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Value of MR diffusion weighted imaging in the diagnosis of prostate cancer

Weiqing QIAN ; Wenbin DAI ; Huadong MIAO ; Zhongquan SUN ; Jianda SONG

Chinese Journal of Urology.2009;30(12):841-844. doi:10.3760/cma.j.issn.1000-6702.2009.12.021

Objective To investigate the value of magnetic resonance (MR) diffusion weighted imaging(DWI) in the diagnosis of prostate cancer(PCa). Methods Fifty-seven patients with suspected prostate cancer underwent DWI and T_2-weighted imaging (T_2W). These images and apparent diffusion coefficient (ADC) maps results were compared with histopathologic findings. Receiver operating characteristic(ROC) analysis was used to compare the cancer detection performance of them. The results were rated on a scale of scores Ⅰ (benign) to Ⅴ (malignant) on the basis of ADC maps. Abnormal voxels were overlaid on the corresponding transverse TRUS images and used to perform voxel-guided biopsy. Results DWI had a sensitivity of 85%, specificity of 82%, positive predictive value of 80%, negative predictive value of 86% , and accuracy of 83%. T2WI had a sensitivity of 77%, specificity of 71%, positive predictive value of 69%, negative predictive value of 79%, and accuracy of 74%. The areas under the ROC curves for DWI and T_2WI were 0. 830 and 0. 742, respectively. The performance of DWI in PCa detection was significantly better than of T_2WI (P<0. 05). 6 of 30 patients with negative DWI results also had negative biopsy findings. PCa was detected in 17(85%) of 24 men findings with voxel score Ⅳ , with a sensitivity of 100%, specificity of 46%, positive predictive value of 71 %, negative predictive value of 100% , and accuracy of 77%. Conclusions The performance of DWI in PCa detection was better than of T_2 WI. ADC maps can be transferred to TRUS images and used to sample regions of cancer in men with rising PSA levels and negative findings at prior biopsy with good accuracy. DWI appears to be a robust and reliable method to examine the whole prostate within an acceptable scan time in clinical settings.

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Transrectal ultrasound-guided transperineal cryosnrgical ablation for localized prostate cancer

Hongqian GUO ; Huibo LIAN ; Weidong GAN ; Xiaogong LI ; Xiang YAN ; Changwei JI ; Shiwei ZHANG ; Tieshi LIU ; Feng QU ; Ziyi CHEN

Chinese Journal of Urology.2009;30(12):827-830. doi:10.3760/cma.j.issn.1000-6702.2009.12.015

Objective To evaluate the safety and short-term efficacy of transrectal ultrasound-guided transperineal cryosurgical ablation(TRUSCSA) for localized prostate cancer. Methods The data of 26 patients who were diagnosed with clinically localized prostate cancer (T_(1a)N_0M_0 - T_(2x)N_0M_0) by biopsy were reviewed. The data of serum prostate-specific antigen (PSA) level, clinical stage and Gleason score were collected. The Gleason score of all cases was ≤7; among them 6 cases were 2 - 4 and 20 cases were 5 - 7. The average pretreatment value of PSA was 11. 9 ng/ml (4. 7 - 19. 2 ng/ml). All the patients were treated with TRUSCSA, with a dual freeze-thaw cycle by using ultrathin 17-gauge cryoneedles. Immediate and delayed morbidities were evaluated. The PSA level was obtained every 3 months for the first 2 years and then every 6 months thereafter, and failure was defined as the inability to reach a nadir of 0. 5 ng/ml or less. All patients were strongly encouraged to undergo routine biopsies despite a stable PSA level. Results The operative time was (102±32)min. The postoperative hospital stay was (6±2)d. After withdrawal of the catheter, 22 cases had good continence) 4 had temporary incontinence for 3 - 7 d. Before operation 9 cases had normal sex life, and among them 5 cases had erectile dysfunction after operation. No one developed urinary retention or urethro-rectal fistula. The follow-up ranged from 6 to 30 months (mean 22). The PSA level at the last follow up visit was less than 0. 5 ng/ml in 23 patients (88%) and 0. 5 ng/ml or more in 3(12%). Postoperative biopsies were taken in 20 cases and the results were negative at the 6th month. Conclusions Transrectal ultrasound-guided percutaneous cryosurgical ablation for clinically localized prostate cancer could be effective and safe. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.

