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Objective:To analyze the prognosis of patients with positive resection margin after radical prostatectomy, as well as the prostate-specific antigen (PSA)level and risk factors for PSA progression.Methods:A retrospective analysis was performed on the data of 141 patients with pathologically diagnosed prostate cancer who underwent RP from May 2012 to August 2020 in Beijing Hospital. The mean age was (67.4±6.7)years, the preoperative median PSA was 9.6 (1.4-152.8) ng/ ml and the median follow-up time was 56 months. Postoperative pathology was T 2 stage 74 (52.5%), T 3 stage 63 (44.7%), T 4 stage 4 (2.8%). Biochemical recurrence after radical resection was defined as PSA rose to more than 0.2 ng/ml and showed an upward trend after two consecutive follow-ups. In this study, serum PSA ≥ 0.1 ng/ml without biochemical recurrence after radical operation was defined as PSA progression. The PSA level, risk factors of PSA progression and prognosis of patients with positive resection margin were analyzed. Univariate and multivariate Cox regression analysis was used to analyze the correlation between age, preoperative PSA level, pathological stage (pT), ISUP classification, surgical approach, lymph node dissection, single/multiple positive margins and PSA progression. Results:The median follow-up of 141 patients was 52 months(1-104 months). There were 69 (48.9%) patients in the PSA progression group and 72 (51.1%) patients in the non PSA progression group. In the PSA progression group, 13 (18.8%) patients did not receive treatment and 8 (61.5%) patients had biochemical recurrence. 4 (5.8%) patients received radiotherapy alone, and 2 (50.0%) patients had biochemical recurrence. 52 (75.4%) patients received endocrine therapy or endocrine therapy combined with radiotherapy, and 5 (9.6%) patients developed castration resistance. Multivariate Cox regression analysis showed preoperative PSA ( HR=1.015, 95% CI 1.005-1.025, P =0.004), ISUP grade and group ( HR=1.351, 95% CI 1.091-1.673, P =0.006), surgical method ( HR=2.233, 95% CI 1.141-4.370, P =0.019) was correlated with PSA progression. Conclusions:The incidence of surgical positive margin is high after RP. Nearly half of the patients with surgical positive margin developed a PSA progression status. Preoperative PSA, ISUP grade group, and the surgical approach are risk factors for PSA progression in patients with positive surgical margins. Patients with these risk factors should be monitored more closely and treated more aggressively.
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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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Objective To investigate the effects of radical prostatectomy on the overall survival (OS)and tumor-specific survival in prostate cancer(PCa)patients aged 75 years and older.Methods Clinical data of patients aged 75 and older with localized PCa from Surveillance,Epidemiology,and End Results(SEER)Database from 2004 to 2016 were retrospectively analyzed.There were 17 899 cases of PCa undergoing radical prostatectomy and 3 648 cases of PCa without surgery in this study.The OS and prostate cancer-specific survival(PSS)were compared between the surgery group and the nonsurgery group.Results For 75-79-year-old patients with high-risk localized PCa,the OS and PSS in the surgery group were better than in the non-surgery group (OR =1.49,95 ％ CI:1.22 ～ 1.82,P ＜ 0.01;OR=1.43,95％CI:1.09～2.04,P＜0.05).For patients aged 75-79 years with low-risk PCa and patients aged 80 years and older with low-,middle-,or high-risk PCa,the OS was worse in the surgery group than in the non-surgery group(OR =0.54,95％CI:0.38～0.76,P＜0.01;OR =0.47,95％CI:0.34～0.66,P＜0.01;OR =0.58,95％CI:0.44～0.78,P＜0.01;OR =0.59,95％CI:0.51 ～0.68,P＜0.01).For patients aged 75-79 years with low-or medium-risk PCa and patients aged 80 years and older with medium-risk PCa,there was no statistical difference in PSS between the surgery and non-surgery groups(P＞0.05).Conclusions Age limits for prostatectomy should be extended as a result of increasing average life expectancy.Patients aged 75-79 years with high-risk PCa can be considered for surgical treatment,while it should not be recommended for patients aged 75-79 years with low-or medium-risk localized PCa or aged more than 80 years.Many factors should be considered in making treatment decisions for prostate cancer.
