Repeat prostate biopsy is of great significance for missed diagnosis of prostate cancer. We make a review on the independent risk factors, route selection and new techniques to improve clinicans’ cognition of prostate biopsy indications. MpMRI targeted biopsy is recommended for patients who are eligibile for repeat biopsy for higher detection rate of clinically significant prostate cancer and lower rate of non-clinically significant prostate cancer.

Objective To exploie the choices and timing of different treatment regimens of prostate cancer.Methods The complete clinical data of one case of localized high-risk prostate cancer was reported.The patient,aged 69 years old,was admitted to hospital with urinary frequency and dysuria for 2 years.Serum total PSA was 36.8ng/ml and prostate biopsy dignosed as prostate cancer.The Gleason score was 4 + 3,and the clinical stage was T2b N0M0.Results The patient underwent radical prostatectomy,salvage radiotherapy + androgen deprivation therapy,abiraterone,enzalutamide,Radium-223,docetaxel + prednisone chemotherapy and mitoxantrone + prednisone chemotherapy,which included almost all of the current domestic treatment regimens.The patient lived for 57 months from the initiation of treatment.Conclusions For the patients with high-risk prostate cancer,especially for elderly patients,they should firstly be recommended the treatment of radical radiotherapy + 2-3 years of androgen deprivation therapy.For young patients,radical prostatectomy + extended pelvic lymph node dissection as part of multi-modal therapies is considered to be a positive choice.However,for the patients with risk factors or recurrence after radical prostatectomy,the postoperative radiotherapy should be performed in order to reduce biochemical recurrence and improve local control.Currently,the order of choice of abiraterone,enzalutamide or docetaxel + prednisone chemotherapy,is based on the patient's situation,past history of treatment,symptoms,side effects as well as other related clinical features.

Familial clear renal cell carcinoma consists of hereditary clear renal cell carcinoma syndromes and familial non-syndromic renal cell carcinoma,of which the former can be the renal cell carcinoma accompanied with von Hippel-Lindau disease(VHL), Tuberous Sclerosis Complex(TSC), Birt-Hogg-Dube(BHD) syndrome and familial translocation of chromosomal 3. The most commonly involved gene includes VHL, TSC and BHD. Here, the current research status of familial clear renal cell carcinoma is reviewed.

Objective To discuss the characteristics of renal cell carcinoma with regional lymph node metastasis at diagnosis. Methods The data of 19 patients diagnosed with renal cell carcinoma with regional lymph node metastases at diagnosis from January 2004 to December 2008 were reviewed.The median age was 57 years (29-77).The study group included 15 males and four females.The primary tumor was located in the left kidney in 12 patients and fight in seven patients.The median maximam diameter of retroperitoneal lymph nodes was 2.8 cm(1.5-5.0).The lymph nodes in four patients were not detected by the preoperative image examination,but were confirmed by intraoperative exploration.Eleven cases had enlarged retroperitoneal lymph nodes resected and eight had regional lymph nodes dissected. Results The patients with regional lymph node metastases at diagnosis of renal celI carcinoma accounted for 1.6% (19/1213) of the total renal cell carcinoma cases.With a median follow-up of 34 months,six patients were survival without progression,and seven were survival with progression.giving a 5-year survival rate of 68.4%.The survival and recurrence rates after surgery were not significantly different by Fisher test(P=0.644 and 0.319 respectively) between the patients who underwent retroperitoneal regional lymph node dissection and those who underwent enlarged lymph node resection. Condmiom Renal cell carcinoma with regional lymph node metastasis at diagnosis is uncommon.Some patients may achieve long-term tumor-free survival through regional lymph node dissection or enlarged Iymph nodes resection.

