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To evaluate the safety and efficacy of neoadjuvant radiohormonal therapy for oligometastatic prostate cancer (OMPC), we conducted a 3 + 3 dose escalation, prospective, phase I/II, single-arm clinical trial (CHiCTR1900025743), in which long-term neoadjuvant androgen deprivation was adopted 1 month before radiotherapy, comprising intensity modulated radiotherapy to the pelvis, and stereotactic body radiation therapy to all extra-pelvic bone metastases for 4-7 weeks, at 39.6, 45, 50.4, and 54 Gy. Robotic-assisted radical prostatectomy was performed after 5-14 weeks. The primary outcome was treatment-related toxicities and adverse events; secondary outcomes were radiological treatment response, positive surgical margin (pSM), postoperative prostate-specific antigen (PSA), pathological down-grading and tumor regression grade, and survival parameters. Twelve patients were recruited from March 2019 to February 2020, aging 66.2 years in average (range, 52-80). Median baseline PSA was 62.0 ng/mL. All underwent RARP successfully without open conversions. Ten patients recorded pathological tumor down-staging (83.3%), and 5 (41.7%) with cN1 recorded negative regional lymph nodes on final pathology. 66.7% (8/12) recorded tumor regression grading (TRG) -I and 25% (3/12) recorded TRG-II. Median follow-up was 16.5 months. Mean radiological progression-free survival (RPFS) was 21.3 months, with 2-year RPFS of 83.3%. In all, neoadjuvant radiohormonal therapy is well tolerated for oligometastatic prostate cancer.
Subject(s)
Male , Humans , Prostatic Neoplasms/radiotherapy , Prostate-Specific Antigen/therapeutic use , Neoadjuvant Therapy , Androgen Antagonists/therapeutic use , Prospective StudiesABSTRACT
Prostate cancer is one of the most common malignant tumors in the world.Without typical early manifestations in the early stage, it is often too late when found. Therefore, early diagnosis, treatment, and prognosis are critical to improving the survival rate of patients with prostate cancer. Over the past few years, artificial intelligence(AI) has developed rapidly in the field of prostate cancer. In terms of diagnosis, AI is used as a tool to screen the images to reduce the error caused by the professionalism and subjectivity of the technician and to improve the repeatability of the results; In the prediction of prognosis, the algorithm calculates and evaluates disease-related parameters such as recurrence rate, lymph node metastasis rate and mortality rate, so as to assistant clinicians in decision-making and treatment improvements. This reviews aims to introduce the application of artificial intelligence in the diagnosis, treatment and prognosis of prostate cancer in recent years, as well as the prospect and challenges faced by artificial intelligence in the medical field.
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Objective:To evaluate the feasibility and effectiveness of sing-port robot-assisted laparoscopic radical prostatectomy(sp-RALP) through different approaches.Methods:The data of 115 patients who underwent sp-RALP through different approaches from May 2018 to June 2020 were retrospectively reviewed. In our study, 92 cases through extraperitoneal approach, 10 through transperineal approach and 13 though transvesical approach. Preoperative, intraoperative and early postoperative outcomes after various approaches were collected and analyzed. The mean age was 67(52-84) years, mean preoperative body mass index was 24.44(19.52-32.33) kg/m 2. Patients were graded as cT 1-3aN 0M 0 with no signs of regional lymph node invasion or distal metastasis. The median preoperative PSA was 9.77(6.54, 15.32) ng/ml. Results:All 115 sp-RALP were successfully completed with no conversion to open surgery or additional ports being placed. The mean operative time was 91.8(40-200)min, with 88.0(40-200)min for extraperitoneal approach, 132.5 (90-190)min for transperineal approach and 87.3(60-150)min for transvesical approach. The mean estimated blood loss was 85.5 (45-400)ml, with 77.6(50-200)ml for extraperitoneal approach, 178.0(80-400)ml for transperineal approach and 70.4 (45-150)ml for transvesical approach. Of the 115 patients, 60.9% (70/115)were <pT 3a, 39.1%(45/115) were ≥pT 3a. Positive margin(PSM) rate was 17.4%(20/115), with 31.1%(14/45) for ≥T 3a group, 8.6%(6/70) for <T 3a group. Postoperative pathology revealed a Gleason score of 3 + 3 in 6 patients, 3 + 4 in 45 patients, 4+ 3 in 52 patients, and ≥8 in 2 patients. Mean hospital stay was 3(1-7)d. Median postoperative PSA was 0.03(0.01, 0.05)ng/ml at 1 month postoperatively, and 88.7% patients reported less than 1 pad per day at 3 month postoperatively. Conclusions:With several advantages, such as better cosmesis, postoperative fewer pain, and better recovery as well as comparable oncological outcomes in the short-term follow-up, sp-RALP through various approaches is a feasible and effective procedure for organ-confined prostate cancer.
