前列腺癌集团检诊对临床前列腺癌诊断的影响

目的　探讨前列腺癌集团检诊对临床前列腺癌诊断的影响。　方法　总结 1996至2 0 0 1年集团检诊发现的 67例前列腺癌和 1986至 2 0 0 1年长春各大医院诊治的 3 58例前列腺癌患者资料 ,从年度及年龄分布、临床分期、血清前列腺特异性抗原 (PSA)含量、病理分级和治疗等方面进行对比分析。　结果　 1999至 2 0 0 1年 3年间年均确诊例数较 1986至 1989年增长 4.7倍。其中集团组B期以下早期癌占 58.2 % ,临床组只占 2 7.9% ,且多为偶发癌 ;转移癌的诊断率集团组低于临床组 ;临床组PSA≥ 2 0ng/ml的比率高于集团组 ,低分化癌的比率高于集团组 ,差异均有统计学意义。集团组行前列腺癌根治术的比率较临床组提高了 15.3 %。　结论　集团检诊可以真正揭示国人前列腺癌的发病现状 ,可明显增加临床前列腺癌特别是早期癌的诊断例数 ,是实现前列腺癌早期诊断与治疗的最佳途径     

早期前列腺癌的诊断与治疗

随着前列腺癌发病率在我国的逐年升高,泌尿外科医生对此疾病的早期诊断与治疗也越来越关注。尽管美国的资料显示前列腺癌的筛查可以降低前列腺癌相关的死亡率,但对是否开展此项筛查依然存在争议。诊断方面依然以直肠指检(DRE)、前列腺特异性抗原(PSA)和B超引导的经直肠前列腺穿刺活检为主。治疗方面强调对这类患者实施治愈性治疗手段如前列腺癌根治术和放疗。严密的随访可以尽早发现肿瘤复发并及时开始二线治愈性治疗。本文对早期前列腺癌诊断与治疗的现状进行了综述。     

PSA在诊断早期前列腺癌及疗效监测中的应用

PSA使早期发现前列腺癌和早期发现治疗后复发成为可能 ,本文主要就如何提高PSA的特异性、高危人群PSA值的意义、PSA在前列腺癌治疗后随访中的应用等进行综述。     

PSA在诊断早期前列腺癌及疗效监测中的应用

PSA使早期发现前列腺癌和早期发现治疗后复发成为可能，本文主要就如何提高PSA的特异性、高危人群PSA值的意义、PSA在前列腺癌治疗后随访中的应用等进行综述。     

前列腺癌生物标志物筛查的临床研究现状

肿瘤的生物标志物研究对肿瘤的早期诊断和治疗有重要意义。虽然前列腺特异性抗原(PSA)用于临床前列腺癌的筛查和治疗效果评价已经20余年,但是其效果并不能完全让人满意。随着对前列腺癌研究的深入,目前已经发现了多种前列腺癌的生物标志物。本文就前列腺癌生物标志物筛查的临床研究进展进行综述。     

前列腺癌患者尿液DD3mRNA表达及其意义的研究进展

随着前列腺癌在老年男性中的发病率的升高,早期诊断对其治疗及预后评价有着重要意义.DD3是近年来发现的在前列腺癌细胞特异性表达的一种新的肿瘤标志物,与传统的肿瘤标记物(如PSA等)相比具有更高的敏感性和特异性.对前列腺癌患者进行尿液DD3检测为一种既方便又理想的方法,本文对该方面的研究进展进行了综述.     

前列腺癌患者尿液DD3mRNA表达及其意义的研究进展

随着前列腺癌在老年男性中的发病率的升高,早期诊断对其治疗及预后评价有着重要意义.DD3是近年来发现的在前列腺癌细胞特异性表达的一种新的肿瘤标志物,与传统的肿瘤标记物(如PSA等)相比具有更高的敏感性和特异性.对前列腺癌患者进行尿液DD3检测为一种既方便又理想的方法,本文对该方面的研究进展进行了综述.     

前列腺癌的内分泌治疗现状及研究进展

目的:前列腺癌发病的流行病学上的改变,导致前列腺癌内分泌治疗的治疗指征和治疗时机也随之改变。本文综述了在新的前列腺癌流行病学背景下,前列腺癌内分泌治疗的现状;同时对内分泌治疗中现存的争议,诸如单纯去势治疗与雄激素联合阻断治疗、间断性雄激素阻断治疗与持续性雄激素阻断治疗、早期内分泌治疗与推迟内分泌治疗等方面的相关研究进展进行了讨论。     

日本胃癌的诊疗现状(文献综述)

日本是胃癌高发区之一,它仅次于智利,每年胃癌的死亡人数约4万9千人左右。近十年来由于诊断技术的完善,特别是内窥镜的广泛应用和普及,以及胃癌治疗的规范化,胃癌的治疗取得了引人注目的成绩,在世界上居领先地位。诊断 1.普查(集团检查)在日本对胃癌的处理原则是早期发现和早期治疗,     