Objective To study the character of multiple primary malignant neoplasms (MPMN) in patients with bladder cancer.Methods From 1958 to 1998,patients with bladder cancer associated MPMN were studied retrospectively.Results MPMN was found in 49(5.7%,49/847) patients with bladder cancer,including 32 male and 17 female.All the bladder cancer were urothelial carcinoma,47 cases of non muscleinvasive urothelial carcinoma and 2 muscle-invasive.47 cases were double-primary cancer patients,and 2 triple-primary.Non-bladder primary malignancies were found in digestive system(36.7%),respiratory system (20.4%),genital system(20.4%),and other system(20.4%).Lung cancer was the second primary cancer in 7 cases(14.3%,7/49).The MPMN were diagnosed at the same time in 5 cases,and the others one after another.Bladder cancer was the first primary cancer in 25 cases,and 24 as the second primary.The mean age when the first cancer was diagnosed was 51y.It was 86.2 months between the first cancer and the second for the mean time.90% cancer was in clinical stage Ⅰor stage Ⅱ.The median survival time was 39 months after the second primary malignant,and 104 months after the first primary malignant.Conclusion The most pathology type of the bladder cancer in MPMN is non muscle-invasive urothelial carcinoma. Non-bladder primary malignancies are found more common in digestive system,the following are respiratory system and genital system.When lung cancer is the second primary malignant,it should be discriminated from metastasis of bladder cancer.90% cancer is in early clinical stage.They will have a good prognosis if diagnosed early and treated properly.

Objective To investigate the incidence of renal dysfunction among patients received radical nephrectomy during 5-year follow-up and to discover the risk factors for chronic kidney dysfunction (CKD).Methods Data of 339 patients who underwent radical nephrectomy for renal cell carcinoma between Jan.2006 to Dec.2007 were investigated,and those who suffered renal dysfuntion before surgery or lost follow-up were excluded.Finally,148 patients were enrolled in this retrospective study.GFR after surgery were replaced by eGFR which were calculated with the abbreviated equation of MDRD.It will be defined as CKD when eGFR was less than 60 ml/(min · 1.73 m2).Postoperative occurence rate of CKD was estimated using the Kaplan-Meier methods.Rank sum test and chi-square test were used for the univariate analysis in term of CKD between groups.Multivariate Logistic regression analysis was used to judge the independent risk factors for CKD.Results Patients were followed up for 42-60 months.CKD occurred in 58 cases,and the 5 year cumulative incidence of CKD was 42.7％.As many as 17.4％ of the patients with a normal eGFR during the first 3 months follow-up would progress to CKD 5 years later.Clinical characteristics,including age at surgery,weight,body mass index,hypertension,preoperative total GFR and contralateral GFR,complications,size of tumor,pathologic type,eGFR calculated shortly after operation,were significantly different between the CKD group and the normal group (P＜0.05).Multivariate Logistic regression analysis shows that age at surgery (P =0.016,OR =1.106),size of tumor (P =0.048,OR =0.680) and eGFR calculated within one week postoperatively (P=0.002,OR=0.874) were the independent risk factors for postoperative CKD.Conclusions The incidence of CKD after radical nephrectomy in patients with renal cell carcinoma is not uncommon.The of age at surgery,size of tumor and eGFR value calculated within one week postroperatively have a close relation with the incidence of postoperative CKD.

Objective To observe the effect of intravesical chemotherapy in papillary urothelial neoplasm of low malignant potential (PUNLMP) urinary bladder after transurethral resection of bladder tumor (TUR-Bt). Methods 44 cases of PUNLMP confirmed by pathological examination from Jan 2004 to Dec 2013 were retrospectively analyzed. Clinical manifestation: 24 asymptomatic, 19 gross hematuria and 1 abdominal discomfort. All cases were treated by TUR-Bt and immediately administered by intravesical instillation of 40 mg HCPT once, then 32 cases (A group) underwent additional intravesical instillation of HCPT once, and 12 cases (B group) underwent instillation qw for 8 times. Results PUNLMP cases accouted for 2.28 %(44/1 926) of bladder neoplasms admitted during the same period. There were 32 males and 12 females. 39 patients had multiple tumors, and 5 had single. All of cases were followed up with the medial follow-up time of 82 months (16-136 months), only one case in B group recurred after 14 months, and postoperatively without pathological progression. The difference of recurrence rates between two groups had no statistical significance (P=0.273). Conclusions PUNLMP has low incidence rate and is more common among middle-aging males. Doctors should consider PUNLMP when patients with bladder neoplasm are asymptomatically detected. Immediate instillation combined with additional one postoperatively could reduce the recurrence rate of PUNLMP obviously with satisfying prognosis. However, maintenance instillation does not enhance effect.

