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【Objective】 To investigate the expressions of P53 and Ki-67 in prostate cancer (PCa)and to explore their correlation with the clinicopathological characteristics. 【Methods】 The expressions of P53 and Ki-67 in 90 PCa patients were detected with immunohistochemistry. Patients’ age, preoperative prostate-specific antigen (PSA) level, postoperative Gleason score, pathological stage, and invasion of neurovascular cancer embolus of all patients were recorded. The relationship of P53 expression with the above indexes was evaluated. 【Results】 The positive rates of P53 and Ki-67 were 27.8% (25/90) and 46.7% (42/90), respectively. The positive rate of P53 in pT2 and pT3-T4 stage groups were 19.7% (13/66) and 50.0% (12/24) (P=0.005), and the positive rate of Ki-67 were 36.4% (24/66) and 75.0% (18/24) (P=0.001), respectively. The positive rate of Ki-67 in Gleason score ≤6, ≤7 and ≥8 groups were 30.4%, 53.8% and 66.7%, respectively, with statistical difference. Positive expression of P53 was related to Ki-67 expression, but not to patients’ age, preoperative PSA level, postoperative Gleason score and nerve and invasion of neurovascular cancer embolus. 【Conclusion】 P53 expression is related to tumor stage and Ki-67, while Ki-67 expression is associated with tumor stage ang grade.
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Objective:To investigate the practicality and safety of performing a radical prostatectomy(RP)shortly after the diagnosis of prostate cancer using a combination of prostate targeted biopsy and intraoperative frozen section.Methods:Prospective enrollment was conducted for patients suspected of having prostate cancer based on abnormal prostate specific antigen(PSA)levels.The inclusion criteria for the study were as follows: patients aged 80 years or younger with an ECOG score of 1 or lower.Prior to biopsy, patients underwent both prostate magnetic resonance imaging(MRI)and prostate specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)to determine the likelihood of prostate cancer with clinical stages within T 2-3aN 0M 0.In order to be included in the study, patients must agree to receive RP after their prostate cancer diagnosis has been confirmed by biopsy.All enrolled patients underwent a targeted prostate biopsy, consisting of 1-2 cores.These specimens were then examined through frozen section analysis.For patients diagnosed with prostate cancer through intraoperative frozen section pathology, RP was immediately performed.In this study, transperineal prostate targeted+ systematic biopsy was utilized for patients with undiagnosed prostate cancer.Additionally, routine pathological examination of specimens was conducted.The study analyzed the baseline data, surgical conditions, pathological results, and follow-up information of patients in a descriptive manner. Results:Seven patients, ranging in age from 54 to 77 years with a mean age of 66.7 years, were enrolled in the study.Their mean PSA level was 12.668 μg/L, ranging from 4.359 to 22.195 μg/L.Of these patients, 4 had a PI-RADS score of 4 and 3 had a score of 5.The maximum diameter of the index lesion was 1.3 cm, ranging from 0.5 to 2.2 cm.PSMA PET/CT scores were 4 in 1 case and 5 in 6 cases.The index lesions detected by PSMA PET/CT were consistent with those detected by MRI, and the maximum standardized uptake value(SUVmax)was 15.7, ranging from 5.3 to 39.4.Prostate cancer was diagnosed through targeted biopsy and intraoperative frozen section pathology.Four cases had a Gleason score of 3+ 3=6, while one case had a Gleason score of 3+ 4=7, another had a score of 4+ 3=7, and the last had a score of 4+ 4=8.All patients underwent RP treatment immediately after the prostate cancer diagnosis.Only one patient had slight adhesion at the apex of the prostate, while the other six patients were evaluated by surgeons as having no obvious adhesion at the apex.All surgeries were completed successfully, with a mean operation time of 149.7(ranging from 108 to 255)minutes.After RP, whole mount pathology results indicated that all cases were prostate adenocarcinoma, with a Gleason score of 3+ 4=7 in four cases and 4+ 3=7 in three cases.The pathological stages were pT2 in three cases and pT3a in four cases, with five cases having negative surgical margins and two cases with positive surgical margins.During the study, all patients were monitored for a period of 5.4 months(ranging from 3 to 7 months)and no complications of Clavien Dino≥Ⅰ were observed.PSA levels were measured at 6 weeks and 3 months after surgery, with readings of 0.020 μg/L(ranging from 0 to 0.079 μg/L)and 0.016 μg/L(ranging from 0 to 0.087 μg/L), respectively.No hormonal therapy or radiotherapy was administered during this time.Four patients were able to recover from urinary continence.Conclusions:Based on a combination of MRI and PSMA PET/CT, it is both safe and feasible to promptly perform RP following the diagnosis of prostate cancer through targeted biopsy for index lesions, along with intraoperative frozen section.
