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Objective:To analyze the clinical features and magnetic resonance imaging of non-malignant patients assigned to Prostate Imaging Reporting And Data System (PI-RADS) 5 score.Methods:We performed a retrospective review of 289 patients who underwent magnetic resonance ultrasound targeted combined system biopsy with PI-RADS 5 lesions in the First Affiliated Hospital of Nanjing Medical University between May 2019 and July 2021. The median age 72 (66, 77)years, median body mass index 24.4(22.3, 27.1)kg/m 2, median prostate volume (PV) 37.39(29.39, 48.86) ml, median PSA 22.24(10.91, 62.69) ng/ml, and median PSAD 0.53(0.30, 1.52)ng/ml 2 were recorded. According to the biopsy pathological results, all patients were divided into benign lesion group and prostate cancer group. PSA, PSAD, PV, and apparent diffusion coefficient (ADC) values were compared, and magnetic resonance imaging and clinical characteristics of patients with biopsy benign lesions were analyzed. Results:There were 11 cases (3.8%) with benign lesion and 278 cases (96.2%) with prostate cancer. The characters of 11 negative biopsy cases were displayed as follows: median age 69(66, 79)years, median body mass index 22.0(21.0, 25.5)kg/m 2, median PV 62.90(38.48, 71.96)ml, median PSA 5.55(2.99, 20.52)ng/ml, median PSAD 0.16(0.07, 0.24) ng/ml 2, median ADC 714.47(701.91, 801.26)×10 -6 mm 2/s, abnormal digital rectal and amination in 5 cases, smoking in 7 cases, and alcohol consumption in 4 cases. The median PV [62.90(38.48, 71.96) vs. 37.21(29.22, 47.82)ml, P<0.01], the PSA value [5.55(2.99, 20.52) vs. 23.53(11.14, 65.98)ng/ml, P<0.01], and the PSAD value [0.16(0.07, 0.24) vs. 0.58(0.31, 1.57)ng/ml 2, P<0.01] were significantly different between benign condition group and prostate carcinoma group. Benign condition group included 5 chronic prostatitis, 2 acute prostatitis (1 with focal adenocarcinoma), 2 granulomatous inflammation, and 2 tuberculous granulomatous inflammation. In 7 benign cases, PSA was less than 10 ng/ml, combined with frequent urination, urgency of urination and incontinence were founded. In 8 benign cases, the area of lesion was more than 50% of the total prostate area in the axial position and the imaging of magnetic resonance were diffused, with regular shape and uniform signal. The imaging of symmetrical distribution was in 6 cases. Conclusions:The benign condition with PI-RADS 5 lesions included chronic prostatitis, acute prostatitis, granulomatous inflammation and tuberculous granulomatous inflammation, among which prostatitis was the most common cause. The PSA value were less than 10 ng/ml in most benign cases, with symptoms such as frequent urination, urgency of urination and incontinence. The imaging of magnetic resonance were diffused, symmetrically distributed, with regular shape and uniform signal.
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Objective:To compare the differences of prostate cancer (PCa) and clinically significant prostate cancer (CsPCa) positive rate and postoperative complications between transperineal cognitive prostate biopsy (COG-TPBx) and transrectal cognitive prostate biopsy (COG-TRBx) based on biparametric magnetic resonance imaging (bpMRI).Methods:The data of 276 patients undergoing prostate biopsy from January 2019 to June 2021 in the First Affiliated Hospital of Nanjing Medical University were retrospectively reviewed. 157 patients underwent COG-TPBx(TPBx group) and 119 patients underwent COG-TRBx (TRBx group). The average age [(66.39 ± 8.31) vs. (66.30 ± 8.42)years], body mass index (BMI) [(23.85±2.49) vs. (23.68±2.61) kg/m 2], PSA values [9.43(1.47-19.80) vs. 8.94(0.66-19.99) ng/ml], prostate volume [37.92(13.99-167.40) vs. 40.78(11.67-188.21) cm 3], PSA density [0.21(0.04-1.17) vs. 0.20(0.04-1.04) ng/(ml·cm 3)], and suspicious digital rectal examination [17.20% (27/157) vs. 21.10% (25/119) ] were not significantly different between TPBx group and TRBx group. The positive rate of PCa, CsPCa, as well as post-biopsy complications of the two groups were compared. Results:There were no significant differences in the positive rate of PCa [49.68%(78/157) vs. 47.06%(56/119), P=0.666] and CsPCa [38.22%(60/157) vs. 34.45%(41/119), P=0.520] between the two groups. In stratification analysis, TPBx group has a significantly higher positive rate of both PCa [54.69%(35/64)] and CsPCa[43.75%(28/64)] in apex zone than TRBx group[39.62%(21/53) and 20.75%(11/53), all P<0.05). Moreover, the postoperative complications were not significantly different in TPBx group compared to that in TRBx group [10.19% (16/157) vs. 12.61%(15/119), P= 0.567]. Conclusions:Our investigations revealed that the overall positive rate of PCa, CsPCa, and the complications were not statistically different between COG-TPBx and COG-TRBx. COG-TPBx has a significantly higher positive rate of both PCa and CsPCa in apex zone.
