Radical cystectomy(RC)with pelvic lymph node dissection remains the standardized surgical approach for patients with muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. Urinary diversion is a crucial step following cystectomy. With the advent of laparoscopic and robotic-assisted surgical techniques, laparoscopic or robotassisted radical cystectomy combined with intracorporeal urinary diversion has become widely adopted in numerous domestic and international medical centers, yielding promising clinical outcomes. This article elaborates on the following three aspects. In terms of complications, gastrointestinal-related complications are the most prevalent among early postoperative complications, which vary with different surgical approaches, while enhanced recovery after surgery(ERAS)protocols can effectively reduce certain complications and facilitate early recovery. Nevertheless, late complications such as uretero-enteric anastomotic strictures remain a concern that requires attention. Functional outcomes demonstrate that orthotopic neobladder reconstruction can achieve satisfactory continence rate and preservation of sexual function. Additionally, various innovative surgical techniques have further optimized functional results. Oncological outcomes indicate that laparoscopic or robot-assisted radical cystectomy combined with intracorporeal urinary diversion constitutes a safe and reliable surgical strategy. Moreover, achieving the “RC Pentafecta” is likely to confer benefits on patient prognosis.

Objective:To assess the predictive value of the percentage of Gleason pattern 4 (G4%) in prostate biopsy for adverse pathology and biochemical recurrence.Methods:We retrospectively analyzed consecutive patients who underwent radical prostatectomy in our institution between January 2019 and December 2023, and included those who were diagnosed with ISUP 2-3 cancer at biopsy. A total of 109 patients were included in this study. The average age of patients was (67.40±6.11) years, and the average BMI of patients was (25.36±2.97) kg/m 2. 49 Cases (45.0%) had a PI-RADS score of 5, and the median prostate volume was 32.60 (24.57, 45.63) ml. The median of most recent tPSA before biopsy was 9.76 (6.89, 12.95) ng/ml, the median PSAD was 0.28 (0.17, 0.44) ng/ml 2, and the median f/tPSA was 0.11 (0.08, 0.16). Clinical T 2b or higher stage was found in 84 cases (77.1%). The total biopsy core length was (22.91±5.18) cm, with a median of 24 (20, 24) biopsy cores and a median of 6 (4, 9) positive cores. Gleason score 3+ 4 was found in 52 cases (47.7%), and Gleason score 4+ 3 in 57 cases (52.3%). Cribriform was present in 30 cases (27.5%). G4% was calculated based on the proportion of Gleason grade 4 tumor relative to total tumor, tumor proportion relative to total tissue, and tissue length. Patients were divided into high-G4% (≥2.45%) and low-G4% (<2.45%) groups based on the median G4% value, with 55 and 54 cases, respectively. No significant differences were observed in baseline characteristics between the two groups ( P>0.05). The main risk factor of adverse pathology was analyzed by logistic regression, and receiver operating characteristic (ROC) curve and area under curve (AUC) were performed. Patients were further stratified by the G4% cutoff value from ROC, and Kaplan-Meier survival curves were plotted to compare biochemical recurrence free survival (BCRFS) between groups. The main risk factor affecting BCRFS was analyzed by Cox regression. Adverse pathology was defined as postoperative Gleason score ≥4+ 3 or pathological stage ≥T 3a. Results:Adverse pathology occurred in 44 (80.0%) high-G4% and 16 (29.6%) low-G4% patients ( P<0.01). Multivariate analysis identified G4% as an independent risk factor for adverse pathology ( OR=1.23, 95% CI 1.02-1.50, P=0.033). The highest ROC AUC value was seen for G4% (0.799), significantly outperforming Gleason score (0.799 vs. 0.641, P=0.003), tPSA (0.799 vs. 0.615, P=0.003), PSAD (0.799 vs. 0.679, P=0.038), positive cores (0.799 vs. 0.677, P=0.009), clinical T stage (0.799 vs. 0.607, P=0.001) and cribriform (0.799 vs. 0.639, P=0.001). The G4% cutoff value for predicting biochemical recurrence was 10.97%. The median BCRFS was significantly higher in the low G4% (<10.97%) group than that in the high G4% (≥10.97%) group (55 vs. 28 months, P=0.002). Cumulative recurrence free survival rates at 1 and 3 years were 94.6% vs. 74.1% and 78.0% vs. 47.6%, respectively. Multivariate Cox regression analysis indicates that G4% was an independent risk factor affecting BCRFS ( HR=1.11, 95% CI 1.00-1.23, P=0.041). Conclusions:For patients with ISUP 2-3 nmPCa, a higher G4% in biopsy specimens demonstrates strong predictive ability for adverse pathology and biochemical recurrence, outperforming traditional clinical indicators such as Gleason score and PSA.