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Objective:To assess the efficacy of Tamsulosin monotherapy for overactive bladder(OAB)symptoms in benign prostatic hyperplasia(BPH)patients with the prostate volume(PV)<40 ml, and to analyze related factors affecting the efficacy.Methods:300 BPH patients with OAB were enrolled, with an average age of(66.9±7.7)years and the PV<40 ml.Smoking, drinking and other living habits were investigated.Data on the Overactive Bladder Symptom Score(OABSS), International Prostate Symptom Score(IPSS)and Quality of Life Scale(QOLS)were collected before and after 4 weeks of treatment with Tamsulosin 0.2 mg QN.The maximum urine flow rate(Qmax)and bladder residual urine volume(PVR)were measured before and after treatment.OBASS was used as the main assessment parameter to analyze the correlation of efficacy with age, lifestyle, pre-treatment symptom scores, PV, Qmax and PVR.Results:257 patients completed the study, and 169 patients were treated effectively, with an overall effectiveness rate of 65.8%.The effectiveness rates of the mild, moderate and severe OAB groups were 83.6%, 62.4% and 38.5%, respectively, with statistical significance( χ2=13.037, P=0.001).3 patients showed adverse drug reactions, including 2 patients with mild dizziness and 1 patient with nausea.The baseline OABSS score, the proportion of smoking patients and the proportion of drinking patients in the effectively treated OAB group were significantly lower than those in the ineffectively treated group.Multivariate analysis showed that baseline OABSS score( OR=0.735, P<0.001)and smoking( OR=2.111, P=0.029)were correlated with tamsulosin's efficacy in treating BPH patients with OAB with PV<40 ml. Conclusions:The effectiveness rate of Tamsulosin for the treatment of BPH patients with mild OAB with PV<40 ml is high.The baseline OABSS score and smoking are factors affecting the efficacy of Tamsulosin on OAB symptoms in these patients.
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Objective:To investigate the safety and efficacy of MR-guided focused ultrasound surgery (MRgFUS) in treating localized prostate cancer.Methods:Six patients with localized prostate cancer who underwent MRgFUS treatment from August 2020 to September 2021 in Beijing Hospital were prospectively enrolled in this study. The patients were all over 18 years old, with an average age of (68±10) years, and had not received any prior treatment for prostate cancer. Pretreatment pelvic MR and CT scans were performed to determine the region of treatment (ROT). Different urinary catheterization measures were given based on the location of the lesion. Under general anesthesia, the lesions were treated by MRgFUS using a specialized rectal ultrasound transducer on the treatment bed. The patients were followed up at 1, 3, and 6 months after treatment and annually thereafter. During follow-up, prostate-specific antigen (PSA) levels, pelvic MR scans, International Prostate Symptom Score (IPSS), International Index of Erectile Function-15 (IIEF-15) scores, and adverse events were assessed.Results:(1) All six patients underwent MRgFUS treatment for six lesions, with an average duration of (126±56) minutes, an average number of (7.3±3.2) focal ultrasound pulses per lesion, and an average non-perfusion volume of (3.8±1.1) cm 3, which covered the entire treatment target area. No treatment-related adverse events were reported. (2) The PSA levels at baseline, 1, 3, 6, and 12 months after treatment were (6.6±0.8), (3.6±1.3), (3.4±3.0), (2.5±1.7), and (2.3±1.8) ng/ml, respectively. PSA levels increased in 2 out of 6 patients during follow-up, and pelvic MR scan revealed recurrent lesions, while PSA levels continued to decrease in the remaining 4 patients, and pelvic MR scan were normal. (3) The IPSS scores at baseline, 1, and 3 months after treatment were 13.0 (4.0, 16.0), 10.0 (4.0, 12.0), and 5.0 (3.0, 6.0) points, respectively. For the three sexually active patients, the IIEF-15 scores at baseline were 40, 51, and 14 points, respectively, and IIEF-15 at 1 month after treatment were 9, 8, and 14 points, respectively, and at 3 months after treatment were 9, 66 and 26 points, respectively. (4) One patient was diagnosed with recurrence 10 months after treatment, and another patient was found to have a new lesion 6 months after treatment. Conclusions:MRgFUS might be a safe, non-invasive, and effective treatment for localized prostate cancer, but regular follow-up is vital for detecting tumor recurrence.