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Objective To review the clinical characteristics of prostate mucinous adenocarcinoma cases and update literatures,and recommend the corresponding clinical treatment strategy.Methods From October 2010 to March 2018,36 cases of prostate mucinous adenocarcinoma were involved from 5 urinary centers in China,including 9 cases from Shanghai Changhai Hospital,4 cases from Wuhan Tongji Hospital,13 cases from Shanghai Renji Hospitals,8 cases from the First Affiliated Hospital of Nanjing Medical University,and 2 cases from Sichuan West China Hospitals.The patients' age were (66.8 ±7.2) years (53-83 years) and the median PSA was 22.89 ng/ ml (2.67-1786 ng/ ml).Prostate biopsy confirmed Gleason score 3 + 3 points in 6 cases,3 + 4 points in 9 cases,4 + 3 points in 5 cases,8 points in 11 cases,and 9 to 10 points in 5 cases.According to D'Amico risk stratification,2 patients were in the low-risk group,9 in the intermediate-risk group,and 25 in the high-risk group.Eight cases underwent radical retroperitoneal prostatectomy,13 cases underwent laparoscopic radical prostatectomy,and 12 cases underwent robotic laparoscopic radical prostatectomy.Twenty-three cases underwent pelvic lymphadenectomy,including 12 cases of bilateral obturator lymph node dissection,and 11 cases of bilateral obturator + intraorbital + para-vascular para-aortic lymphadenectomy.Results All 36 operations were completed successfully.Twenty-three cases underwent pelvic lymphadenectomy,including 12 of bilateral obturator lymph node dissection,and 11 of bilateral obturator,intraorbital,and para-aortic lymphadenectomy.Pathological examination showed 9 cases of prostate mucinous adenocarcinoma,26 cases of mucinous adenocarcinoma with acinar adenocarcinoma,and 1 case of mucinous adenocarcinoma with neuroendocrine and immunohistochemical positive of MUC2 (+).Among 33 cases undergoing radical surgery,the pathological stage of ≤T2b in 12 cases (36.3％),T2c in 7 cases (21.2％),T3a in 7 cases (21.2％),T3b in 6 cases (18.2％),and T4 in 1 case (3.0％).Four cases had positive pelvic lymph nodes and 9 cases had positive margin.The median follow-up period was 26 months (6-48 months).The biochemical recurrence occurred in 6 patients one year after surgery,including 3 cases in the intermediaterisk group and 3 cases in the high-risk group.Six cases with postoperative biochemical recurrence and 19 cases with PSA ＞ 0.2 ng/ml after radical or palliative resection underwent adjuvant androgen deprivation therapy(ADT),no postoperative adjuvant radiotherapy or chemotherapy was administered,and 4 cases progressed to castration-resistant prostate cancer.Four cases with CRPC were in the high-risk group and had underwent radical surgery,and the median period progressed to CRPC was 26 months(3-37months)with 2 cases of death.However,there was no significant difference in the rate of biochemical recurrence and the incidence of CRPC in the low-risk group,the intermediate-risk group and the high-risk group.In addition,2 cases had metastases,with pelvic MRI presenting pelvic multiple nodular mass in one case which was consistent with recurrence and metastasis at the 5th month after radical surgery,and pathological examination presenting the mucinous adenocarcinoma being neurosecretory in another case and mestastasis being detected on glans at the 3rd months after radical surgery.The recovery rate of urinary continience at 6 and 12 months after radical surgery was 86.2％ (31/36) and 89.7％ (32/36) respectively.Conclusions Prostate mucinous adenocarcinoma is a variant of acinar adenocarcinoma.This study clarifies prostate mucinous adenocarcinoma of Chinese patients with high Gleason scores,advanced pathological stage,variant in prognosis,and prone to recurrence and metastasis.For treatment strategy,the low-risk and intermediate-risk mucinous adenocarcinoma is recommended undergoing radical surgery,and the prognosis maybe good.High-risk mucinous adenocarcinoma could treated with radical surgery or palliative surgery with adjuvant ADT,and most high-risk patients can benefite,with a small number of poor prognosis.