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Objective:To explore the influencing factors of clinically significant prostate cancer (CsPCa) in patients with PI-RADS score 3.Methods:The data of 133 consecutive patients with the PI-RADS score 3 from January 2019 to December 2020 were retrospectively analyzed. All patients underwent 4-needle transperineal targeted biopsy and 12-needle systematic prostate biopsy (SB). The overall age was 66 (60-72) years, and the overall PSA value was 8.22 (5.95-11.41) ng/ml. All patients underwent multiparametric magnetic resonance imaging (mpMRI), and PI-RADS v2.0 score was 3. Patients were divided into two mutually exclusive groups: non CsPCa group and CsPCa group. The differences of lesion location, laterality, focality and sequence parameters of mpMRI between the two groups were compared, and multivariate binary logistic regression was used to analyze the independent predictors of PI-RADS score 3 in patients with CsPCa.Results:Biopsy results showed 57 cases of prostate cancer, including 41 cases of CsPCa, and 76 cases of non-prostate cancer. The detection rate of prostate cancer was 46.62 %(57/133), and the detection rate of CsPCa was 30.83 %(41/133). There were 41 cases in CsPCa group and 92 cases in non CsPCa group. There was no significant difference between CsPCa group and non CsPCa group in age [66 (58-70) years vs. 66 (60-72) years], body mass index [24.22 (21.82-25.71) kg/m 2 vs. 23.71 (21.99-26.12) kg/m 2], PSA [9.39 (6.35-12.55) ng/ml vs. 7.67 (5.83-10.51) ng/ml], abnormal rate of rectal digital examination [21.95% (9/41) vs. 9.78% (9/92)] (all P > 0.05). There was significant difference in PSAD [0.40 (0.16-0.65) ng/ml 2 vs. 0.17 (0.12-0.24) ng/ml 2] ( P<0.05). In MRI, PI-RADS=3 lesions were mainly located in the transitional zone [46.62 %(62/133)]. In CsPCa group, MRI lesions were located in peripheral zone in 16 cases, transitional zone in 19 cases, and both areas in 6 cases. There were 16 cases on the right, 15 cases on the left and 10 cases on both sides. The lesions were diffused in 19 cases and localized in 22 cases. In the non CsPCa group, 41 lesions were located in the peripheral zone, 43 in the transitional zone, and 8 in both areas. There were 26 cases on the right, 35 cases on the left and 31 cases on both sides. The lesions were diffuse in 56 cases and localized in 36 cases. There was no significant difference in lesion location, side and diffusion degree between the two groups ( P> 0.05). Compared with the non CsPCa group, the positive rate of all MRI sequences in CsPCa group was higher (82.93% vs. 40.22%, P < 0.001), the positive rate of T2 weighted imaging (T2WI) was higher (92.68% vs. 75.00%, P = 0.018), the positive rate of diffusion weighted imaging (DWI) was higher (90.24% vs. 56.52%, P < 0.001), the maximum diameter was larger[(0.67(0.30-1.19)mm vs. 0.48(0.20-0.62)mm, P < 0.001], and the apparent diffusion coefficient (ADC) was lower[0.70(0.61-0.87) vs. 1.10(0.86-1.50), P < 0.001]. Concurrently, PSAD and lesion ADC were important predictors of CsPCa in logistic regression model [mean 10 fold cross validation AUC: 0.78(95% CI 0.65-0.88)]. Conclusions:Most of the MRI lesions in patients with PI-RADS 3 were located in the transitional zone, and the MRI lesions in CsPCa were more obvious and diffusion limited. PSAD and ADC values are independent predictors for the diagnosis of CsPCa in patients with PI-RADS score 3, and the log 2PSAD-ADC prediction model is helpful to find CsPCa from patients with PI-RADS score 3 and protect patients from unnecessary biopsy.
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Objective:To explore the optimal core numbers in targeted prostate biopsy (TB).Methods:The clinical data of 138 patients with prostate cancer diagnosed by six needle trans-perineal TB combined with system biopsy in the First Affiliated Hospital of Nanjing Medical University from October 2018 to March 2020 were retrospectively analyzed. Their age was (69.07 ± 7.97) years old, the PSA value was 9.15 (6.66, 12.95) ng/ml, the prostate volume was 35.01 (27.65, 43.27) cm 3and the PSA density was 0.25 (0.17, 0.36) ng/(ml ·cm 3). All patients accepted bi-parametric magnetic resonance imaging examination and had regions of interests (ROIs) with prostate imaging reporting and data system (PI-RADS) version 2.0 scores ≥ 3. The detective rate of prostate cancer (PCa), clinically significant PCa (CsPCa) and clinically insignificant PCa (CIPCa), along with the Gleason score upgrading rate after radical prostatectomy were compared between different numbers of prostate TB cores. Results:The detective rates for present PCa or CsPCa for the first 1-, 2-, 3-, 4-, 5- and 6-core TB were 74.64%(103/138), 85.51%(118/138), 94.20%(130/138), 98.55%(136/138) and 100.00%(138/138) compared with the total number of cores taken, respectively. The detective rates for CsPCa for the first 1-, 2-, 3-, 4-, 5- and 6-core TB were 67.52%(79/117), 77.78%(91/117), 88.89%(104/117), 93.16%(109/117) and 98.29%(115/117) compared with the total number of cores taken, respectively. Additionally, 20.72%(23/111) patients had Gleason score upgrade after RP. Compared with 6-core TB, the rates of postoperative upgrading for the first 1-, 2-, 3-, 4- and 5-core TB were 50.00%(44/88), 67.05%(59/88), 81.82%(72/88), 88.64%(78/88) and 95.45%(84/88), respectively. For the ROIs with PI-RADS score of 3, 4 and 5, the CsPCa detected by 5, 4 and 3 needles of TB were 95.00% (19/20), 94.92% (56/59) and 94.74% (36/38) respectively. Postoperative upgrading rates were 11.11% (2/18), 9.30% (4/43) and 7.41% (2/27) respectively.Conclusions:For ROIs with PI-RADS score of 3, 4 and 5, TB with 5, 4 and 3 cores respectively is enough to obtain higher diagnostic efficiency and accuracy.