Objective To investigate the copy number changes on chromosome 3q26. 1 in urothelial carcinoma of the bladder, and to explore its potential clinical significance. Methods The microarray-based comparative genomic hybridization (Array-CGH) approach was used to analyze the genome-wide copy number changes of 35 tumor tissue samples of bladder cancer. To confirm the loss of a small fragment in 3q26. 1 detected by Array-CGH, real-time fluorescent quantitative polymerase chain reaction (real-time PCR) was performed with 57 frozen tumor tissue samples and 34 formalinfixed paraffin-embedded (FFPE) tumor tissue samples. The urine sediment cells collected from 15 healthy volunteers and 29 bladder cancer patients were checked as above. Results The Array-CGH data showed that the copy number loss of a small fragment in 3q26. 1 was detected in 77.1% (27/35)of the tumor tissue samples investigated. Real-time PCR analysis validated this loss of a small fragment of 3q26.1 with high frequencies in both 57 frozen tumor samples and 34 FFPE tumor samples.The percentage of samples exhibiting loss was 78.9% (45/57) and 100. 0% (34/34) respectively.Furthermore, the relative copy number of the 3q26.1 small fragment was significantly lower in the urinary sediment cells of the patients (median=0. 0020), comparing with that of healthy controls (median=0. 0030) (P＜0.01). Conclusions Loss of the small fragment in 3q26.1 could be a characteristic genetic change of urothelial carcinoma of the bladder. It may serve as a potential molecular marker for bladder cancer.

Objective To evaluate the safety and efficacy of sorafenib for patients with advanced stage renal cell carcinoma.Methods The clinical data of 85 patients with advanced renal cell carcinoma were reviewed.These patients were treated by sorafenib 400 mg Bid,dose escalation of sorafenib(400 mg Bid 1-4 weeks;600 mg Bid 5-8 weeks;800 mg Bid since then) or sorafenib 400 mg Bid+NF-α,respectively,until intolerance or disease progression occurred.The primary end points were objective response,disease control rate and adverse effects rate.Results The data of 80 patients can be evaluated.The median follow-up duration was 72 weeks (4-108 weeks).One patient (1.2%) reached complete remission(CR),17 cases(21.2%) reached partial remission(PR),50 cases (62.5%) maintained stable disease (SD),and 12 cases (15%) progressed.The objective response (CR+PR) was 22.5%,disease control rate (CR+PR-SD)was 85.0%.By May 2009,only 18 patients died,progression free survival and overall survival were not available.The common side effects included hand-foot skin reaction (55.0%),mucosa hemorrhage (52.5%),diarrhea(40.0%),lassitude (35.0%),anorexia(22.5%),mucosa ulcer(20.0%),hypertension(15.0%) and baldness(15.0%)etc.Most of these side effects could be released by symptomatic treatment.Conclusion Sorafenib has good short term effect for patients with advanced renal cell carcinoma and is well tolerated.

Objective To investigate the creatinine level of wound drainage and the changes of serum creatinine after radical nephrectomy or partial nephrectomy in patients with renal cell carcinoma,to explore the feasibility of testing creatinine level to predict urine leakage after surgery and to compare the influence on rcnal function after different kinds of operations.Methods 65 patients data were analyzed,in which 31 patients had undergone partial nephrectomy and 34 had radical nephrectomy for renal cell carcinoma from March 2012 to July 2012.The level of creatinine in serum and wound drainage were detected within 24 hours after surgery.Also,the serum creatinine were redetected 3 months later.Results The creatinine level of wound drainage were significantly lower than that in serum in both groups [(99.94±21.10) μmol/L vs (114.61± 25.09) μmol/L,P =0.000].Urine leakage was observed in only one patient (2.9 ％) after partial nephrectomy,which his level of creatinine in serum and wound drainage was 107 μmol/L and 686μmol/L,respectively.The other 30 patients' creatinine level of wound drainage were also significantly lower than serum after partial nephrectomy [(92.90±26.21) μmol/L vs (99.83±28.77) μmol/L,P =0.021).Although the level of creatinine in the wound drainage was not significantly different between these two groups (P =0.239),the serum creatinine was statistical lower in partial nephrectomy group than that of radical nephrectomy group (P =0.035).Also,after three months,the partial nephrectomy group had a lower level of serum creatinine [(81.43±12.82) μmol/L vs (106.53±21.73) μmol/1,P =0.001].Conclusion Partial nephrectomy has advantages in protecting renal function when compared with radical nephrectomy.The level of creatinine in wound drainage is significantly lower than serum.The level of creatinine in wound drainage is a predictive indicator for diagnosing urine leakage.