Long-term oncological outcomes of men undergoing radical prostatectomy with preoperative prostate-specific antigen <2.5 ng/ml and 2.5–4 ng/ml

ObjectivesProstate-specific antigen (PSA) screening has increased the detection of small, organ-confined tumors, and studies suggest that these patients may have favorable outcomes following radical prostatectomy (RP). To date, there are limited data available on the outcomes of patients diagnosed with low PSA (≤4 ng/ml) who underwent RP. This study aimed to evaluate long-term oncological outcomes of patients undergoing RP with preoperative PSA <2.5 and 2.5–4 ng/ml compared with PSA 4.1–10 ng/ml.Materials and methodsData were analyzed from 3,621 men who underwent RP between 1988 and 2010 at our institution. Patients were stratified into 3 PSA groups: <2.5 ng/ml (n = 280), 2.5–4 ng/ml (n = 563), and 4.1–10 ng/ml (n = 2,778). Patient and disease characteristics were compared. Overall, biochemical disease-free (bDFS), and PCa-specific survivals were analyzed and compared between the groups. Multivariable analyses were conducted using proportional hazards model.ResultsCompared with the 4.1–10 ng/ml PSA group, Gleason score >7, extracapsular extension, and non-organ-confined disease were less common in patients with PSA ≤4 ng/ml (all P < 0.001). The incidence of organ-confined disease was similar between the PSA < 2.5 and 2.5–4 ng/ml groups while perineural invasion (P = 0.050) and Gleason score ≥7 (P = 0.026) were more common in the 2.5–4 ng/ml PSA group. Estimated 10-year overall and PCa-specific survivals were comparable across all PSA groups, whereas bDFS was significantly lower in PSA 4.1–10 group (P < 0.001). bDFS was not statistically different between PSA <2.5 and 2.5–4 groups (P = 0.300). 10-year bDFS were 59.0%, 70.1%, and 76.4% in PSA 4.1–10, 2.5–4, and <2.5, respectively. For the PSA ≤ 4 ng/ml groups, age, race, margin status, pathologic stage, but not PSA were independent predictors of bDFS, whereas age, pathologic Gleason, and biochemical recurrence were associated with overall survival.ConclusionsLong-term oncological outcomes (overall, bDFS, PCa-specific survivals) of patients presenting with low PSA (≤4 ng/ml) were excellent in this study. Compared with PSA 4.1–10 ng/ml, patients presenting with PSA ≤4 ng/ml had better bDFS outcomes. However, there was no difference in long-term outcomes between PSA <2.5 and 2.5–4 ng/ml.     

SA水平≤4ng/ml时直肠指检的意义

本研究以直肠指检前列腺癌可疑，并且血ＰＳＡ≤４ｎｇ／ｍｌ为标准，对前列腺癌的检出率及检出前列腺癌的分期分级进行评估。作者对２２５１３名社区志愿者每隔６个月行血ＰＳＡ检查和直肠指检进行筛选。当其中任何一项检查结果可疑时，建议病人行前列腺活检。筛选出２７...     

巧抽2ml粉剂药液

2ml装的粉剂药品（高3．5cm）在临床中大量应用，其药量少，价格贵。在配制的过程中，操作不当易造成浪费，甚至影响患者疗效。临床常规操作：取20ml注射器（针长3．5cm，不带乳头）取溶媒，排尽空气后将溶媒（约2ml）注入药瓶，拔出针头，通过振荡使药物溶解，然后将针头再次穿刺瓶塞，瓶底朝上抽吸，常因药瓶塞较高致药液难已吸尽，且针头到达瓶塞，针体基本外露．易污染、脱出。注射器相应加大了长度，致抽吸费力，穿刺瓶塞2次，瓶塞脱屑率会明显增加。笔者采用将瓶底向下抽取的方法，可克服上述弊端。     

50ml果糖玻璃瓶替代奶瓶

市售的奶瓶多为塑料制品,不耐高温高压,不能进行有效的消毒灭菌处理,不适合批量使用。笔者经过长期的临床实践发现,采用50 ml果糖玻璃瓶替代奶瓶,安全、耐用,能有效地预防和控制医院感染,介绍如下。     

PSA＞1Ong/ml时经直肠前列腺穿刺活检的临床分析

目的 探讨当PSA＞ 10ng/ml时经直肠前列腺穿刺活检的临床价值。方法 对120例前列腺特异性抗原(PSA)＞ 10ng/ml的患者行超声引导下经直肠前列腺穿刺活检。结果 120例患者中前列腺癌患者46例,前列腺增生患者44例,前列腺炎患者9例,前列腺上皮内瘤(PIN)患者19例,前列腺梗死患者3例。有38例出现一...     

