慢性前列腺炎与根治性前列腺切除术后生化复发的相关性研究

目的 探讨慢性前列腺炎与根治性前列腺切除术后生化复发的相关性。方法 回顾性分析笔者医院自2010年6月~2016年6月期间所有行腹腔镜根治性前列腺切除术患者的临床资料,根据穿刺病检结果分为慢性前列腺炎组（CP）及非慢性前列腺炎组（NCP）,比较两组患者临床、病理特点、无生化复发率及无无生化复发生存期的差异。结果 中位随访50个月。171例患者中,50例出现生化复发,其中CP组18例（36.00%）,NCP组22例（18.19%）,生化复发时间为11~72个月,平均49个月。CP组术前PSA、术前Gleason评分及术后Gleason评分均高于NCP组（P<0.05）。单因素、多因素Cox回归分析示慢性前列腺炎是生化复发的高危因素（HR=2.262,95%CI：1.180~4.336）。Kaplan-Meier分析示CP组无生化复发率及无生化复发生存期明显低于NCP组（P<0.05）。结论 慢性前列腺炎是根治性前列腺切除术后生化复发的高危因素,慢性前列腺炎可能促进了前列腺癌的发生、发展。     

前列腺癌根治性切除术后生化复发的探讨

前列腺癌根治性切除术是治愈局限性前列腺癌最有效的方法之一,但术后约有15%的患者会出现生化复发[1]。目前,判断前列腺癌根治术后生化复发常用的指标为连续两次血清前列腺特异     

根治性前列腺切除术可减少前列腺癌所致死亡率但并不能降低总死亡率

问题:对于患早期前列腺癌的男性,观察等待是否和根治性前列腺切除术一样有效? 设计:随机(隐匿分配),盲法(结果评估者、数据分析者和监控委员会),对照试验,平均随访6.2年(斯堪的纳维亚前列腺癌组研究编号4号[SPCG-4])。区间(CI)0.27～0.91(附表);较少发生远处转移(RH0.63,CI0.41～0.96)和局部进展(RH0.31,CI0.22～0.44)。两组问所有原因所致总死亡率并无显著统计学差异(RH 0.83,CI 0.57～1.2)(附     

前列腺根治性切除术后ISUP分级升高的危险因素

目的 研究分析根治性前列腺切除术前后基于2014年国际泌尿病理协会分级系统病理分级升高的相关因素。方法 回顾性分析杭州市第一人民医院2012年1月~2020年8月收治的335例前列腺癌患者的临床病理资料,患者平均年龄为69.0±6.7岁,身高为167.9±5.5cm, 体重为66.6±9.7kg,体重指数为23.6±3.0kg/m²;中位前列腺特异性抗原(prostate specific antigen,PSA)为10.57(0.01～182.30)ng/ml,游离PSA 为1.28(0.01～16.92)ng/ml,前列腺体积为35.59(7.10～100.37)ml,PSA密度为0.32(0.01～4.55),穿刺针数为10(6～13)针,穿刺Gleason评分为7(6～10)分,穿刺病理基于2014年国际泌尿病理协会(international society of urologic pathology,ISUP)分级系统的分级为2(1～5)级,其中1级126例(37.6%),2级75例(22.4%),3级58例(17.3%),4级47例(14.0%),5级29例(8.7%)。穿刺距离根治性前列腺切除术(radical prostatectomy,RP)间隔中位天数为14(7～499)天,RP术后切缘阳性165例(49.3%),RP术后淋巴结转移21例(6.3%),RP术后精囊腺侵犯36例(10.7%)。335例患者均行RP术,并根据是否发生RP术后ISUP病理升级进行分组,分为病理升级组和病理未升级组,采用多因素Logistic回归分析研究RP术后导致病理升级的独立影响因素。结果 本研究335例RP手术后病理降级的43例(12.9%),病理一致的191例(57.0%),病理升级的101例(30.1%)。多因素Logistic回归分析发现前列腺体积(OR=0.979,P=0.028)、切缘情况(OR=0.435,P=0.002)、穿刺时Gleason评分(OR=0.556,P＜0.001)、穿刺病理ISUP分级(OR=0.661,P＜0.001)是RP术后病理升级的独立影响因素。前列腺体积、切缘情况、穿刺时Gleason评分、穿刺病理ISUP分级ROC曲线下面积分别为0.594(95% CI: 0.528～0.660)、0.421(95% CI:0.356～0.486)、0.757(95% CI:0.706～0.808)、0.774(95% CI:0.725～0.824)。结论 前列腺体积、切缘情况、穿刺病理Gleason评分以及穿刺病理ISUP分级是RP术后病理ISUP分级升高的独立影响因素。     