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Relationship between delayed graft function and glutathione S-transferase polymorphisms

Ziqiang XU ; Jinjun WANG ; Xiaojie NI ; Bicheng CHEN ; Yirong YANG ; Shaoling ZHENG ; Jianjian ZHENG ; Yan CHEN

Chinese Journal of Urology.2009;30(12):816-819. doi:10.3760/cma.j.issn.1000-6702.2009.12.010

Objective To explore the factors related to the delayed graft function (DGF). Methods Clinical data of 150 recipients were collected and performed by Cox proportional hazards regression analysis . In addition, the glutathione S-transferase (GST) gene polymorphism of 172 donors and 157 healthy persons was analyzed by multiple PCR and SSP-PCR. Results DGF was observed in 24 patients among 150 recipients. Pretranplantation dialysis mode, PR A levels and recipient gender were uncorrelated with the incidence of DGF(P>0. 05). Urinary volume of the second 24 hours after transplantation was an independent predictor of DGF(RR=1. 002, P = 0. 001). The frequency of donor's null GSTM1 in DGF group was significantly higher than that in non-DGF group(P<0. 05). Conclusions Urinary volume of the second 24 hours after transplantation could be a predictor for DGF. The null GSTM1 in donor might be one of the factors related to the EGF.

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Risk factors of BK virus infection post renal transplantation

Yingxin FU ; Wenli SONG ; Chunbai MO ; Gang FENG ; Xuexi GUO ; Haiming ZHANG ; Zhenglu WANG ; Weiping ZHENG ; Hong ZHENG ; Zhongyang SHEN

Chinese Journal of Urology.2009;30(12):809-812. doi:10.3760/cma.j.issn.1000-6702.2009.12.007

Objective To analyze the risk factors of BKV infection and compare the real-time PCR procedure and urinary sediment smears of patients checked for decoy cells. Methods The peripheral blood samples of 129 renal recipients were collected. According to the result of PCR, 129 patients were divided into 2 groups:①BKV-DNA(+);②BKV-DNA(-). The sex, age, cold ischemia time, hemotodialysis duration, immunosuppressive agent and other clinical parameters were compared between the 2 groups and a Logistic regression was performed to analyze the risk factors of BKV infection. Results There were 20(15. 5%) patients in BKV-DNA(+), 109(84. 5%)patients in BKV-DNA(-)group. Logistic regression found that the cold ischemia time, hematodialysis duration, living donor were significantly related to the BKV-DNA. The results of the real-time PCR procedure and urinary sediment smears of patients checked for decoy cells were related. Conclusion Real-time fluorescent quantitative PCR and urine decoy cell are good way for detection of BKV infection after renal transplantation. The cold ischemia time and hematodialysis duration and brain death donor were the risk factors of BKV infection post renal transplantation.

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Screening and identification of renal cancer specific peptide from a phage displaypeptide library

Xiangan TU ; Linquan ZANG ; Liang ZHAO ; Liwen DENG ; Wenwei WANG ; Liangyun ZHAO ; Hui LIANG ; Lingyou ZENG ; Jingtao ZHUANG

Chinese Journal of Urology.2009;30(12):799-801. doi:10.3760/cma.j.issn.1000-6702.2009.12.002

Objective To screen and identify the novel markers for renal cell carcinoma. Methods The renal cancer A498 cell line was used as the antigen and human normal renal cell line HK-2 was used as control for subtraction biopanning from a phage display peptide library at 37 ℃ The positive and specific binding clones were identified by cell-based ELISA and immunocytochemical staining, and the identified clones were sequenced. Thus the amino acid sequence was deduced and the peptide was synthesized. The peptide was identified by immunofluorescence. Results Through a cell-based ELISA, immunocytochemical staining, and immunofluorescence, the Phage ZT-2 and synthetic peptide ZT-2 were shown to specially bind to the A498. The affinity binding to A498 was the highest (A_(ZT-2)/A_(control) = 3. 15) among the peptides assayed. The optical density of ZT-2 in renal cancer tissue (0. 453±0. 123) was significantly higher than that in normal and inflammatory renal tissue (0. 148±0. 075)(P<0. 01). Conclusions A peptide ZT-2 which is specific binding to renal cancer cell line A498 had been selected from phage display peptide libraries. Therefore, it provides a potential tool for early diagnosis of renal cancer or targeted drug delivery in chemotherapy.

