输精管结扎与前列腺癌发病相关性Meta分析

目的:探讨输精管结扎与前列腺癌发病间的相关性。方法:以"输精管结扎术"、"前列腺癌"及其同义词和近义词为关键词,在CBMDisc、CMCC、CMAC、CNKI(1978年~2014年1月1日)和PubMed(1965年~2014年1月1日)等国内外数据库上进行全面检索,按文献纳入及剔除标准筛选出符合要求的文献,采用Meta分析方法进行综合分析。结果:共有17篇病例对照研究文献纳入本次研究,符合研究标准的研究对象33 841例,其中病例12 243例,对照21 598例。合并OR值(95%CI)为1.03(0.87,1.23)。结论:输精管结扎不增加前列腺癌的发病风险。     

中国人群输精管结扎术不增加前列腺癌发病风险:Meta分析

目的:探讨中国人群输精管结扎术与前列腺癌发病间的相关性。方法:系统检索3个中文文献数据库(CNKI、万方、维普)及3个英文文献数据库(Pud Med、Embase、Cochrane Library)截至2014年12月之前发表的有关中国人群输精管结扎术与前列腺癌关系的文献。由两位研究者独立按纳入和排除标准筛选文献,进行质量评价和数据提取,并采用STATA 12.0软件进行Meta分析。结果:共纳入合格的研究文献9篇,包括前列腺癌病例1 202例,对照4 496例。采用随机效应模型合并分析后的结果未发现中国人群输精管结扎术与前列腺癌相关(OR=1.05;95%CI,0.62~1.79),且异质性明显(P0.001,I2=85.7%)。尚不能认为目前纳入的研究存在发表偏倚(Egger,P=0.824;Begg,P=0.348)。结论:Meta分析结果提示中国人群输精管结扎术不会增加前列腺癌的发病风险。     

输精管结扎术与前列腺癌发病风险关系的Meta分析

目的:评价输精管结扎术与前列腺癌发病风险的关系。方法:以"前列腺癌"、"输精管结扎术"及其同义、近义词为关键词,在CBMDisc、CMCC、CMAC、CNKI(1978年至2009年1月6日)和PubMed(1965年至2009年1月6日)等国内外数据库上进行全面检索,按文献纳入及剔除标准筛选出符合要求的文献,提取出相关数据,以RevMan4.2进行一致性检验后采取随机效应模型对纳入研究的文献进行综合定量分析,求出合并OR值及95%CI,并分层分析结扎年限<20年和≥20年与前列腺癌发病风险的OR值及95%CI。结果:共有27篇文献纳入研究,其中队列研究7篇,病例对照研究20篇,共收集研究对象252594例,其中病例20088例,对照232506例。合并OR值(95%CI)为1.10(0.97～1.24),分层分析显示结扎年限<20年和≥20年的合并OR值(95%CI)分别为0.94(0.83～1.06)和1.05(0.90～1.23)。结论:现有研究表明输精管结扎术不会增加前列腺癌的发病风险。     

输精管结扎与前列腺癌

输精管结扎与前列腺癌的相关性 ,目前一直存在争论。本文就有关正反两方面的观点进行综述。     

输精管结扎与前列腺癌

输精管结扎与前列腺癌的相关性，目前一直存在争论，本文就有关正反两方面的观点进行综述。     

前列腺增生症与输精管结扎的相关性分析

目的 :探讨前列腺增生症 (BPH)与输精管结扎的关系。　方法 :调查 6 0岁以上男性农民 5 70人的国际前列腺症状评分 (IPSS)、生活质量评分 (L)、最大尿流率 (MFR)、前列腺体积 (V)及残余尿 (R)等指标 ,其中作过输精管结扎者 140人。　结果 :输精管结扎者BPH发病率 (2 7.1% )明显低于未作结扎者 (4 7.9% ) ,两者有极显著差异 (P<0 .0 1)。　结论 :输精管结扎对BPH的发生有阻遏作用。     

对输精管切除单纯结扎法的商榷

经对449例输精管切除1cm,两断端单纯结扎并加石炭酸烧灼的对象进行了术前和术后0.5至18月的系统精液检查及其配偶的孕情调查,证实输精管自发性再通占7.8％,且其中未避孕的妻子有1/3妊娠。木后18个月的观察结果还表明,90.6％的自发性再通发生在9月以内,而且距手术时间越短发生率相对越高。由于输精管切除1cm,两断端单纯结扎法再通率高达7.8％,故不宜继续采用此法。     

