Objective:To compare the outcomes of low-dose-rate prostate brachytherapy (BT) and radical prostatectomy (RP) in patients with T 1c-T 3a prostate cancer. Methods:A group of 745 patients with T 1c-T 3a prostate cancer between January 2010 and August 2017 at Peking Union Medical College Hospital were identified. The records of these patients, who were followed up for a minimum of 2 years, were reviewed. 384 cases received BT. Their characters included age(72.1±6.6), tPSA (12.4±6.1) ng/ml, prostate volume (33.6±13.8) ml, Gleason grade group (2.0±1.2). In this group, T 1c-T 2a stage was diagnosed in 189 cases, T 2b-T 2c stage in 182 cases and T 3a stage in 13 cases.361 cases received RP. Their characters included age(65.7±6.2), tPSA(12.6±6.4) ng/ml, prostate volume (37.2±17.8) ml, Gleason grade group (1.9±1.2). In this group, T 1c-T 2a stage was diagnosed in 177 cases, T 2b-T 2c stage in 170 cases and T 3a stage in 14 cases.The log-rank test compared survival rates between the two modalities, and Cox regression identified factors associated with bRFS. Results:Median follow-up was 60 months. Kaplan-Meier analysis did not show any statistically significant differences in terms of cRFS( P=0.321), cancer specific survival (CSS, P=0.643) and overall survival (OS, P=0.565) rate between the two groups. BT was associated with improved bRFS compared to RP( P=0.018). Risk of biochemical recurrence was significantly lower with BT compared with RP in the patients with a biopsy Gleason grade group 2 and 3 ( P=0.008), or prostate volume ≤35 ml ( P=0.027), or tPSA ≤10 ng/ml ( P=0.013), or the clinical T stages of T 2b and T 2C( P=0.031), or in the intermediate-risk group according to NCCN risk classification ( P=0.003). On multivariate analysis of all 745 patients, age≤ 70 and T stage≥T 2b was associated with significantly shorter bRFS. Conclusions:BT produced equivalent cRFS, CSS and OS compared to RP, while it was associated with improved bRFS. BT On multivariate analysis of all 745 patients, age≤ 70 and T stage≥T 2b was associated with significantly lower bRFS.

Objective To evaluate the diagnostic value of template-guided transperineal prostate biopsy (TTPB) by comparing biopsy-derived pathological results with findings from radical prostatectomy (RP) specimens.Methods From April 2013 to December 2015,patients who were diagnosed prostate cancer by transperineal template-guided 11-region prostate biopsy were enrolled in our study,and underwent laparoscopic RP.All whole-mount slices were reconstructed via a three-dimensional prostate model.Pathological features of the biopsy and RP specimens were compared.Detection rate of index lesions,overall sensitivity and specificity of TTPB,Gleason scores (GSs) in comparisons of biopsy and RP specimens were analyzed.Results One hundred and three patients were enrolled in our study,and the mean age was (65 ± 6)years.The median serum PSA was 11.7 ng/ml(IQR 7.2-19.1 ng/ml).The Gleason score ranged from 6 to 9.The clinical stage was T1c-T3a and the median prostate volume was 33.0 ml(IQR 26.0-43.0 ml).Eighty-nine of the 103 index lesions (86.4％) were detected by biopsy.The median volume was 1.2 ml (IQR 0.5-3.3 ml) and the mean maximum tumor length was (0.6 ± 0.4)cm.The overall sensitivity and specificity of the transperineal prostate biopsies were 53.3％ and 94.2％,respectively.RP-derived GSs were unchanged,upgraded and downgraded relative to the corresponding biopsy-derived GSs in 75 (72.8％),24 (23.3％) and 4 (3.9％) patients,respectively.Conclusions Stematic transperineal template-guided prostate biopsy could detect most of the index lesions.This biopsy approach was less able to determine tumour focal positioning and could only serve as a reference for guiding focal therapy.