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Objective:To investigate the diagnostic value of the combination of 18F-prostate specific membrane antigen (PSMA) PET/CT and multiparametric magnetic resonance imaging (mpMRI) in identifying the grade group of prostate cancer, using parameters derived from the two imaging modalities. Method:Prostate cancer patients diagnosed by histopathology and received 18F-PSMA PET/CT and mpMRI during September 2018 to May 2021 in our hospital were retrospectively studied. The median age was 68(64-75), with the median PSA level of 14.74(7.75-24.19)ng/mL. All patients received mpMRI before biopsy. On biopsy, 6(12.2%) patients had International Society of Urological Pathology grade group(ISUP GG) 1 diseases, 16(32.7%) had ISUP GG 2 diseases, 12(24.5%) had ISUP GG 3 diseases, and 15(10.9%) had ISUP GG 4 or 5 diseases. Patients were then divided into high-grade group (ISUP 4-5) and low-grade group(ISUP 1-3). The median age of patients in high-grade group and low-grade group were 65(62-76) and 71(65-74), respectively. The PSA level in high-grade group and low-grade group were 15.11(6.63-42.86) ng/ml and 12.31(7.94-18.25) ng/ml, respectively. No significant differences were found in age and PSA level between the two groups ( P=0.334, P=0.448). All patients underwent 18F-PSMA PET/CT within 4 weeks after biopsy. The maximum standardized uptake value(SUV max) and the minimum apparent diffusion coefficient(ADC min)were recorded, and the ratio of SUV max/ ADC minwere calculated. The correlation between the above parameters and ISUP grade group were analyzed.The diagnostic value of the parameters was evaluated by the receiver operating characteristic (ROC) curve. Results:The data of 49 patients were analyzed. The average ADC minwas (0.57±0.16)×10 -3 mm 2/s, with the average SUV max and SUV max/ADC min of 15.30±12.54 and (29.69±23.72)×10 3, respectively. Statistical differences were found in SUV max ( P=0.012) and SUV max/ADC min ( P=0.002) between the high- and low-grade groups, while ADC min ( P=0.411) showed no statistical differences between the two groups. Significant positive correlations were found between SUV max(r=0.501, P<0.001), SUV max/ADC min (r=0.527, P<0.001) and ISUP grade group, respectively. There was a negative correlation between ADC min and ISUP grade group (r=-0.296, P=0.039). SUV max/ADC min was the best index to distinguish high-grade group from low-grade group prostate cancer with the area under the curve(AUC) of 0.749. In contrast, the AUC of SUV maxand ADC min were 0.731 and 0.615, respectively. The diagnostic sensitivity and specificity of SUV max/ADC min were 73.3% and 85.3%, respectively, with a critical value of 37.23×10 3. Conclusion:The combination use of 18F-PSMA PET/CT and mpMRI could improve the diagnostic efficiency for prostate cancer, compared to either modality alone. The ratio of SUV max/ADC min has a positive correlation with ISUP grade group, and is a promising index for distinguishing the high-grade prostate cancer from low-grade cancer.
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Objective:To determine the predictive value of preoperative monocyte-to-lymphocyte ratio(MLR) for prognosis in elderly patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy(RNU).Methods:A retrospective study was performed on 168 elderly patients who underwent RNU in Beijing Hospital between March 2004 to February 2019.Males accounted for 44.6% (75 patients) and females 55.4%(93 patients) of the patients. Median age at the time of surgery was 73(69-78) years, and 110 (65.5%) patients suffered from hydronephrosis. There were 147 cases(87.5%)with single tumor, and 21 cases(12.5%)with multiple tumors, including 75(46.6%) cases in renal pelvis or pelvi-ureteric junction, and 93(53.4%)cases in ureter. Open RNU was performed in 106(63.1%) patients, and laparoscopic method in 62(32.9%) patients. The optimal cutoff value of MLR was set as 0.22 by using the median.χ 2 test, which was used to detect the association between MLR(≤0.22 vs.>0.22) and clinicopathological variables. Survival analyses were performed using the Kaplan-Meier method and were compared using the log-rank test. Additional subgroup analyses(low grade vs. high grade) were performed according to pathological grade. Univariate and multivariate analysis by Cox’s proportional hazards model was used to determine the significance of MLR in respect to OS and PFS. Results:The follow-up period ranged from 19.2 to 86.9 months (median 51.9 months). Next, the cohort was divided into 2 groups , including 77 patients with low MLR(≤0.22) and 91 patients with high MLR(>0.22). High MLR was significantly more frequent in male patients(31.2% vs.56.0%), as well as those undergoing laparoscopic surgery (54.5% vs.70.3%)(All P<0.05). Based on a Cox univariate proportional hazards analysis, male gender( HR=1.793, 95% CI 1.003-3.205, P=0.049), presence of lymph node metastasis( HR=6.809, 95% CI 2.124-17.454, P=0.001) and high MLR( HR=2.287, 95% CI 1.259-4.154, P=0.007)were associated with poor OS. Male gender( HR=1.758, 95% CI 1.066-2.902, P=0.027), presence of lymph node metastasis( HR=6.524, 95% CI 2.542-16.748, P<0.001), lymphovascular invasion(LVI) ( HR=2.348, 95% CI 1.139-4.838, P=0.021), high MLR( HR=2.801, 95% CI 1.657-4.735, P<0.001)and PLR( HR=1.663, 95% CI 1.003-2.757, P=0.049) were significantly associated with subsequent PFS. By multivariate analysis, tumor site( HR=2.050, 95% CI 1.079-3.892, P=0.028), lymph node metastasis ( HR=6.641, 95% CI 1.852-23.811, P=0.004) and MLR( HR=2.089, 95% CI 1.062-4.113, P=0.033) were the independent risk factors for OS in elderly patients with UTUC. Tumor side( HR=2.024, 95% CI 1.033-3.965, P=0.040), multifocality ( HR=2.992, 95% CI 1.161-7.713, P=0.023), lymph node metastasis ( HR=6.454, 95% CI 2.026-20.564, P=0.002) and MLR( HR=2.866, 95% CI 1.554-5.284, P=0.001) were associated with PFS.The multivariate analysis of the significant risk factors established a postoperative risk stratification model for OS and PFS. The results showed significant differences among the 3 subgroups of patients with low(0 risk factor), intermediate(1 risk factor), or high risk(2-3 risk factors)(All P<0.05). Conclusion:MLR was an independent risk factor for OS and PFS in elderly patients with UTUC and patients with elevated MLR have worsen prognosis.
