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Latent prostate cancer is defined as prostate cancer that was undiagnosed during life and then detected through autopsy. As a complement to clinical data of diagnosed prostate cancer, autopsy studies provide us with epidemiological and pathological characteristics of latent prostate cancer and facilitate our understanding of this disease. Though differences in time, population, methods, and reporting of results across studies exist, we managed to integrate findings of global autopsy studies on latent prostate cancer, analyze the effect of methodology on the results and propose deficiencies as well as directions for further research.
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There are few studies about the treatment of metastatic castration-resistant prostate cancer (mCRPC) with darolutamide. This paper reports a case that an 83-year-old patient complained of dysuria. His initial diagnosis was metastatic hormone sensitive prostate cancer(mHSPC). Androgen deprivation therapy (ADT) plus bicalutamide was performed. Re-examination of bone scan after half a year revealed that there were more than two new bone metastases, which was considered entering mCRPC. Due to the patient’s advanced age, post medical history of epilepsy, type 2 diabetes and cardiac radiofrequency ablation, long-term use of phenobarbital and repaglinide, the therapy was changed to ADT plus darolutamide to avoid drug contraindications. Re-examination of bone scan after 10 months revealed decreased metabolism in some metastases, and tPSA declined continuously.
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Prostate cancer has become the most common malignant disease in male. Due to development of therapy methods, the overall survive rate of advanced prostate cancer has been improved significantly. The demands for higher quality of life are impending in advanced prostate cancer patient. With the progression of prostate cancer, about 1/3 to 2/3 of patients will suffer from moderate to severe lower urinary tract symptoms. Severe lower urinary tract symptoms can lead to negative effects on treatment and quality of life. However, there is no standard treatment for lower urinary tract symptoms in advanced prostate cancer patients. This article reviews the clinical application of palliative transurethral resection of prostate in patients with advanced prostate cancer.
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Objective:To compare the outcomes of low-dose-rate prostate brachytherapy (BT) and radical prostatectomy (RP) in patients with T 1c-T 3a prostate cancer. Methods:A group of 745 patients with T 1c-T 3a prostate cancer between January 2010 and August 2017 at Peking Union Medical College Hospital were identified. The records of these patients, who were followed up for a minimum of 2 years, were reviewed. 384 cases received BT. Their characters included age(72.1±6.6), tPSA (12.4±6.1) ng/ml, prostate volume (33.6±13.8) ml, Gleason grade group (2.0±1.2). In this group, T 1c-T 2a stage was diagnosed in 189 cases, T 2b-T 2c stage in 182 cases and T 3a stage in 13 cases.361 cases received RP. Their characters included age(65.7±6.2), tPSA(12.6±6.4) ng/ml, prostate volume (37.2±17.8) ml, Gleason grade group (1.9±1.2). In this group, T 1c-T 2a stage was diagnosed in 177 cases, T 2b-T 2c stage in 170 cases and T 3a stage in 14 cases.The log-rank test compared survival rates between the two modalities, and Cox regression identified factors associated with bRFS. Results:Median follow-up was 60 months. Kaplan-Meier analysis did not show any statistically significant differences in terms of cRFS( P=0.321), cancer specific survival (CSS, P=0.643) and overall survival (OS, P=0.565) rate between the two groups. BT was associated with improved bRFS compared to RP( P=0.018). Risk of biochemical recurrence was significantly lower with BT compared with RP in the patients with a biopsy Gleason grade group 2 and 3 ( P=0.008), or prostate volume ≤35 ml ( P=0.027), or tPSA ≤10 ng/ml ( P=0.013), or the clinical T stages of T 2b and T 2C( P=0.031), or in the intermediate-risk group according to NCCN risk classification ( P=0.003). On multivariate analysis of all 745 patients, age≤ 70 and T stage≥T 2b was associated with significantly shorter bRFS. Conclusions:BT produced equivalent cRFS, CSS and OS compared to RP, while it was associated with improved bRFS. BT On multivariate analysis of all 745 patients, age≤ 70 and T stage≥T 2b was associated with significantly lower bRFS.
