前列腺特异性抗原密度诊断前列腺偶发癌的临床价值

为探讨前列腺偶发癌早期诊断的有效指标，对11例前列腺偶发癌和20例前列腺增生症（BPH）患者前列腺特异性抗原密度（DPSA）进行了检测。结果前列腺偶发癌DPSA平均值为0．15±0．13ng／（ml·cm3），BPH为0．07±0．06ng／（ml·cm3），两者有非常显著性差异（P＜0．01）。11例DPSA＞0.1ng／（ml·cm3）者，9例为前列腺偶发癌；20例DPSA＜0．1ng／（ml·cm3）者，18例为BPH。而有9例前列腺偶发癌前列腺特异性抗原（PSA）＜10．0ng／ml，有12例BPH者PSA＞2.8ng/ml。认为当患者血清PSA轻、中度增高或正常时，DPSA可作为前列腺偶发癌早期诊断的有效指标。     

An unusual presentation of advanced prostate cancer in a 56-year old Nigerian

Introduction

Advanced prostate cancer usually presents with lower urinary tract symptoms associated with features of malignancy on digital rectal examination. The bones, the liver, and the lungs are the common sites of metastasis for advanced prostate cancer.

Brain metastases: a rare initial presentation of prostate cancer

Although brain metastases are common in cancer patients, carcinoma of the prostate rarely metastasizes to the brain. Cerebral metastases as an initial clinical presentation of prostate carcinoma are extremely rare. We report a patient, who presented with confusion and behavioral changes. Cranial magnetic resonance imaging revealed a large right temporal lobe lesion. The pathological diagnosis of the tumor was consistent with metastatic prostate carcinoma. Further evaluation revealed widespread bony metastases by technetium 99 bone scan and high level of prostate-specific antigen.     

Interactions in the aetiology,presentation and management of synchronous and metachronous adenocarcinoma of the prostate and rectum

Adenocarcinoma of the prostate and rectum are common male pelvic cancers and may present synchronously or metachronously and, due to their anatomic proximity. The treatment of rectal or prostate cancer (in particular surgery and/or radiotherapy) may alter the presentation, incidence and management should a metachronous tumour develop. This review focuses on the interaction between prostatic and rectal cancer diagnosis and management. We have restricted the scope of this large topic to general considerations, management of rectal cancer after prostate cancer treatment and vice versa, management of synchronous disease and cancer follow-up issues.     

Screening for prostate cancer: an update

OBJECTIVES: To review evidence regarding the potential introduction of prostate cancer screening programmes and highlight issues pertinent to the management of screen-detected prostate cancer. METHODS: Screening for prostate cancer is a controversial health care issue in general and urological practice. A PubMed database search was performed, followed by a systematic review of the literature, to examine the evidence base underlying prostate cancer screening. RESULTS: A prostate cancer screening programme should satisfy several key postulates prior to its introduction. To date, several of these postulates have not been satisfied, and the evidence available for prostate cancer screening is currently insufficient to warrant its introduction as a public health policy. The natural history of screen-detected prostate cancer remains poorly understood, and recent evidence suggests that a screening programme may detect a large number of men with indolent disease who may be subsequently overtreated. Several randomised clinical trials are currently in progress and it is hoped that they will provide robust evidence to inform future practice. CONCLUSIONS: National systematic prostate cancer screening programmes outside randomised clinical trial settings have not been implemented to date owing to lack of robust evidence that such programmes would improve survival and/or quality of life in men with screen-detected disease. Forthcoming results of clinical trials and the application of appropriate risk stratification to prevent overtreatment of indolent prostate cancer are likely to change practice in coming years.     