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Fibroblast growth factor receptor 3 and p53 gene mutation in recurrent bladder cancer

Yi WANG ; Guang SUN ; Xiaoqiang LIU ; Zhanjun GUO ; Baomin QIAO ; Jiwu CHANG ; Shumin ZHANG ; Jin WANG ; Haitao NIU

Chinese Journal of Urology.2009;30(12):820-823. doi:10.3760/cma.j.issn.1000-6702.2009.12.012

Objective To study the gene mutation of fibroblast growth factor receptor 3 (FGFR3) and p53 in bladder cancer tissue and to explore their relationship with tumor recurrence. Methods DHPLC and PCR direct sequence were used to detect the mutation of FGFR3 and p53 in BTCC (n=98) and normal bladder mucosa (n=10). Genomic DNA of 98 BTCC was extracted. The exon 5-8 of P53 and the exon 7, 10, 15 were amplification by PCR. The products of PCR was screened by DHPLC to detect the mutation of the production. The results of the FGFR3 and p53 mutation were analyzed by Kaplan-Meier method and no recurrence survival rate was tested by log rank test. All the analysis were aim to explore the clinical biological value of the mutation of FGFR3 and p53. Results Mutation of FGFR3 in BTCC (44. 9%) was higher than normal bladder mucosa(0, P<0.01). Mutation in T_a-T_1 was 75. 6%(33/45) ,T_2 -T_4 was 26. 6%C10/53). Mutation in G_1 was84. 6%(11/13),inG_2 was 61. 4% (27/44), in G_3 was 14. 6% (6/41), (P<0. 05). The mutation rate was lower with the higher of stage and grade. Mutation of p53 in BTCC (34. 6%) was higher than normal bladder mucosa (0%) (P<0. 01). Mutation in T_a - T_1 was 20. 0% (9/45), T_2 - T_4 was 47. 2%(25/53). Mutation in G_1 was G_1 7. 7%(1/13), in G_2 18. 2%(8/44),in G_3 58. 1%(25/41) , (P<0. 05). The mutation rate was higher in the higher stage and grade. Kaplan-Meier method results revealed that mutation of FGFR3 indicating a favorable prognosis while mutation of p53 indicating a poor prognosis. As to the analysis of genotype, the type of FGFR3mut/p53wt had a relative longer recurrent interval (P<0. 01). Conclusions Mutation of FGFR3 indicated a relative longer recurrent interval, which revealed a favorable prognosis of BTCC. Mutation of p53 indicated a relative shorter recurrent interval, which revealed a poor prognosis.

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Expression of potential molecular markers in prostate cancer: correlation with progression in patients after endocrine therapy

Yangbo GUAN ; Yifen ZHANG ; Hang WEN ; Qiang ZHOU ; Hongyan WU ; Yutian DAI

Chinese Journal of Urology.2009;30(12):848-851. doi:10.3760/cma.j.issn.1000-6702.2009.12.023

Objective To evaluate the expression of molecular markers in prostate cancer and to clarify the significance of these markers as prognostic indicators for androgen deprivation therapy. Methods A series of 116 prostate cancer patients under androgen deprivation therapy as a single treatment was reviewed. Expression levels of 7 proteins, including androgen receptor(AR),E-cadherin, Chromogranin A(CgA) , Ki-67, Survivin, EZH2 and hepsin, were measured by immunohistochemical staining. Results Of the 7 molecules. Ki67,EZH2 and Survivin expression were significantly associated with several conventional prognostic factors. Univariate analysis identified clinical stage, Glea-son scores,pretreatment serum PSA level, Ki-67 and Survivin expression as significant predictors for prostate-specific antigen (PSA) progression after endocrine therapy. Of these significant factors, Survivin expression, clinical stage and Gleason scores appeared to be independently related to PSA progression after endocrine therapy by multivariate analysis. Furthermore, there were significant differences in PSA progression-free survival according to positive numbers of these three independent risk factors. Conclusion Survivin could be a useful independent prognostic factor in prostate cancer with endocrine therapy, besides clinical stage and Gleason score.

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Analysis of hormonal therapy for advanced metastatic prostate cancer

Chunguang MA ; Dingwei YE ; Xudong YAO ; Shilin ZHANG ; Bo DAI ; Hailiang ZHANG ; Yao ZHU ; Yijun SHEN ; Yiping ZHU ; Guohai SHI ; Xiaojian QIN ; Guowen LIN ; Lifeng YANG ; Boshuai YANG ; Wenjun XIAO

Chinese Journal of Urology.2009;30(12):831-833. doi:10.3760/cma.j.issn.1000-6702.2009.12.017