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Objective To evaluate the diagnostic value of template-guided transperineal prostate biopsy (TTPB) by comparing biopsy-derived pathological results with findings from radical prostatectomy (RP) specimens.Methods From April 2013 to December 2015,patients who were diagnosed prostate cancer by transperineal template-guided 11-region prostate biopsy were enrolled in our study,and underwent laparoscopic RP.All whole-mount slices were reconstructed via a three-dimensional prostate model.Pathological features of the biopsy and RP specimens were compared.Detection rate of index lesions,overall sensitivity and specificity of TTPB,Gleason scores (GSs) in comparisons of biopsy and RP specimens were analyzed.Results One hundred and three patients were enrolled in our study,and the mean age was (65 ± 6)years.The median serum PSA was 11.7 ng/ml(IQR 7.2-19.1 ng/ml).The Gleason score ranged from 6 to 9.The clinical stage was T1c-T3a and the median prostate volume was 33.0 ml(IQR 26.0-43.0 ml).Eighty-nine of the 103 index lesions (86.4％) were detected by biopsy.The median volume was 1.2 ml (IQR 0.5-3.3 ml) and the mean maximum tumor length was (0.6 ± 0.4)cm.The overall sensitivity and specificity of the transperineal prostate biopsies were 53.3％ and 94.2％,respectively.RP-derived GSs were unchanged,upgraded and downgraded relative to the corresponding biopsy-derived GSs in 75 (72.8％),24 (23.3％) and 4 (3.9％) patients,respectively.Conclusions Stematic transperineal template-guided prostate biopsy could detect most of the index lesions.This biopsy approach was less able to determine tumour focal positioning and could only serve as a reference for guiding focal therapy.
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Objective To evaluate the outcomes and complications of permanent brachytherapy combined with external beam radiotherapy and hormonal therapy for local high-risk or intermediated-risk prostate cancer.Methods There were 354 men with local high-risk or intermediated-risk prostate cancer were reviewed,including 111 men with local intermediated-risk prostate cancer and 243 men with local highrisk prostate cancer.The age of the patients were 48 to 84 years old (mean age 72.4 years old).The preoperative PSA levels were in a range of 3.8 to 99.8ng/ml (mean 29.6 g/ml) and the preoperative Gleason scores were 4 to 9 (mean 6.8).The prostate volume were 13.7 to 65.0 ml (mean 30.5 ml).All the patients were treated with brachytherapy combined with hormonal therapy,including 69 patients received additional external beam radiotherapy.All patients were followed up for biochemical progression-free survival (bPFS),distant disease free survival (DDFS),overall survival (OS),cause-specific survival (CSS) rate and complications.Results Among 354 cases,174 cases underwent brachytherapy after the diagnosis of prostate cancer,and 157 cases underwent brachytherapy after maximal androgen blockade (MAB) treatmentfor 3 months,while the other 23 patients with large prostate underwent brachytherapy after MAB treatment for 6 months.All 354 cases were treated with MAB after brachytherapy.One hundred and eleven cases in intermediated-risk group were treated with MAB for 6 months and 243 cases in high-risk group were treated with MAB for 6 months to 3 years.Another 69 patients received adjuvant external radiotherapy.All cases were followed up for 9 to 128 months (mean 91 months),including 135 cases having biochemical recurrence,and 63 cases having distant metastasis.There were 81 cases died,including 24 cases died of prostate cancer.The overall bPFS,DDFS,OS and CSS were 61.9％,82.2％,77.1％ and 93.2％ respectively.There were significant difference in the survival rate between the high-risk group and the intermediated-risk group(P ＜ 0.001).The incidence of urinary retention and long term urethral stricture were 6.8％ and 1.7％,respectively.No serious complications occurred.Conclusion Permanent brachytherapy combined with external beam radiotherapy and hormonal therapy treating local high-risk or intermediated-risk prostate cancer can be effective with few complications.