Objective To evaluate the outcomes and complications of permanent brachytherapy combined with external beam radiotherapy and hormonal therapy for local high-risk or intermediated-risk prostate cancer.Methods There were 354 men with local high-risk or intermediated-risk prostate cancer were reviewed,including 111 men with local intermediated-risk prostate cancer and 243 men with local highrisk prostate cancer.The age of the patients were 48 to 84 years old (mean age 72.4 years old).The preoperative PSA levels were in a range of 3.8 to 99.8ng/ml (mean 29.6 g/ml) and the preoperative Gleason scores were 4 to 9 (mean 6.8).The prostate volume were 13.7 to 65.0 ml (mean 30.5 ml).All the patients were treated with brachytherapy combined with hormonal therapy,including 69 patients received additional external beam radiotherapy.All patients were followed up for biochemical progression-free survival (bPFS),distant disease free survival (DDFS),overall survival (OS),cause-specific survival (CSS) rate and complications.Results Among 354 cases,174 cases underwent brachytherapy after the diagnosis of prostate cancer,and 157 cases underwent brachytherapy after maximal androgen blockade (MAB) treatmentfor 3 months,while the other 23 patients with large prostate underwent brachytherapy after MAB treatment for 6 months.All 354 cases were treated with MAB after brachytherapy.One hundred and eleven cases in intermediated-risk group were treated with MAB for 6 months and 243 cases in high-risk group were treated with MAB for 6 months to 3 years.Another 69 patients received adjuvant external radiotherapy.All cases were followed up for 9 to 128 months (mean 91 months),including 135 cases having biochemical recurrence,and 63 cases having distant metastasis.There were 81 cases died,including 24 cases died of prostate cancer.The overall bPFS,DDFS,OS and CSS were 61.9％,82.2％,77.1％ and 93.2％ respectively.There were significant difference in the survival rate between the high-risk group and the intermediated-risk group(P ＜ 0.001).The incidence of urinary retention and long term urethral stricture were 6.8％ and 1.7％,respectively.No serious complications occurred.Conclusion Permanent brachytherapy combined with external beam radiotherapy and hormonal therapy treating local high-risk or intermediated-risk prostate cancer can be effective with few complications.

Objective To develop a practical image acquisition strategy using intermittent breath?hold cone beam computed tomography (CBCT). Methods A breathing phantom was used to simulate the movement of tumor near the diaphragm during free breathing and breath hold and scanned by conventional breath?hold CBCT and type Ⅰ/Ⅱ intermittent breath?hold CBCT. In the conventional breath?hold CBCT, scan paused and free breathing occurred at the break of breath hold and free breathing was not included in the scan. In the intermittent breath?hold CBCT, one scan covered several breath holds separated by free breathing in a ratio of 3 vs1. Image quality and three?dimensional registration accuracy were quantitatively compared between conventional breath?hold CBCT and type Ⅰ/Ⅱ intermittent breath?hold CBCT. Comparison of image quality parameters between conventional breath?hold CBCT and intermittent breath?hold CBCT was made by paired t test. Results Motion artifacts arose in type I and Ⅱ intermittent breath?hold CBCT scans. There were no significant differences in the reconstructed pixel value or uniformity between intermittent breath?hold CBCT and conventional breath?hold CBCT ( P>0. 05, and P= 0. 02, 0. 53 ) . Compared with conventional breath?hold CBCT images, the signal?to?noise ratios of type I andⅡintermittent breath?hold CBCT images were reduced by 30% and 60%, respectively ( P<0. 05 ) . The registration error was up to 0 . 4 cm in the anterior?posterior direction and less than 0 . 1 cm in other directions . Conclusions The phantom study shows that intermittent breath?hold CBCT does not significantly reduce image quality or registration accuracy compared with conventional breath?hold CBCT. The feasibility of intermittent breath?hold CBCT in clinical application needs to be further validated among a large number of patients.