保留性神经的根治性前列腺切除术研究进展

前列腺癌是西方国家最常见的泌尿系统肿瘤之一。而根治性前列腺切除术是局限性前列腺癌的首选治疗方式。随着近年来前列腺癌发病的年轻化,患者对术后性功能保留的要求越来越高,故保留性神经的根治性前列腺切除术受到广大泌尿外科医师的关注。根治性前列腺切除术经历了从开放到微创、经腹腔到经腹膜外、非保留到保留神经血管束等一系列变化,手术方式、技术及设备均得到改进。未来,相信会有更多新术式被逐渐发掘,以使更多的患者获益。     

前列腺癌患者的根治性前列腺切除术治疗分析

局限性前列腺癌（ Pca）早期多无症状，如出现临床症状，多已发生转移失去治愈机会，A和B期病变常无症状。对A期、B期行根治性前列腺切除术治疗，15年生存率可达86％～93％，因此其是局限性前列腺癌的最佳疗法。局限性前列腺癌是指肿瘤局限于前列腺内，无周围浸润和淋巴结、远处脏器转移。局限性前列腺癌是能够治愈的恶性肿瘤。根治性前列腺切除术适用于 A期及B期的前列腺癌。现对2013年1月～2014年3月收治的30例前列腺癌患者行根治性前列腺切除术治疗方法报告如下。     

减瘤性根治性前列腺切除术对骨转移前列腺癌患者的临床疗效分析

目的 评估骨转移前列腺癌患者接受减瘤性根治性前列腺切除术的临床疗效。方法 纳入首都医科大学附属北京朝阳医院泌尿外科2012年2月至2021年6月共计34例接受减瘤性根治性前列腺切除术的骨转移前列腺癌患者。回顾性分析患者的基线资料、围手术期指标以及预后情况,采用描述性统计分析、Kaplan-Meier法、单因素和多因素分析评估总生存期(overall survival,OS)及无生化进展生存期(biochemical progression-free survival,BPFS)。结果 中位随访时间29.0个月,2年总生存率85.9%,中位无生化进展时间75.0个月,2年无生化进展率63.9%。术后1个月内9例患者出现Clavien-DindoⅠ～Ⅱ级并发症,术后3个月尿控基本恢复。骨转移灶数目≥5和＜5患者的BPFS分别为28.1个月和63.2个月(P=0.012),切缘阳性和阴性患者的BPFS分别为34.8个月和70.3个月(P=0.029),两组间差异具有统计学意义。多因素分析发现切缘阳性/阴性和无生化进展生存期显著相关(P=0.026)。结论 前列腺癌骨转移不是手术的绝对禁忌。经过筛选和准备的患者行减瘤性根治性前列腺切除术是安全可行的,手术时间、失血量以及手术并发症在可接受范围之内。术后联合内分泌治疗等其他治疗,可有效控制血清前列腺特异性抗原(prostate specific antigen,PSA),有望改善疾病进展,延长生存期。     

肥胖可增加前列腺癌的复发风险

美国得克萨斯大学Anderson癌症中心的Sara s．Strom博士报道说,肥胖男性(特别是40岁时被确诊为肥胖的患者)的前列腺癌进展风险增大;在任何年龄,特别是成年人,保持健康的体重和饮食不但可使前列腺癌患者减少复发的机会,还可降低其心血管疾病和糖尿病的风险。     

T3期前列腺癌行根治性切除术的时机选择及意义

T3期前列腺癌(prostate cancer,PCa)治疗方案的选择目前尚存在较大争议。近年来,认为经过挑选的cT3(clinically locally advanced T3)期患者应行根治性前列腺切除术(radical prostatectomy),但是cT3期前列腺癌患者施行根治性前列腺切除术的适应证及术后疗效尚不明确。文中综述近年来有关研究进展。     

Salvage radical prostatectomy for radiorecurrent prostate cancer: the Chinese experience

For localized prostate cancer, radiation therapy （RT） is commonly used. However, in the first five years of RT, 10%-20% of localized prostate cancer patients, ano 30%-50% of the locally advanced prostate cancer patients will progress to biochemical recurrence. In the past, only few these patients considered salvage radical prostatectomy （SRP） as their primary selection due to the significant morbidity.     