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Objective To verify the safety and advantages of total transperitoneal laparoscopic nephroureterectomy (ttLNU) in the treatment of upper urinary tract urothelial carcinoma (UTUC).Methods From Jun.2013 to Jun.2014,there were 13 UTUC patients treated with ttLNU,including 7 males and 6 females.The mean age was 70.4 ± 8.3 yrs,and BMI was 23.3±4.1.Of them,11 cases were diagnosed with renal pelvis carcinoma,6 in the left and 5 in the right.2 cases were diagnosed with left ureteral carcinoma.TNM stages were T1-T3N0M0.Patients were put on lateral position and the position was not changed during the operation.A ttLNU was performed,and the specimen was removed from the middle extended inferior umbilical incision.Results The mean operative time was 188±33 (150-240) min,the intraoperative blood loss was 150.5±60.1 (50-700) ml,and the time of out-of-bed activity was between 1 and 4 d.The mean postoperative drainage time was 6.8±4.6 (3-6) d.The mean postoperative bowel function recovery time was 1.5± 1.0 (2-4) d and postoperative hospital stay was 12.8±7.0 (3-27) d.The ttLNU procedures were successfully performed in all cases without conversion to open surgery.Pathological results showed urothelial carcinoma in all cases,including 8 high grade and 5 low grade.All the surgical margins were negative.The followed up was from 2 to 12 mon,and there was no tumor recurrence and metastasis found.Conclusions Total transperitoneal laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma is characterized by short operative time,low blood loss,decreased trauma and quick recovery.This is a safe and effective treatment option for the treatment of upper urinary tract urothelial carcinoma.
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Objective To use enzyme-linked immunosorbent assay (ELISA) for measuring thrombospondin-1 (TSP-1),and to analyze its diagnostic value for prostatic carcinoma.Methods The possible difficulties and the way to solve the difficulties with ELISA spot were explored first.Three agents which could segregate idio-antigen and one technique which could depurate proteinum were designed and developed.The non- idio- proteinum cross reaction problems were solved and the routine method to measure TSP-1 with ELISA was set up successfully.The serum TSP-1 was measured in 14 patients with benign prostatic hyperplasia (BPH) and 18 patients with prostatic carcinoma.Results The TSP-1 values were (73.77±12.72)% and (121.86±-19.47)% in prostatic carcinoma group and benign prostatic hyperplasia group,respectively (t= 8.44,P＜0.01).The diagnostic sensitivity and specificity of TSP-1 and prostate specific antigen (PSA) for prostatic cancer were 92.7%,88.9% and 85.7%,66.7%,respectively (P＜0.01).The area under the receiver operating characteristic curve (ROC) of TSP-1 and PSA were 0.9663 and 0.7421 (P＜0.05).Conclusions The determination of TSP-1 with ELISA is feasible.TSP-1 is an ideal diagnostic parameter for prostatic carcinoma and it may distinguish BPH from malignant prostatic disease more exactly than PSA.
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Objective To evaluate the morbidity trend of prostate cancer since the clinical usage of PSA was introduced in Beijing Hospital.Methods Retrospectively we analyzed prostate cancer cases diagnosed in Beijing Hospital from 1995 to 2008.The incidence, age, PSA and clinical stage at diagnosis were taken into account.Results Four hundred and thirty-two cases were enrolled into the study.Who were aged 40 - 90 years old, mean age 72.0 ± 7.8 years.The most frequent age at diagnosis was 70 to 79 years.The incidence increased annually with the most significant increase taking place in 2007 and 2008.Compared with the period 1995 to 1999, the localized prostate cancer rate between 2004 and 2008 increased from 23.9% to 36.3%; the metastatic prostate cancer rate decreased from 49.3% to 32.1%; the rate of patients with PSA 4 - 10 ng,/ml increased from 12.7% to 29.2%; the rate of PSA ＞ 100 ng/ml decreased from 22.5% to 13.2%.Conclusions The incidence and early detection rate of prostate cancer in Beijing Hospital increased from 1995 to 2008.The age at diagnosis had not significantly changed.However, the early detection rate should be improved.