Objective To develop a Nomogram clinical prediction model for the pathological occurrence of extraprostatic extension(EPE)after radical prostatectomy in prostate cancer patients,using simplified site-specific magnetic resonance imaging(MRI)indicators and other clinical parameters.Methods A total of 181 prostate cancer patients[mean age(69.0±7.3)years]who underwent radical prostatectomy were included.These patients had received 3-Tesla multi-parametric magnetic resonance imaging(3-T mpMRI)within 6 months prior to surgery.Based on mpMRI measurements[capsular contact length(CCL)>15 mm,capsular bulging/irregularities,diameter of index lesion(dIL),and evident extraprostatic extension(eEPE)],the dIL?sEPE grading system was derived.The optimal cut-off value of dIL(denoted as dIL)was determined using the Youden J index,and categorized it into a binary variable.A Logistic regression model was established based on the dIL?sEPE grading and clinical scores.The predictive performance of clinical indicators,MRI indicators,and combined clinical and MRI indicators were compared.Finally,a clinical prediction model integrating both clinical and MRI data was developed.Results Pathological EPE was found in 46 out of 181 cases(25.4% ).A Nomogram prediction model for EPE was established with a combination of the dIL?sEPE grading and clinical indicators.Conclusion The combination of dIL?sEPE grading with clinical indicators accurately predicts extracapsular extension in prostate cancer.The Nomogram model that established,based on MRI imaging characteristics and clinical indicators has good performance and is easy to use.It is beneficial to stratifying management for prostate cancer patients,and it provides valuable guidance for patients suitable for nerve-sparing surgery.

Both the androgen receptor pathway and PI3K/AKT pathway play pivotal roles in the progression of prostate cancer.There are intricate interactions between these two pathways,showing a negative regulatory relationship of mutual restriction between them.In view of the above,a combined inhibition strategy targeting these two pathways is expected to become a significant therapeutic approach for prostate cancer.This article aims to comprehensively review the molecular mechanisms underlying the interactions between the androgen receptor and PI3K/AKT pathways,to provide new perspectives and insights for research in the fields.

Objective To explore the correlation between chronic diseases and the risk of benign prostatic hyperplasia(BPH)in middle-aged and older Chinese man.Methods Data from the 2013 China Health and Retirement Longitudinal Study(CHARLS)were used,including 4 509 male participants aged 45 years and older.Chronic diseases and BPH diagnoses were obtained through a questionnaire survey.Logistic regression analysis was performed to identify independent risk factors for BPH.Restricted cubic splines(RCS)were used to explore the nonlinear relationship between variables and BPH prevalence,while stratified analyses were conducted to assess the differential impact of chronic diseases on BPH prevalence in different subgroups.Results Compared to patients without BPH,those with BPH had a significantly higher prevalence of comorbid chronic diseases,including hypertension,diabetes,chronic respiratory diseases,chronic heart disease,stroke,chronic kidney disease,chronic digestive diseases,arthritis or rheumatism,depression,and memory-related disorders.Multivariable Logistic regression analysis indicated that factors such as the 10-item Center for Epidemiological Studies Depression Scale(CESD-10)scores(OR=1.043,95% CI:1.022-1.063,P<0.001),chronic respiratory disease(OR=1.518,95% CI:1.143-1.998,P=0.003),chronic heart disease(OR=1.515,95% CI:1.143-1.998,P=0.003),chronic kidney disease(OR=2.384,95% CI:1.799-3.137,P<0.001),and chronic digestive disease(OR=1.427,95% CI:1.129-1.796,P=0.003)were independently associated with the occurrence of BPH.RCS analysis demonstrated no non-linear association between age,BMI,and CESD-10 scores and BPH.Stratified analysis revealed that the influence of these chronic conditions on BPH remained constantly stable across different subgroups.Conclusion BPH is commonly comorbid with various chronic diseases.Future treatment strategies for BPH should consider the shared pathological mechanisms between BPH and these chronic conditions,with a focus on integrated interventions targeting common pathways.

