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Objective:To investigate the risk factors for biochemical recurrence after radical prostatectomy.Methods:The clinical data of 558 radical prostatectomy patients admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2010 to December 2020 were retrospectively analyzed. The average age was 67.9 (40-87) years old, and the average body mass index was 24.56 (15.12-35.94) kg/m 2. The average PSA was 41.07 ng/ml, including 48 cases<10 ng/ml, 98 cases 10-20 ng/ml, and 412 cases>20 ng/ml. There were 123, 214, 118, 89, and 14 cases with biopsy Gleason 6-10 score, respectively. The clinical stage : 90 cases in ≤T 2b, 273 cases in T 2c, and 195 cases in ≥T 3 . 558 cases underwent radical prostatectomy, including 528 robotic-assisted laparoscopic surgery, 25 laparoscopic surgery, and 5 open-surgery. The risk factors for postoperative biochemical recurrence were analyzed by Cox regression. Results:A total of 63 patients had postoperative pathological stage pT 2a, 32 patients had pT 2b, 241 patients had pT 2c, and 222 patients had ≥pT 3. A total of 210 cases developed biochemical recurrence after surgery, and the mean time to biochemical recurrence was 33.3 (3-127) months after the radical prostatectomy. The biochemical recurrence rates at 1, 3, and 5 years were 9.7% (54/558), 21.5% (120/558), and 31.7% (177/558), respectively. Among pT 2a and pT 2b patients, 7 (11.1%) and 4 (12.5%) cases developed biochemical recurrence, respectively. Among pT 2c stage patients, 145 (60.17%) cases had positive cut margins, treated with androgen-deprivation therapy (ADT) after surgery. 68 (28.21%) cases of pT 2c stage patients had biochemical recurrence at mean 36.1 (3-106)months after the radical prostatectomy. Among ≥pT 3 patients, 147 patients with positive margins, perineural invasion, seminal vesicle invasion and positive pelvic lymph nodes were treated with postoperative androgen deprivation therapy (ADT) + radiotherapy. 98 of 147 patients (66.67%) had biochemical recurrence, and the average time to biochemical recurrence was 30.6 (24-98) months.75 patients of ≥pT 3 without positive margins, perineural invasion, seminal vesicle invasion or positive pelvic lymph nodes, were treated with postoperative ADT. 33 of them (44%) had biochemical recurrence, and the average time to biochemical recurrence was 32.5 (21-106) months. 5-and 10-year survival rates of 210 patients with biochemical recurrence were 89.05% (187/210) and 78.09% (164/210) respectively, 5- and 10-year tumor-specific survival rates were 92.57% and 87.69%, respectively. 46 of 210 cases died, of which 31 (67.39%) died from prostate cancer, and 15 cases (32.61%) died from cardiovascular and cerebrovascular diseases. Multifactorial Cox regression analysis showed that patient's age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7 were independent risk factors for biochemical recurrence. Conclusions:After radical prostatectomy, patients were treated according to their pathological stage and surgical margins. Patients with positive margins have a higher risk of biochemical recurrence. The independent risk factors for biochemical recurrence included age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7.
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With wide application of 68Ga-prostate specific membrane antigen(PSMA)positron emission tomography(PET)technology in the diagnosis of prostate cancer (PCa), researchers have paid more attention to nodal staging in PCa by 68Ga-PSMA PET. Currently, 68Ga-PSMA PET has been used to detect lymph node metastases (LNMs) in primary prostate cancer patients and recurrent prostate cancer patients. Compared with the traditional imaging techniques, 68Ga-PSMA PET can detect LNMs with higher sensitivity, specificity and accuracy, which has great impact on treatment management of PCa patients. This article reviewed the research progress of detection of LNMs by 68Ga-PSMA PET in prostate cancer patients.