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Objective To assess the long-term outcome of unilateral adrenaletomy in patients with adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The data from 82 cases of AIMAH were reviewed and summarized including clinical manifestations, endocrinological data, imaging findings and postoperative follow-up.Fouty-nine males and thirty-three females with a mean age of fifty years composed our series.Among the 82 cases, 41 demonstrated Cushing syndrome (CS), 74 presented with hypertension, 38 manifested diabetes mellitus, 35 complicated of osteoporosis and 11 of them with bone fracture, 39 complained of edema.Laboratory tests showed low ACTH plasma levels (＜ 2.2 pmol/L) in 62 of 79 cases.High level of 24-hour urinay free cortisol excretion(＞ 284.2nmol/L) was found in 67 of 79 cases.Elevated serum cortisol with loss of the circadian rhythm was presented in 55 of 60 cases.Failed to suppress cortisol secretion was observed in 61 of 63 conducted with low-dose dexamethasone suppression tests and in 47 of 53 implemented with high-dose dexamethasone suppression tests.Bilateral massively enlarged multinodular adrenal glands were found in all cases with CT or MR imaging.Unilateral adrenalectomy was performed in the larger side of adrenal gland in all 82 cases.All adrenalectomies were carried out including 47 in right sides and 35 in left sides, with 77 by retroperitoneoscopic approach and 5 by open retroperitoneal approach.Results Histopathological examination confirmed nodular hyperplasia of the adrenal cortex for all specimens.After a mean duration of 48.5 months, 80 of 82 patients were available for follow-up.Most clinical symptoms resolved within 6 months after operation.Cushingoid features disappeared in 58.5％ (24/41)of patients who initially presented with typical signs of Cushing Syndrome.Weight loss was seen in 56.3％ (45/80).Improvement of hypertension and diabetes was observed in 63.5％ (47/74) and 76.3％ (29/38) respectively.All the eyelids swelling and edema of the limbs subsided within 3 months.In long-term follow-up (more than 6 months), 82.9％ (63/76) had clinical and biochemical recurrence within a mean time of 14.6 months and 46.0％ (29/63) received contralateral adrenal surgery.Two patients died, one died from heart attack and another one died from pulmonary infection, 2 years and 7 years after unilateral adrenalectomy, respectively.Conclusions Unilateral adrenalectomy just has transient efficiency for AIMAH.Most patients will experience clinical and biochemical recurrence for a long period,and have to receive another operation for the contralateral hyperplastic adrenal gland.
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In these recent over twenty years, transrectal prostate biopsy takes predominant place in diagnosing prostate cancer for its relatively convenient procedure and low cost. In contrast, transperineal biopsy approach is much less popular. However, transrectal prostate biopsy has disadvantages of"blind region"in the anterior apex regions of the prostate gland and relatively high risk of biopsy associated sepsis. The transperineal biopsy approach is again gaining attention and even becoming a mainstream approach. The advantages of transperineal prostate biopsy are the following: a high positive rate, particularly in the detection of tumors at the anterior or apical prostate; accurate assessment of the volume and Gleason score of prostate cancer; the possibility of providing information about the spatial distribution of the cancer; good consistency of pathology with radical resection; and a lower infection rate, making it suitable for patients with a high infection risks. The expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach.
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Humans , Male , Biopsy , Methods , Magnetic Resonance Imaging , Neoplasm Grading , Prostatic Neoplasms , DiagnosisABSTRACT
Objective To investigate the diagnosis and treatment of renal neoplasm with calcification .Methods Retrospectively summarized the clinical data of the 2 patients with calcific renal neoplasm admitted in our hospital from the May to July in 2014, then analyzed and discussed the clinical manifestations , diagnosis and treatment com-bined with the literatures .Results The two cases were both suspected of renal malignant tumor preoperatively .The case 1 was a 32-year-old male , laparoscopic partial resection of the left kidney was performed , and the postoperative pathology was clear cell carcinoma (Fuhrman levelⅠ).The case 2 was a 18-year-old male, partial resection of the right kidney was performed because of the tumor size , and the postoperative pathology was adult nephroblastoma . Conclusions The calcific renal neoplasm is a rare disease , the property determination depends on postoperative pa-thology, and as to the choice of surgical method , the patients'age, the tumor size and the tumor location should be taken into consideration , and intraoperative frozen should be performed when necessary .