CYP1B1基因多态性对前列腺癌根治术后生化复发(BCR)预测价值的初步研究

 目的 探讨CYP1B1基因多态性对前列腺癌根治术后生化复发（biochemical recurrence,BCR）的预测价值。方法 在426例行前列腺癌根治术的患者中采用Taqman探针法检测CYP1B1基因8个标签单核苷酸多态性（single nucleotide polymorphism,SNP）的分布情况。采用RT-PCR方法检测127例前列腺癌旁组织中CYP1B1 mRNA的表达。采用Cox比例风险模型和Kaplan-Meier法进行关联性和生存分析。结果 CYP1B1 rs1056836是前列腺癌根治术后BCR的独立预测因素（HR：0.65,95% CI：0.33~0.93,P=0.025）,并且与CYP1B1 mRNA的表达相关。结论 CYP1B1 rs1056836有助于预测前列腺癌根治术后BCR的风险,其机制可能与影响CYP1B1基因表达相关。     

前列腺癌根治术后HMGB1表达的意义

目的调查HMGB1在人类前列腺癌细胞链中的表达及对前列腺癌根治术预后的影响。方法通过实时荧光定量反转录聚合酶链反应检测前列腺癌细胞株DU-145、PC-3以及LNCaP和正常前列腺细胞株RWPE-1中HMGB1的mRNA和蛋白表达水平。免疫组化法测定168例前列腺癌患者标本中的HM GB1蛋白表达水平。比较前列腺癌患者中HMGB1表达阳性和阴性组间的临床指标。探讨HMGB1蛋白的表达是否可以预测前列腺癌根治术后患者生化复发的危险性。结果三个前列腺癌细胞株DU-145、PC-3以及LNCaP与正常前列腺细胞株RWPE-1相比较,HM GB1的mRNA和蛋白表达水平都较高。前列腺癌根治术后患者的HM GB1蛋白表达阳性比率为60.1%（101/168）。标本中HMGB1蛋白表达阳性与患者的病理分期、Gleason评分、术前PSA和生化复发等因素相关。前列腺癌患者中HMGB1蛋白表达阳性相比于阴性其无生化复发生存时间较短（23.1 months vs.15.6 months）（P〈0.001）。HM GB1蛋白表达可以预测前列腺癌根治术后患者无生化复发的生存时间（hazard ratio=2.348,95%CI=1.373,6.361,P=0.001）。结论前列腺癌细胞株中HMGB1的mRNA和蛋白表达水平都较高,可能和前列腺癌的发病有关,可能作为一种新的瘤标预测前列腺癌根治术后生化复发的危险性。     

术前白蛋白碱性磷酸酶比值对前列腺癌根治术后生化复发时间的影响

目的 探讨术前白蛋白碱性磷酸酶比值(AAPR)与前列腺癌(PCa)根治术后生化复发(BCR)的关系.方法 收集苏州大学附属第一医院2012年5月至2015年10月收治的137例PCa患者的临床资料,根据患者有无发生BCR分为发生BCR组及未发生BCR组,比较两组间年龄、体质指数(BMI)、前列腺特异性抗原(PSA)、A...     

认知靶向融合穿刺病理联合mpMRI参数预测前列腺癌长期生化复发的随访研究

目的确定生化复发相关的前列腺癌根治术前特征,寻找前列腺癌远期生化复发风险预测方法。方法回 顾性分析2009年—2018年于复旦大学附属华东医院接受前列腺癌根治手术的210例患者临床资料,63例患者出现术后生化复发,作为生化复发组,其余147例未出现生化复发的患者作为对照组,中位随访时间71个月。比较2组患者的一般情况、磁共振结果及病理学特征。采用Cox回归模型分析生化复发的危险因素以及构建模型,使用Kaplan-Meier法分析该模型在术前预测前列腺癌患者生化复发的诊断效能。结果生化复发组MRI病灶长径[（16±8） mm vs （12±5） mm]、MRI下包膜外侵犯率（42.9% vs 20.4%）、MRI下精囊侵犯率（23.8% vs 5.4%）、PI-RADS评分、活检国际泌尿外科病理协会(International Society of Urological Pathology, ISUP)分级分组均高于对照组（P<0.05）,Cox多因素分析筛选出MRI病灶长径、MRI下精囊侵犯、ISUP分级分组为前列腺癌患者生化复发的独立危险因素。基于融合穿刺的术前特征包括磁共振最大病灶长径>23 mm、术前靶向穿刺ISUP分级分组≥3分和磁共振精囊侵犯,建立风险预测分层模型,精准预测了前列腺癌根治术后生化复发（AUC=0.692,P<0.001）,对于传统的d’Amico风险评分在同一队列中检验有更大的曲线下面积。结论生化复发与术前MRI病灶长径、包膜外侵犯、精囊侵犯、PI-RADS评分和ISUP分级分组有关,认知靶向融合穿刺病理联合mpMRI参数能够用于评估前列腺癌患者术后长期生化复发风险,为前列腺癌治疗提供参考。     

Clinical results of radical prostatectomy for patients with prostate cancer in Macau

