The focus and prospect of prostate cancer research / 中华外科杂志

The incidence and mortality of prostate cancer in China are increasing year by year. The review is focused on current hot prospects of prostate cancer. The value of serum prostate specific antigen (PSA) screening is still controversial, and PSA screening in high-risk groups is recommended for early diagnosis of prostate cancer. Prostate biopsy including transrectal approach and perineal approach, and two methods have both advantages and disadvantages. There is significant correlation between testosterone levels and the prognosis of prostate cancer, and the monitoring of testosterone level contributes to the treatment. The main complications of radical resection of prostate cancer is urinary incontinence and erectile dysfunction, three-dimensional laparoscopic and robot assisted laparoscopic techniques have obvious advantages in radical operation. Brachytherapy is another option for radical treatment, with relaxed age limit, low incidence of erectile dysfunction, urinary incontinence and reliable curative effect. The diagnosis and treatment of new technologies include such as MRI dynamic enhancement scan, ¹⁸F-fluoroethyl PET/CT, ultrasound contrast technology, prostate cancer immunotherapy, et al.

Analysis of permanent brachytherapy combined with maximal androgen blockade in local intermediated-risk prostate cancer / 中华外科杂志

<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>

Clinical analysis of transperineal prostate biopsy in patients age ≤ 50 years / 中华外科杂志

<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>