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Risk stratification for disease progression in pT3 prostate cancer after robot-assisted radical prostatectomy

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Asian Journal of Andrology 2017年第6期19卷 700-706页

作者： Jeong Hee Hong Young Suk Kwon Isaac Yi Kim Section of Urologic Oncology Rutgers Cancer Institute of New Jersey Division of Urology Rutgers Robert Wood Johnson Medical School Rutgers The State University of New Jersey New Brunswick NJ 08903 USA Department of Urology Dankook University College of Medicine Cheonan 31116 South Korea.

The aim of this study is to identify optimal patients for adjuvant radiation therapy （ART） in pT3 prostate cancer. The role of ART for patients with adverse pathologic features after radical prostatectomy （RP） has been demonstrated, but over- or under-treatment remains a significant concern. Two-hundred and five patients with pT3NOMO who underwent robot-assisted RP without ART were analyzed. Multivariate Cox proportional regression analyses were used to identify predictors of biochemical recurrence （BCR） and clinical progression （CP）. The estimated 5-year BCR-free survival （BCRFS） and CP-free survival （CPFS） were 52.8% and 85.6%, respectively. Preoperative prostate-specifc antigen （PSA）：〉10 ng m1-1 （hazard ratio [HR]： 3.288-6.027; P = 0.003）, pathologic Gleason score （pGS）：〉8 （HR： 4.146; P = 0.014）, and lymphovascular invasion （LVI）（HR： 2.167; P = 0.026） were associated with BCR. Based on these factors, a risk stratification tool was developed. Patients with no risk factors （PSA 〈10 ng m1-1, pGS 6, and absent LVI） showed excellent BCRFS and CPFS at 5 years （91.9% and 100.0%, respectively）, but those with two or more risk factors （PSA ：〉10 ng ml-1, pGS ≥8, or present LVI） had poor BCRFS and CPFS （12.1% and 54.6%, respectively）. In addition, the multivariate analysis revealed that pathologic stage pT3b （HR： 5.393; P = 0.025） was the only predictor of CP. Our study demonstrated the heterogeneity of oncologic outcomes in patients with pT3 prostate cancer. The proposed risk stratification can be used to identify patients who are at risk for disease progression and may aid in identifying the best patients for ART.

关键词： prostatectomy prostate-specific antigen recurrence survival

The combined role of MRI prostate and prostate health index in improving detection of significant prostate cancer in a screening population of Chinese men

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Asian Journal of Andrology 2023年第6期25卷 674-679页

作者： Peter KF Chiu Thomas YT Lam Chi-Fai Ng Jeremy YC Teoh Carmen CM Cho Hiu-Yee Hung Cindy Hong Monique J Roobol Winnie CW Chu Samuel YS Wong Joseph JY Sung SH Ho Urology Centre Department of SurgeryThe Chinese University of Hong KongHong Kong SARChina The Jockey Club School of Public Health and Primary Care The Chinese University of Hong KongHong Kong SARChina Department of Imaging and Interventional Radiology The Chinese University of Hong KongHong Kong SARChina Erasmus MC Cancer Institute Erasmus Medical UniversityRotterdam 3015The Netherlands Lee Kong Chian School of Medicine Nanyang Technological UniversitySingapore 308232Singapore