前列腺腔内术后尿道狭窄原因及处理

目的探讨前列腺患者腔内手术后尿道狭窄的原因及处理方法。方法经尿道前列腺汽化电切术后尿道狭窄32例，术前均行膀胱镜检未见尿道狭窄，术后出现排尿困难，经尿道探杆检查、膀胱镜检及尿道造影明确诊断为尿道狭窄。其中14例为尿道外口狭窄，9例为尿道球膜部狭窄，4例为阴茎部尿道狭窄缘于尿道扩张造成，5例为前列腺尿道部疤痕狭窄。18例行尿道扩张治愈，7例行尿道内切开加尿道扩张治愈，4例前列腺部尿道狭窄再次电切治愈，3例行尿道成形术。结果32例治疗后能维持通畅的排尿，其中4例患者须定期尿扩随访。结论经尿道前列腺汽化电切术后尿道狭窄主要发生于尿道外口及前尿道，与器械、留置尿管、感染及尿道扩张等因素相关。治疗方法主要为尿道扩张及尿道内切开，尤应重视术后的尿扩随访。     

Penile metastasis: an unusual presentation of metastatic colonic cancer

We report here an interesting presentation of a primary colonic carcinoma in a urological setting. A previously unknown case of colonic carcinoma presented with a lesion in the glans penis which was later diagnosed as a secondary deposit from colonic cancer. Penile involvement has been implicated as a metastatic site in several tumours. Although uncommon, this presentation is not unknown. A literature review of this unusual presentation has been performed and is summarised in the article     

前列腺导管腺癌20例报告并文献复习

目的:探讨前列腺导管腺癌的临床表现、病理特征、治疗方法等。方法:报告1995～2010年天津各大医院收治的20例前列腺导管腺癌疾病的情况:患者年龄64～82岁,平均74.5岁,其中13例主因不同程度的排尿困难入院,9例PSA高于正常,17例B超和MRI提示异常,20例均经过穿刺或病理活检确诊。根据病情需要行不同的手术和药物治疗。结果:免疫组化检查提示有前列腺导管腺癌较特异性表现。术后随访12～60个月,14例患者死亡。结论:前列腺导管腺癌在前列腺癌中较罕见,难于早期诊断;确诊主要依靠病理和免疫组化检查;治疗方法可采用根治性前列腺切除术。     

Ureteric reconstruction for the management of transplant ureteric stricture: a decade of experience from a single centre

This study was conducted to review the outcomes of patients who had undergone surgical repair of a ureteric stricture following renal transplantation. All patients who developed a ureteric stricture and underwent ureteric reconstruction following renal transplantation, between December 2003 and November 2013, were reviewed. One thousand five hundred and sixty renal transplants were performed during the study period. Forty patients required surgical repair of a ureteric stricture (2.5%, 25 male, median age 48 [14–78]). The median time to stricture was 3 [1–149] months. 19 patients were reconstructed by reimplantation to the bladder, 18 utilized a Boari flap, two were a pre‐existing ileal conduit and one was an anastomosis to a native ureter. In one patient, reconstruction was impossible and consequently an extra‐anatomic stent was used. Two patients required re‐operation for restricture and kinking. Median serum creatinine at 12 months following surgery was 148 [84–508] μmol/l. There was no 90‐day mortality. Eleven grafts were lost at the time of this study, a median time of 11 [1–103] months after reconstruction. The incidence of ureteric stricture following renal transplant is low. Surgical reconstruction of the transplant ureter is the optimal treatment and is successful in the majority of patients.     

The prognostic importance of prostate specific antigen in the monitorisation of patients undergoing maximum androgen blockade for metastatic prostate cancer

Introduction The changes in serum prostate specific antigen (PSA) concentrations can be used as a prognostic factor in patients undergoing maximum androgen blockade for metastatic prostate cancer. Material and method A total of 149 patients followed up in our department were classified into 4 groups on the basis of PSA changes: group 1; those with normalisation of PSA levels within the first 3 months, group 2; those with normalisation PSA between months 3 and 6, group 3; those with a decrease in PSA but not reaching normal range, group 4; those with no decrease. The gleason scores and the number of bone metastases were also compared between the groups. Result The time to progression was significantly delayed in group 1 (mean: 23.3 months) compared to those with group 2 (mean: 16.9 months) (P < 0.02). The time to progression in group 3 (mean: 8.45 months) was significantly shorter compared to the first two groups (P < 0.001). Also, in patients with gleason scores 5–7 (grades 2) and gleason scores over 7 (grade 3) and group 1, the time to progression (mean: 21.2 months) was significantly delayed compared to those with the same gleason scores but with group 2 (mean: 13.4 months) (P < 0.001). Conclusion The decrease in PSA level is more important than gleason scores in determining the time to progression. Early normalisation of PSA delays the time to progression, and when combined with gleason scores, PSA is an important prognostic factor in predicting the success of the therapy.     