前列腺癌内分泌治疗后认知功能障碍的研究进展

前列腺癌是最常见的男性泌尿生殖系肿瘤之一,在我国,前列腺癌的发病率呈逐年上升趋势。目前,内分泌治疗是局部进展期前列腺癌、转移性前列腺癌等的重要手段,雄激素的快速撤除,使多数患者生存期延长,但同时产生一系列雄激素缺乏症状如认知功能障碍等,严重影响了患者的生活质量。本文介绍目前前列腺癌内分泌治疗后认知功能损伤的概况、可能的发生机制等方面的研究进展,为临床早期发现患者认知功能障碍,并对患者进行早期的药物、行为医学等干预提供依据。     

前列腺癌首次治疗失败后的临床处理

本文总结了前列腺癌首次治疗失败后的临床处理经验。对85例临床资料齐全的病例分析、观察其恶化的临床表现、治疗方法及其疗效。结果16例病情稳定，占18．8％；69例出现局部复发或远处转移症状，占81．2％。主要恶化症状为骨痛、尿潴留、肾积水、血尿和脊髓压迫等。内分泌治疗和放疗仍是目前主要的治疗手段，内分泌治疗宜早不宜迟，间断性雄激素阻断治疗应予提倡，放疗对骨痛的缓解有一定价值。     

Prostate Cancer in the Elderly

Prostate cancer is the second leading cause of cancer deaths among men. Despite earlier diagnosis due to prostate specific antigen (PSA) screening, it is still a disease of the elderly. Diagnosis is based on digital rectal examination (DRE) and PSA assessment. Refinements in PSA testing (age-specific reference ranges, free PSA, PSA density and velocity) increased specificity and limited unnecessary prostate biopsies. Diagnosis in earlier stages (T1 and T2) commonly leads to cure with current treatment modalities. These include radical prostatectomy, external beam radiotherapy and brachytherapy. Other treatment options under development include cryotherapy and high-intensity focused ultrasound. Metastatic prostate cancer is incurable and treatment is based on hormonal therapy. Cytotoxic chemotherapy has only limited role in hormone-independent prostate cancer. Radioisotopes and biphosphonates may alleviate bone pain and prevent osteoporosis and pathological fractures. Follow-up is based on PSA. Prognostic factors for recurrence include stage, Gleason score, pre- and posttreatment PSA. Quality of life issues play an important role in selecting treatment, especially in the elderly due to comorbidities that may negatively affect the overall quality of life. A holistic approach is recommended addressing all quality of life issues without focus only in cancer control.     

Prostate Abscess: A Rare Complication of Brachytherapy for Prostate Cancer

Brachytherapy involves the therapeutic implantation of a radio-active seed source into, or close to, prostate cancer.We report the rare case of a 76-year-old man who presented with a prostate abscess after months of intractable pelvic pain following prostate cancer treatment with iodine- 125 brachytherapy.Despite multiple investigations, the diagnosis was made only once the abscess discharged exudate per-urethra.     

前列腺癌的早期诊断

前列腺癌(PC)是一种极为特殊的肿瘤,早期诊断、及时治疗是提高PC患者生存率的关键。探讨国内外有关PC的早期诊断方法,重视PC的危险信号,重视危险人群的检查、直肠指诊(DRE) 、经直肠超声及前列腺特异抗原,是目前临床上筛查PC的主要方法,磁共振波谱成像( MRS)对前列腺节结的鉴别有重要意义,确诊依靠前列腺穿刺活检。     

Emerging Therapies in Castrate-Resistant Prostate Cancer

Prostate cancer is the most common cancer in men in the United States, and despite screening and early treatment, more than 27,000 men are predicted to die of the disease this year, almost all of whom will die of castrate-resistant, metastatic cancers that have progressed despite androgen deprivation therapy, also known as hormonal therapy. In recent years, an increased understanding of molecular mechanisms of prostate cancer progression and castration resistance has led to improved treatment strategies. This review focuses on emerging therapies for the treatment of castrate-resistant prostate cancer, with an emphasis on the importance of the drug targets as well as the state of current clinical trials, including those utilizing hormonal therapies, biological agents, and immunotherapy that are underway or have recently been completed.     

Obesity and Prostate Cancer: Weighing the Evidence

Context

Obesity and prostate cancer (PCa) affect substantial proportions of Western society. Mounting evidence, both epidemiologic and mechanistic, for an association between the two is of public health interest. An improved understanding of the role of this modifiable risk factor in PCa etiology is imperative to optimize screening, treatment, and prevention.

Objective

To consolidate and evaluate the evidence for an epidemiologic link between obesity and PCa, in addition to examining the proposed underlying molecular mechanisms.