输精管电凝术与输精管结扎术的临床对比观察

为提高输精管绝育术的手术效果，减少术后并发症，我们对经皮穿刺输精管电凝术与直视钳穿输精管结扎术两种手术方法进行了探讨。     

输精管结扎和未结扎者慢性前列腺炎发病率的对比分析

对输精管结扎0.5—27年的2,145例与群体配对的2,026例未结扎者的慢性前列腺炎对比调查分析,结果发现其患病率结扎组为27.09%,未结扎组为28.23%,差別无显著性(P>0.05)。表明输精管结扎和慢性前列腺炎的发生无直接的联系,因此不宜将慢性前列腺炎常规列为输精管结扎术后的并发症。经对输精管结扎术后有无感染史者所发生慢性前列腺炎的对比调查,发现有感染史者慢性前列腺炎患病率较无感染史者高5.6%,但经统计学处理其患病率差別无显著性,说明术后感染并不明显增高慢性前列腺的患病率。不过对术后短期内由阴囊入口,结扎断端感染继发的急性前列腺炎,因治疗不当或病变严重而导致的慢性前列腺炎可作为输精管结扎于术后的并发症。     

中国部分市县前列腺癌发病趋势比较研究

目的 探讨中国大陆前列腺癌发病的流行病学特征.方法收集整理中国大陆30个肿瘤登记处1988-2002年15年间前列腺癌发病登记的数据资料,选取数据较为齐全的北京、天津、上海、武汉、哈尔滨、河北磁县、江苏肩东、浙江嘉善、广西扶绥、福建长乐、河南林州11个登记处的资料,按5年1个时段分为1988-1992、1993-1997、1998-2002年3个时间段,比较分析前列腺癌发病率、病死率,采用美国癌症研究所开发的统计软件Joinpoint Regression Program 3.3.1分析其流行趋势.通过对发病率的对数转换线性回归分析计算年度变化百分比.结果 30个登记处1988-1992、1993-1997、1998-2002年前列腺癌的发病率分别为1.96/10万、3.09/10万、4.36/10万,发病率有明显上升趋势.但与美国、加拿大、欧洲部分国家和地区比仍处于较低水平.结论 我国前列腺癌发病率呈现逐年上升趋势,将成为影响我国居民健康的主要恶性肿瘤之一,需引起重视.     

Association of clinical benign prostate hyperplasia with prostate cancer incidence and mortality revisited: a nationwide cohort study of 3,009,258 men

Background

Although benign prostate hyperplasia (BPH) and prostate cancer (PCa) share features such as hormone-dependent growth and response to treatment with antiandrogen therapy, BPH is generally not considered a premalignant lesion.

Objective

To determine whether clinical BPH is associated with an increased risk of PCa incidence and mortality.

Design, setting, and participants

Using designs with individual participant data from five national registries, we studied the entire Danish male population from 1980 through 2006, a total of 3 009 258 Danish men. We collected PCa diagnoses (n = 53 315), information on PCa mortality (n = 25 459), and ascertained clinical BPH (not histologically proven BPH) through hospitalization (n = 187 591) and/or surgery (n = 77 698) from 1980 to 2006 and the use of α-adrenergic receptor antagonists (n = 143 365) and/or the use of 5α-reductase inhibitors (5-ARIs) (n = 47 465) from 1995 to 2006.

Measurements

PCa incidence and mortality was assessed for each category of clinical BPH using Kaplan-Meier plots of cumulative incidence and Cox proportional hazard ratios (HRs) adjusted for potential confounders.

Results and limitations

For the entire cohort studies, multivariate-adjusted HRs for PCa incidence were 2.22 (95% confidence interval, 2.13-2.31) in men hospitalized and 3.26 (3.03-3.50) in men operated on for clinical BPH versus general population controls. Corresponding HRs for PCa mortality were 2.00 (1.91-2.08) for hospitalization and 7.85 (7.40-8.32) for surgery. For age-matched cohort studies, corresponding HRs for PCa incidence were 3.04 (2.96-3.13) for hospitalization, 2.60 (2.47-2.73) for surgery, 4.49 (4.33-4.65) for α-adrenergic receptor antagonist use, and 2.54 (2.40-2.68) for 5-ARI use. Each category of clinical BPH has limitations, but limitations differ between the categories and therefore are unlikely to explain the results.

Conclusions

In Danish men followed for up to 27 yr, clinical BPH was associated with a two- to three-fold increased risk of PCa incidence and with a two- to eight-fold increased risk of PCa mortality. These data should not be used to infer causality.     

