median tumor size and ischemia time were 2.7 cm and 35 minutes, respectively. Univariate analysis identified increased American Society of Anesthesiologists risk score (odds ratio 2.99, 95% confidence interval [CI] 1.28, 6.94) and ischemia time (odds ratio 1.31; 95% CI 1.00, 1.71) as associated with complication risk. On multivariate analysis, longer ischemia time was associated with increased estimated blood loss (95% CI 3, 57; P = .03). Hospital readmission and reintervention was required in 15 (10.4%) and 9 (6.2%) patients, respectively.Complications from LPN occur in a meaningful proportion of procedures although the majority does not require reintervention and half are not urologic. Increasing ischemia time and American Society of Anesthesiologists score are associated with risk for unfavorable surgical outcomes.

Urology, 2010

Objectives-Focal treatment is a curative option for localized prostate cancer (PCA), but appropri... more Objectives-Focal treatment is a curative option for localized prostate cancer (PCA), but appropriate selection of patients hasn't been established. We analyzed patients who had undergone radical prostatectomy (RP), with preoperative disease features considered favorable for focal treatment, to test the hypothesis that they would be accurately characterized with transrectal biopsy and prostate MRI.

Journal of Urology, 2009

Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is as... more Objective-We evaluated our experience with renal cortical tumors to determine if tumor size is associated with malignant histology and/or nuclear grade.

Urologia Internationalis, 2010

To assess the role of short-term antibiotic therapy (ABT) in preventing urinary tract infection (... more To assess the role of short-term antibiotic therapy (ABT) in preventing urinary tract infection (UTI) after catheter removal following laparoscopic radical prostatectomy (LRP). 729 consecutive patients underwent LRP by one of two surgeons. One surgeon systematically prescribed a 3-day course of ABT (ciprofloxacin) starting the day before catheter removal; the other surgeon did not. The groups were compared for the incidence of symptomatic UTI occurring within 6 weeks after catheter removal. ABT was given to 261 of 713 patients (37%), while the remaining 452 patients (63%) did not receive ABT. After catheter removal, UTI was observed less frequently among patients receiving ABT: 3.1 vs. 7.3% in those not receiving ABT (p = 0.019). A number needed to treat to prevent 1 UTI is 24. Hospital readmission for febrile UTI was observed only in patients who did not receive ABT (n = 5, 1.1 vs. 0%, p = 0.16). One would need to prescribe ABT for 91 LRP patients to prevent 1 case of febrile UTI. ABT at the time of catheter removal reduced the risk of postoperative UTI after LRP. One would need to prescribe ABT to 24 patients to prevent 1 case of UTI.

Journal of Urology, 2009

INTRODUCTION AND OBJECTIVES: To describe the additional risk for complications and the potential ... more INTRODUCTION AND OBJECTIVES: To describe the additional risk for complications and the potential benefits of extending the indications and anatomical limits of laparoscopic pelvic lymph node dissection (PLND).

European Urology, 2010

Background: Although oncologic outcomes appear to be similar after laparoscopic partial nephrecto... more Background: Although oncologic outcomes appear to be similar after laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN), data on renal function are lacking. Objective: To evaluate the change over time in renal function after LPN and OPN. Design, setting, and participants: We identified 987 patients with a single sporadic tumor and a normal contralateral kidney who were treated by LPN (n = 182) and OPN (n = 805) between January 2002 and July 2009. Intervention: All patients underwent LPN or OPN at Memorial Sloan-Kettering Cancer Center. Measurements: Estimated glomerular filtration rate (GFR) was calculated using the abbreviated Modification of Diet in Renal Disease formula. We created a multivariable generalized estimating equations linear model that predicted GFR based on the time from surgery, preoperative GFR, tumor size, American Society of Anesthesiologists score, and ischemia time. Results and limitations: Mean patient age, tumor size, and ASA score were similar between LPN and OPN patients. The baseline preoperative GFR was lower in the laparoscopic group (67 ml/min per 1.73 m 2 vs 73 ml/min per 1.73 m 2 ; p < 0.001). The mean ischemia time was shorter after LPN than OPN (35 min vs 40 min, respectively; p < 0.001). In a multivariable model, the interaction term between time from surgery and approach was statistically significant ( p = 0.045), indicating that there was a differential effect on recovery of renal function over time by approach. Laparoscopically treated patients maintained a slightly higher renal function than those treated via an open approach. The 2-mo and 6-mo predicted GFR for a typical patient increased slightly from 65 ml/min per 1.73 m 2 to 67 ml/min per 1.73 m 2 , respectively, for those treated laparoscopically but remained constant at 62 ml/min per 1.73 m 2 after OPN. Conclusions: Our data suggest that the surgical approach has a small effect on the recovery of renal function after partial nephrectomy. Laparoscopically treated patients maintained slightly higher renal function.

