Current Progress and Controversies in Prostate Cancer Management.

OBJECTIVE: The optimal management strategy for prostate cancer (PCa) remains controversial. We performed a systemic review of current progress and controversies regarding the diagnosis and treatment of PCa. DATA SOURCES: We searched PubMed for recently published articles up to July 2017 using the following key words: "prostate cancer," "progress," "controversy," "immunotherapy," and "prevention." STUDY SELECTION: Articles were obtained and reviewed to provide a systematic review of the current progress and controversies regarding PCa management. RESULTS: The value of serum prostate-specific antigen (PSA) screening remains controversial, but PSA screening is recommended to facilitate the early diagnosis of PCa in high-risk groups. Prostate biopsy via the transrectal or perineal approach has both advantages and disadvantages. There was a significant correlation between testosterone levels and PCa prognosis. The current research is focused on the mechanisms responsible for PCa. Active surveillance has been proposed as a management strategy for low-risk, localized PCa, but there is an urgent need for further clinical studies to establish the criteria for recommending this approach. The main complications of radical resection for PCa are urinary incontinence and erectile dysfunction, though three-dimensional laparoscopic and robot-assisted laparoscopic techniques have obvious advantages over radical surgery. Radiotherapy is also a therapeutic option for PCa, while immunotherapies may alter the prostate tumor microenvironment. Ongoing studies aim to provide guidance on effective sequential and combination strategies. Prevention remains an important strategy for reducing PCa morbidity and mortality. CONCLUSIONS: The diagnosis, treatment, and prevention of PCa are complex issues, worthy of intensive study. Further studies are needed to improve the management of PCa.

Preliminary Application of WCX Magnetic Bead-Based Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry in Analyzing the Urine of Renal Clear Cell Carcinoma.

Objective To evaluate the application of weak cation exchange (WCX) magnetic bead-based Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) in detecting differentially expressed proteins in the urine of renal clear cell carcinoma (RCCC) and its value in the early diagnosis of RCCC.Methods Eleven newly diagnosed patients (10 males and 1 female, aged 46-78, mean 63 years) of renal clear cell carcinoma by biopsy and 10 healthy volunteers (all males, aged 25-32, mean 29.7 years) were enrolled in this study. Urine samples of the RCCC patients and healthy controls were collected in the morning. Weak cation exchange (WCX) bead-based MALDI-TOF MS technique was applied in detecting differential protein peaks in the urine of RCCC. ClinProTools2.2 software was utilized to determine the characteristic proteins in the urine of RCCC patients for the predictive model of RCCC. Results The technique identified 160 protein peaks in the urine that were different between RCCC patients and health controls; and among them, there was one peak (molecular weight of 2221.71 Da) with statistical significance (P=0.0304). With genetic algorithms and the support vector machine, we screened out 13 characteristic protein peaks for the predictive model. Conclusions The application of WCX magnetic bead-based MALDI-TOF MS in detecting differentially expressed proteins in urine may have potential value for the early diagnosis of RCCC.

[Screening for the serum differential proteins of renal cell carcinoma using magnetic beads-based matrix-assisted laser desorption/ionization time-of-flight mass spectrometry].

OBJECTIVE: To screen for the differential protein peaks of renal cell carcinoma (RCC) using magnetic beads-based matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). METHODS: Serum proteins were profiled by magnetic beads (WCX) from 62 RCC patients and 37 patients with benign renal space-occupying lesions. Protein peaks were identified by MALDI-TOF-MS. Data were analyzed with Biomarker Wizard 3.1 and Biomarker Patterns Software 5.0. Diagnostic model for RCC was constructed based on 47 RCC cases and 26 patients with benign renal space-occupying lesions. The remaining 26 cases were evaluated with blind method. RESULTS: Seven differential protein peaks related to RCC were identified (Pß0.05). The diagnostic model for RCC constructed by the differential protein peaks (m/z 2945.35, 15340.8, 6984.51, and 5819.23) generated excellent separation between the RCC and control groups, with a sensitivity of 83.0% and the specificity of 84.6%. As validated by blind method, the model had a sensitivity of 80.0% and a specificity of 81.8%. CONCLUSION: Differential protein peaks for RCC can be identified in serum by magnetic beads-based MALDI-TOF-MS, which is also valuable for the establishment of a RCC diagnostic model with a high sensitivity and specificity.

[Distribution and differentiation of marrow mesenchymal cells in tumor tissue: experimental with rabbits].