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Objective:To explore the efficacy of single-plane bi-parameter magnetic resonance imaging (bpMRI) in the diagnosis of prostate cancer.Methods:The clinical data of 343 patients who underwent transperineal template prostate magnetic resonance-transrectal ultrasound (MRI-TRUS) cognitive fusion biopsy at the First Affiliated Hospital of Nanjing Medical University from January 2020 to July 2021 were retrospectively analyzed, with median age of [65.0(59.0, 72.0)] years, median body mass index (BMI) of [24.1(22.2, 25.6)]kg/m 2, median prostate volume (PV) of [41.7(29.1, 53.3)]ml, median PSA[6.9 (5.5, 8.4) ng/ml], median PSAD of[0.17(0.12, 0.22) ng/ml 2], and abnormal rate of digital rectal examination (DRE) [6.4%(22/343)]. All patients underwent initial biopsy and bi-parameter magnetic resonance imaging (bpMRI) examination before biopsy, and the images were interpreted using prostate image reporting and data system version 2.1 (PI-RADS v2.1). The detection rates of prostate cancer and clinically significant prostate cancer (csPCa) were compared between single-plane bpMRI and bpMRI. When PI-RADS≥3 score, MRI results were positive; when PI-RADS ≤2 score, MRI results were negative. Results:In the single-plane bpMRI group, 121 MRI results were negative and 222 were positive. Positive patients included 95 with PI-RADS 3 score, 94 with PI-RADS 4 score, and 33 with PI-RADS 5 score. In bpMRI group, 141 MRI results were negative and 202 were positive. Among the positive patients, 67 patients with PI-RADS 3 score, 102 patients with PI-RADS 4 score, and 33 patients with PI-RADS 5 score. The detection rates of single-plane bpMRI and bpMRI for prostate cancer were 22.3% (27/121) and 15.6% (22/141) in MRI negative cases[22.3% (27/121) and 15.6% (22/141), P=0.17], and PI-RADS scores with 3 points [35.8% (34/95) vs. 44.8% (30/67), P=0.25], 4 points [89.4% (84/94)vs. 90.2% (92/102), P=0.85] and 5 points [90.9% (30/33) vs. 93.9% (31/33), P=1.00] showed no significant difference in stratification. The detection rate of csPCa in the single-plane bpMRI group and bpMRI group was significantly different in the MRI negative cases [7.4% (9/121) and 2.1% (3/141), P=0.04]. PI-RADS scores with 3 points [22.1% (21/95) vs. 29.9% (20/67), P=0.27], 4 points [80.9% (76/94) vs. 79.4% (81/102), P=0.80] and 5 points [84.9% (28/33) vs. 90.9% (30/33), P=0.71] showed no significant difference in stratification. Conclusions:For those suspected of prostate cancer patients with PSA 4-10 ng/ml and PI-RADS score ≥3, single-plane bpMRI or bpMRI examination has the same efficacy in term of the detection rate of prostate cancer and csPCa.
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Objective:To detect the value of utilizing bpMRI in prostate biopsy in the detection of prostate cancer with PSA≤20ng/ml.Methods:The clinical data of 394 patients who underwent prostate biopsy in the First Affiliated Hospital of Nanjing Medical University from November 2017 to October 2019 were retrospectively analyzed. Of all the patients, 177 underwent modified systematic biopsy, named TRUS group, 217 patients accepted pre-biopsy bpMRI examination, undergoing modified systematic biopsy if Prostate Imaging Reporting and Data System (PI-RADS) score < 3 or MRI-TRUS cognitive fusion targeted prostate + systematic biopsy if PI-RADS score ≥ 3, named MRI group. The median age of TRUS group was 66 (61, 74) years old, prostate specific antigen (PSA) was 9.52 (7.26, 12.30) ng / ml, and prostate volume (PV) was 36.84 (28.95, 57.72)ml. The median age of MRI group was 66 (59, 72) years old, PSA was 8.84 (6.65, 12.16) ng/ml, and PV was 39.45 (29.25, 58.69)ml. There was no difference in above parameters between the two groups. The χ 2 test was used to compare the detection rate of prostate cancer and clinically significant prostate cancer (CsPCa) between the two groups. Results:There was no significant difference in the detection rates of prostate cancer between TRUS group and MRI group [51.41% (91/177) vs. 48.39% (105/ 217), P = 0.550], but the detection rates of CsPCa were significantly different [26.55% (47/177) vs. 36.41% (79/217), P = 0.037]. In patients with PSA ≤ 10 ng / ml, there was no significant difference in the detection rates of prostate cancer between the two groups [43.62% (41/94) vs. 43.08% (56/130), P = 0.936], but there was a significant difference in the detection rates of CsPCa [17.02% (16/94) vs. 28.46% (37/130), P = 0.047]. There was no significant difference in the detection rates of prostate cancer [60.24% (50/83) and 56.17% (48/87), P= 0.504] and the detection rates of CsPCa [37.35% (31/83) vs. 48.28% (42/87), P = 0.150] between the two groups. The total detection rates of the last two needles in TRUS group and MRI group were 23.16% (41/177) and 36.63% (86/217), respectively, with significant difference ( P=0.001); the detection rates of CsPCa in the last two needles were 11.86% (26/177) and 29.03% (63/ 217), respectively, with significant difference ( P < 0.001). In MRI group, the detection rates of prostate cancer in patients with PI-RADS score <3, 3, 4, 5 were 21.21% (7/33), 25.84% (23/89), 73.24% (52/71), 95.83% (23/24), respectively; the detection rates of CsPCa were 12.12% (4/33), 17.98% (16/89), 54.93% (39/71), 83.33% (23/24), respectively. Conclusions:In patients with PSA ≤ 20 ng / ml, prostate biopsy based on bpMRI may improve the detection of CsPCa, especially in patients with PSA ≤ 10 ng/ml.