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Objective To investigate the efficacy and safety of 3D-laparoscopic surgery in adrenalpheochromocytomas /paragangliomas.Methods From December 2012 to July 2014,23 cases of adrenal pheochromocytomas/paragangliomas were treated by 3D-laparoscopic surgery.Among them,7 cases were male and 16 cases were female,whose mean age are 47 (32-68) years old.Their clinical symptoms including sustained hypertension in 11 cases,intermittent hypertension in 8 cases,sustained hypertension with intermittent progression in 2 cases and asymptom in 2 cases.All tumors were diagnosed by endocrine examination,image test and nuclear medicine.Mean diameter of tumors are 8 cm,ranged from 3-14cm.In order to adjust the blood pressure,patients took α-receptor blocker for 2-4 weeks preoperatively.Under the general anesthesia,19 patients received the 3D-laparoscopic surgery via retroperitoneal approach and 4 cases received the procedure via peritoneal approach.Results All operations were completed successfully.There were no major intraoperative complications.Mean operating time was (78 ± 21) min and mean estimated blood loss was (54.8 ± 36.3) ml.Mean hospital stay after operation was (3.8 ± 1.4) days.The pathological diagnosis included pheochromocytomas in 15 cases and paragangliomas in 8 cases.During the 3 to 18 months following up,no recurrence or metastasis was found in this study.Conclusions 3D-laparoscopic surgery has obvious advantage in spatial location and the sense of depth for adrenal pheochromocytomas /paragangliomas,which shortens the operation time and increase the safety obviously.
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<p><b>OBJECTIVE</b>To evaluate the outcomes of permanent brachytherapy combined with maximal androgen blockade (MAB) in local intermediated-risk prostate cancer.</p><p><b>METHODS</b>From December 2003 to December 2009, 307 patients of local prostate cancer were treated with brachytherapy, 98 cases of intermediated-risk were followed-up for 5 years and data were recorded, aged from 58 to 84 years, average 74 years. Serum PSA was 0.4-19.0 µg/L, average 11.2 µg/L, clinical TNM stage was T1cN0M0-T2bN0M0. Gleason score 4-7, 6.7 in average. Prostate volume ranged from 14 to 65 ml, average 32.1 ml. All the 98 patients underwent permanent brachytherapy combined with MAB. Biochemical recurrence rate, biochemical-free survival, tumor-specific survival, overall survival, salvage therapy and complications were analyzed.</p><p><b>RESULTS</b>Followed up for 5 years, 19 cases had biochemical recurrence, median recurrence period: 36 months. One patient died of prostate cancer 45 months after brachytherapy of all 7 patients died in 5 years. Five-years biochemical-free recurrence rate: 80.6%, overall survival: 92.9%, tumor-specific survival: 98.9%, biochemical-free survival: 79.3%. Low-urinary tract and rectal irritation symptoms occurred in 75 cases(76.5%). Urinary retention occurred in 7 cases (7.1%) with catheterization duration less than 1 week, no surgical operation were performed. Seeds immigration to lung in 2 cases. No serious complications occurred.</p><p><b>CONCLUSION</b>In local intermediated-risk prostate cancer patients, permanent brachytherapy combined with short-term MAB can be an effective treatment with few complications.</p>
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Aged , Aged, 80 and over , Humans , Male , Middle Aged , Androgen Antagonists , Therapeutic Uses , Brachytherapy , Combined Modality Therapy , Neoplasm Recurrence, Local , Prostate-Specific Antigen , Blood , Prostatic Neoplasms , Drug Therapy , Radiotherapy , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To assess the clinical features of transperineal prostate biopsy in patients age ≤50 years.</p><p><b>METHODS</b>The clinical data of 124 patients ≤ 50 years old were retrieved retrospectively in Peking Union Medical College Hospital between January 2005 and September 2014. The age of patients were 14 to 50 years (mean age 43.6 years), and their prostatic specific antigen(PSA) levels were fluctuated in a range of 0.01 to 579.00 µg/L (mean 15.5 µg/L). Twenty patients were abnormal in digital rectal examination (DRE). All the patients were underwent transperineal prostate biopsy using an 11-region template.</p><p><b>RESULTS</b>Prostate cancer was detected in 14 of 124 patients (11.3%). The prostate cancer detection rates in groups with PSA 0-4.0, >4.0-10.0, >10.0-20.0, >20.0-50.0, and >50.0 µg/L were 0, 6.2% (4/65), 13.3% (4/30), 1/5, and 5/5, respectively. Non-adenocarcinoma prostate malignancy (NAPM) was detected in 7 of 124 patients (5.6%), and their PSA levels were fluctuated in a range of 0 to 4.0 µg/L. Four patients were abnormal in DRE and 5 patients were abnormal in radiological examination.</p><p><b>CONCLUSION</b>The positive rate of transperineal prostate biopsy in patients age≤50 years is low, and rigorous screening before prostate biopsy is necessary. The men with DRE or radiological abnormalities but normal PSA should be wary of NAPM.</p>
