ABSTRACT
Objective To explore risk factors of the progression to castration-resistant prostate cancer(CRPC)after hormone therapy (HT).Methods A total of 178 patients with prostate cancer from February 2009 to February 2018 were enrolled to analyze the risk factors of the progression to castrationresistant prostate cancer after androgen deprivation therapy in Fujian Medical University Union Hospital.The mean age was72 years (range,49-91 years);the middle Gleason score was 7 (range,4-10);the middle PSA at the initiation of HT was 24.45 ng/ml (range,0.16-100.0 ng/ml);the middle time to PSA nadir was 9 months (range,0.5-69.0 months);the middle PSA nadir after HT was 0.030 ng/ml (range,0.003-78.670 ng/ml);the mean hemoglobin level was 131 g/L (range,64-184 g/L);the mean alkaline phosphatase level was 98 U/L (range,35-734 U/L);39 patients were diabetes mellitus (21.9％);82 patients were bone metastasis/visceral metastasis (46.1％);85 patients (47.8 ％) were in clinical T1 + T2;93 patients(52.2％)were in clinical T3 + T4.We studied the relationship between CRPC and these risk factors including age,Gleason score,PSA at the initiation of HT,PSA nadir after HT,the time to PSA nadir,hemoglobin level,alkaline phosphatase,bone metastasis/visceral metastasis,clinical T stage,diabetes mellitus by x2 test,univariate and multivariate Cox regression analysis methods.Results The middle follow-up time was 30 months (range,6-92 months).There were 74 of 178 patients progressed to CRPC after HT.The median time of progression to CRPC in this cohort was 15 months (range,4-47 months).On x2 test analysis,there were statistically significant differences between the progression to CRPC group after HT and the rest group in Gleason score (P ＜0.001),PSA nadir after HT (P ＜0.001),PSA at the initiation of HT (P =0.042),alkaline phosphatase (P =0.002),bone metastasis/visceral metastasis (P＜0.001) and clinical T stage (P ＜0.001).Additionally,on multivariate Cox regression analysis,Gleason score (OR =6.152,P ＜ 0.001),PSA nadir after HT (OR =3.022,P ＜ 0.004) and the time to PSA nadir (OR =0.375,P ＜0.001) were found to be significantly associated with the rapid progression to CRPC.Conelusions Gleason score,PSA nadir after HT and the time to PSA nadir were significantly associated with the progression to CRPC.Patients with higher PSA nadir or the shorter time to PSA nadir were more likely to progress to CRPC.
ABSTRACT
Objective To identify the risk factors for prostate-sparing cystectomy by evaluating the risk of prostatic invasion or incidental prostatic adenocarcinoma (PCa) in bladder cancer (BCa) patients undergoing radical cystectomy.Methods The patients undergoing radical cystectomy from 2009 to 2014 in Fujian Medical University Union Hospital were enrolled to analyze the risk factors of prostatic tumor invasion.These factors included age,tumor size,location,quantity,histologic grade and pathologic stage.Results In the 123 male patients,the mean age was 60 years (range,31-78 years);23 (18.7％) patients had BCa or PCa in the prostate;14 (11.4％) had prostatic Bca;11 (8.9％) had PCa.The risk factors of prostatic BCa included multifocal bladder tumors (OR =26.70,P =0.032),tumor in the bladder neck and trigone(OR =17.13,P =0.013),pathological stage (OR =26.70,P ＜ 0.001).Among the 11 patients with PCa,3(27.3％) patients had Gleason score of ≥7,8(72.7％) patients ≤6 and 2(18.2％) patients had extracapsular extension.Three patients had clinically significant PCa.The factor of advanced age was associated with incidental PCa (P =0.003).Conclusion The risk factors of prostatic tumor invasion in patients undergoing radical cystectomy included advanced age,bladder tumor in bladder neck and trigone,muhifocal bladder tumors,and advanced pathological stage.
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Objective To evaluate the role of PSA density with prostate volume determined by MR images in the prediction of extraprostatic extension in patients with clinically organ-confined prostate cancer.Method A total of 71 patients with clinically organ-confined prostate cancer who underwent radical prostatectomy from January 2009 to December 2013 were included in the study.MRI PSAD,preoperative total serum PSA (tPSA),free PSA/total PSA (fPSA/tPSA),biopsy Gleason score,prostate volume,age,body mass index in patients with extraprostatic extension were compared with those in patients with organ-confined disease.The receiver operating characteristic (ROC) curve was used to analyze the performance of each of the above parameters to predict the extraprostatic extension.Multivariate logistic regression analysis was used to select the independent influencing factors for extraprostatic extension.Results Pathologic examination revealed 32 patients were positive for extraprostatic extension and 39 paticnts had organ-confined disease.MRI PSAD(P ＜ 0.001),tPSA (P ＜ 0.00l) and biopsy Gleason score levels (P =0.006) were higher in patients with extraprostatic extension than that in patients with organ-confined disease,and prostate volume was lower(P =0.009).MRI PSAD showed the largest area under ROC curve (AUC) among those parameter(AUC =0.852,P ＜ 0.001),and tPSA was the second (AUC =0.764).Multivariate logistic regression analyses showed that MRI PSAD was an independent predictor of extraprostatic extension.Conclusions MRI PSAD was better than tPSA in predicting pathological stage of extraprostatic extension.The value of PSAD should not be ignored in the prediction of pathological stage.
ABSTRACT
Objectives To evaluate the relationship between phaeochromocytoma and renal cell carcinoma,and to present 2 cases of coexisting phaeochromocytoma and renal cell carcinoma. Methods 2 cases of coexisting phaeochromocytoma and renal cell carcinoma diagnosed and treated were reviewed and studied. A case of left adrenal phaeochromocytoma was disdiagnosed as metastatic carcinoma from the left kidney.Nephrectomy and adrenalectomy were carried out without preoperative preparation crisis occurred in the operation and was managed in time.The another is a case of coexising right adrenal phaeochromocytoma and right renal cell carcinoma.After adequate preoperative preparation,the operation was carried out safely.The postoperative course of both the patients has been uneventful. Conclusions An adrenal growth on the same side of a renal cases may not be a metestatic carcinoma.The possibility of an coexisting phaeochromocytoma shuld be kept in mind.Surgical management was the only means for cure and preoperative preparation was extremely important.