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There’s a lack of understanding on the urinary incontinence after radical prostectomy (RP) among urologists domextically. The standard of the prevention, diagnosis, and treatment is urgently needed. Considering the current condition of the uncertainty of the definition, evaluation criteria, etiology, and risk factors, and the need of further exploration of current surgical techniques and prevention measures, this work reviewed the latest research progression and expert advices, to fulfill more precise prevention, diagnosis, and treatment of urinary incontinence after RP, and to eventually improve the precaution treatment of the disease and the quality of life of the patients in China.
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Objective:To investigate the feasibility and reliability of the frozen section during targeted prostate biopsy.Methods:The clinical and pathological information of patients who received cognitive fusion transperineal targeted plus systematic biopsy and frozen section of 1-2 core targeted biopsy were consecutively collected and retrospectively studied. The median age was 70 (ranging 64-78) years, with the median prostate-specific antigen (PSA) level of 11.00 (ranging 6.63-16.52) ng/ml and the median prostate volume of 35.72 (ranging 22.59-47.71) ml. All patients received bi-parametric magnetic resonance imaging (bp-MRI) and have Prostate Imaging Reporting and Data System (PI-RADS) 3 or higher lesions diagnosed on bp-MRI. The suspected lesions would be taken by targeted biopsy of which one or two cores would be sent to prepare for the frozen sections. Then a cognitive fusion targeted and systematic biopsy covering the above targeted zones would be routinely administered under a transperineal approach as a standard protocol. The total time used for diagnosis of the frozen sections, the pathological diagnosis and the International Society of Urological Pathology (ISUP) grade groups (GG) would be recorded. The sensitivity, the positive predictive value, and the accuracy on grade groups would be analyzed, using the pathological diagnosis based on standard sections from the same targeted lesion.Results:A total of 29 patients were included in this study. Accordingly, 29 suspected lesions were identified on bp-MRI. A total of 20 lesions were finally diagnosed of PCa on frozen section, with the detection rate of 69.0%. Of those, 9(45.0%) cases were ISUP GG 1 diseases, 5(25.0%) cases were GG 2 diseases, 1(5.0%) case was GG 3 disease, and 5(25.0%) cases were GG 4-5 diseases. A total of 22 lesions were diagnosed with PCa on standard sections of cores from the same targeted lesions, with the detection rate of 75.9%. Of those, 6(27.3%) cases were GG 1 disease, 11(50.0%) cases were GG 2 diseases, 1(4.5) case was GG 3 disease, and 4(18.2%) cases were GG 4-5 diseases. The sensitivity and the positive predictive value of frozen section were 90.9% and 100%, respectively. No false positive diagnosis was made by frozen section. Compared to diagnosis from frozen sections, the GG diagnosed from final standard sections were found to upgrade and downgrade in 2 and 2 cases, respectively. The accuracy rate on GG of frozen sections was 80%. The time used for the diagnosis of frozen sections was (11±2) minutes. The histology quality control of four specimens was dissatisfactory. Two were due to tissue loss and deformation during sampling, and the other two were due to cytoclasis during low-temperature transferring.Conclusion:It is feasible and reliable to make a pathological diagnosis from frozen section of prostate targeted biopsy.
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Objective:To evaluate the feasibility, safety and efficacy of the magnetic resonance imaging guided focused ultrasound surgery (MRgFUS) in the treatment of localized prostate cancer (PCa).Methods:The data of 5 patients treated by MRgFUS from August 2020 to June 2021 in our institution were retrospectively analyzed. The median age was 73 (58-80) years, with the median PSA of 7.34 (5.19-8.40) ng/ml, and a median prostate volume of 27.96 (21.50-37.91) ml. The median pretreatment international prostate symptom score (IPSS) was 13(0-18). Of the 3 patients with intention of erectile function preservation, the pretreatment international index of erectile function-15 (IIEF-15) score was 12, 23 and 3, respectively. All patients had histopathology-proven PCa of grade group ≤ International Society of Urological Pathology (ISUP) 3, pre-operative PSA level <20 ng/ml, and a clinical stage ≤T 2b. A total of 6 lesions was confirmed by biopsy, with 3 of ISUP grade group 3 and 3 of ISUP grade group 1. All 5 patients underwent MRgFUS which was guided by a real-time magnetic resonance imaging (MRI). PSA, MRI and repeated biopsy were conducted to monitor recurrence. Questionnaires consisted of IPSS, IIEF-15, and the International Consultation on Incontinence-questionnaire-Short Form (ICI-Q-SF) were recorded before and after MRgFUS to evaluate the impact on functional preservation. Results:A total of 5 patients received MRgFUS. In total, 5 of the 6 lesions were treated. 1 lesion unvisible on MRI was not clinically significant and was left untreated. The median time in MRI scanner was 190 (140-355) min, and the median sonication time was 64 (35-148) min with the median sonications of 8 (5-13). The median catheter indwelling time was 1 (1-8) days. No other adverse effects were reported. The PSA level of all 5 patients decreased, with the nadir PSA of 1.196 ng/ml, 4.398 ng/ml, 4.135 ng/ml, 1.562ng/ml and 1.350ng/ml, respectively. 4 of the patients had a PSA decrease over 50%. No PCa lesion was seen on MRI at 3-month follow-up visit. As for functional preservation, the post-MRgFUS IPSS declined compared with the baseline score, and the IPSS of last follow-up was 5(0-14). Of the 3 patients with intention to preserve the erectile function, the erectile function score of IIEF-15 were 12, 30 and 9 three months after the treatment, respectively. No incontinence occurred postoperatively.Conclusions:MRgFUS is a feasible and safe way for the treatment of low- to intermediate-risk localized PCa, with satisfactory performance on functional preservation and low incidence of complications. The oncological outcomes still need to be establised with longer follow-up time and larger sample studies.