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Objective To evaluate the efficiency and safety of extraperitoneal laparoscopic radi-cal prostatectomy for the treatment of localized prostate cancer. Methods Fifteen localized prostate cancer patients were treated with extraperitoneal laparoscopic radical prostatectomy. The mean pre-op-erative PSA was 8.1 ng/ml and prostate biopsy pathological Gleason score was 5.7±1.3. The Beijing Hospital Technique characterized by cutting directly into linea alba abdominis was used to establish the extraperitoneal space. Harmonic scrapple was used in dissection and haemostasis during the proce-dure. This technique was evaluated in respects of operating time, estimated blood loss, complications during surgery, postoperative complications, post-operative pain score (NRS), catheterization time, length of hospital stay, pathological results and post-operative PSA. Results All the surgeries had been completed successfully except 1 case converted to open surgery. The average operation time was (316±74)min, the average estimated blood loss was (4084±362)m1. There were 5 cases accepted blood transfusion. No rectal or ureteral injury happened during operation. The NRS at post-operative day 1 and day 2 were 2.3 and 1.4. The average length of hospital stay was (19.5±4.9)d. The cathe-terization time was (14.1±2.9)d. There were 2 cases (13%) with positive surgical margins. No case was found having lymph node metastasis. During the 1-12 month follow up, 10 cases (67%) were continence. PSA in 12 cases was lower than 0.2 ng/ml. Conclusion Extraperitoneal laparoscopic radical prostatectomy is feasible and safe in the treatment of localized prostate cancer.
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Objective To improve the finding of prostate cancer (PCa) and prevent the unnecessary biopsies, we select proper patients for biopsy and analyze. Methods The retrospective study included 258 patients who were biopsied for suspected early PCa. Then we analyse how the age, prostate volume, PSA, transrectal ultrasound sonography (TRUS) and MRI affect the finding of prostate cancer. Results Altogether 146 BPH and 112 prostate cancer by biopsy were detected. Positive ratio of biopsy was increased with the age or PSA increases but has no relationship with the prostate volume. Combination with digital rectal examination, PSA and TRUS, the positive ratio was improved and unecessary biopsies were avoided. The detective rate reached 84.6% when all of these three parameters were positive. The sensitivity of MRI was 98.3% but specificity was only 22.4%. The total efficacy was 21.8%. Conclusions The effect of DRE, PSA and TRUS in the screening of prostate cancer should be emphasized. However, importance of MRI is limited for the early detection of PCa.
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ObjectiveTo study the association between the prognosis of Ta transitional cell carcinoma (TCC) of the bladder and risk-related factors.MethodsA total of 88 cases (62 males and 26 females;mean age,61 years;age range,41-81 years)of initial T_a TCC of the bladder treated with transurethral resection of bladder tumor (TURBt) plus intravesical chemotherapy or immunotherapy were enrolled.Among them,there were 26 cases of G_1,61 cases of G_2 and 1 case of G_3.For tumor site,62 cases (16 cases of G_1,45 of G_2,1 of G_3) had single tumor and 26 cases (10 cases of G_1,16 of G_2) had multi-site tumors.The mean follow-up was 113 months (range,56-168 months).The tumor grade,original tumor number and their association with the recurrence and progression of this type of TCC were retrospectively analyzed. Results The overall recurrence rate (RR) was 60%(53/88).In single tumor group,RR of G_1 cases was 25%(4/16);RR of G_2 cases was 62%(28/45) and the total RR was 52%(32/62).In multi-site tumor group,RR of G_1 cases was 80%(8/10),RR of G_2 cases was 75%(12/16) and the total RR was 77%(20/26).The RR of multi-site tumor group was significantly higher than that of single tumor group ( P