Using prostate-specific antigen(PSA)for prostate cancer(PCa)screening led to overinvestigation and overdiagnosis of indolent *** aimed to investigate the value of prostate health index(PHI)and magnetic resonance imaging(MRI)prostate in an Asian PCa screening *** aged 50–75 years were prospectively recruited from a community-based PSA screening *** with PSA 4.0–10.0 ng ml^(−1) had PHI result *** prostate was offered to men with PSA 4.0–50.0 ng ml−1.A systematic prostate biopsy was offered to men with PSA 4.0–9.9 ng ml^(−1) and PHI≥35,or PSA 10.0–50.0 ng ml^(−1).Additional targeted prostate biopsy was offered if they had PI-RADS score≥*** significant PCa(csPCa)was defined as the International Society of Urological Pathology(ISUP)grade group(GG)≥2 or ISUP GG 1 with involvement of≥30%of total systematic *** total,12.8%(196/1536)men had PSA≥4.0 ng ml^(−1).Among 194 men with PSA 4.0–50.0 ng ml^(−1),187(96.4%)received MRI *** them,28.3%(53/187)had PI-RADS≥3 ***,7.0%(107/1536)men were indicated for biopsy and 94.4%(101/107)men received *** the men received biopsy,PCa,ISUP GG≥2 PCa,and csPCa was diagnosed in 42(41.6%),24(23.8%),and 34(33.7%)men,*** with PSA/PHI pathway in men with PSA 4.0–50.0 ng ml^(−1),additional MRI increased diagnoses of PCa,ISUP GG≥2 PCa,and csPCa by 21.2%(from 33 to 40),22.2%(from 18 to 22),and 18.5%(from 27 to 32),*** benefit of additional MRI was only observed in PSA 4.0–10.0 ng ml^(−1),and the number of MRI needed to diagnose one additional ISUP GG≥2 PCa was 20 in PHI≥35 and 94 in PHIprostate was mainly observed in PSA 4.0–9.9 ng ml^(−1) and PHI≥35 *** was an important risk stratification step for PCa

关键词： magnetic resonance imaging prostate prostate cancer prostate health index prostate-specific antigen screening

Evaluation of PSA-age volume score in predicting prostate cancer in Chinese population

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Asian Journal of Andrology 2018年第4期20卷 324-329页

作者： Yi-Shuo Wu Xiao-Bo Wu Ning Zhang Guang-Liang Jiang Yang Yu Shi-Jun Tong Hao-Wen Jiang Shan-Hua Mao Rong Na Qiang Ding Department of Urology Huashan Hospital Fudan University Shanghai 200040 China Urology Research Center Fudan University Shanghai 200040 China Department of Urology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China

This study was performed to evaluate prostate-specific antigen-age volume （PSA-AV） scores in predicting prostate cancer （PCa） in a Chinese biopsy population. A total of 2355 men who underwent initial prostate biopsy from January 2006 to November 2015 in Huashan Hospital were recruited in the current study. The PSA-AV scores were calculated and assessed together with PSA and PSA density （PSAD） retrospectively. Among 2133 patients included in the analysis, 947 （44.4%） were diagnosed with PCa. The mean age, PSA, and positive rates of digital rectal examination result and transrectal ultrasound result were statistically higher in men diagnosed with PCa （all P 〈 0.05）. The values of area under the receiver operating characteristic curves （AUCs） of PSAD and PSA-AV were 0.864 and 0.851, respectively, in predicting PCa in the entire population, both performed better than PSA （AUC = 0.805; P 〈 0.05）. The superiority of PSAD and PSA-AV was more obvious in subgroup with PSA ranging from 2.0 ng ml^-1 to 20.0 ng ml^-1. A PSA-AV score of 400 had a sensitivity and specificity of 93.7% and 40.0%, respectively. In conclusion, the PSA-AV score performed equally with PSAD and was better than PSA in predicting PCa. This indicated that PSA-AV score could be a useful tool for predicting PCa in Chinese population.

关键词： age China prostate cancer prostate-specific antigen volume

Hormone naive prostate cancer： predicting and maximizing response intervals

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Asian Journal of Andrology 2015年第6期17卷 929-935,I0007,I0008页

作者： Judd W Moul Division of Urology Department of Urology Duke Cancer Institute Duke South Duke University Medical Center Durham NC 27710 USA.