Prediction of locoregional extension and metastatic disease in prostate cancer: a review

Despite efforts to enhance the accuracy of prediction of extraprostatic disease, approximately 40% of the men undergoing radical prostatectomy are found at surgery to have non-organ-confined cancer. Predictive algorithms based on multivariate regression analysis and neural networks are widely available and are superior to our standard empirical methods of clinical staging. These algorithms have been validated in diverse and well-characterized patient groups. For enhancement of the predictive value, data input must be standardized and improved input variables must be incorporated. In addition to the three “classic” staging parameters, i.e., pretreatment prostate-specific antigen (PSA), biopsy pathology, and digital rectal examination, new variables now show promise in predicting disease extent and may be integrated in future predictive models. This review focuses on our present methods for prediction of locoregional spread and distant metastases in men with clinically localized prostate cancer.     

经尿道前列腺电切术后尿道狭窄的原因分析

目的 分析并探讨经尿道前列腺电切术(TURP)术后尿道狭窄的原因,避免其发生.方法 回顾性分析我院1999年1月至2010年1月收治的23例前列腺电切术后尿道狭窄患者,年龄57~78岁,平均67.8岁;狭窄段尿道长度为1.6~3.5cm(平均2.3cm);最大尿流率为4～14ml/s,平均75ml/s;术后出现狭窄的时间为1个月~17年,平均25个月.其中前尿道狭窄6例,后尿道狭窄15例,膀胱颈口处狭窄2例.对于明确的尿道狭窄患者,针对不同情况分别给予尿道扩张、尿道内冷刀切开、残留前列腺组织切除或瘢痕切除处理.结果 随访3个月~6个月,23例患者中6例前尿道狭窄经定期尿道扩张后症状消失,疗效满意.后尿道狭窄的15例患者,2例采用定期尿道扩张的方法治愈,3例行残留腺体切除后症状逐渐缓解,另外1例因后尿道瘢痕较多,于尿道内行冷刀切开后复发,其余后尿道狭窄患者疗效满意.膀胱颈口处狭窄的2例患者,行膀胱颈口冷刀切开及瘢痕切除后治愈.术后23例患者最大尿流率19~29 ml/s,平均24.4 ml/s.结论 尿道狭窄是TULIP术后常见的并发症,其发生与尿路感染、操作损伤、术后留置尿管过粗、置管时间过长、腺体残留等因素密切相关.     

The prognostic significance of Gleason scores in metastatic prostate cancer

PurposeAlthough the majority of metastatic prostate cancer (mPCa) will arise from tumors with Gleason scores (GS) of 8 to 10 existing tumor grade analyses for mPCa have been almost uniformly limited to comparisons of≤7 vs.≥8. In this analysis, we comprehensively evaluate the GS as a prognostic factor for mPCa in the era of the updated Gleason grading system.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with mPCa, GS 6 to 10, diagnosed from 2006 to 2008. GS and primary-secondary Gleason pattern variations were analyzed for overall survival and prostate cancer–specific survival (PCSS).ResultsA total of 4,654 patients were evaluable. At 4 years, the overall survival rates were 51%, 45%, 34%, 25%, and 15% and PCSS rates were 69%, 57%, 44%, 33%, and 21% for GS 6, 7, 8, 9, and 10, respectively. Survival differences for GS 7 vs. 8, 8 vs. 9, and 9 vs. 10 were highly significant on both univariate and multivariate analyses accounting for age, prostate-specific antigen level, and T stage (all P<0.001). Gleason pattern 5 was an independent prognostic factor, both overall for patients with GS 6 to 10 and on primary-secondary Gleason pattern comparisons within the GS 8 (4+4 vs. 3+5 and 5+3) and GS 9 (4+5 vs. 5+4) subgroups. No survival differences were observed between 3+4 vs. 4+3. Overall, lower prostate-specific antigen level, younger age, and lower GS were associated with improved survival, with GS being the strongest prognostic factor for PCSS.ConclusionsIn this large population-based cohort, stratified survival outcomes were observed for GS 6 to 10, with sequential comparisons of GS 7 to 10, and the presence and extent of Gleason pattern 5 representing independent prognostic factors in the metastatic setting.