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Objective:To study the efficacy of 68Ga-PSMA PET/CT in evaluating lymph node metastases (LNMs) in patients with prostate cancer (PCa). Methods:Patients who recieved 68Ga-PSMA PET /CT examination in the First Affiliated Hospital of Air Force Military Medical University from July 2021 to February 2022 were enrolled. The patients’ age was (64.4±6.1) years old, with median total prostate specific antigen (tPSA) 34.5 (6.1-99.0) ng/ ml, including PSA<10ng/ ml in 12 cases, 10-20ng/ ml in 21 cases, and > 20 ng/ml in 25 cases. Preoperative clinical staging: 1 case in T 1 stage, 38 cases in T 2 stage, 16 cases in T 3stage, 3 cases in T 4 stage. Preoperative Gleason score of 10 cases was <7, 20 cases was 7, and 28 cases was > 7. According to D 'Amico risk grouping criteria, there were 8 cases in the low-risk group, 20 cases in the medium-risk group and 30 cases in the high-risk group. Preoperative examination of 68Ga-PSMA PET/CT showed no distant metastasis such as visceral metastasis and bone metastasis. All patients underwent radical prostatectomy and pelvic lymph node dissection. The following patients were excluded: patients received preoperative prostate surgery, patients received endocrine therapy, chemotherapy and radiotherapy for prostate cancer before surgery, a history of other malignant tumors in the past 2 years, biopsy pathological diagnosis of neuroendocrine cell prostate cancer and other special types of prostate cancer, prior history of major pelvic surgery, etc. Radical prostatectomy was performed. 38 patients received laparoscopic surgery and 20 patients received robot-assisted laparoscopic surgery. The sensitivity and specificity of 68Ga-PSMA PET /CT for the diagnosis of lymph node metastasis of prostate cancer were calculated according to the comparison of lymph node metastasis in postoperative pathological results and preoperative examination. Results:Postoperative pathological diagnosis: Gleason score of 9 cases was <7, 19 cases was 7, and 30 cases was >7. 37 cases were in pT 2 stage, 17 cases in pT 3 stage, and 4 cases in T 4 stage. There were 12 cases (20.7%) of positive resection margin, and 7 cases (12.1%) of lymphatic fistula. There were 10 patients with lymph node metastasis diagnosed by 68Ga-PSMA PET/CT before surgery, and 17 positive lymph node regions. A total of 11 patients were pathologically positive in lymph nodes, and a total of 20 lymph nodes regions were positive. Based on the number of patients, the specificity and sensitivity of 68Ga-PSMA PET /CT in diagnosing lymph node metastasis in patients were 97.9% (46/47) and 81.2% (9/11), respectively. Based on the number of regional lymph nodes, the specificity and sensitivity of 68Ga-PSMA PET /CT for regional lymph node diagnosis were 99.4%(326/328) and 75.0%(15/20), respectively. The specificity of lymph node metastasis in the external iliac group, the internal iliac group and the obturator group were 100.0%(114/114), 99.1%(110/111) and 98.1%(101/103), and the sensitivity was 100.0%(2/2), 60.00%(3/5) and 69.2%(9/13), respectively. Conclusion:68Ga-PSMA PET/CT can be used as a strong tool for precise guidance of PLND in PCa patients.
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Objective:To explore the clinical value of introducing 68Ga PSMA PET / CT into the prostate cancer(PCa)screening clinic, and to analyze the incidence rate and biopsy of PCa in the screening clinic of our hospital. Methods:The data of the people who participated in PCa screening in the urology screening clinic of our hospital from March 2021 to November 2021 were retrospectively analyzed. Serum PSA was used as the screening index. The subjects with PSA≥4ng/ml were first examined by mpMRI to find suspicious nodules, and the positive ones were further examined by 68Ga-PSMA PET/CT to determine the lesions.The puncture target was outlined, and systematic+ targeted puncture was conducted under ultrasound guidance. The age, PSA distribution, puncture detection rate, Gleason score and clinical stage of patients with PCa were recorded. Results:A total of 1 079 subjects were included in the screening, with an average age of (63.9±9.9)(ranging 40-92) years old, and 249 patients (23.1%, 249/1 079) with PSA≥4ng/ml. Among them, 87 cases (87/249, 34.9%) received mpMRI, and 34 cases (34/249, 13.7%) had PI-RADS score ≥3 points. These 34 patients with suspected nodules on MRI were further scanned with 68Ga-PSMA PET/CT, and 11 cases (11/249, 4.4%) had abnormal uptake of PSMA nuclide. A total of 32 patients (12 patients with PSA abnormalities and 20 patients with positive imaging) finally received prostate biopsy, and 11 patients were diagnosed with PCa, with a positive detection rate of 34.4% (11/32), accounting for 1.0% (11/1 079) of the screening population. Among them, 20 patients with positive imaging (9 patients with only mpMRI positive and 11 patients with both mpMRI and 68Ga-PSMA PET/CT positive) underwent system + targeted fusion biopsy, and the positive rate was 45% (9/20). 12 patients (only PSA abnormal) underwent routine systematic puncture biopsy, and the positive detection rate was 16.7% (2/12). The difference between the two groups was statistically significant ( P<0.05). Among the patients with confirmed PCa, 27.3% (3/11) had Gleason score less than 7, and 72.7% (8/11) had Gleason score≥7. Localized PCa (≤T 2) accounted for 45.4% (5/11), local progression (T 3-T 4) accounted for 18.2% (2/11), and metastatic PCa suggested by 68Ga-PSMA PET/CT accounted for 36.4% (4/11), including 3 systemic multiple bone metastases and one bone metastasis with distant lymph node metastasis. Clinically significant PCa accounted for 90.9% (10/11) of the confirmed patients, and the proportion of high-risk patients in localized or locally advanced PCa was 71.4% (5/7). Conclusions:In PCa screening, if 68Ga-PSMA PET/CT is introduced on the basis of conventional mpMRI, the detection rate of clinically meaningful PCa can be improved. Combined with targeted puncture, tumor lesions can be found early and the screening efficiency of PCa can be improved. In this study, the detection rate of PCa in outpatient screening reached 1.0%. In confirmed cases, the proportion of high-risk patients and metastatic patients was higher.