The effects of prostate cancer on intimate relationships

Prostate cancer (PCA) represents an intensely ‘personal’ medical condition. PCA and its treatments affect intimate aspects of a man's bodily and psychological function, aspects that only the man himself and his partner can fully appreciate. There is growing evidence that the diagnosis of PCA has important adverse psychosocial effects on both the patient and his partner. An understanding of the ways in which a patient's female partner is affected by PCA is beginning to emerge. In this review several key issues for future psychosocial research are outlined and discussed: adjusting to the challenge of the PCA diagnosis, the impact on the couples’ relationship, the dilemma of treatment choice, the desire to conceal treatment side-effects, the effect of gender on the reaction of patients and female partners, and the unique problems facing same-sex couples. Pulling these issues together, the conclusion is drawn that psychosocial interventions designed to help the couple face this ‘relationship disease’ together are the most likely to be acceptable and effective for those affected by this common cancer.     

前列腺体积和前列腺特异抗原密度与前列腺穿刺阳性率的关系

目的:探讨前列腺体积及前列腺特异抗原密度与前列腺穿刺阳性率的关系并分析其原因.方法:选择2004～2007年间于我院行超声引导下经直肠前列腺系统8针穿刺的患者192例.以前列腺体积<30 ml、30～50 ml、>50 ml为界,计算并比较各组问前列腺穿刺的阳性率及PSAD≥0.15时,前列腺穿刺阳性率的变化.结果:前列腺体积与前列腺穿刺阳性率呈负相关(r＝0.237,P<0.01),前列腺体积<30 ml组,穿刺阳性率为39.1%(18/46);30～50 ml组,阳性率为21.7%(13/60);>50 ml组,阳性率为9.3%(8/86).各组间差异有统计学意义(P<0.01,P<0.05).前列腺特异抗原密度≥0.15时,三组间阳性率差异仍有统计学意义(P<0.01).但三组漏诊率分别为11.1%(2/18)、30.8%(4/13)、62.5%(5/8),差异有统计学意义(P<0.01).结论:前列腺体积是前列腺穿刺阳性率的独立影响因素,应根据前列腺体积制定穿刺方案.     

International variation in prostate cancer incidence and mortality rates

Context

Wide variation exists internationally for prostate cancer (PCa) rates due to differences in detection practices, treatment, and lifestyle and genetic factors.

Objective

We present contemporary variations in PCa incidence and mortality patterns across five continents using the most recent data from the International Agency for Research on Cancer.

Evidence acquisition

PCa incidence and mortality estimates for 2008 from GLOBOCAN are presented. We also examine recent trends in PCa incidence rates for 40 countries and mortality rates for 53 countries from 1985 and onward via join-point analyses using an augmented version of Cancer Incidence in Five Continents and the World Health Organization mortality database.

Evidence synthesis

Estimated PCa incidence rates remain most elevated in the highest resource counties worldwide including North America, Oceania, and western and northern Europe. Mortality rates tend to be higher in less developed regions of the world including parts of South America, the Caribbean, and sub-Saharan Africa. Increasing PCa incidence rates during the most recent decade were observed in 32 of the 40 countries examined, whereas trends tended to stabilize in 8 countries. In contrast, PCa mortality rates decreased in 27 of the 53 countries under study, whereas rates increased in 16 and remained stable in 10 countries.

Conclusions

PCa incidence rates increased in nearly all countries considered in this analysis except in a few high-income countries. In contrast, the increase in PCa mortality rates mainly occurred in lower resource settings, with declines largely confined to high-resource countries.     

Prostate cancer incidence in guadeloupe, a French Caribbean archipelago

OBJECTIVE: To determine the incidence rate of prostate cancer in Guadeloupe, a French Caribbean archipelago with 420,000 inhabitants, 90% of whom are of African descent. METHODS: All new cases of prostate cancer diagnosed from 1995 to 2003 were identified from the records of all public and private pathology laboratories. We studied changes in incidence rate over time by calculating incidence rates and cumulative risk, standardized to the World Standard Population, and comparing them with the rates in other countries. RESULTS: 2531 new cases of prostate cancer, all pathologically confirmed, were recorded from 1995 to 2003. For 2003, there were 427 new cases, corresponding to a world age-standardized incidence rate, and cumulative risk up to 74 years of age of 168.7 per 100,000 and 20%, respectively. CONCLUSIONS: Guadeloupe has one of the highest incidences of prostate cancer in the world. The geographic and environmental characteristics of Guadeloupe make this area unique and should shed new light on the role of genetic and environmental factors in prostate cancer.     

