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Objective To investigate the value of magnetic resonance (MR) diffusion weighted imaging(DWI) in the diagnosis of prostate cancer(PCa). Methods Fifty-seven patients with suspected prostate cancer underwent DWI and T_2-weighted imaging (T_2W). These images and apparent diffusion coefficient (ADC) maps results were compared with histopathologic findings. Receiver operating characteristic(ROC) analysis was used to compare the cancer detection performance of them. The results were rated on a scale of scores Ⅰ (benign) to Ⅴ (malignant) on the basis of ADC maps. Abnormal voxels were overlaid on the corresponding transverse TRUS images and used to perform voxel-guided biopsy. Results DWI had a sensitivity of 85%, specificity of 82%, positive predictive value of 80%, negative predictive value of 86% , and accuracy of 83%. T2WI had a sensitivity of 77%, specificity of 71%, positive predictive value of 69%, negative predictive value of 79%, and accuracy of 74%. The areas under the ROC curves for DWI and T_2WI were 0. 830 and 0. 742, respectively. The performance of DWI in PCa detection was significantly better than of T_2WI (P<0. 05). 6 of 30 patients with negative DWI results also had negative biopsy findings. PCa was detected in 17(85%) of 24 men findings with voxel score Ⅳ , with a sensitivity of 100%, specificity of 46%, positive predictive value of 71 %, negative predictive value of 100% , and accuracy of 77%. Conclusions The performance of DWI in PCa detection was better than of T_2 WI. ADC maps can be transferred to TRUS images and used to sample regions of cancer in men with rising PSA levels and negative findings at prior biopsy with good accuracy. DWI appears to be a robust and reliable method to examine the whole prostate within an acceptable scan time in clinical settings.
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Objective To evaluate the expression of alpha-methylacyl-coenzyme-A racemase (AMACR,P504s) with immunohistochemical staining in diagnosis of prostate carcinoma. Methods A total of 133 specimens were taken from the patients (mean age,71 years),including 46 cases of prostate carcinoma (PCa) (1 case of stage A,19 cases of stage B,14 cases of stage C,12 cases of stage D;4 cases of gradeⅠ,14 cases of gradeⅡ,28 cases of grade Ⅲ),53 cases of benign prostate hyperplasia (BPH),13 cases of prostate intraepithelial tumor (PIN),9 cases of normal prostate,6 cases of prostatitis,3 cases of metastatic prostate cancer.Two sections of each specimen were made,with 1 stained by hematoxylin and eosin,and the other stained immunohistochemically by a rabbit monoclonal antibody to AMACR (P504s).AMACR staining expression was characterized as negative (score,1), weak (positive) (2), moderate (3) or strong (4). Results In 46 cases of PCa,AMACR staining expression was negative in 2 cases,weak in 1,moderate in 25 and strong in 18,with a mean staining intensity of 3.28 [95% confidence interval (CI), 3.07-3.50]. In 53 cases of BPH, the staining expression was negative in 47 cases, weak in 6, with a mean intensity of 1.11 (95% CI, 1.02-1.20).In 13 cases of PIN, the staining expression was negative in 12, weak in 1, with a mean intensity of 1.08 (95% CI, 0.91-1.24).The score of PCa group was significantly different from those of the latter 2 groups (P
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Objective To evaluate the efficacy of oral etopside (VP16) and oral cyclophosphamide (CPM) combination in the treatment of hormone-refractory prostate cancer (HRPC). Methods Between June 2000 and July 2003,9 patients with HRPC were treated with oral etopside (50 mg/d) and oral cyclophosphamide (100 mg/d) for 21 days with every 28 days as a cycle.Inclusion criteria were previous complete androgen blockade,anti-androgen (flutamide) withdrawal evaluation,and clinical or biochemical disease progression.The therapy was continued until there was evidence of disease progression or the patients could not tolerate the adverse effects of the medications. Results All the 9 patients had a mean follow-up of 7.5 months.PSA levels decreased by at least 50%,from pre-treatment of (90.5?43.6)ng/ml to post-treatment of (24.8?22.2)ng/ml,in 4 patients. The mean duration of response was 6.8 months (range,2-15 months).An objective response was obtained in 2 patients (1 of CR and 1 of PR).Toxic and adverse effects were minimal. Conclusions The combination of oral VP16 and CPM may be an efficacious and well-tolerated regimen in patients with HRPC.
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Purpose:To improve the surgical technique in the treatment of renal pelvic and ureteral malignancy.Methods:From May. 1998 to December. 2000 intravesical ureterectomy has been carried out for 9 cases of renal pelvic malignancy . the distal ureter was intussuscepted into the bladder by traction of a ureteral catheter that had been attached to the cephalad end of the ureter after the kidney was removed. Patients have been followed up for 6 to 30 months with a mean of 18.6 months.Results:No surgical complication has been observed. On cystoscopy, no tumor occurrence has been found at the site of the removed ureteral orifice and other part of the bladder.Conclusions:The surgical technique is characterized by good results,few complication and simplicity.
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Objective For preventing the recurrence of superficial transitional cell carcinoma of bladder. Methods Recombinant interferon-alpha and mitomycin C have been used combindly in cl inical study.42 patients were divided into two groups: recombinant interferon-a lpha plus mitomycin group and mitomycin C group.The protocol of chemoimmunoprop hylaxis include 6 weekly and 6 two weekly instillation of 3?10 7 IU recombinan t interferon-alpha plus 40mg mitomycin C in 40ml normal saline via catheter.Che moimmunotherapy was given once monthly for at least two years. Resul ts Follow-up(from 6 to 30 months with a median of 18 months)consist ed of cystoscopy and cytology with cold cup biopsies carried out every 3 months for 2 years. Recurrence after instillation of recombinant interferon-alpha plus mitomycin C was observed in only 2 (10%). Recombinant interferon-alpha plus mi tomycin C yielded better effect ive rate(P
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50% for more than 1 month as effective,and the efficacy for soft tissue metastases were classified as complete,partial remission,stabilization and progression.Results All patients were followed up for 6-24 months(mean,12 months) with the evaluation of efficacy and toxicity.PSA levels decreased by at least 50% in 6 of 12 cases(50%);it decreased from(63.9?47.3)ng/ml before treatment to(14.4?8.8)ng/ml after treatment,with a mean duration of response being 7.5 months(range,5-12 months).Partial remission of soft tissue metastases was obtained in 2 cases;the metastatic lesions were reduced from 4.0 cm?5.0 cm,(3.0cm?)(3.5) cm to 2.0 cm?2.0 cm,1.0 cm?1.5 cm,respectively,by the treatment,with response duration being 3 and 8 months,respectively.Toxicities were minimal with leukopenia at grade Ⅰ in 1 case,anemia at grade Ⅰ in 1,baldness at grade Ⅰ in 1,nausea at grade Ⅰ in 2 and impaired liver function at grade Ⅱ in 1.Conclusions The combination of oral estramustine phosphate and oral etoposide may be an effective and well-tolerated regimen in patients with HRPC.