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Adolescent , Adult , Humans , Male , Middle Aged , Young Adult , Beijing , Biopsy , Methods , Early Detection of Cancer , Prostate-Specific Antigen , Blood , Prostatic Neoplasms , DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To analyze the clinical features of retroperitoneal bronchogenic cyst.</p><p><b>METHODS</b>The clinical data of 6 cases with retroperitoneal brochogenic cyst treated in Peking Union Medical College Hospital from April 1996 to October 2014 were retrospectively analyzed. The clinical manifestation, diagnosis, treatment and prognosis were analyzed.</p><p><b>RESULTS</b>Of the patients, 1 was male and 5 were female aging from 31 to 50 years with a mean age of 38.3 years. Three cases were diagnosed from physical examination, 2 cases from upper abdominal pain and 1 case from left flank pain. The cysts located in the left adrenal region, between the liver and the pancreas, and anterior aspect of the tail of the pancreas were seen in 4 cases, 1 case and 1 case, respectively. The major diameter was from 5 cm to 13 cm, and the mean major diameter was 7 cm. Ultrasonography and CT scan could reveal cystic, cystic-solid or solid masses. Color doppler flow imaging showed no obvious blood flow, and contrast-enhanced CT scans showed no enhancement or no obvious enhancement. Six cases were all misdiagnosed preoperatively. They all underwent operations via retroperitoneal laparoscopic resection for 3 cases, laparotomy for 2 cases and open flank resection for 1 case respectively. The pathological diagnoses were all bronchogenic cysts. Three symptomatic patients became asymptomatic after operations. Five patients had been followed up. During the follow-up of 2 months to 15 years, no recurrence had been found with CT scan.</p><p><b>CONCLUSIONS</b>Retroperitoneal bronchogenic cyst is rare and easily misdiagnosed. It should be considered in the differential diagnosis of a retroperitoneal mass. Most cysts are positioned in the left adrenal region and adjacent regions. Some cysts demonstrate soft tissue characteristics in image. After surgical removal, the patients have a good prognosis.</p>
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Adult , Female , Humans , Male , Middle Aged , Bronchogenic Cyst , Diagnosis , Pathology , Diagnosis, Differential , Laparoscopy , Laparotomy , Liver , Pathology , Pancreas , Pathology , Prognosis , Retroperitoneal Space , Pathology , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective To investigate the prognostic factors of biochemical relapse in patients with early stage prostate cancer after brachytherapy.Methods From December 2003 to December 2007,117 patients (age 51-84 years,median 73 years) with early stage prostate cancer underwent brachytherapy at our hospital.The PSA ranged from 0.4 to 47.6 μg/L (median,14.7 g/L),in which 75 cases with PSA＜ 20.0 μg/L and 42 cases with PSA≥20.0 μg/L.Clinical stage ranged from T1b to T2c.The prostate volume ranged from 13 to 69 ml (average,31 ml),and the percentage of positive biopsy cores was 8％ to 100％ (average,45％),in which 69 cases with a positivity＜50％ and 48 cases with a positivity≥50％.The D90 ranged from 106 to 170 Gy (average,142 Gy).And 6 patients were treated with external beam radiation in combination.The biochemical no evidence of disease (bNED) rate was recorded.And possible prognostic factors,including risk stratification,PSA,clinical stage,prostate volume,biopsy positivity and D90,were analyzed by using SPSS 19.0 software.Results The patients were followed up for 19 to 114 months (average,84 months; median,82 months).And biochemical relapse was observed in 33 cases (bNED rate,72％).The bNED rates in low-risk,intermediate-risk and high-risk groups were 86％,79％ and 64％,respectively and significant correlations were found between bNED rate and risk stratification (P=0.040).Moreover,the bNED rate was significantly higher in patients with the following factors,namely PSA＜20.0 μg/L (P =0.028),percentage of positive biopsy cores＜50％ (P =0.006) and high-dose implants (D90 ≥ 140 Gy) (P=0.009).Conclusions The long-term efficacy of brachytherapy in early stage prostate cancer is definite.Significant associations are found between bNED rate and risk stratification.And higher rates of biochemical relapse could be found in patients with PSA ≥ 20.0 μg/L,percentage of positive biopsy cores ≥ 50％ or D90＜ 140 Gy groups.