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Objective:To investigate the use of bi-parametric magnetic resonance imaging (bpMRI)-based cognitive fusion targeted biopsy and systematic biopsy in patients with prostate imaging reporting and data system (PI-RADS)≥3.Methods:The clinical data of 220 patients with PI-RADS ≥3 who underwent bpMRI-transrectal ultrasound (TRUS) cognitive fusion targeted biopsy and systematic biopsy in the First Affiliated Hospital of Nanjing Medical University from May 2018 to November 2019 were retrospectively analyzed. The median age was 66 (60, 73) years old, median prostate specific antigen (PSA) was 8.73 (6.52, 11.93) ng/ml, medlian prostate volume was 39.25(29.26, 58.39) ml and the mean body mass index (BMI) was (24.02±2.60) kg/m 2. For each patient, bpMRI-TRUS cognitive fusion targeted biopsy and systematic biopsy were performed by two independent experienced urologists. The primary endpoint was the detection rate of CsPCa-A [clinically significant prostate cancer-A, defined as International Society of Urological Pathology (ISUP) grade group 2 or higher tumors]. The secondary endpoints were the detection rates of CsPCa-B (defined as ISUP grade group 3 or higher tumors) and CIPCa (clinically insignificant prostate cancer, defined as ISUP grade group 1 tumors). McNemar test and Chi-square test were used to compare the positive rates of CsPCa-A, CsPCa-B and CIPCa between targeted biopsy and systematic biopsy. Results:In this study, 112 patients (50.91%) were diagnosed with prostate cancer, and the detection was 42.73% (94/220) in targeted biopsy and 46.82% (103/220) in systematic biopsy.CsPCa-A was detected in 84 (38.18%) patients. Detection of CsPCa-A by targeted biopsy and systematic biopsy was not different significantly [30.00% (66/220) vs.34.09% (75/220), P=0.120]. CsPCa-A would have been missed in 8.18% (18/220) patients had not performed systematic biopsy, and in 4.09% (9/220) patients had not performed targeted biopsy. CsPCa-B was detected in 26.36% (58/220) patients. Detection of CsPCa-B by targeted biopsy and systematic biopsy was not different significantly [20.00% (44/220) vs. 23.18% (51/220), P=0.190]. CsPCa-B would have been missed in 6.36% (14/220) patients had not performed systematic biopsy, and in 3.18% (7/220) patients had not performed targeted biopsy. In addition, there was no difference in the positive rates of CIPCa between targeted biopsy combined with systematic biopsy, targeted biopsy only or systematic biopsy only [all three were 12.73% (28/220), P=1.000]. Nine post-biopsy adverse events were reported, including 5 cases of infection, 2 cases of vagal reflex and 2 cases of urinary retention. All of them were improved after symptomatic treatment. Conclusions:No significant difference was identified in the detection rate of CsPCa between targeted biopsy and systematic biopsy. However, combination of targeted biopsy and systematic biopsy could further improve the detection rate of CsPCa without increasing the detection of CIPCa. Therefore, a pre-biopsy bpMRI did have significant importance in the biopsy-na?ve patients, but did not seem to skip the need for systematic biopsy.