OBJECTIVE: To study the distribution of bone marrow mesenchymal stem cells (MSCs) in tumor tissue and the possibility of MSCs differentiating into myofibroblast under the induction of local tumor microenvironment. METHODS: MSC were isolated from 24 New Zealand rabbits, and cultured. Then vx-2 tumor tissue was transplanted under the bladder mucosa of each animal. Then the rabbits were randomly divided into 2 equal groups: control group and test group. One week after the transplantation, the autologous F2 passage MSCs marked by diamino-phenyl-indole (DAPI) were transplanted into the tumor tissue of the test group and DMEM medium was infused into the tumor tissue of the control group. Ultrasonography was performed 1, 2, 3, and 4 week(s) after the vx-2 tumor mass was transplanted. The maximum bladder tumor diameters of each animal were recorded and the mean value of each group was calculated. One animal in each group with its tumor diameter closest to the average value of the very group was put to death in the third week and all the left animals were killed in the fourth week to observe the tumor development. Another rabbit underwent same treatment as that in the test group was put to death to observe the distribution of MSCs in the tumor tissue one week after self-MSC transplantation. Immunofluorescence was used to trace the MSCs in the tumor tissue. Double labeling immunofluorescence for alpha-smooth muscle actin (alpha-SMA) and vimentin was performed to identify whether MSCs could differentiate into myofibroblasts. RESULTS: Ultrasonography showed no tumor mass one week after the vx-2 tumor mass transplantation. In the second week, the mean maximum tumor diameter of the control group was 0.70 +/- 0.14 cm, not significantly different from that of the test group (0.78 +/- 0.14 cm, t = 1.308, P = 0.204), however, the mean maximum tumor diameter in the third and fourth weeks of the control group were 1.8 +/- 0.4 cm and 2.3 +/- 0.6 cm respectively, both significantly shorter than those of the test group (2.2 +/- 0.3 cm and 3.8 +/- 0.9 cm respectively, both P < 0.05). Microscopy showed that MSCs were distributed uniformly in the tumor tissue one week after transplantation while most of the MSCs were distributed in the tumor stroma three weeks after transplantation. Double labeling immunofluorescence showed an increase of alpha-SMA and vimentin expression three weeks after MSC engraftment. CONCLUSION: MSCs are initially distributed uniformly in the tumor tissue and then distributed mainly in the tumor stroma. Furthermore, MSCs accelerate tumor development and can differentiate into myofibroblasts under the induction of tumor microenvironment.

[Establishment of a new model of neurogenic bladder dysfunction caused by lumbar intervertebral diskhernia and its urodynamic evaluation].

OBJECTIVE: To establish a new rat model of neurogenic bladder dysfunction caused by lumbar intervertebral disk hernia, and to confirm the model by urodynamic examination. METHODS: Twenty male Wistar rats were divided into two groups at random:experimental group (n = 15) and pseudo-operation group (n = 5). The rats underwent laparotomy to disclose the intervertebral disk of L(6)-S(1), and a 1.50 mm x 4.50 mm blunt screw with flat end was inserted into the intervertebral disk of L(6)-S(1) of the rats in the experimental group so as to establish the model of lumbar intervertebral disk hernia. Computed radiography (CR) was performed 3 days after the operation to conform the successful insertion of the screw. Combined behavioral score (CBS) was used 1 d, 3 d, 1 week, 2 weeks, and 4 weeks after the operation. Four weeks after the laparotomy a vesical fistula above the pubis was made in all of the rats, and then urodynamic examination was performed three days after this operation. RESULTS: CR after operation confirmed that the blunt screw had been inserted into the lumbar disk of L(6). The CBS scores of the 2 groups at different time points all decreased along with time, and basically remained unchanged 1 week after. The CBS scores of the experiment group were significantly higher than those of the pseudo-operation group (all P < 0.05). The spontaneous vesical contraction rate in the filling period of the experimental group was (4.37 +/- 2.13) times/min, significantly higher than that of the pseudo-operation group [(0.06 +/- 0.13) times/min, t = 4.425, P = 0.000], the maximum bladder capacity of the experimental group was (1.20 +/- 0.34) ml, significantly greater than that of the pseudo-operation group [(0.60 +/- 0.14) ml, t = 5.141, P = 0.002], and bladder compliance of the experimental group was (0.024 +/- 0.012) ml/cm H(2)O, significantly lower than that of the pseudo-operation group [(0.096 +/- 0.088) ml/cm H(2)O, t = 2.891, P = 0.011], and the leak point pressure of the experimental group was (75 +/- 27) cm H(2)O, not significantly different from that of the pseudo-operation group [(62 +/- 23) cm H(2)O]. The urodynamic examination on the conscious rats confirmed the successful establishment of the neurogenic bladder dysfunction caused by lumbar intervertebral disk hernia. CONCLUSION: A new model of neurogenic bladder dysfunction caused by lumbar intervertebral disk hernia has been established by insertion of a blunt screw into the lumbar intervertebral disk of L(6). The model is confirmed by urodynamic examination.

[Medication for premature ejaculation].

Drugs for the treatment of premature ejaculation (PE) are divided to two categories: oral drugs and local drugs. Oral drugs include antidepressive drugs, alpha-adrenoceptor blocking drugs, phosphodiesterase type V blocking drugs and Chinese herbal medicine. Local drugs include local surface drugs, intracavernosal injective drugs and local urethra drugs. Antidepressive drugs are extensively used, which have moderate efficacy, relatively more side effects and high recurrence rate; alpha-adrenoceptor blocking drugs are seldom used and are less effective than antidepressive drugs; phosphodiesterase type V blocking drugs like sildenafil have good efficacy and few side-effects and are worthy to be studied further. Local surface drugs like SS-Cream have good efficacy and few side-effects and are worthy to be applied and promoted; local urethral drugs like MUSE and Befar may become a new method to treat PE after being further studied. Medication for premature ejaculation shall be made specific and suitable as much as for each individual patient.

[A review of operative treatment of hypospadias in twelve years].

OBJECTIVES: To evaluate the relationship between the operative methods and the therapeutic results of the patients with hypospadias. METHODS: Nine operative types and different tissue materials taken in hypospadias operations in the past 12 years were retrospectively analyzed. RESULTS: The operative types and tissue materials had significantly effects on the therapeutic results besides the clinical experience of the operators. The cure rates of Tunneltron Urethroplasty, Preputial island flap urethroplasty and Bladder mucosa graft urethroplasty were 86.4%, 83.3% and 83.0% respectively. CONCLUSIONS: All the nine types and different tissue materials of Hypospadias operations have its own advantages and disadvantages. They are worth further study and improvement.