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This study prospectively collected the clinical data of patients who received sacral neuromodulation(SNM)variable-frequency stimulation (VFS) mode from June 2020 to December 2020, in order to explore the efficacy and safety of VFS mode in the treatment of refractory lower urinary tract dysfunction. The inclusion criteria were as follows: ①SNM was implanted; ②age ≥18 years old; ③The traditional constant-frequency stimulation (CFS) mode has poor therapeutic effect, and can not be improved after repeated adjustment of stimulation parameters; ④Patients with overactive bladder (OAB) symptoms, who fail to respond to conservative treatment or are intolerant to conservative treatment; ⑤The drugs that affect the lower urinary tract symptoms and pelvic function should not be increased or decreased during the trial; ⑥provision of informed consent. A total of six patients meeting the criteria were included in the study, with three males and three females. The age ranged from 47 to 74 years, with an average age of 55 years. Among those patients, three cases were diagnosed of OAB, two cases were diagnosed of interstitial cystitis, and one case was diagnosed of neurogenic bladder. All patients had received CFS-SNM for an average of 20.6 months before upgrading to VFS mode, and suffered from severe frequency of urination at the same time. Compared with the severity of symptoms during the baseline period and the CFS period, a trend of improvement was found among four patients during the VFS period. The severity of symptoms was mainly based on the average daily urination frequency and OAB-Q score. For the two patients with interstitial cystitis, OAB symptoms worsened during the VFS period, while the VAS score did not change significantly. In general, VFS-SNM is not inferior to CFS-SNM in improving the symptoms of frequent micturition. For patients with interstitial cystitis, multiple sets of VFS parameters can be tried under the premise of satisfactory pain management.
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The development of urodynamics in China is the epitome of the country's reform and opening up, economic development, and technological progress. With the continuous popularization of urodynamic measurements and the emergence of new technologies, it is necessary to further establish and promote urodynamic quality control standards and to develop talents-nurturing and training systems. Urodynamic quality control is a complex systematic project and an original research. Quality control depends on typical value ranges, typical signal pattern and technical standard. Quality control should be performed in the real-time measurement and retrospective data analysis. The urodynamic training will combine the professional course with popular one. Quality of Urodynamics will be improved continuously.
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Objective:To evaluate the cancer detection rate in patients with multiparametric magnetic resonance imaging (mpMRI) PI-RADS 1-2 prior to initial biopsy, and analyze the risk factors of prostate cancer.Methods:A total of 196 patients undergoing initial prostate biopsy between July 2011 and June 2018 were retrospectively analyzed. According to ESUR PI-RADS system, the patients’ PI-RADS score was 1 and 2, with the mean age of 66.6±9.0 years, and the median PSA 7.44 ng/ml. Twenty-eight patients were enrolled with PSA<4 ng/ml but with abnormal directeral rectun examination. The rest 168 patients were enrolled with elevated PSA. According to the Epstein prostate risk classification criteria, clinically insignificant prostate cancer was defined as: PSA density ≤0.15 ng/ml 2, Gleason score≤6, less than 3 positive needles, <50% puncture length. If any of the above is not met, the diagnosis should be clinically significant prostate cancer(CsPCa). T test or Mann-Whitney U test were used for comparison between groups. Risk factors for diagnosis of prostate cancer and CsPCa were analyzed by chi square test(or Fisher’s exact probability method) and multivariate logistic regression analysis. Results:There were 42(21.4%) patients diagnosed with prostate cancer, 30(15.3%)patients were CsPCa. The negative predictive value of mpMRI was 78.6%(154/196)for prostate cancer overall, and 84.7%(166/196)for CsPCa. Patients with higher age and PSA density were associated with higher possibility of prostate cancer. Higher age, PSA level, PSA density, and lower PSA ratio were associated with higher possibility of CsPCa. Multivariate logistic regression analysis showed that PSA density>0.15 ng/ml 2( OR=2.94, 95% CI 1.45-5.95) was independent risk factor of prostate cancer.Ages over 70 years( OR=2.49, 95% CI 1.22-5.07), PSA ratio<0.2( OR=3.70, 95% CI 1.25-11.23), PSA density>0.15 ng/ml 2( OR=5.77, 95% CI 1.96-16.96) were independent risk factors of CsPCa ( P<0.05). Conclusions:The detection rate of prostate cancer was 21.4% in patients with elevated PSA or abnormal digital prostate examination but with PI-RADS score of 1-2. Higher age and PSA density were associated with higher risk of prostate cancer. The detection rate of CsPCa was 15.3%. Ages over 70 years, PSA ratio<0.2, PSA density>0.15 ng/ml 2 were independent risk factors of CsPCa.