Objective To explore the effects of visceral fat thickness on the operation time,intraoperative bleeding,postoperative recovery and complications of open surgery,laparoscopic surgery and robot-assisted laparoscopic total cystectomy with ileal conduit(Bricker surgery).Methods The clinical data of 373 patients with bladder malignancy undergoing Bricker surgery in Beijing Friendship Hospital and Shanghai Renji Hospital during Jan.2015 and Jul.2025 were retrospectively analyzed.The patients were divided into three groups based on the surgical approaches:open surgery group(n=120),laparoscopic surgery group(n=139),and robot-assisted laparoscopic surgery group(RLS group,n=114).The patients were further divided into group A(with visceral fat thickness＜5.06 cm)and group B(with visceral fat thickness ≥ 5.06 cm)based on preoperation CT results.The parameters were statistically analyzed and collected,including age,gender,underlying diseases,operation time,intraoperative blood loss,blood transfusion,postoperative exhaustion time,hospital stay and postoperative complications.Results In patients undergoing open surgery and Bricker surgery,the operative time for group B was(264.00±68.11)min and(310.06±42.81)min,respectively,longer than that of group A.The intraoperative blood loss was(482.46±192.84)mL and(392.54±147.00)mL,respectively,also more than that of group A(P＜0.05).The incidence of severe complications such as postoperative wound infection,urinary fistula,and bleeding in group B was 22.8％and 16.4％,respectively,significantly higher than that of group A(P＜0.05).In the open surgery group,although the postoperative recovery time of gastrointestinal function of group B was similar to that of group A,the average postoperative hospital stay was(22.91±13.09)d,which was significantly longer than that of group A[(18.95±4.42)d,P＜0.05].For group B,RLS could significantly reduce the intraoperative blood loss compared to open surgery and traditional laparoscopic surgery,lower the incidence of severe complications,and shorten the hospital stay.Conclusion For patients with bladder cancer who are scheduled for Bricker surgery,if preoperative CT reveals thick visceral fat,RLS should be considered.This approach can effectively reduce the surgical difficulty and incidence of severe postoperative complications,and accelerate the postoperative recovery.

Objective To explore the effects of visceral fat thickness on the operation time,intraoperative bleeding,postoperative recovery and complications of open surgery,laparoscopic surgery and robot-assisted laparoscopic total cystectomy with ileal conduit(Bricker surgery).Methods The clinical data of 373 patients with bladder malignancy undergoing Bricker surgery in Beijing Friendship Hospital and Shanghai Renji Hospital during Jan.2015 and Jul.2025 were retrospectively analyzed.The patients were divided into three groups based on the surgical approaches:open surgery group(n=120),laparoscopic surgery group(n=139),and robot-assisted laparoscopic surgery group(RLS group,n=114).The patients were further divided into group A(with visceral fat thickness＜5.06 cm)and group B(with visceral fat thickness ≥ 5.06 cm)based on preoperation CT results.The parameters were statistically analyzed and collected,including age,gender,underlying diseases,operation time,intraoperative blood loss,blood transfusion,postoperative exhaustion time,hospital stay and postoperative complications.Results In patients undergoing open surgery and Bricker surgery,the operative time for group B was(264.00±68.11)min and(310.06±42.81)min,respectively,longer than that of group A.The intraoperative blood loss was(482.46±192.84)mL and(392.54±147.00)mL,respectively,also more than that of group A(P＜0.05).The incidence of severe complications such as postoperative wound infection,urinary fistula,and bleeding in group B was 22.8％and 16.4％,respectively,significantly higher than that of group A(P＜0.05).In the open surgery group,although the postoperative recovery time of gastrointestinal function of group B was similar to that of group A,the average postoperative hospital stay was(22.91±13.09)d,which was significantly longer than that of group A[(18.95±4.42)d,P＜0.05].For group B,RLS could significantly reduce the intraoperative blood loss compared to open surgery and traditional laparoscopic surgery,lower the incidence of severe complications,and shorten the hospital stay.Conclusion For patients with bladder cancer who are scheduled for Bricker surgery,if preoperative CT reveals thick visceral fat,RLS should be considered.This approach can effectively reduce the surgical difficulty and incidence of severe postoperative complications,and accelerate the postoperative recovery.