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We retrospectively analyzed the clinical characteristic of one patient with metastatic prostate cancer and the relative literatures were reviewed. A 40-year-old man was admitted and diagnosed as prostate cancer on March 20, 2018(T 4N 1M 1a) with prostate-specific antigen (PSA) at 47.99 ng/ml. The first 68Ga-PSMA PET/CT showed multiple nodular lesions in the bilateral peripheral bands of the prostate, multiple nodular lesions in the right apex, abnormal uptake of nuclides in multiple lymph nodes in the abdominal aortic wandering zone, the abdominal aortic bifurcation zone, and the bilateral iliac artery wandering zone at the level of the lumbar 2-5 vertebral body, and metastasis was considered. The patient was treated with six cycles of drug castration combined with antiandrogenic treatment and pre-operative system chemotherapy(docetaxel). Six months later, the PSA decreased to 0.225ng/ml. Robot-assisted laparoscopic prostatectomy and expanded pelvic lymph node dissection was performed. Postoperative total androgen blocking therapy was maintained, and PSA slowly increased. Ten months after operation, salvage radiotherapy for enlarged lymph nodes was performed in pelvic extension field, prostate tumor bed area and pelvic cavity. PSA remained stable for 7 months postradiotherapy, and then increased. The patient developed castration-resistant prostate cancer and was treated with triptorelin combined with abiraterone. PSA was decreased, and local radiotherapy was performed for new lymph node metastases in the neck. 68Ga-PSMA PET/CT could provide a decision-making basis for accurate clinical staging, therapeutic effect evaluation and distant metastatic lesions location with guiding value for the formulation of individualized treatment plans.
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Objective:To explore the preoperative 68Ga-PSMA PET/CT examination on the guidance of surgical strategies for high-risk prostate cancer patients and the influence of positive surgical margins after surgery. Methods:The clinical data of 118 patients with high-risk prostate cancer who underwent robot-assisted laparoscopic radical prostatectomy from June 2019 to December 2020 in Xijing Hospital of Air Force Military Medical University was retrospectively analyzed. 47 patients received 68Ga-PSMA PET/CT examination before surgery (study group), and 71 cases without 68Ga-PSMA PET/CT examination before operation ( control group). There was no statistically significant difference in the age [69 (63, 76) vs. 67 (64, 74) years], PSA [PSA≤20ng/ml: 9.91 (6.00, 13.67) vs. 11.64 (8.15, 15.44) ng/ ml, PSA> 20ng/ml: 66.53 (53.66, 195.30) vs. 63.18 (30.08, 148.05) ng/ml], preoperative clinical staging (T 2/≥T 3: 21/26 cases vs. 34/37 cases), and Gleason score [8 (7, 9) vs. 8 (7, 9) points] (all P>0.05) between study group and control group. Both groups underwent robot-assisted laparoscopic radical prostatectomy. The surgical plan was based on the PSMA PET/CT and MRI results in study group and control group respectively. First, ensure that all tumors are removed, and secondly, preserve the patient's urethral length as much as possible to ensure postoperative urinary control.If there is seminal vesicle invasion, expand the scope of resection as needed. If lymph node metastasis is shown, lymph node dissection is performed. For those with negative lymph nodes in imaging studies, if enlarged lymph nodes are found during the operation, lymph node dissection is also performed. After the operation, the perioperative results and surgical margins of the two groups were compared, and the correlation between the PSA value and the SUVmax value of prostate cancer tissue was analyzed. Results:The operations of the two groups were successfully completed, and there was no transfer to open surgery. The operation time of the study group was shorter than that of the control group [175 (155, 205) min vs. 205 (155, 235) min, P=0.003], and the positive rate of resection margin was significantly lower than that of the control group [23.40% (11/47) vs. 45.07%(32/71), P=0.017]. For patients with pathological stage ≥pT 3, the positive rate of surgical margins in the study group was significantly lower than that in the control group [30.77%(8/26) vs. 62.16%(23/37), P=0.014]. In the study group, 11 cases of PSMA-PET showed positive lymph nodes before operation, 10 cases were pathologically positive after operation (90.91%). PSMA-PET showed negative lymph nodes in 1 case, which was pathologically positive after operation. In the control group, 26 cases underwent lymph node dissection, and 16 cases (61.54%) were pathologically positive after operation. The preoperative PSA value of 47 cases in the study group was positively correlated with the SUVmax value of prostate cancer tissue ( r=0.579, P<0.01). Conclusions:Preoperative 68Ga-PSMA PET/CT for high-risk prostate cancer patients can guide the surgeon to optimize the surgical plan, reduce the positive rate of resection margins, and effectively remove the metastatic lymph nodes, which will benefit the patients.