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Objective To perform an exploratory investigation on confocal laser endomicroscopy (CLE) in the diagnosis of malignant bladder tumour.Methods From June 10 to July 11,2017,6 male bladder cancer patients underwent white light cystoscopy (WLC) + CLE examination,aging 64-86 years (median 72 years).All patients received TURBT on suspected lesions.WLC and CLE imaging results were recorded and validated by pathologic specimens.Results Lesions confirmed by histopathology were 3 low grade non-invasive papillary urothelial carcinomas,1 high grade non-invasive papillary urothelial carcinoma,1 low grade invasive urothelial carcinoma,1 high grade invasive urothelial carcinoma,1 carcinoma in situ (CIS),1 high grade dysplasia,1 cystitis glandularis,1 chronic inflammation,and 1 scar tissue.For CLE images in the normal urothelium,three layers of cells with different presentation were observed,namely,the superficial umbrella cells,the intermediate cells smaller in size and uniformly shaped,and the capillary network in the lamina propria.For non-invasive urothelial carcinoma,tumour cells appeared as papillary lesions growing from fibrovascular cores,with low grade cells appearing monomorphic and more cohesively arranged,and high grade cells relatively pleomorphic,more disorganised and with tortuous blood vessels in the fibrovascular core.For invasive urothelial carcinoma,tumour cells invaded the lamina propria,with uniform appearances,poor cohesion and indistinct cellular borders,and high grade ones were more pleomorphic.CIS and inflammation both appeared as erythematous patch-like flat lesions under WLC and sometimes difficult to differentiate.Under CLE,the former appeared as dysplastic and disorganised cells with indistinct cellular borders,with intact lamina propria,and inflammatory cells were discovered as infiltrative clusters in the lamina propria that were uniformly shaped and loosely connected.Dysplasia appeared somewhat similar compared with CIS under WLC,but with lower cellular irregularity as confirmed with pathology.Cellular appearance and structure in scar tissue was similar to that in the normal urothelium,but superficial umbrella cells were more likely absent,with thinner cell layers,and inflammatory infiltration was sometimes discovered in the lamina propria.Conclusions CLE provides real-time cellular imaging of the urothelium,and shows promising potential for clinical diagnosis,especially in differentiating fiat urothelial lesions.Large prospective studies are required for further validation.
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Objective To investigate the diagnostic value of narrow-band imaging for flat bladder lesions.Methods Forty-nine patients with flat bladder lesions diagnosed by white light cystoscopy + narrow-band imaging followed by transurethral resection were included.The diagnostic value of narrow-band imaging was evaluated based on postoperative pathological results.Results A total of 59 flat lesions were identified,in which 8 were normal urothelium,3 were chronic inflammation,1 was papillary urothelial neoplasm of low malignant potential,1 were mild dysplasia,1 was moderate dysplasia,1 were severe dysplasia,3 were carcinoma in situ,16 were low-grade papillary urothelial carcinoma,16 were high-grade papillary urothelial carcinoma,and 8 were invasive papillary urothelial carcinoma.For narrow-band imaging,the sensitivity was 86.7 ％ (39/45),specificity was 57.1％ (8/14),diagnostic accuracy was 79.7 ％ (47/ 59),false-positive rate was 42.9％ (6/14),positive predictive value was 86.7％ (39/45),negative predictive value was 57.1％ (8/14),area under ROC curve was 0.719.Among these lesions,the sensitivity and specificity for postoperative recurrent lesions were 100％ (3/3) and 40％ (2/5),respectively,and those for erythematous patch-like lesions were 90％ (9/10) and 100％ (4/4),respectively.Conclusion Narrow-band imaging can improve the detection rate for flat bladder tumor lesions,and reduce the risk for missed diagnosis under white light cystoscopy,especially for otherwise indistinguishable erythematous patch-like lesions.
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Objective To review the clinical data of the first 100 consecutive robotic-assisted laparoscopic radical prostatectomy ( RALRP) performed by a single surgeon , and to provide our experience in passing the learning curve of RALRP .Methods The retrospective study enrolled 100 consecutive patients diagnosed with prostate cancer from June 2012 to November 2014, who had undertaken RALRP , performed by Prof.Gao Xu.The patients aged 67 (50 to 87) years, with a mean PSA level of 20.3 (1.3 to 214.0)μg/L, among which 89 had a clinical staging of T1a to T2b, 4 staged T2c, and 7 staged T3a to T4.Of the patients, 16, 37, and 47 patients were categorized as low , intermediate, and high risk level , respectively. The operation time and blood loss volume were analyzed by moving average method .Results RALRP in all 100 cases were carried out successfully , with no conversion to open prostatectomy .The mean operation time was 221 (120 to 480) min, with an average intraoperative blood loss of 207 (50 to 800) ml; 2 cases received blood transfusion.Positive surgical margin rate was 26%.Eighty (89%) of 90 cases had recovery of continence ( equal to or less than 1 pad used daily ) 3 months postoperatively;10 cases had a follow-up time less than 3 months, and 5 had gained recovery of continence .The operation time and blood loss volume were stable at the 85th -90th case.Conclusion RALRP has a short learning curve , with a promising overall treatment outcome in the early phase of learning .