Objective To assess the long-term outcome of unilateral adrenaletomy in patients with adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The data from 82 cases of AIMAH were reviewed and summarized including clinical manifestations, endocrinological data, imaging findings and postoperative follow-up.Fouty-nine males and thirty-three females with a mean age of fifty years composed our series.Among the 82 cases, 41 demonstrated Cushing syndrome (CS), 74 presented with hypertension, 38 manifested diabetes mellitus, 35 complicated of osteoporosis and 11 of them with bone fracture, 39 complained of edema.Laboratory tests showed low ACTH plasma levels (＜ 2.2 pmol/L) in 62 of 79 cases.High level of 24-hour urinay free cortisol excretion(＞ 284.2nmol/L) was found in 67 of 79 cases.Elevated serum cortisol with loss of the circadian rhythm was presented in 55 of 60 cases.Failed to suppress cortisol secretion was observed in 61 of 63 conducted with low-dose dexamethasone suppression tests and in 47 of 53 implemented with high-dose dexamethasone suppression tests.Bilateral massively enlarged multinodular adrenal glands were found in all cases with CT or MR imaging.Unilateral adrenalectomy was performed in the larger side of adrenal gland in all 82 cases.All adrenalectomies were carried out including 47 in right sides and 35 in left sides, with 77 by retroperitoneoscopic approach and 5 by open retroperitoneal approach.Results Histopathological examination confirmed nodular hyperplasia of the adrenal cortex for all specimens.After a mean duration of 48.5 months, 80 of 82 patients were available for follow-up.Most clinical symptoms resolved within 6 months after operation.Cushingoid features disappeared in 58.5％ (24/41)of patients who initially presented with typical signs of Cushing Syndrome.Weight loss was seen in 56.3％ (45/80).Improvement of hypertension and diabetes was observed in 63.5％ (47/74) and 76.3％ (29/38) respectively.All the eyelids swelling and edema of the limbs subsided within 3 months.In long-term follow-up (more than 6 months), 82.9％ (63/76) had clinical and biochemical recurrence within a mean time of 14.6 months and 46.0％ (29/63) received contralateral adrenal surgery.Two patients died, one died from heart attack and another one died from pulmonary infection, 2 years and 7 years after unilateral adrenalectomy, respectively.Conclusions Unilateral adrenalectomy just has transient efficiency for AIMAH.Most patients will experience clinical and biochemical recurrence for a long period,and have to receive another operation for the contralateral hyperplastic adrenal gland.

In these recent over twenty years, transrectal prostate biopsy takes predominant place in diagnosing prostate cancer for its relatively convenient procedure and low cost. In contrast, transperineal biopsy approach is much less popular. However, transrectal prostate biopsy has disadvantages of"blind region"in the anterior apex regions of the prostate gland and relatively high risk of biopsy associated sepsis. The transperineal biopsy approach is again gaining attention and even becoming a mainstream approach. The advantages of transperineal prostate biopsy are the following: a high positive rate, particularly in the detection of tumors at the anterior or apical prostate; accurate assessment of the volume and Gleason score of prostate cancer; the possibility of providing information about the spatial distribution of the cancer; good consistency of pathology with radical resection; and a lower infection rate, making it suitable for patients with a high infection risks. The expansion of transperineal biopsy has been propagated by the increase in multiparametric MRI-guided biopsies, which often use the transperineal approach.
Biopsy ; methods ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasm Grading ; Prostatic Neoplasms ; diagnosis

Prostate cancer is currently diagnosed by prostate biopsy performed by the transrectal ultrasound-guided technique.However,overdetection of clinical insignificant tumours and missed detection of clinical significant tumours have become problematic.MRI of the prostate,particularly if performed with multiparametric imaging,is capable of detecting clinical significant prostate cancer,which has brought the opportunity to use those images as targets for needle biopsy.Three methods of fusing MRI for targeted biopsy have been recently described:MRI-ultrasound fusion,MRI-MRI fusion ('in-bore' biopsy) and cognitive fusion.Fusion of MRI with ultrasound allows urologists to progress from blind,systematic biopsies to biopsies,which are mapped,targeted and tracked.In the future,MRI-ultrasound fusion for lesion targeting is likely to result in fewer and more accurate prostate biopsies than the present use of systematic biopsies with ultrasound guidance alone.