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The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities.Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality.Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit a typical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention.The general condition of the elderly should be considered during diagnosis and treatment.In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients.Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population.
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Objective:To investigate the detection rate and the characteristics of detected prostate cancer foci on multi-parametric MRI (mp-MRI) and to evaluate the potential influence factors.Methods:A total of 66 patients undergoing radical prostatectomy (RP) from August 2017 to July 2019 in Beijing Hospital were retrospectively studied. The median age was 67(56-80)years, with the median preoperative PSA level of 8.73 (1.22-72.46)ng/ml, and median prostate volume of 35.9(16.8-131.8) ml. All patients underwent mp-MRI before surgery and the whole mount section of RP specimens was prepared. Two radiologists reviewed all the foci independently and then matched each foci with an urological pathologist. The primary outcome was the detection rate of prostate cancer. The potential influence factors were also investigated.Results:Of all 66 patients, a total of 62(93.9%) patients were diagnosed with prostate cancer on a preoperative mp-MRI. On whole mount section, 109 prostate cancer foci were detected, of which 77 foci were correctly diagnosed on mp-MRI, with the overall sensitivity of 70.6%. For all the foci detected, 53(48.6%) were grade group 1 disease of International Society of Urological pathology (ISUP), 31(27.5%) were ISUP grade group 2 disease, 19(17.4%) were ISUP grade group 3 disease, and 6(5.5%) were ≥ISUP grade group 4 disease. Mp-MRI detected 62/67(92.5%) lesions with tumor diameter ≥1 cm, 49/56(87.5%) lesions with tumor Gleason score ≥7, and 59/66(89.4%) index lesions. The tumor diameter( OR=3.183, 95% CI 1.580-6.411, P=0.001)and index lesion status( OR=4.042, 95% CI 1.127-14.503, P=0.032)were independently associated with the detection of prostate cancer foci on mp-MRI. Conclusions:mp-MRI is an effective technique for prostate cancer detection. Sensitivity increased with increased tumor size and index lesion status. The tumor diameter and index lesion status were independently associated with the detection of prostate cancer foci on mp-MRI.
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Objective:To establish a nomogram model for predicting positive resection margins after prostate cancer surgery, and to perform the corresponding verification, in order to predict the risk of positive resection margins after surgery.Methods:A total of 2 215 prostate cancer patients from The First Affiliated Hospital of Naval Medical University, Hospital, Peking University First Hospital, Peking University Third Hospital, Peking University, and First Affiliated Hospital of Xi′an Jiaotong University were included in the PC-follow database from 2015 to 2018, and a simple random sampling method was used. They were divided into 1 770 patients in the modeling group and 445 patients in the verification group. In the modeling group, the age (<60 years, 60 to 70 years, >70 years), PSA (<4 ng/ml, 4-10 ng/ml, 11-20 ng/ml, >20 ng/ml), pelvic MRI (negative, suspicious, positive), clinical stage of the tumor (T 1-T 2, ≥T 3), percentage of positive needles (≤33%, 34%-66%, >66%), Gleason score of biopsy pathology (≤6 points, 7 points, ≥8 points). Univariate and multivariate logistic analysis were performed to screen meaningful indicators to construct a nomogram model. The model was used for validation in the validation group. Results:The results of multivariate analysis showed that preoperative PSA level ( OR=2.046, 95% CI 1.022 to 4.251, P=0.009), percentage of puncture positive needles ( OR=1.502, 95% CI 1.136 to 1.978, P=0.002), Gleason score of puncture pathology ( OR=1.568, 95% CI 1.063 to 2.313, P=0.028), pelvic MRI were correlated ( OR=1.525, 95% CI 1.160 to 2.005, P=0.033). Establish a nomogram model for independent predictors of positive margin of prostate cancer. The area under the receiver operating characteristic (ROC) curve of the validation group is 0.776. The area under the ROC curve of the preoperative PSA level, percentage of puncture positive needles, puncture pathology Gleason score, pelvic MRI, postoperative pathology Gleason score were 0.554, 0.615, 0.556, 0.522, and 0.560, respectively. The difference between the nomogram model and other indicators was statistically significant ( P<0.05). Conclusions:The constructed nomogram model has higher diagnostic value than the preoperative PSA level, percentage of puncture positive needles, Gleason score of puncturing pathology, pelvic MRI, and postoperative pathological Gleason score in predicting positive margin.