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Objective:To investigate the difference of prostate cancer (PCa) detection rate between transperineal cognitive fusion targeted biopsy (COG-TB) and software fusion targeted (FUS-TB).Methods:We retrospectively analyzed 157 patients accepted transperineal targeted biopsies from December 2018 to December 2019, including 67 cases of COG-TB and 90 cases of FUS-TB. All patients were prostate biopsy na?ve, with PSA levels ≤ 20 ng/ml and prostate imaging reporting and data system version 2.1 (PI-RADS v2.1) scores ≥ 3. There was no significant difference between COG-TB and FUS-TB in the age [(70.78 ± 8.86) vs. (70.52 ± 8.79) years old], body mass index [(24.36 ± 2.69)vs. (24.14 ± 3.15) kg/m 2], prostate volume [36.69 (27.52, 47.40) vs. 38.81 (28.80, 53.46) cm 3], PSA level [8.27 (6.0, 11.65) vs. 8.88 (6.40, 13.54) ng/ml], PSAD [0.23 (0.15, 0.36) vs. 0.21 (0.14, 0.34) ng/ml 2], suspicious digital rectal examination findings [16 (23.9%) vs. 17 (18.9%)] and PI-RADS scores [24 (35.8%), 24 (35.8%), 19 (28.4%) and 21 (23.3%) vs. 21 (23.3%), 42 (46.7%), 27 (30.0%) for PI-RADS 3, 4, and 5, respectively]. There was no significant difference in baseline characteristics between the two groups (all P<0.05). The overall and stratified detection rates of PCa and clinically significant prostate cancer (CsPCa) were compared between the two groups. The upgrading rates of Gleason score after radical prostatectomy against biopsy Gleason score were compared between the two groups. Results:There was no significant difference between COG-TB and FUS-TB in the detection rate of PCa [76.1% (51/67) vs. 68.9% (62/90), P=0.32]. Also, no significant difference was found in the detection rate of PCa stratified by PSA [0-10ng/ml: 69.1% (29/42) vs. 57.1% (28/49); 10-20ng/ml: 88.0% (22/25) vs. 82.9% (34/41); all P>0.05] and PI-RADS score [3: 45.8% (11/24) vs. 23.8% (5/21); 4: 91.7% (22/24) vs. 81.0% (34/42); 5: 94.7% (18/19) vs. 85.2% (23/27); all P>0.05]. Similarly, there was no dramatically difference between COG-TB and FUS-TB in the detection rate of CsPCa [58.2% (39//67) vs. 50.0% (45/90), P>0.05]. No significant difference was found in the detection of CsPCa stratified by PSA [0-10ng/ml: 45.2% (19/42) vs.36.7% (18/49); 10-20 ng/ml: 80.0% (20/25) vs. 65.9% (27/41) ; all P>0.05] and PI-RADS score [3: 29.2% (7/24) vs. 9.5% (2/21), 4: 66.7% (16/24) vs. 57.1% (24/42), 5: 84.2%(16/19) vs. 70.4% (19/27) ; all P>0.05]. Additionally, the two technique was not different significantly in the upgrading rate [28.9% (13/45) vs. 26.2% (11/42), P=0.78]. Conclusions:There is no significant difference between FUS-TB and COG-TB in the detection rate of PCa and CsPCa, along with the upgrading rate after RP in patients with PSA ≤ 20 ng / ml and PI-RADS v2.1 score≥3.
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Objective To compare the dijference of prostate cancer detection rate (PCDR) between 12 + 1-core biopsy and 6-core biopsy of the prostate system guided by transrectal ultrasonography (TRUS).Methods The clinical data of 2 707 patients with prostate biopsy from July 1999 to June 2012 were retrospectively analyzed.These patients were 54 to 92 years old,mean age was 69 years old.The range of PSA was 0.02-158.56 ng/ml,with an average of 16.97 ng/mt.People in the range of PSA 0-4.00,4.01-10.00,10.01-20.00,20.01-30.00,and ＞ 30.00 were 161,826,827,312,581,respectively.The volume of the prostate ranged from 14.1 to 82.6 cm3,mean 47.9 cm3.The 1 603 cases before the July 2009 were performed 6-core biopsy guided by the finger,followed by 1104 TRUS-guided 12 + 1-core biopsy.In addition,after March 2012,60 patients accepeted the MRI examination before prostate biopsy.The strategy of prostate biopsy was medial 6-core,lateral 6-core,the 13th core was positioned at abnormal signal area of TRUS and MRI.Explore the difference of PCDR medial 6-core,lateral 6-core,systematic 12-and 12 + 1-core,and the difference of 13th core and the other 12 cores,with the cut off value of PSA quartile of 30 ng/ml and PV quartile of 46 cm3.Results Comparison of clinical characteristics of prostate biopsy between positive group and negative group was performed,and the result suggested that The positive outcome of prostate cancer biopsy was related with element such as high PSA,old age [(71.7 ±7.1)vs.(68.3 ± 8.1),P =0.008],large fPSA [(8.5 ± 36.4) vs.(2.3 ± 3.4),P ＜ 0.001],small prostate volume [(41.3 ±22.9) vs.(52.3 ±29.3),P ＜0.001],small value of f/t[(0.12 ± 0.07) vs.(0.17 ±0.10,P ＜0.001)],high density of PSA [(2.04 ± 9.36) vs.(0.32 ± 0.42),P ＜ 0.001],digital rectal examination [72.0％ (522/725) vs.23.1％ (457/1 982),P ＜ 0.001],irregular echo level [41.1％ (695/1 693) vs.28.0％ (284/1 014),P ＜ 0.001],hypoechoic [64.3％ (695/1 081) vs.17.5％ (284/1 626),P ＜ 0.001],microcalcifcation[56.8％ (586/1 032) vs.23.5％ (393/ 675),P ＜ 0.001].PCDR of 12 + 1-core biopsy was significantly higher than lateral 6-core biopsy[41.5％ (458/1 104)vs.37.0％ (408/1 104),P =0.033].However,PCDR of 12-core biopsy had no statistical differences with 6-core biopsy[40.7％ (449/1 104) vs.37.0％ (408/1 104),P =0.081].PCDR of TRUS-guided biopsy was higher than that of finger-guided biopsy in patients with PSA≤30 ng/ml and PV ＞46 cm3 [30.0％ (254/846)vs.22.2％ (284/1 280),P ＜0.001;31.7％ (124/391)vs.18.1％ (131/723),P ＜0.001].PCDR of the 13th core positioned at abnormal signal area of TRUS and MRI was higher than the average PCDR of other 12 cores [70.9％ (107/151) vs.56.6％ (3 109/5 496),P ＜ 0.001].Conclusion PCDR of TRUS-guided biopsy was higher than that of finger-guided biopsy in patients with PSA≤30 ng/ml and PV ＞46 cm3.PCDR of 12 + 1-core biopsy was significantly higher than that of lateral 6-core biopsy.However,PCDR of 12-core biopsy had no statistical differences with that of 6-core biopsy.PCDR of the 13th core positioned at abnormal signal area of TRUS was higher than the average PCDR of other 12 cores.