The 30 ml cement test

We describe a simple and reliable test which can be used while performing hip arthroplasty as an indicator of the size and volume of the femoral canal to roughly estimate the volume of cement required to fill the femoral canal for cementing the femoral prosthesis.     

巧抽2ml粉剂药液

2ml装的粉剂药品(高3.5cm)在临床中大量应用,其药量少,价格贵。在配制的过程中,操作不当易造成浪费,甚至影响患者疗效。临床常规操作:取20ml注射器(针长3.5cm,不带乳头)取溶媒,排尽空气后将溶媒(约2ml)注入药瓶,拔出针头,通过振荡使药物溶解,然后将针头再次穿刺瓶塞,瓶底朝上抽吸,常因药瓶塞较高致药液难已吸尽,且针头到达瓶塞,针体基本外露,易污染、脱出。注射器相应加大了长度,致抽吸费力,穿刺瓶塞2次,瓶塞脱屑率会明显增加。笔者采用将瓶底向下抽取的方法,可克服上述弊端。方法:同样用20ml的注射器取溶媒10～15ml,用针头穿刺瓶塞,再拔出…     

f/tPSA比值对tPSA值为2.6～4.0ng/ml前列腺癌的诊断意义

目的探讨利用血清游离前列腺特异性抗原(fPSA)和总前列腺特异性抗原(tPSA)的比值(f/tPSA),提高tPSA2.6～4.0ng/ml前列腺癌的诊断率的价值。方法对117例tPSA在2.6～4ng/ml可疑前列腺癌患者行直肠B超引导下前列腺穿刺活检,对患者血清tPSA,fPSA及f/t PSA值及其他临床病理资料进行统计学分析。结果经病理诊断良性前列腺增生(BPH)82例和前列腺癌35例,35例癌中Gleason score≤4分共6例(17%),Gleason score5-7分和8-10分别为22例(63%)和7例(20%)。前列腺癌的f/tPSA明显高于BPH(P＜0.01),以f/tPSA0.22为界值,诊断癌的特异性为83%,敏感性为71%,阳性预测值为68%。结论f/t PSA作为一项辅助检查可提高tPSA 2.6～4.0ng/ml前列腺癌的诊断率。     

ProPSA用于总PSA在4.0～10.0 ng/ml的前列腺癌的早期检测

当总PSA(tPSA)水平在 4 .0～ 10 .0ng/ml时 ,仅 2 5 %的患者确诊为前列腺癌 ,这种情况下 ,tPSA明显缺乏特异性。ProPSA是游离PSA(fPSA)的衍生物 ,目前主要有 3种形式 ,[- 2 ]proPSA、[- 4 ]proPSA和含前导肽全长的 [- 7]proPSA ,ProPSA前导肽经裂解去除后 ,产生具有活性的tPSA。研究发现 ,ProPSA水平与前列腺癌密切相关。为了解proPSA能否用于早期诊断前列腺癌 ,作者对 93例血清tPSA 4 .0～ 10 .0ng/ml的患者测定血清 %fPSA和上述 3种proPSA水平 ,并同时行前列腺 12点系统活检及前列腺体积测定。 93例中 4 1例 (4 4 % …     

碳酸氢钠的mol与ml间的换算

碳酸氢钠的ｍｏｌ与ｍｌ间的换算王明义＊＊于东兰＊＊＊上海第二军医大学长征医院麻醉科，邮政编码：２００００３＊＊山东省聊城地区第二人民医院麻醉科，邮政编码：２５２６０１在日常医疗工作中，经常会遇到术中需静脉补充碳酸氢钠若干ｍｍｏｌ／ｋｇ这一问题，若干ｍ...     

Should we limit the ferritin upper threshold to 500 ng/ml in CKD patients?