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Urinary continence is an important branch of the urology and one of the most complex fields. The scientific research and clinical works in the field of urinary continence in China started late and from a low starting point. Over the past 40 years, with the joint efforts of our colleagues in the field of urology, the field of urinary continence in China has developed rapidly in the fields of urodynamics, urinary incontinence, overactive bladder, neurourology, functional urology, pelvic floor dysfunction, etc., and a significant progress has been made; but there are still some gaps compared with the international level. The Chinese Journal of Urology has been following the development of urinary continence in China. On the occasion of the 40th anniversary of the publication of the Journal, we made a review based on the retrieved papers published in this journal, in order to congratulate the Chinese Journal of Urology on its 40th birthday, and to urge and encourage the urinary continence workers to make more efforts, to promote the Chinese cause of urinary continence to a higher level.
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Objective To analyze effects of androgen deprivation therapy on lipid metabolism and nutritional status in patients with prostate cancer.Methods The clinical data of 255 elderly patients (≥ 65 years old) with prostate cancer who received endocrine therapy and complete follow-up data from January 2010 to December 2018 were analyzed retrospectively.The median age of the 255 patients was 76 years (65-92).The average PSA of patients was (58.15 ± 9.62) ng/ml,where 101 patients had PSA ＜ 10 ng/ml,62 patients had PSA 10-20 ng/ml,and 92 patients had PSA ＞ 20 ng/ml.All patients were diagnosed pathologically by prostate biopsy.As for Gleason score,Gleason score≤6,Gleason score =7 and Gleason score ≥ 8 had 62,103 and 90 patients,respectively.Endocrine therapy included maximum androgen blockade (197 cases) and drug castration (58 cases),and continued for at least 1 year.Among them,123 cases had complete blood lipid index data,and the subgroup analysis was based on the age of 80 years old,including 98 cases aged 65 to 80 years old and 25 cases over 80 years old.A total of 186 cases had complete data of total protein and albumin,of which 147 cases were 65 years old and 80 years old and 39 cases were more than 80 years old.Before treatment,cholesterol was (4.08 ±0.87) mmoL/L,including (4.14 ±0.86) mmol/L in the 65-80 years old group,(3.82 ± 0.88) mmol/L in ＞ 80 years old group;triglyceride was (1.23 ± 0.56) mmol/L,65-80 age group was (1.26 ± 0.56) mmol/L and ＞ 80 years old group was (1.11 ± 0.57) mmol/L;High density lipoprotein cholesterol was(1.09 ± 0.24)mmol/L,65-80 age group was (1.10 ±0.25) mmol/L and ＞ 80 years group was (1.04 ± 0.21) mmol/L.Low density lipoprotein cholesterol was (2.50 ± 0.78) mmol/L,65 ～ 80 age group was (2.55 ± 0.77) mmol/L and (2.34 ± 0.83) mmol/L in ＞80 years old group.The total protein before endocrine therapy was (63.81 ± 5.93) g/L,including (63.95 ± 5.79) g/L in the 65-80 years old group,(63.30 ± 6.49) g/L in ＞ 80 years old group.In terms of pre-treatment albumin (39.68 ± 3.50) g/L,including (39.82 ± 3.60) g/L in the 65-80 years old group and (39.21 ± 3.12) g/L in ＞ 80 years old group.The differences of various indexes before and after treatment were analyzed.Results The results of blood lipid data analysis of 123 cases showed that,there were increased significant differences(P ＜ 0.01) in cholesterol (4.80 ± 1.82)mmol/L,triglyceride (1.59 ± 1.17) mmol/L,high density lipoprotein cholesterol (1.21 ± 0.25) mmol/L and low density lipoprotein cholesterol (3.07 ± 1.53) mmol/L after endocrine therapy compared with baseline.In the subgroup analysis,the levels of cholesterol,triglyceride,high density lipoprotein cholesterol and low density lipoprotein cholesterol in 65-80-year-old group after treatment were (4.92 ± 1.95) mmol/L,(1.64 ± 1.25) mmol/L,(1.20 ± 0.25) mmol/L,and (3.15 ± 1.66) mmol/L,respectively,which were significantly higher than those before treatment (P ＜0.01).In the group over 80 years old,the blood lipid index after treatment was higher than that before treatment,including cholesterol (4.35 ± 1.08) mmol/L,triglyceride (1.39 ± 0.73) mmoL/L,high density lipoprotein cholesterol (1.27 ± 0.26) mmol/L and low density lipoprotein cholesterol (2.76 ± 0.93) mmol/L.The levels of cholesterol,triglyceride and high density lipoprotein cholesterol were significantly higher than those before treatment (P ＜ 0.05),but there was no significant difference in low density lipoprotein cholesterol between before and after treatment (P ＞ 0.05).The results of data analysis of 186 cases of total protein and albumin showed that,the total protein after treatment was (62.81 ±7.34) g/L,which was not significantly different from that before treatment (P ＞ 0.05).The total protein in 65-80 years old group after treatment was (62.36 ± 7.36) g/L,which decrease and have statistical significantly different from that before treatment (P ＜ 0.05);The total protein in ＞ 80 years old group after treatment was (64.49 ± 7.12) g/L,it was higher than that before treatment,but the difference was not statistically significant (P ＞ 0.05).The level of albumin after endocrine therapy was (38.34 ± 4.48) g/L,which was significantly different from that before treatment (P ＜ 0.01).The levels of albumin in 65-85 years old group and ＞ 80 years old group after treatment were (38.32 ± 4.54) g/L and (38.44 ± 4.30) g/L respectively,but only in the group of 65 to 80 years old,there were significant differences compared with those before treatment (P ＜ 0.05).Conclusion Endocrine therapy can not only significantly increase total cholesterol,triglyceride,low density lipoprotein cholesterol and high density lipoprotein cholesterol in elderly patients with prostate cancer,but also significantly reduce albumin after treatment.