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Objective To assess the improvement of prostate cancer detection rate ( PCDR) with the advance of prostate biopsy technologies and analyse the changing epidemiology of patients with positive prostate biopsy, especially the PCDR and classficaton of risk.Methods From March 1999 to March 2015, a total of 3 762 patients were recruited to the department of urology, the first affiliated hospital of Nanjing medical university.All patients underwent a systematic 6-, 8-or 13-core biopsy, guided by finger or TRUS. The PCDR of different prostate specific antigen ( PSA) interval was analyzed.The PCDR of 6-or 8-core biopsy guided by finger and 13-core biopsy guided by TRUS were compared.The trends of PSA level, age and Gleason score in the patients with positive biopsy were summarized.Results A total of 3 762 patients underwent prostate biopsies and PCa were detected in 1479 patients (39.3%).Finger-guided 6-core biopsy was performed on 1 106 patients, and PCa were detected in 343 cases ( 31.0%) .Finger-guided 8-core biopsy was performed on 398 patients, and PCa were diagnosed in 144 cases (36.2%).Since 2009, 2 258 patients underwent TRUS-guided 13-core biopsy, and 992 ( 43.9%) were diagnosed as PCa, higher than that of finger-guided biopsies ( 43.9% vs.32.4%, P4 ng/ml) were lower than that of positive in digital rectal examination.The PCDR of 6 needles biopsy was higher in prostate peripheral zone than that of prostate medial zone (37.5% vs.31.4%, P<0.001) and further analysis indicated that the PCDR of extra 13th biopsy of the area with abnormal TRUS or MRI findings was higher than the mean positive rate of the other 12 biopsies.Regarding adverse effects, 34.9%(1312/3762) reported slight gross hematuria or microscopic haematuria, 56 ( 1.5%) developed gross hematuria, 72 (1.9%) occurred rectal bleeding, 63(1.7%) needed short-term hospitalization due to fever, one patient suffered hepatorenal function failure and one patient died after biopsy.Since 1999, the PSDR rise gradually. With the increase of tPSA level, Gleason score increased in biopsy positive patients.The percentage of low risk PCa patients increased from 6.5% to 15.7% gradually in last decade, while the percentage of intermediate or high risk PCa patients is still over 80%.Since 2009, the percentage of patients who underwent prostate biopsies because of evaluated PSA level was higher than before ( 46.7% vs.34.1%, P<0.001).The PCDR of patients with an evaluated tPSA level showed no difference compared with the patients presented lower urinary tract symptoms ( LUTS ) ( 45.2% vs.43.2%, P =0.362 ) , while their mean Gleason score in positive patients was lower than that of LUTS group(6.76 vs.7.25,P<0.001). Conclusions The PCDR of TRUS-guided 13-core transrectal prostate biopsy was significantly higher than that of finger-guided 6-or 8-core biopsy.Due to the application of PSA test, the PCDR increased gradually and the mean age of positive patients decreased.The higher the age, the higher the PCDR.Gleason score was higher when patients with positive DRE, compared to an evaluated tPSA level.Biopsies of prostate peripheral zone is helpful to improve the PCDR.The higher the tPSA level, the higher the Gleason score. With the application of PSA test, TRUS-guided 13-core prostate biopsy detected more low risk PCa, and most of PCa were still clinical significant.
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<p><b>OBJECTIVE</b>To study the technique and clinical outcomes of laparoscopic radical prostatectomy for high risk prostate cancer.</p><p><b>METHODS</b>A total of 65 patients with high risk prostate cancer were treated with surgery in the First Affiliated Hospital of Nanjing Medical University from January 2011 to June 2013. The mean age was 67 years (range 45-75 years). The mean preoperative prostate specific antigen (PSA) level was 26.7 µg/L (range 11.2-65.5 µg/L). The transrectal biopsy revealed Gleason score of 3+3 in 4 patients, Gleason 3+4 in 27 patients, Gleason 4+3 in 11 patients, Gleason 4+4 in 21 patients and Gleason 4+5 in 2 patients. The bone metastasis was excluded by scintigraphy examination. The surgical procedures were performed through transperitoneal approach. Extended pelvic lymph nodes dissection was performed after the removal of the prostate. Adjuvant radiotherapy or hormonal therapy was administrated according to the pathological results. Serum PSA was detected every 1 to 2 month and urinary continence was evaluated every 3 month in the first year, and then serum PSA was detected every 2 to 3 month.</p><p><b>RESULTS</b>The mean operative time was (134±21) minutes and the median blood loss was (300±146) ml. Bladder neck reconstruction was performed in 15 cases. The drainage was removed on postoperative day 4 and the catheter was removed on day 7. Pathologic results demonstrated pT2 in 25 patients, pT3a in 28 patients, pT3b in 9 patients and pT4 in 3 patients. Positive surgical margin was presented in 15 patients. A median of 19 lymph nodes (range 11-24 nodes) were retrieved during lymphadenectomy and 11 patients had lymph nodes metastasis with a total of 19 positive nodes. Forty-three patients recovered continence after the removal of catheter. Eleven patients received adjuvant hormonal therapy and 19 patients received adjuvant radiation therapy. With the median of 20 months follow-up (range 12-30 months), 5 patients got biochemical recurrence.</p><p><b>CONCLUSIONS</b>Laparoscopic radical prostatectomy with extended lymph nodes dissection for high risk prostate cancer is safe and technical feasible. It provides accurate information on tumor stage and grade. It is an important component of multimodality for the treatment of high risk prostate cancer.</p>