Hormone naive advanced prostate cancer is subdivided into two disease states： biochemical recurrence and traditional M 1 （metastatic） prostate cancer and characterized by no prior hormonal therapy or androgen deprivation therapy （ADT）. In biochemical recurrence/ prostate-specific antigen （PSA） recurrence, men should be risk-stratified based on their PSA doubling time, the Gleason score and the timing of the recurrence. In general, only men who are at high risk should be considered for early/immediate ADT although this is best done using shared decision with the patient. The type of ADT to be used in biochemical recurrence ranging from oral-only peripheral blockade （peripheral androgen deprivation） to complete hormonal therapy （combined androgen blockade [CAB]） remains in debate owing to lack of randomized controlled trials （RCT）. However, there is good RCT support for use of intermittent hormonal therapy （IHT）. There is also limited research on biomarker response （PSA and testosterone decline） to predict prognosis. On the other hand, in the setting of M1 hormone naive prostate cancer, there are many more RCT＇s to inform our decisions. CAB and gonadotrophin-releasing hormone antagonists perhaps provide a slight efficacy advantage while IHT may be slightly inferior with minimal M1 disease. The PSA nadir at 7 months after starting ADT is a powerful prognostic tool for M1 patients. There is growing recognition that serum testosterone （T） control while on ADT is linked to the development of castrate-resistant prostate cancer. Especially for a M 1 patient, maintaining a serum T below 20-30 ng d1-1 prolongs the response to ADT. Novel oral agents （abiraterone and enzalutamide） may soon find use in hormone naive disease and may alter the treatment landscape. Despite over 75 years of experience with ADT, many questions remain, and the field continues to evolve.

关键词： androgen deprivation therapy cancer gonadotrophin-releasing hormone antagonists hormonal therapy luteinizing hormone-releasing hormone agonists prostate prostate-specific antigen testosterone

What we have learned from randomized trials of prostate cancer screening

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Asian Journal of Andrology 2011年第3期13卷 369-373,510页

作者： Richard M Hoffman Anthony Y Smith Medicine Service New Mexico VA Health Care System Albuquerque NM 87108 USA Department of Medicine University of New Mexico School of Medicine Albuquerque NM 87108 USA Department of Surgery University of New Mexico School of Medicine Albuquerque NM 87108 USA

The introduction of prostate-specific antigen （PSA） for prostate cancer screening in the late 1980s led to an epidemic of prostate cancer, particularly in developed countries. However, the first valid reports from randomized controlled trials on the efficacy of screening were not published until 2009. Men in the screening group in the European Randomized Study of Screening for prostate Cancer were 20% less likely than those in the control group to die from prostate cancer. The absolute difference was only 0.7/1000, implying that over 1400 men needed to be screened to prevent one prostate cancer death. Screening was also associated with a 70% increased risk for being diagnosed with prostate cancer. The American prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial found no survival benefit for screening. Results were not conclusive because a substantial proportion of study subjects had previously undergone PSA testing, over half of the control group had PSA testing, follow-up was relatively short, and fewer than 100 subjects died from prostate cancer. Balancing the potential survival benefit from screening is the risk of overdiagnosis--finding cancers that would not otherwise cause clinical problems^and the risk of treatment complications, including urinary, sexual and bowel dysfunction. prostate cancer screening efforts would benefit from improved biomarkers, which more readily identify clinically important cancers. Cancer control efforts might also need to include chemoprevention, though currently available agents are controversial. In the meantime, oatients need to be supoorted in achievine informed decisions on whether to be screened for orostate cancer.

关键词： cancer screening prostate-specific antigen prostatic neoplasms randomized controlled trials as topic

Peripheral zone PSA density:a predominant variable to improve prostate cancer detection efficiency in men with PSA higher than 4 ng ml^(-1)

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Asian Journal of Andrology 2021年第4期23卷 415-420页

作者： Cheng Wang Yue-Yang Wang Shi-Yuan Wang Ji-Xiang Ding Mao Ding Yuan Ruan Xiao-Hai Wang Yi-Feng Jing Bang-Min Han Shu-Jie Xia Chen-Yi Jiang Fu-Jun Zhao Department of Urology Jiangsu Jiangyin People's HospitalJiangyin 214400China Department of Urology Shanghai General Hospital of Nanjing Medical UniversityShanghai 200080China Department of Urology Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghai 200080China Department of Urology Kashgar Prefecture Second People's HospitalKashi 844000China