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Objective@#To explore the independent predictors for disease-specific survival (DSS) rate in patients with stage N1-3 testicular seminoma (TS), and establish a nomogram to predict individual 5-year DSS.@*Methods@#The data of N1-3 TS patients registered in the SEER database of National Cancer Institute (USA) from January 2004 to December 2015 were retrospectively analyzed. The 5-year overall survival (OS) rate and DSS rate were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using log-rank test. Besides, the independent predictors of DSS were defined using multivariate Cox regression analysis, and nomogram was drawn using R software. Furthermore, the predictive performance of the nomogram was internally validated using the C-index and calibration plot.@*Results@#TNM stage ⅢA (HR=5.604, 95%CI: 1.252-25.083, P=0.024), ⅢB (HR=6.710, 95%CI: 1.923-23.410, P=0.003) and ⅢC (HR=13.189, 95%CI: 3.916-44.420, P<0.001), age at diagnosis ≥45 years old (HR=3.575, 95%CI: 2.014-6.344, P<0.001), and patients without spouse (HR=2.346, 95%CI: 1.406-3.914, P=0.001) were identified as independent risk factors for DSS. On internal validation, the predictive accuracy of our nomogram was 0.751 (C-index: 0.751, 95%CI: 0.694-0.808). Besides, the calibration plot showed that the predicted survival outcomes were highly consistent with the actual survival outcomes.@*Conclusion@#The study confirms that age at diagnosis ≥45 years old, TNM stage ≥ⅢA and patients without spouse are the independent risk factors for DSS in TS patients with stage N1-3, and the nomogram for predicting individual 5-year DSS is established.
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Objective To explore the independent predictors for disease-specific survival (DSS) rate in patients with stage N1-3 testicular seminoma (TS),and establish a nomogram to predict individual 5-year DSS.Methods The data of N1-3 TS patients registered in the SEER database of National Cancer Institute (USA) from January 2004 to December 2015 were retrospectively analyzed.The 5-year overall survival (OS) rate and DSS rate were calculated using Kaplan-Meier method and the differences among different subgroups were assessed using log-rank test.Besides,the independent predictors of DSS were defined using multivariate Cox regression analysis,and nomogram was drawn using R software.Furthermore,the predictive performance of the nomogram was internally validated using the C-index and calibration plot.Results TNM stage ⅢA (HR =5.604,95％ CI:1.252-25.083,P =0.024),ⅢB (HR =6.710,95％ CI:1.923-23.410,P =0.003) and ⅢC (HR =13.189,95％ CI:3.916-44.420,P ＜ 0.001),age at diagnosis ≥45 years old (HR =3.575,95％ CI:2.014-6.344,P ＜ 0.001),and patients without spouse (HR =2.346,95％ CI:1.406-3.914,P =0.001) were identified as independent risk factors for DSS.On internal validation,the predictive accuracy of our nomogram was 0.751 (C-index:0.751,95％ CI:0.694-0.808).Besides,the calibration plot showed that the predicted survival outcomes were highly consistent with the actual survival outcomes.Conclusion The study confirms that age at diagnosis ≥45 years old,TNM stage ≥ ⅢA and patients without spouse are the independent risk factors for DSS in TS patients with stage N1-3,and the nomogram for predicting individual 5-year DSS is established.
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ObjectiveTo evaluate the therapeutic effect of endoscopic full-thickness resection (EFTR) for gastric stromal tumors.MethodsA total of 33 patients with gastric stromal tumor orgination from deep muscularis propria layer received EFTR from January 2010 to July 2011.The effectiveness and safety of EFTR were compared with those of other 34 patients with gastric stromal tumor origination from muscularis propria layer who underwent endoscopic submucosal dissection (ESD).ResultsExcept in 2 patients with lesions larger than 3.0 × 3.0 cm,EFTR was successful in others 31 patients,who recovered well and had no recurrence during the follow-up within 12 months.There were no significant differences in resection rate,incidence of complications,body temperature,white blood cell counts or recovery time between 2 procedures (P ＞ 0.05 ).However,the number of clips used in EFTR ( 7.0 ± 3.5 vs.4.9 ± 3.1,P =0.013 ) and postoperative fasting days (3.4 ± 1.5 vs.2.0 ± 1.0,P =0.001 ) were significantly higher than those of ESD procedures.ConclusionEFTR is effective and safe for gastric stromal tumors with no higher risk than ESD,but it is more complex technically.EFTR can be used as an expanding method of ESD in endoscopic treatment of gastric stromal tumors.