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Aged , Humans , Male , Middle Aged , Biopsy , Laparoscopy , Lymph Node Excision , Lymph Nodes , Pathology , Lymphatic Metastasis , Neoplasm Grading , Postoperative Period , Prostate-Specific Antigen , Blood , Prostatectomy , Prostatic Neoplasms , Diagnosis , General SurgeryABSTRACT
Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 285 patients received the operation with mean age of 67 years (50-76 years) from January 2008 to April 2012.Mean level of PSA was 15.7 μg/L (1.8 -50.0 μg/L),and mean prostatic volume was 44 ml (26 -74 ml). No lymph node or seminal vesicle involvement was found by CT or MR and radionuclide bone scan revealed no metastasis.271 cases were confirmed diagnosis by prostatic biopsy and 14 were detected through pathological studies of TURP specimens.Gleason score ranged from 6 to 8.14 cases were in clinical stage T1b,29 cases in T1c,214 cases in T2 and 28 cases in T3a.Transperitoneal approach and modified technique involving bladder neck dissection,nervesparing technique and vesicoureteral anastomosis were applied on patients. Results Mean operative time was 105 min (55 -150 min).Mean intraoperative estimated blood loss was 240 ml (50-800 ml).Rectal injures occurred in 2 cases and were repaired under laparoscopy.Drainage tube and urinary catheter were removed 48 -72 h and 5 -8 d postoperatively.Postoperative hospital stay was 7 d (5 - 11 d).Positive surgical margin was present in 58 patients.Mean follow-up time was 29 months (3 -50 months).Complete continence were found in 208 patients immediately after catheter removal.68 patient recovered continence within 3 months and 9 patients remained incontinence 3 months after surgery. Normal erection presented in 42 of the 57 cases with nerve-sparing. Conclusions Transperitoneal laparoscopic radical prostatectomy is safe and efficient.Higher efficiency and lower complication rate have been achieved through modified laparoscopic technique involving bladder neck dissection,nerve-sparing technique and vesicoureteral anastomosis.
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Objective To investigate the association between functional polymorphism IVS8-poly (T) in cystic fibrosis transmembrane conductance regulator (CFTR) gene and prostate cancer risk.Methods A population-based case-control study was conducted including 230 prostate cancer patients and 230 agematched controls.PCR-STRP was used to analysis the IVS8-poly (T) tract in CFTR gene.Results The prevalences of the low expression allele,the IVS8-5T,in prostate cancer patients and controls were 1.52 ％ (7/460) and 5.22 ％ (24/460),respectively (x2 =12.489,P =0.002).Logistic regression analysis confirmed the 5T/7T genotype was in protective association with prostate cancer risk (OR =0.232,P =0.003,95 ％ CI0.090-0.599).Conclusion The low expression CFTR IVS8-5T allele contributes to a reduced risk of prostate cancer in Chinese Han population,and may be a protective factor against prostate cancer.
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Objective To evaluate the technique and efficacy of retroperitoneal laparoscopic partial nephrectomy. Methods From June 2002 to December 2009, 113 cases of renal tumor received retroperitoneal laparoscopic partial nephrectomy. The age ranged from 26 to 73 years. The tumor located in left side in 51 cases and right side in 62 cases with the mean diameter of 3.7 cm(1.2-6.3cm). During the procedure, the renal artery was separated and then clamped with bulldog. The renal parenchymal was incised with cold endoscissor and the tumor was totally removed. Pelvicalyceal repairing and parenchymal hemostasis were then performed. Renal defect closure was achieved with running suture or horizontal mattress suture. Results All the procedures were completed successfully.There was no open conversion. The mean operation time was 85 min(60- 125 min), the mean warm ischemic time was 24 min(19-43 min). The pathology studies revealed 87 cases of clear cell carcinoma, 9 cases of papillary renal cell carcinoma, 7 cases of chromophobe cell carcinoma, 6 cases of perivascular epithelioid renal cell tumor and 4 cases of renal oncocytoma. The surgical margin was negative in all cases. There was no complication of urine leakage. Gross hematuria occurred in 2 cases.During 3-41 months of following up, there was no recurrence. Conclusion Retroperitoneal laparo-scopic partial nephrectomy is safe and effective for the treatment of renal tumor, which becomes an alternative treatment to open procedure.