To improve the diagnostic efficiency of prostate cancer(PCa)and reduce unnecessary biopsies,we defined and analyzed the diagnostic efficiency of peripheral zone prostate-specific antigen(PSA)density(PZ-PSAD).Patients who underwent systematic 12-core prostate biopsies in Shanghai General Hospital(Shanghai,China)between January 2012 and January 2018 were retrospectively identified(n=529).Another group of patients with benign prostatic hyperplasia(n=100)were randomly preselected to obtain the PSA density of the non-PCa cohort(N-PSAD).prostate volumes and transition zone volumes were measured using multiparameter magnetic resonance imaging(mpMRI)and were combined with PSA and N-PSAD to obtain the PZ-PSAD from a specific *** operating characteristic(ROC)curve analysis was used to assess the PCa detection efficiency in patients stratified by PSA level,and the area under the ROC curve(AUC)of PZ-PSAD was higher than that of PSA,PSA density(PSAD),and transition zone PSA density(TZ-PSAD).PZ-PSAD could amend the diagnosis for more than half of the patients with inaccurate transrectal ultrasonography(TRUS)and mpMRI *** TRUS and mpMRI findings were ambiguous to predict PCa(PIRADS score≤3),PZ-PSAD could increase the positive rate of biopsy from 21.7%to 54.7%,and help 63.8%(150/235)of patients avoid unnecessary prostate *** patients whose PSA was 4.0–10.0 ng ml^(−1),10.1–20.0 ng ml^(−1),and>20.0 ng ml^(−1),the ideal PZ-PSAD cut-off value for predicting clinically significant PCa was 0.019 ng ml^(−2),0.297 ng ml^(−2),and 1.180 ng ml^(−2),respectively(sensitivity>90%).Compared with PSA,PSAD,and TZ-PSAD,the efficiency of PZ-PSAD for predicting PCa is the highest,leading to fewer missed diagnoses and unnecessary biopsies.

关键词： benign prostate hyperplasia detection efficiency peripheral zone prostate-specific antigen density prostate biopsy prostate-specific antigen prostatic neoplasm

Measurement of serum zinc improves prostate cancer detection efficiency in patients with PSA levels between 4 ng/mL and 10 ng/mL

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Asian Journal of Andrology 2005年第3期7卷 323-328页

作者： Xiao-Meng Li Ling Zhang Jiang Li Yang Li Hong-Liang Wang Guo-Yi Ji Masaaki Kuwahara Xue-Jian Zhao Department of Pathophysiology School of Basic Medical Sciences Department of Prosthodentics Dental School Jilin University Changchun 130021 China Department of Urology Miyagi Prefecture Cancer Center Natori 981-1293 Japan

Aim： To investigate whether the measurement of serum zinc may improve the detection of prostate cancer （PCa） in men who had total prostate-specific antigen （PSA） levels higher than 4.1 ng/mL. Methods： A mass screening for PCa of 3940 men over 50 years old was undertaken using total serum PSA. Of the 190 men （4.8 %） with elevated PSA, 143 （3.6 %） underwent a transrectal ultrasonography （TRUS）-guided biopsy of the prostate, and 42 men （1% of total and 29.3 % of men undergoing biopsy） were found to have cancer. The areas under the receiver operating characteristic curves （ROC-AUC） were used to compare the diagnostic power of cancer detection by means of serum zinc, and free PSA/total PSA ratio （fit）. Results： The men with levels of serum zinc that ranged from 40 ng/mL-60 ng/mL, had an age-adjusted odds ratios（OR） of 5.0. A cutoff value of 100 gg/mL for-serum zinc concentration provided a sensitivity of 90.5 % and a specificity of 32.7 % in elevated PSA range, and a sensitivity of 93.3 % and specificity of 27.1% in gray zone, respectively. In the gray zone ranges of 4.1 ng/mL-10.0 ng/mL, the ROC-AUC for zinc was 73.0 % higher than 62.7 % of f/t PSA ratio and 56.7 % of total PSA. Conclusion： PCa displays a lower serum zinc concentration. The measurement of zinc levels improves PCa detection in the gray zone compared with the f/t PSA ratio and total PSA. （Asian J Androl 2005 Sep; 7： 323-328）