Evidence acquisition

A PubMed search for relevant articles published between 1991 and July 2012 was performed by combining the following terms: obesity, BMI, body mass index and prostate cancer risk, prostate cancer incidence, prostate cancer mortality, radical prostatectomy, androgen-deprivation therapy, external-beam radiation, brachytherapy, prostate cancer and quality of life, prostate cancer and active surveillance, in addition to obesity, BMI, body mass index and prostate cancer and insulin, insulin-like growth factor, androgen, estradiol, leptin, adiponectin, and IL-6. Articles were selected based on content, date of publication, and relevancy, and their references were also searched for relevant articles.

Evidence synthesis

Increasing evidence suggests obesity is associated with elevated incidence of aggressive PCa, increased risk of biochemical failure following radical prostatectomy and external-beam radiotherapy, higher frequency of complications following androgen-deprivation therapy, and increased PCa-specific mortality, although perhaps a lower overall PCa incidence. These results may in part relate to difficulties in detecting and treating obese men. However, multiple molecular mechanisms could explain these associations as well. Weight loss slows PCa in animal models but has yet to be fully tested in human trials.

Conclusions

Obesity appears to be linked with aggressive PCa. We suggest clinical tips to better diagnose and treat obese men with PCa. Whether reversing obesity slows PCa growth is currently unknown, although it is an active area of research.     

Follow-up Survey of Donor Candidates for Living Related Kidney Transplantation With Prostate Cancer

Introduction

With the increasing number of elderly kidney donor candidates due to the lack of available donors, prostate cancer has sometimes been detected in these candidates during pretransplant screening examinations. There are currently no guidelines or consensus on prostate cancer screening and treatment in donors. We retrospectively evaluated the clinical course of donor candidates with prostate cancer.

Genetically Engineered Mouse Models of Prostate Cancer

ObjectivesMouse models of prostate cancer are used to test the contribution of individual genes to the transformation process, evaluate the collaboration between multiple genetic lesions observed in a single tumour, and perform preclinical intervention studies in prostate cancer research.MethodsMouse models for human prostate cancer are generated through genetic engineering of the mouse germline, introducing lesions that reflect those observed in human prostate cancer specimens. The optimal mouse model accurately reflects the pathogenesis of the disease including the sporadic nature of the initiating insult, the identity of the genetic lesions accumulated throughout the transformation process, the hormone dependency of the malignant cells, the incidence and tissue specificity of metastatic lesions, and the responses to therapeutic intervention.ResultsAlthough this ultimate goal has not yet been reached, the currently existing mouse models for prostate cancer have yielded important insights. These mostly relate to the contribution of individual genes and the mechanism of oncogene collaboration in the early stages of the disease. Modelling metastatic and hormone-refractory prostate cancer, however, remains a major challenge.ConclusionsMouse models have made an invaluable contribution in identifying the genetic lesions involved in high-grade prostatic intraepithelial neoplasia lesions and locally invasive prostate cancer. Most mouse models are less accurate in modelling the progression to metastatic disease. Moreover, most mouse models for prostate cancer do not facilitate analysis of hormone-refractory prostate cancer, although this would constitute the most valuable contribution to preclinical testing of novel therapeutic intervention strategies for the human disease.     

Androgen Receptor Mediated Growth of Prostate (Cancer)

The understanding of the mode of action of androgens requires insight in the cell biological architecture of the prostate. In the prostate secretory acini, morphologically two cell layers can be discriminated; i.e. the basal and the luminal compartment. The stem cells are thought to be located in the basal compartment. The stem cells have the unique capacity of self-renewal, providing the full repertoire to develop the differentiated ductal system via transient proliferating/amplifying (TP/A) intermediate stem cells. These are in fact early and late progenitors for the exocrine/secretory and neuro-endocrine cells. Exocrine differentiation occurs in the majority of the luminal compartment and is identified by the expression of the androgen receptor (AR), keratin 18 (K18) and prostate specific antigen (PSA). Neuro-endocrine cells are dispersed in the prostate epithelium and express K5 and typical neuro-endocrine markers such as chromogranin A and/or bombesin. The exocrine lineage of differentiation is critically dependent on androgens and thus androgen deprivation therapy will result in declining numbers of secretory/exocrine cells, while the number of stem cells and TP/A intermediate stem cells remains stable. This implies that stem cells and TP/A intermediate stem cells are for their renewal androgen independent, although the TP/A intermediate stem cells are androgen sensitive for expanding the epithelial compartment.Recently, these TP/A intermediate stem cells gained attention because they are thought to play an important role in normal prostate growth as well as in neoplastic transformation. Current hypotheses suggest that from the TP/A cell population, the cancer stem cell develops. Hypothetically, the more committed the cancer stem cell is, the more sensitive the tumour might be for androgen ablation, which could explain why some patients are long-term hormone therapy responders, while others are intrinsically androgen independent. In conclusion, typing of the transformed TP/A intermediate stem cells could enable to discriminate long-term hormone responders from non-responders and could help individualisation of prostate cancer therapy in the future.