Effect of dimensions and volume of the prostate on cancer detection rate of 12 core prostate biopsy

Purpose To evaluate if volume or any of the three dimensions of prostate influences cancer detection rate by 12-core transrectal ultrasound (TRUS) guided prostate biopsy. Materials and methods We have searched our database for patients who underwent 12 core TRUS guided prostate biopsy with PSA values between 4.0 and 9.9 ng/ml, benign digital exam and no suspicious lesions at TRUS. The measurements of three dimensions and volume of the prostate of 99 patients were correlated with cancer detection rates of biopsy. Results There were no statistically significant differences between patients with prostate cancer or with benign histopathologic result for mean age, PSA and % PSA. Patients without cancer had a significantly higher mean prostate volume (58.88 cc) than patients with cancer (48.85 cc) (P = 0.038). A volume of 48.5 cc was determined as a cut-off value above which cancer detection rate decreases. Of the three dimensions, only the difference for the craniocaudal dimension between benign and malignant groups was marginally significant (P = 0.052). Conclusions With 12 core biopsy, cancer detection rate is lower in patients with prostates larger than 48.5 cc. Further studies comparing biopsy results with prostatectomy specimens can clarify whether these results necessitates higher number of cores for such patients.     

膀胱前列腺共存肿瘤12例临床资料分析

目的：提高对膀胱前列腺共存肿瘤的认识及检出率。方法：回顾性分析2003年1月～2008年1月收治的12例膀胱癌并发前列腺癌患者的临床资料。结果：12例中以膀胱肿瘤首诊9例，其中I例于术后11个月死于脑血管意外，余8例随访4～47个月（平均16．5个月），5例无瘤生存，2例分别于术后10和16个月死于肿瘤转移。以前列腺腺癌首诊的3例，分别随访38、25和6个月，2例无瘤生存，I例于术后25个月死于全身广泛转移。结论：膀胱前列腺共存肿瘤少见，临床上易漏诊。对于膀胱癌或前列腺癌患者，都应考虑到共存癌的可能。     

不同穿刺针数经直肠前列腺穿刺活检诊断前列腺癌的研究

目的探讨针对国人的不同体积前列腺理想的前列腺活检穿刺针数。方法临床表现怀疑前列腺癌患者879例,按照前列腺体积分为10～30ml组、30.1～40ml组,40.1～50ml组,以及50.1ml组,记录患者一般临床资料以及活检结果。依穿刺结果,按照不同体积对比分析不同穿刺针数的穿刺结果。结果总的肿瘤检测率为27.3%,随着前列腺体积的增大,肿瘤检测率降低(P0.05)。6、8、10和12针的肿瘤检测率分别为18.0%、28.0%、32.0%和29.0%。与8、10和12针比较,传统的6针穿刺有较低的穿刺阳性率(P0.05)。在不同的前列腺体积之间,8、10和12针穿刺阳性率之间比较,差异无统计学意义(P0.05)。在经直肠超声和经直肠指诊有可疑的患者中,穿刺阳性率分别为71.0%和65.0%。结论 6针穿刺具有较低的穿刺阳性率,按照不同的前列腺体积,8、10和12针有相似的穿刺阳性率,可疑部位活检能够提高穿刺的阳性率。     

Clinical trials of immunotherapy for advanced prostate cancer

There is a lack of effective therapeutic regimens for advanced hormone-refractory prostate cancer (HRPC). Recent combination regimens of chemotherapy have improved management of HRPC. Neither systemic chemotherapy nor radiation regimens have significantly improved survival. Conventional systemic cytokine therapy has had limited efficacy in the treatment of advanced prostate cancer patients and its toxicity is severe. Combinations of multiple biological response modifiers for treatment of this disease also have limited efficacy. Results from phase II trials have shown that the combination of interferon- and interleukin-2 therapy and the infusion of dendritic cells primed with peptides of prostate specific membrane antigen are promising. The former showed 31% response using the National Prostatic Cancer Project criteria, and the latter showed 27% of objective partial response with a reduction of >50% prostate specific antigen level. The toxicity of these two regimens was tolerated by patients. New approaches with tumor vaccines in conjunction with cytokine gene therapy have also been investigated. The clinical responses of these trials have been limited but promising. Immunotherapy may become an effective modality of prostate cancer treatment in the future.