关键词： prostate cancer prostate-specific antigen zinc gray zone

PSA density in the diagnosis of prostate cancer in the Chinese population: results from the Chinese prostate Cancer Consortium

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Asian Journal of Andrology 2021年第3期23卷 300-305页

作者： Zi-Jian Song Jin-Ke Qian Yue Yang Han-Xiao Wu Mao-Yu Wang Si-Yuan Jiang Fu-Bo Wang Wei Zhang Rui Chen Chinese prostate Cancer Consortium Department of Urology Shanghai Changhai HospitalThe Second Military Medical UniversityShanghai 200433China Department of Urology Binhai People's HospitalYancheng 224500China 不详

We performed this study to investigate the diagnostic performance of prostate-specific antigen density(PSAD)in a multicenter cohort of the Chinese prostate Cancer *** with prostate-specific antigen(PSA)levels≥4.0 ng ml^(-1) regardless of digital rectal examination(DRE)results or PSA levelsspecificity for the diagnosis of prostate cancer(PCa)and high-grade prostate cancer(HGPCa)at different cutoff values were evaluated.A total of 5220 patients were included in the study,and 2014(38.6%)of them were diagnosed with *** patients with PSA levels ranging from 4.0 to 10.0 ng ml^(-1),PSAD was associated with PCa and HGPCa in both univariate(odds ratio[OR]=45.15,P<0.0001 and OR=25.38,P<0.0001,respectively)and multivariate analyses(OR=52.55,P<0.0001 and OR=26.05,P<0.0001,respectively).The areas under the receiver operating characteristic curves(AUCs)of PSAD in predicting PCa and HGPCa were 0.627 and 0.630,*** the PSAD cutoff of 0.10 ng ml^(-2),we obtained a sensitivity of 88.7%for PCa,and nearly all(89.9%)HGPCa cases could be detected and biopsies could be avoided in 20.2%of the patients(359/1776 cases).Among these patients who avoided biopsies,only 30 cases had *** recommend 0.10 ng ml^(-2) as the proper cutoff value of PSAD,which will obtain a sensitivity of nearly 90%for both PCa and *** results of this study should be validated in prospective,population-based multicenter studies.

关键词： Chinese early detection of cancer prostate cancer prostate-specific antigen prostate-specific antigen density

Incidental prostate cancer in radical cystoprostatectomy specimens

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Asian Journal of Andrology 2008年第5期10卷 809-814页

作者： Xiao-Dong Jin Zhao-Dian Chen Bo Wang Song-Liang Cai Xiao-Lin Yao Bai-Ye Jin Department of Urology The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China Department of Pathology The First Affiliated Hospital Zhejiang University School of Medicine Hangzhou 310003 China

Aim： To investigate the rates of prostate cancer （PCa） in radical cystoprostatectomy （RCP） specimens for bladder cancer in China's Mainland. To determine the follow-up outcome of patients with two concurrent cancers and identify whether prostate-specific antigen （PSA） is a useful tool for the detection of PCa prior to surgery. Methods： From January 2002 to January 2007, 264 male patients with bladder cancer underwent RCP at our center. All patients underwent digital rectal examination （DRE） and B ultrasound. Serum PSA levels were tested in 168 patients. None of the patients had any evidence of PCa before RCP. Entire prostates were embedded and sectioned at 5 mm intervals. Results： Incidental PCa was observed in 37 of 264 （14.0%） RCP specimens. Of these, 12 （32.4%） were clinically significant according to an accepted definition. The PSA levels were not significantly different between patients with PCa and those without PCa, nor between patients with significant PCa and those with insignificant PCa. Thirty-four patients with incidental PCa were followed up. During a mean follow-up period of 26 months, two patients with PSA 〉 4 ng/mL underwent castration. None of the patients died of PCa. Conclusion： The incidence of PCa in RCP specimens in China's Mainland is lower than that in most developed countries. PSA cannot identify asymptomatic PCa prior to RCP. In line with published reports, incidental PCa does not impact the prognosis of bladder cancer patients undergoing RCE

关键词： bladder cancer cystoprostatectomy incidental prostate cancer prostate-specific antigen