Objective To develop a Nomogram clinical prediction model for the pathological occurrence of extraprostatic extension(EPE)after radical prostatectomy in prostate cancer patients,using simplified site-specific magnetic resonance imaging(MRI)indicators and other clinical parameters.Methods A total of 181 prostate cancer patients[mean age(69.0±7.3)years]who underwent radical prostatectomy were included.These patients had received 3-Tesla multi-parametric magnetic resonance imaging(3-T mpMRI)within 6 months prior to surgery.Based on mpMRI measurements[capsular contact length(CCL)>15 mm,capsular bulging/irregularities,diameter of index lesion(dIL),and evident extraprostatic extension(eEPE)],the dIL?sEPE grading system was derived.The optimal cut-off value of dIL(denoted as dIL)was determined using the Youden J index,and categorized it into a binary variable.A Logistic regression model was established based on the dIL?sEPE grading and clinical scores.The predictive performance of clinical indicators,MRI indicators,and combined clinical and MRI indicators were compared.Finally,a clinical prediction model integrating both clinical and MRI data was developed.Results Pathological EPE was found in 46 out of 181 cases(25.4% ).A Nomogram prediction model for EPE was established with a combination of the dIL?sEPE grading and clinical indicators.Conclusion The combination of dIL?sEPE grading with clinical indicators accurately predicts extracapsular extension in prostate cancer.The Nomogram model that established,based on MRI imaging characteristics and clinical indicators has good performance and is easy to use.It is beneficial to stratifying management for prostate cancer patients,and it provides valuable guidance for patients suitable for nerve-sparing surgery.

Both the androgen receptor pathway and PI3K/AKT pathway play pivotal roles in the progression of prostate cancer.There are intricate interactions between these two pathways,showing a negative regulatory relationship of mutual restriction between them.In view of the above,a combined inhibition strategy targeting these two pathways is expected to become a significant therapeutic approach for prostate cancer.This article aims to comprehensively review the molecular mechanisms underlying the interactions between the androgen receptor and PI3K/AKT pathways,to provide new perspectives and insights for research in the fields.

Objective To explore the correlation between chronic diseases and the risk of benign prostatic hyperplasia(BPH)in middle-aged and older Chinese man.Methods Data from the 2013 China Health and Retirement Longitudinal Study(CHARLS)were used,including 4 509 male participants aged 45 years and older.Chronic diseases and BPH diagnoses were obtained through a questionnaire survey.Logistic regression analysis was performed to identify independent risk factors for BPH.Restricted cubic splines(RCS)were used to explore the nonlinear relationship between variables and BPH prevalence,while stratified analyses were conducted to assess the differential impact of chronic diseases on BPH prevalence in different subgroups.Results Compared to patients without BPH,those with BPH had a significantly higher prevalence of comorbid chronic diseases,including hypertension,diabetes,chronic respiratory diseases,chronic heart disease,stroke,chronic kidney disease,chronic digestive diseases,arthritis or rheumatism,depression,and memory-related disorders.Multivariable Logistic regression analysis indicated that factors such as the 10-item Center for Epidemiological Studies Depression Scale(CESD-10)scores(OR=1.043,95% CI:1.022-1.063,P<0.001),chronic respiratory disease(OR=1.518,95% CI:1.143-1.998,P=0.003),chronic heart disease(OR=1.515,95% CI:1.143-1.998,P=0.003),chronic kidney disease(OR=2.384,95% CI:1.799-3.137,P<0.001),and chronic digestive disease(OR=1.427,95% CI:1.129-1.796,P=0.003)were independently associated with the occurrence of BPH.RCS analysis demonstrated no non-linear association between age,BMI,and CESD-10 scores and BPH.Stratified analysis revealed that the influence of these chronic conditions on BPH remained constantly stable across different subgroups.Conclusion BPH is commonly comorbid with various chronic diseases.Future treatment strategies for BPH should consider the shared pathological mechanisms between BPH and these chronic conditions,with a focus on integrated interventions targeting common pathways.