Objective To find the predictive factors that related to the effect of hormonal therapy and the survival of advanced metastatic prostate cancer. Methods Three hundred and Sixty-four cases of metastatic prostate cancer were treated with hormonal therapy in Cancer Hospital Fudan University in Shanghai from December 1996 to March 2008. The patients were followed up to the 31 March 2008 and the median follow-up time was 24 months. Two hundred and fifty cases have progressed into the stage of hormonal independent. The statistic software used in this study was SPSS 15. 0. Cumulative survival was analyzed by Kaplan-Meier method. Cox regression was used for univa-riate and multivariate analysis. Log-rank method was used for the significance test. The statistical difference was accepted when the P-value was lower than 0. 05. Results The effective rate of hormonal therapy for advanced metastatic prostate cancer was 98%. The median time of progression free survival of hormonal therapy was 20 months, and the one-year, two-year, three-year progression free survival rate was 69%, 39%, 27%, respectively. The survival analysis indicated that baseline PSA level more than 20ng/ml, with visceral organ metastasis, the PSA nadir more than Ing/ml during hormonal therapy, the time from the start of hormonal therapy to the PSA nadir less than 5 months were poor prognostic factors of progression free survival. Conclusions The baseline PSA level, clinicalstage, the PSA nadir during hormonal therapy and the time form the start of hormonal therapy to the PSA nadir could be the factors that predict the progression free survival time during hormonal therapy.

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Blood lipid level changed by immunosuppressive drugs in renal transplantation recipients

Zhangxin ZENG ; Xinxiang YUAN ; Qinghua WANG ; Ying WANG ; Minying TANG ; Lin WU ; Jianming TAN

Chinese Journal of Urology.2009;30(12):813-815. doi:10.3760/cma.j.issn.1000-6702.2009.12.009

Objective To compare the effects on blood lipid level by immunosuppressive drugs in renal transplantation recipients. Methods Two hundred and eighty-three renal allograft recipients with tacrolimus(FK506), cyclosporine A(CsA) and rapamycin (SRL) immunosuppressive regimen were reviewed in this study. The variation of whose total cholesterol(TC) and triglyceride(TG) concentration in serum were compared before and after three immunosuppressive regimen. Results There was no significant difference in TC and TG before and after oral FK506 for 93 patients[(4.9± 1. 1) and (1. 4±0. 8)mmol/L vs (4. 9±1.1) and (1.4±1.0)mmol/L, respectively, P>0. 05]. The concentration of TC and TG from 106 patients with CsA[(4. 8±1. 0) and (1. 6±0. 8)mmol/L vs (6. 6±1. 7) and (3. 2±1. 0)mmol/L, respectively] and 29 patients with SRL was higher than those before taking drugs, P<0. 05. The concentration was increased after 12 to 24 weeks generally. The concentration of TC and TG of CsA from FK506 to tacrolimus for 51 patients[(6. 7±1. 1) and (2. 8± 1. 0)mmol/L vs (4. 7±1. 7) and (1. 5±1. l)mmol/L, respectively] were decreased after 12 weeks (P<0. 01). Conclusions Primary factor of dyslipidemia was that CsA and SRL were used for patients post-renal transplantation, which should be regarded. The FK506-based immunosuppressive regimen should be recomended in renal transplantation patients who have a hyperlipidmia.

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Analysis of the safety of elderly living related kidney donors

Fengfu GUO ; Zhiqiang SHAO ; Wenyan YANG ; Guangjian WANG ; Shanfeng TAN ; Xiangfei HE ; Jianming WANG ; Hongjun LIU ; Fuguang SUN

Chinese Journal of Urology.2009;30(12):805-808. doi:10.3760/cma.j.issn.1000-6702.2009.12.005

Objective To explore the safety of the elderly donors in living related donor kidney transplantation. Methods Forty-five elderly donors (51 - 78 years,study group) who underwent ne-phrectomy for living related donor kidney transplantation from April 1993 to December 2007 were retrospectively investigated. Clinical data including serum creatinine (SCr), glomerular filtration rate (GFR) in pre-and post-operation, operation complications and hospital stay time were analyzed and compared with the control group(62 cases, the donors age were younger than 50 years). Results The operations of all living donors were successful. The SCr and GFR in pre-operation were (82.16 ± 10.86)μmol/L, (85. 82±6.26)ml/min(study group)and (78. 66±10. 41)μmol/L, (88. 74±9. 44) ml/min (control group) respectively. There were no significant differences in SCr and GFR between the groups at different time points (P>0. 05). The average hospitalization time was 9 days in study group and 8 days in control group. There were no severe perioperative complications and no renal function failure was found in long-term following-up in study group. Conclusions Age is not the absolute contraindication of donor for living related donor kidney transplantation. The preoperative evaluation and careful operation can ensure the safety of elderly donors.

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