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Objective To investigate the long-term efficacy and complications of brachytherapy in early stage prostate cancer.Methods The data of 117 cases of early stage prostate cancer patients were analyzed,aged from 51 to 84 years,with an average of 73 years.The PSA ranged from 0.4 to 47.6 μg/L (14.7 in average),Gleason score ranged from 4 to 9 (6.4 in average),clinical stage ranged from T1b to T2c,the prostate volume ranged from 13 to 69 ml (31 ml in average),and the positive biopsy rate was 8％to 100％ (45％ in average).The low-risk,intermediate-risk and high-risk prostate cancer were 22,29 and 66 cases.Biochemical no evidence of disease (bNED),overall survival and complications were recorded.Results Followed up from 19 to 114 months (84 months in average),33 cases had biochemical recurrence (bNED rate,72％).Twelve patients died,among which 4 patients died of prostate cancer.The overall survival rate was 90％,and the cancer-specific survival rate was 97％.The bNED rates in low-risk,intermediate-risk and high-risk groups were 86％,79％ and 64％,and the difference was significant among the 3groups (P=0.040).The overall survival rates were 100％,90％ and 86％,with no significant difference among the 3 groups (P=0.189).Urinary retention occurred in 11 cases (9％),among which 1 patient had TURP treatment.No serious complications such as rectal fistula occurred.Conclusions The long-term efficacy of brachytherapy in early stage prostate cancer is definite with few complications.With a mean followup of 7 years,the bNED rate was 72％ and the overall survival rate was 90％.
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Objective To study the diagnosis and surgical treatment of adrenal cavernous hemangi -oma. Methods The data of one case with adrenal cavernous hemangioma was retrospectively reviewed .A 62-year-old female patient admitted in out hospital on 18th June, 2013 due to the paroxysmal hypertension for 10 years and finding the left adrenal mass for 2 months.Her highest blood pressure was 175/55 mmHg and the response for the drug treatment was poor .In recent 6 months, her blood pressure was unstable .Ab-dominal ultrasound showed a hypoechoic mass in left adrenal .Enhanced CT examination showed an irregular mass in the left adrenal gland , with the size of 4.5 cm ×2.5 cm ×3.9 cm,peripherally enhanced in arterial phase , contrast agent filling in portal venous phase , and high density in delay phase .Abdominal MR exami-nation showed a mass before abdominal aortic , with clear and smooth edge .The mass showed low signal in T1WI phase and high signal in T 2WI phase, which was considered as pheochromocytoma .24h urinary cate-cholamines showed that norepinephrine was 103.0 nmol, epinephrine was 9.8 nmol and dopamine was 18.9 nmol.Octreotide (99Tcm-TOC) showed slight high expression of somatostatin receptor .Preoperative diagnosis was left pheochromocytoma . Results After the preoperative medical preparation of phenoxybenzamine for 3 weeks, her blood pressure was maintained at 120-132/50-70 mmHg, with stuffy nose, warm hand and foot, and the weight gain of about 1 kg.The patient was undergone laparoscopic resection of left adrenal tumor under general anesthesia on June 24, 2013.The postoperative blood pressure returned to normal .And the left adrenal pathology was cavernous hemangioma .Following up for 5 months, the patient had normal blood pressure without the tumor recurrence . Conclusions The adrenal cavernous hemangioma is extreme-ly rare with high rate of misdiagnosis .For adrenal tumor with typical hemangioma imaging , the diagnosis of cavernous hemangioma should be considered .For tumors larger than 6 cm, surgery is recommended .The first choice of operative approach is laparoscopic resection of adrenal tumor , and normal adrenal tissue should be retained as far as possible.