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Objective:To investigate the effect of maximal androgen blockade(MAB)therapy on serum calcium, phosphorus and other metabolic indices in elderly patients with prostate cancer.Methods:Clinicopathological data of prostate cancer patients treated with MAB in our department from January 2010 to December 2018 were retrospectively analyzed.All patients underwent prostate biopsy for definitive diagnosis.Detailed data on patient's age, body mass index(BMI), previous medical history, treatment plan and peripheral blood indicators before and after endocrine treatment, such as blood calcium, phosphorus, hemoglobin, fasting blood glucose, triglycerides and cholesterol, were collected.Results:Patients had a mean age of(75.5±5.8)years and a mean BMI of(24.6±3.2)kg/m 2.Blood calcium levels exhibited a downward trend after MAB treatment compared pre-treatment[(2.12±0.44)mmol/L vs.(2.17±0.31)mmol/L, t=0.82, P=0.42], but had no significant difference.Serum phosphorus concentrations were higher and the calcium-phosphorus ratio was lower after MAB treatment than before treatment[(1.02±0.26)mmol/L vs.(1.17±0.34)mmol/L, 2.10±0.28 vs.1.88±0.60, t=-4.12 and 3.56, P<0.01]. After MAB treatment, blood fasting glucose[(6.50±1.55)mmol/L vs.(5.34±1.04)mmol/L, t=-7.82, P<0.01], triglycerides[(1.66±1.32)mmol/L vs.(1.22±0.59)mmol/L, t=-3.38, P<0.01]and cholesterol[(4.70±1.08)mmol/L vs.(4.16±0.90)mmol/L, t=-4.72, P<0.01]were elevated, while hemoglobin concentrations[(122.11±20.43)g/L vs.(130.78±23.98)g/L, t=3.98, P<0.01]were decreased compared with pre-treatment levels. Conclusions:MAB therapy can cause varying degrees of metabolic abnormalities in calcium and phosphorus metabolism, hemoglobin concentrations, blood glucose and lipid levels in elderly prostate cancer patients.The above indicators should be closely monitored during treatment, and treatment-related complications should be proactively prevented.
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Objective:To investigate the risk factors for Gleason score upgrading after radical prostatectomy in clinical low-risk prostate cancer patients aged≥65 years.Methods:A total of 485 clinical low-risk prostate cancer patients aged≥65 years at five centers of the national multi-center PC-follow database from January 2015 to March 2019 were retrospectively analyzed.Data including age at diagnosis, prostate-specific antigen(PSA), MRI prostate imaging, puncture Gleason score, operation method, puncture method, positive incision margin and capsule penetration were collected.Differences in Gleason scores before and after operation were compared, and the risk factors for Gleason score upgrading after radical resection were evaluated by univariate and multivariate Logistic regression analysis.Results:Of 485 patients with a puncture Gleason score of 3+ 3=6, 261(53.8%)cases had postoperative pathological upgrading, in whom 228(87.4%)cases had Gleason score upgrading of 7, 22(8.4%)had Gleason score upgrading of 8, and 11(4.2%)had Gleason score upgrading of 9 or more.The rate of Gleason score upgrading was elevated with increased preoperative PSA levels, positive pelvic MRI, and higher positive rates of puncture biopsy.The incidences of postoperative capsule penetration(27.2% vs.12.5%, P<0.001)and positive incision margin(25.2% vs.17.4%, P=0.036)had statistically significant differences between the pathologically upgraded group and the pathologically non-upgraded group.Multivariate analysis showed that preoperative PSA level, percentage of positive puncture biopsies, biopsy Gleason score and pelvic MRI were independent predictors of prostate cancer. Conclusions:For clinical low-risk prostate cancer patients aged≥65 years with high risk factors for Gleason score upgrading, repeated biopsies should be carried out when necessary and the treatment plan should be adjusted accordingly.
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The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities.Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality.Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit atypical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention.The general condition of the elderly should be considered during diagnosis and treatment.In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients.Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population.