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Objective To study the association of MIF-173 locus polymorphism and the risk of prostate cancer (PCa) in China. Methods A case control study including 259 PCa patients and 301 age-matched controls was conducted. The polymorphisms of MIF-173 locus were analyzed by poly-merase chain reaction restriction fragment length polymorphism (PCR-RFLP) technique using genomic DNA isolated from peripheral blood lymphocytes. The correlations between the susceptibility to PCa and different genotypes were compared. The effect of age, smoking method and family history of canc-er were also analyzed. Results The rate of the MIF-173 * C variant allele of the PCa patients(n=259) was significantly higher than that of the controls (n=301) (36.0% vs 15.0%). The MIF-173 *C variant allele could significantly increase the risk of PCa (OR=2.96,95%CI: 1.92-4.57). Peo-ple with older age (age>70) or family history of cancer, who carried MIF-173 * C allele demonstra-ted a significantly increased risk in comparison with those carrying wild genotype of G/G(OR=3.66, 95%CI=2.02-6.62;OR=3.26, 95%CI=1.24-8.55). Conclusion These results suggested that polymorphisms of MIF-173 locus appear to influence the risk of PCa and may have synergistic effect with age and family history of cancer.
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Objective To study the expression of Survivin in breast carcinoma combined with prognosis of ten-year follow-up.Methods The expression of Survivin was investigated by immunohistochemistry in 60 cases of breast cancer and 20 tumor surrounding tissue.All the cases were performed with prognosis of tenyear follow-up.Results The expression rate of Survivin in breast carcinoma(68.3%)was higher than that in fibroadenoma of bast tissue(25%)(χ2=20.03,P＜0.01).Survivin didn't experss in tumor surrounding tissue.There Was no relationship among the expression of Survivin and the histological differentiation,clinical staging,and lymph node metastasis of breast carcinoma.The expression of Survivin was correlated with the survival years of patients.Conclusion The expression of Survivin was up-regulated in breast carcinoma,which indicated that survivin may play an important role of the genesis and development of breast cancer,but it may play negative correlated with breast carcinoma.
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Objective: To investigate the role of prostate specific antigen(PSA) in screening for prostate cancer. Methods: The serum PSA of 4 848 males over 50-years old for serum PSA was evaluated,respectively out of them 33 cases diagnosed as prostate cancer(screening group) were compared in terms of age distribution,level of PSA,clinical stages,Gleason score and treatment modalities with 28 patients in our hospital(clinical group). Results: In the screening group,the positive percentage account for 9.5%(PSA≥4 ng/ml) and the PCa positive rate was 6.8‰(33/4 848).The average age of the patients(73.2?8.0) was insignificant different between these two groups.The percentage of the cases beyond 20 ng/ml PSA in the screening group was significantly lower than that in clinical group,with 42.4% and 71.5% respectively.Furthermore,the cases with clinical stage A+B accounted for 69.7% in the screening group,while it was 35.7% in the clinical group(P
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<p><b>OBJECTIVE</b>To study the diagnosis and treatment of prostate cancer after prostatectomy for benign prostatic hyperplasia (BPH).</p><p><b>METHODS</b>Twelve cases of prostate cancer after prostatectomy for benign prostatic hyperplasia were reviewed and studied. The mean intervals between prostatectomy for BPH and the diagnosis of prostate cancer was 10 months to 14 years, 5.6 years on average. The main symptoms were dysuria, hematuria and pain. Serum prostate specific antigen (PSA) was elevated in 11 cases. Digital rectal examination (DRE) was abnormal in 8 cases. Three cases were in clinical stage B, 3 in stage C and 6 in stage D. Ten cases received combined androgen blockade therapy. Monotherapy with surgical castration was given to 2 cases. Three patients with urinary tract obstruction received additional treatment of TURP.</p><p><b>RESULTS</b>During the 4 months to 8 years follow-up, 3 patients died, 6 remained stable and 2 deteriorated.</p><p><b>CONCLUSION</b>Surgery for BPH could not prevent the development of prostate cancer. PSA and DRE were the main methods for the diagnosis of this prostate cancer.</p>
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Aged , Aged, 80 and over , Humans , Male , Middle Aged , Follow-Up Studies , Postoperative Complications , Prostate-Specific Antigen , Blood , Prostatic Hyperplasia , General Surgery , Prostatic Neoplasms , Diagnosis , Retrospective Studies , Transurethral Resection of ProstateABSTRACT
Objective To explore the cause, diagnosis and treatment of retroperitoneal fibrosis.Methods 5 cases of retroperitoneal fibrosis were respectively treated by moving ureter into abdomen cavity, encapsulating with pediculate omenta and ilel ureter.Results Following-up of 5 cases for 1 to 3 years, all cases had normal renal functions and hydronephrosis were much decreased.Conclusions Intravenous urogenous(IVU),retrograde pyelography(RGP) and computed tomography (CT) are important methods to diagnose the disease. And the treatment method chosen depends on the range, location of ureterostenosis, and whether the ureter is open or not.
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Objective To evaluate the occurrence of antiandrogen withdrawal syndrome in patients with advanced prostate cancer treated with combined androgen blockade. Methods 24 cases of advanced prostate cancer (10 in stage C and 14 in stage D) were retrospectively studied. All the patients have been treated with combined androgen blockade (bilateral orchiectomy and flutamide). After initial beneficial response to hormonal therapy (duration 7 to 36 months), the disease became progressing.Flutamide was then discontinued. Serum prostate specific antigen (PSA) levels and symptoms alterations were observed. Results Following withdrawal of flutamide, 8 patients showed a decline in PSA (mean 75%).In 6 the PSA declined more than 50%. Clinical symptoms improved in 4 patients and the prostate mass became smaller in 2. The mean duration of improvement was 4.3 months. Conclusions In patients with hormone refractory prostate cancer after initial combined androgen blockade, a trial of "antiandrogen withdrawal" is a reasonable therapeutic management prior to other more toxic therapies.