Prostate cancer is currently diagnosed by prostate biopsy performed by the transrectal ultrasound-guided technique.However,overdetection of clinical insignificant tumours and missed detection of clinical significant tumours have become problematic.MRI of the prostate,particularly if performed with multiparametric imaging,is capable of detecting clinical significant prostate cancer,which has brought the opportunity to use those images as targets for needle biopsy.Three methods of fusing MRI for targeted biopsy have been recently described:MRI-ultrasound fusion,MRI-MRI fusion ('in-bore' biopsy) and cognitive fusion.Fusion of MRI with ultrasound allows urologists to progress from blind,systematic biopsies to biopsies,which are mapped,targeted and tracked.In the future,MRI-ultrasound fusion for lesion targeting is likely to result in fewer and more accurate prostate biopsies than the present use of systematic biopsies with ultrasound guidance alone.

OBJECTIVETo assess the clinical features of transperineal prostate biopsy in patients age ≤50 years.

METHODSThe clinical data of 124 patients ≤ 50 years old were retrieved retrospectively in Peking Union Medical College Hospital between January 2005 and September 2014. The age of patients were 14 to 50 years (mean age 43.6 years), and their prostatic specific antigen(PSA) levels were fluctuated in a range of 0.01 to 579.00 µg/L (mean 15.5 µg/L). Twenty patients were abnormal in digital rectal examination (DRE). All the patients were underwent transperineal prostate biopsy using an 11-region template.

RESULTSProstate cancer was detected in 14 of 124 patients (11.3%). The prostate cancer detection rates in groups with PSA 0-4.0, >4.0-10.0, >10.0-20.0, >20.0-50.0, and >50.0 µg/L were 0, 6.2% (4/65), 13.3% (4/30), 1/5, and 5/5, respectively. Non-adenocarcinoma prostate malignancy (NAPM) was detected in 7 of 124 patients (5.6%), and their PSA levels were fluctuated in a range of 0 to 4.0 µg/L. Four patients were abnormal in DRE and 5 patients were abnormal in radiological examination.

CONCLUSIONThe positive rate of transperineal prostate biopsy in patients age≤50 years is low, and rigorous screening before prostate biopsy is necessary. The men with DRE or radiological abnormalities but normal PSA should be wary of NAPM.

Adolescent ; Adult ; Beijing ; Biopsy ; methods ; Early Detection of Cancer ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis ; Young Adult

OBJECTIVETo evaluate the outcomes of permanent brachytherapy combined with maximal androgen blockade (MAB) in local intermediated-risk prostate cancer.

METHODSFrom December 2003 to December 2009, 307 patients of local prostate cancer were treated with brachytherapy, 98 cases of intermediated-risk were followed-up for 5 years and data were recorded, aged from 58 to 84 years, average 74 years. Serum PSA was 0.4-19.0 µg/L, average 11.2 µg/L, clinical TNM stage was T1cN0M0-T2bN0M0. Gleason score 4-7, 6.7 in average. Prostate volume ranged from 14 to 65 ml, average 32.1 ml. All the 98 patients underwent permanent brachytherapy combined with MAB. Biochemical recurrence rate, biochemical-free survival, tumor-specific survival, overall survival, salvage therapy and complications were analyzed.

RESULTSFollowed up for 5 years, 19 cases had biochemical recurrence, median recurrence period: 36 months. One patient died of prostate cancer 45 months after brachytherapy of all 7 patients died in 5 years. Five-years biochemical-free recurrence rate: 80.6%, overall survival: 92.9%, tumor-specific survival: 98.9%, biochemical-free survival: 79.3%. Low-urinary tract and rectal irritation symptoms occurred in 75 cases(76.5%). Urinary retention occurred in 7 cases (7.1%) with catheterization duration less than 1 week, no surgical operation were performed. Seeds immigration to lung in 2 cases. No serious complications occurred.

CONCLUSIONIn local intermediated-risk prostate cancer patients, permanent brachytherapy combined with short-term MAB can be an effective treatment with few complications.

Aged ; Aged, 80 and over ; Androgen Antagonists ; therapeutic use ; Brachytherapy ; Combined Modality Therapy ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; drug therapy ; radiotherapy ; Treatment Outcome