Urology, 2010

The role of pelvic lymphadenectomy is often overlooked in prostate cancer surgery, though serious... more The role of pelvic lymphadenectomy is often overlooked in prostate cancer surgery, though serious attention has been paid of late, with improved understanding of the primary zones of lymph node metastases as described by Studer et al. 1 Indeed, much of the published data on the role of lymphadenectomy have suffered not only from the retrospective design of such studies but also from the absence of accepted standards for dissection templates. Despite these noteworthy limitations, there is growing evidence from clinical data to support 2 important concepts that are not foreign to the oncological surgeon: (1) therapeutic benefit is obtained from lymph node dissection, and (2) wider templates of node dissection increase the potential yield for detecting nodal disease. Several studies have indicated that patients with limited LNM can experience long-term survival. 2-5 Allaf et al 2 reported a significantly improved 5-year PSA progression-free rate after wide node dissection compared with limited node dissection (43% vs 10%), among men with LNM involving Ͻ15% of extracted nodes.

Journal of Urology, 2009

INTRODUCTION AND OBJECTIVE: Laparoscopic partial nephrectomy (LPN) is a minimally invasive techni... more INTRODUCTION AND OBJECTIVE: Laparoscopic partial nephrectomy (LPN) is a minimally invasive technique that has been shown to be safe and effective when compared to open partial nephrectomy (OPN). However, LPN is technically difficult and warm ischemia time (WIT) is longer when compared to OPN. The impact of WIT on the operated kidney's differential function have been poorly studied in the litterature, especially when WIT is less than 30 minutes. We evaluated the impact of WIT on the renal differential function assessed by pre-and post-operative renal scintigraphy.

Bju International, 2008

OBJECTIVETo compare haemostasis and other outcomes after the use of bovine-derived or porcine-der... more OBJECTIVETo compare haemostasis and other outcomes after the use of bovine-derived or porcine-derived gelatine matrix-thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN).To compare haemostasis and other outcomes after the use of bovine-derived or porcine-derived gelatine matrix-thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN).PATIENTS AND METHODSBetween October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine-derived GMTS and Group 2 (10 patients) a porcine-derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination.Between October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine-derived GMTS and Group 2 (10 patients) a porcine-derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination.RESULTSIntraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self-limited gross haematuria.Intraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self-limited gross haematuria.CONCLUSIONSBoth the porcine- and bovine-derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.Both the porcine- and bovine-derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.

International Braz J Urol, 2009

Prostate-specific antigen (PSA) has been used for prostate cancer detection since 1994. PSA testi... more Prostate-specific antigen (PSA) has been used for prostate cancer detection since 1994. PSA testing has revolutionized our ability to diagnose, treat, and follow-up patients. In the last two decades, PSA screening has led to a substantial increase in the incidence of prostate cancer (PC). This increased detection caused the incidence of advanced-stage disease to decrease at a dramatic rate, and most newly diagnosed PC today are localized tumors with a high probability of cure. PSA screening is associated with a 75% reduction in the proportion of men who now present with metastatic disease and a 32.5% reduction in the age-adjusted prostate cancer mortality rate through 2003. Although PSA is not a perfect marker, PSA testing has limited specificity for prostate cancer detection, and its appropriate clinical application remains a topic of debate. Due to its widespread use and increased over-detection, the result has been the occurrence of over-treatment of indolent cancers. Accordingly, several variations as regards PSA measurement have emerged as useful adjuncts for prostate cancer screening. These procedures take into consideration additional factors, such as the proportion of different PSA isoforms (free PSA, complexed PSA, pro-PSA and B PSA), the prostate volume (PSA density), and the rate of change in PSA levels over time (PSA velocity or PSA doubling time). The history and evidence underlying each of these parameters are reviewed in the following article.

Bju International, 2010

Prostate-specific antigen (PSA) has been used for detecting prostate cancer since 1994. Although ... more Prostate-specific antigen (PSA) has been used for detecting prostate cancer since 1994. Although it is the best cancer biomarker available, PSA is not perfect. It lacks both the sensitivity and specificity to accurately detect the presence of prostate cancer. None of the PSA thresholds currently in use consistently identify patients with prostate cancer and exclude patients without cancer. Novel approaches to improve our ability to detect prostate cancer and predict the course of the disease are needed. Additional methods for detecting prostate cancer have been evaluated. Despite the discovery of many new biomarkers, only a few have shown some clinical value. These markers include human kallikrein 2, urokinase-type plasminogen activator receptor, prostate-specific membrane antigen, early prostate cancer antigen, PCA3, α-methylacyl-CoA racemase and glutathione S-transferase π hypermethylation. We review the reports on biomarkers for prostate cancer detection, and their possible role in the clinical practice.