Background Incidence of prostate cancer has been increasing in recent decades. In the year 2005, prostate cancer became the second most common cancer in males in Macau. The purpose of this report was to review and summarize the clinical features and prognosis of the 54 patients undergoing radical prostatectomy in Macau Special Administrative Region （SAR）, China.
Methods From November 2000 to November 2006, retropubic radical prostatectomy were performed in 54 cases for the treatment of prostate cancer. The mean age of patients was 69.8 years （range from 54 to 79）. The preoperative prostate specific antigen （PSA） level, postoperative pathologic stage and Gleason＇s score, operation duration, intraoperative bleeding and intraoperative and postoperative complications were reported. The follow-up duration was 3 months to 6.25 years with a mean of 2.1 years. Postoperative parameters including PSA alteration, biochemical recurrence, local recurrence, distant metastasis and mortality were observed.
Results Most of the patients in our study were diagnosed as localized prostate cancer. The patients＇ preoperative serum PSA was 0-4.0 ng/ml （16.7%）, 4.0-10.0 ng/ml （51.8%）, 10.1-20.0 ng/ml （24.1%） and above 20.0 ng/ml （7.4%）. The TNM stage T1a ＋ T1b comprised 7.6% of patients, stage T2a ＋ T2b comprised 20.3%, stage T2c 38.9%, stage T3a 20.3% and over T3a only 12.9%. There were 9.5% cases with Gleason scores of 2-4, 41.5% with scores of 5-6, 30.2% with scores of 7 and 18.8% with scores of 8-10. The average operative duration was 216 minutes and the average intraoperative bleeding was 760 ml. Intraoperative complications included one massive hemorrhage （1.9%）, one rectal injury （1.9%） and one obturator nerve injury （1.9%）. Early postoperative complications consisted of urinary incontinence （14 cases, 25.9%）, bladder neck stricture （5 cases, 9.3%）, acute urinary retention （4 cases, 7.4%）, pelvic effusion （2 cases, 3.8%）, lymphocele （1 case, 1.9%） and vesicorect     

腹腔镜经腹途径前列腺癌根治术(附2例报告)

目的:探讨经腹膜外途径腹腔镜下前列腺癌根治术治疗前列腺癌的临床疗效。方法:2006年9月我院收治2例前列腺癌患者,均接受腹腔镜下前列腺癌根治术。结果:手术均顺利完成,手术时间480 min,术中出血量500 ml,所有患者均于术后4周拔除导尿管。结论:腹腔镜下经腹膜外前列腺癌根治术是一种安全、有效的治疗方法,术中视野清晰、止血可靠、创伤小、腹腔并发症少,患者住院时间短、恢复快,值得临床推广。     

Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy: a single-center 10-year report

Background  Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.

Methods  From 2000 to 2009, 149 patients with prostate cancer received radical prostatectomy and were followed up. Among these patients, 111 received retropubic radical prostatectomies, 38 received laparoscopic radical prostatectomies. All patients were followed-up on in the 3rd month, 6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint, serum prostate-specific antigen (PSA), full biochemical test and uroflowmetry was acquired.

Results  The average age was (69.0±6.1) years, preoperative average serum PSA was (10.1±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%, the incidence of the most common complication, bladder outlet obstruction, was about 26.8%, and that of the second most common complication, urinary stress incontinence, was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml), average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml, 6.0±1.2 and 5.4±1.4, respectively) (P=0.004, P=0.001 and P=0.001, respectively). A univariate analysis showed that positive surgical margin had a positive statistical association with serum PSA (P=0.007), Gleason score (P <0.001), pathological T stage score (P <0.001) and biochemical recurrence (BCR) (P=0.035). The most common location of a positive surgical margin was in the apex of the prostate, which was about 63% (36/57). Sixty-four percent (23/36) of patients with positive surgical margin in apex were also involved in prostate lobe; other locations were prostate lobe (23%, 13/57), seminal vesicle (9%, 5/57). The multivariate analysis showed that positive surgical margin had a positive statistical association with Gleason score (P=0.03) and pathological T stage score (P=0.02). Neither univariate analysis or multivariate analysis showed any statistical relationship between BCR and any other risk factors covered in this study.

Conclusions  Positive surgical margin is associated with pre-operative PSA, Gleason score, pathological T stage and biochemical recurrence. Earlier diagnosis and improved techniques of dissection of prostate apex could decrease the incidence of positive surgical margins.

     

Laparoscopic radical prostatectomy

During the last 3 years, new laparoscopic radical prostatectomy (LRP) techniques have been used with satisfactory results similar to those of retropubic open surgery. In this article we describe our initial experiences with 19 consecutive LRPs performed between October 2000 and February 2003.     

Laparoscopic radical prostatectomy

During the last 3 years, new laparoscopic radical prostatectomy (LRP) techniques have been used with satisfactory results similar to those of retropubic open surgery.1 In this article we describe our initial experiences with 19 consecutive LRPs performed between October 2000 and February 2003.