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Objective To evaluate the safety and feasibility of transurethral resection of paragangliomas in urinary bladder.Methods Clinical data of 11 patients (5 males and 6 females) with paragangliomas in urinary bladder who underwent transurethral resection in Peking Union Medical College Hospital from June 2008 to February 2014 were analyzed retrospectively.The age ranged from 30 to 76 years (mean 54± 14 years).All cases were diagnosed as single primary tumor.The preoperative CT or MRI showed the tumors located in bladder wall.The diameter of tumors ranged from 0.9-3.0 cm (mean 1.9±0.8).Nine cases presented with hypertension after micturition and 2 cases presented with sustained hypertension.The tumors were localized by B ultrasound,enhanced CT or MRI.The diagnosis was confirmed by detection of 24 hours urinary catecholamine,Octreotide scanning or 131I-MIBG scanning.Transurethral resection of tumors was performed after pharmachological preperation.Eight cases underwent conventional transurethral electroresection and 3 cases underwent transurethral resection with 2 μm thulium laser.All cases were followed up every 3 to 6 months and 24 hours urinary catecholamine and CT scan were performed.Results All tumors were successfully resected without open conversion.The operative time was 20 to 45 min (mean 34±8 min).The estimated blood loss ranged from 10 to 100 ml (mean 27±26 ml).Fluctuation of blood pressure during operation occurred in 9 cases.The maximum systolic blood pressure during operation rised to 220 mmHg (1 mmHg =0.133 kPa) and sodium Nitroprusside was administed to control blood pressure.Blood pressure of all cases returned to normal after operation.No perioperative complications occurred.No recurrence was found during follow-up (3-58 months,mean 26 months).Conclusions For small localized paraganglioma (the diameter less than 3 cm) in urinary bladder,transurethral resection could be a safe and feasible choice of treatment.And 2 μm thulium laser resection has an advantage over conventional electroresection for tumors located in lateral bladder wall to avoid obturator nerve reflex.
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<p><b>OBJECTIVE</b>To evaluate the outcomes of T3a prostate cancer treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy, and analyse the influence of preoperative factors on prognosis.</p><p><b>METHODS</b>From January 2003 to December 2008, 38 pactients with T3a prostate cancer aged from 48 to 81 years (mean: 71 years) were enrolled, with serum prostate specific antigen (PSA) levels ranged from 10.000 to 99.800 µg/L (mean: 56.300 µg/L), Gleason score from 5 to 9 (mean: 7.6) and percentage of positive biopsy cores from 10.0% to 100% (mean: 65.3%). All patients were treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy. Survival curves were calculated using the Kaplan-Meier method. The predictive factors including patient's age, prostate volume, serum pre-treatment PSA, Gleason score and percentage of positive biopsy cores were used for univariate analysis on biochemical failure-free, distant metastasis-free and overall survival.</p><p><b>RESULTS</b>The mean follow-up was 69 months (range: 9-109 months).Nineteen patients experienced biochemical failure. The average biochemical failure time was 13.4 months (range: 1-40 months). There were 13 patients developed as distant metastatic prostate cancer since average 19.7 months (range: 1-70 months) after brachytherapy. Of all patients, 9 died of prostate cancer recurrence, while 6 passed away because of other reasons, with an average of 52.2 months (range: 9.0- 98.5 months). The 5-year biochemical failure-free survival (BFFS), distant metastasis free survival (DMFS), cancer specific survival (CSS) and overall survival (OS) rate were 44.1%, 68.6%, 82.4 and 75.8%, respectively. Twenty-nine patients experienced grade 1-2 gastrointestinal toxicity and 18 patients experienced grade 1-2 genitourinary toxicity. In univariate analysis, the percentage of positive biopsy cores was significantly correlated with BFFS (χ(2) = 17.240, P = 0.000), DMFS (χ(2) = 18.641, P = 0.000) and OS (χ(2) = 8.970, P = 0.003); the Gleason score was significantly correlated with DMFS (χ(2) = 12.484, P = 0.000) and OS (χ(2) = 6.575, P = 0.010); and patient's age was significantly correlated with OS (χ(2) = 5.179, P = 0.023).