The new National Kidney Foundation's Kidney Disease Outcome Quality Initiative clinical practice guidelines for anemia management in chronic kidney disease include several important modifications to the previous recommendations. These changes may have major implications in clinical practice and outcome of the chronic kidney disease patient population. Among the important guideline modifications are the elimination of the upper thresholds for hemoglobin (12 g/dL), transferrin saturation ratio (TSAT, v 50%) and ferritin (800 ng/ml). There are, however, additional recommendations pertaining to anemia management when hemoglobin is above 13 g/dL or serum ferritin above 500 ng/ml. The KDOQI anemia working group explains that the upper ferritin level of 500 ng/ml is not a stopping point for IV iron administration, but adds that decisions regarding IV iron administration should weigh erythropoietin responsiveness, hemoglobin and transferrin saturation level, and the patient's clinical status.The selected upper ferritin level of 500 ng/ml lacks adequate scientific evidence in the CKD population. Approximately half of all maintenance hemodialysis patients in the United States may have a serum ferritin above 500 ng/ml. Serum ferritin in 500-1,200 ng/ml range is not associated with increased death risk in hemodialysis patients if controlled for the confounding effect of malnutrition and inflammation. Given the lack of support from the literature, any attempt to contemplate an upper limit for serum ferritin would be arbitrary, and would not serve to improve the quality of treatment in the CKD population.     

基于bpMRI的前列腺活检对PSA≤20 ng/ml前列腺癌诊断价值的研究

目的:探讨基于双参数磁共振(bpMRI)的前列腺活检对PSA≤20ng/ml前列腺癌的诊断价值。方法:回顾性分析2017年11至2019年10月南京医科大学第一附属医院行前列腺活检的394例患者的临床资料。其中177例行经直肠超声(TRUS)引导改良系统活检,为TRUS组;217例活检前行bpMRI检查,为MRI组,其...     

5例前列腺增生患者PSA＞60ng/ml的原因分析及治疗选择

目的 探讨前列腺增牛症患者血清前列腺特异性抗原(PSA)>60ng/ml的原因及治疗选择.方法 总结5例血清PSA>60ng/ml前列腺增生患者的临床资料以及手术治疗后PSA的变化,结合文献复习进行分析.结果 5例患者术后PSA水平均明显下降,术后3月PSA由术前平均(72.8±8.3)ng/ml降至平均(16.4±3.2)ng/ml.其中1例前列腺增生伴炎症患者由术前103.5ng/ml降至34.8ng/ml,l例前列腺增生伴部分不典型增生患者由术前84.6ng/ml降低至42.6ng/ml.术后6个月复查,5例PSA平均(11.6±4.8)ng/ml(7.5～18.5 ng/m1).结论 PSA增高除了与前列腺癌相关外,还与年龄、前列腺体积、尿潴留、尿路感染以及前列腺炎症密切有关.对于高水平PSA的前列腺增生患者,建议尽早采取手术治疗.     

一次性1ml注射器在胃肠减压器中的应用

一次性负压吸引器在临床中广泛应用，是较为常见的护理操作技术。但在使用过程中常遇到一些问题，如胃管与负压吸引管连接不紧密，连接管与胃管外接头不吻合，影响负压治疗效果。我科在临床护理工作中运用一次性1ml注射器解决上述问题，现介绍如下。     

采用1 ml注射器解除留置套管针阻塞

动脉留置插管和外周静脉留置套管针的临床应用 ,在很大程度上减少了病人因反复穿刺的痛苦 ,同时也减少了护理工作量。但有时因种种原因易引起导管内凝血 ,导致导管阻塞。常规方法是应用 5～ 10ｍｌ注射器推注肝素生理盐水或生理盐水解除阻塞 ,但效果不理想。鉴此 ,笔者采用 1ｍｌ注射器抽吸浓度为 10 0Ｕ ｍｌ肝素生理盐水或生理盐水反复推注 2～ 3次 ,成功率达 97.3% (36 37)。其机制为 :根据压强 =压力÷受力面积的原理 ,注射器栓的推力 (压力 )一定时 ,注射器筒的横截面积越小 ,对药液的压强就越大 ,喷射速度就越快。 1ｍｌ注射器是所有…     

50 ml注射器用于气管切开患者雾化吸入

气管切开患者雾化吸入时,不能口含雾嘴或使用面罩吸入,造成了大部分雾化气流的浪费.为了使更多的雾化气流被吸入,临床多将雾嘴尽量接近气管切开处,但雾化气流遇空气后有少部分会凝集成小水珠,易滴进患者气管内,引起呛咳.鉴此,我科用50 ml注射器空筒连接雾化管道代替雾化器雾嘴和面罩,试用15例患者,效果较好,介绍如下.     

5 ml一次性注射器用于口服碘剂

甲亢患者手术前后均要口服碘剂,且剂量较小,仅3～16 gtt不等,碘剂一般100 ml/瓶,临床应用中很不方便.为此,我科用5 ml一次性注射器帮助患者服碘,效果较好,介绍如下.