</p><p><b>CONCLUSIONS</b>Permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy is alternative for T3a prostate cancer. The percentage of positive biopsy cores is correlated with BFFS, DMFS and OS.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Brachytherapy , Methods , Combined Modality Therapy , Hormones , Therapeutic Uses , Neoplasm Recurrence, Local , Prognosis , Prostate-Specific Antigen , Blood , Prostatic Neoplasms , Drug Therapy , Mortality , Radiotherapy , Radiotherapy , Methods , Survival Rate , Treatment OutcomeABSTRACT
Objective To study the application of proteomics in detecting differentially expressed proteins in renal clear cell carcinoma (RCCC) patient's urine in order to improve the diagnosis rate of RCCC.Methods From Mar.2010 to May.2010,the urine samples of 11 RCCC cases were collected,including 10 males and 1 female with average age of 63 (46-78) years.All patients were finally diagnosed as RCCC by post-operative or biopsy pathology.The normal control urine samples were collected from 10 males with average age of 29 (25-32) years.WCX beads combined with matrix assisted laser desorption ionization time of flighl mass spectrometry (MALDI-TOF MS) technique was applied in detecting differentially expressed proteins in RCCC patient's urine to find out differentially expressed proteins.And genetic algorithm was utilized to establish a diagnosis model.Results 160 differentially expressed proteins in RCCC patient 's urine were detected,and 1 was in significant difference,P=0.0304.ClinProTools 2.2 software was utilized with genetic algorithm to find out 13 differentially expressed proteins to establish a diagnosis model,and the sensitivity and specificity rate was 100％ after cross validation.Conclusions The diagnosis model established by genetic algorithms has high sensitivity and specificity rate,and can improve the diagnosis of RCCC.
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Objective To estimate the diagnostic significance and indication of repeated prostate biopsy in patients with persistently abnormal serum PSA.Methods From Jan 2004 to Sep 2011,90 patients with persistently abnormal serum PSA levels underwent transperineal ultrasound guided template prostate biopsy.They were diagnosed as benign lesions (BPH 66/90,PIN 10/90,ASAP 14/90)by previous first biopsies.The ages were 43 to 86 years old (mean age 71),and their PSA levels were fluctuated in a range of 3.1 to 168.0 μg/L (mean 17.6 μg/L),26 patients were abnormal in digital rectal examination (DRE).Results According to the repeated biopsies,it was divided into three groups including benign group (57/90),PIN or ASAP group (5/90) and PCa group (28/90).21.2％ patients were confirmed as PCa (14/66) in BPH group,while 60％ (6/10) patients in PIN group and 57.1％ (8/14) patients in ASAP group were confirmed as PCa.There were significant differences in BPH group compared with PIN or ASAP group (P＜0.05).The mean prostate volume (PV) was (65.9±22.6) ml in benign group and (50.4±20.8) mlin PCa group,while abnormal DRE were foundin 7/41 in benign group and 5/9 in PCa group.There was significant differences in PV and DRE between the two groups (P＜0.05).There were no significant differences in age,PSA,PSAD,PV or DRE between PIN and ASAP group (P＞0.05).Conclusions Repeated biopsy can improve the diagnosis of PCa in patients with persistently abnormal serum PSA.Smaller PV or abnormal DRE in the patients who were diagnosed as BPH by previous first biopsies may strongly need repeated biopsies,while in the patients who were diagnosed as PIN/ASAP by previous first biopsies,repeated biopsies were required despite any age,PSA,PSAD,PV or DRE.