OBJECTIVE To provide direction and reference for the adjustment of the discount rate （DR） in China’s pharmacoeconomic guidelines. METHODS Search was conducted on the official websites of the International Society for Pharmacoeconomics and Outcomes Research， health technology assessment agencies in various countries/regions， as well as relevant websites of other upper-middle-income or high-income countries/regions. The recommended DR， adjustment trends， and setting rationales in pharmacoeconomic evaluation guidelines across different countries/regions were then summarized and compared. Based on theoretical derivation and literature analysis， the effects of different DR on the incremental cost-effectiveness ratio （ICER） were examined. RESULTS & CONCLUSIONS Among the 40 included guidelines， the base-case DR ranged from 1.5% to 5%， with 5% being the most common value； the range for sensitivity analysis was 0 to 12%. Thirty-six countries/regions applied the same DR to both costs and health outcomes， while in the Netherlands， Belgium， Poland and Czech Republic， DR for costs was higher than for health outcomes. In recent years， Korea， France and Ireland had lowered their DR in response to economic changes， whereas the Netherlands and Czech Republic had raised their DR for cost. The setting of the DR was primarily based on the public project investment interest rate or referred to recommendations from internationally authoritative institutions and other relevant guidelines. The direction and magnitude of the impact of different DR on the ICER largely depended on the distribution of costs and health outcomes between the intervention and reference measure. The setting and adjustment of DR were closely associated with the economic environment. Based on international experience, the DR in China can be lowered by 0.5% to 1.5%， and localized empirical research can be conducted using internationally common estimation methods.

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.

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

Objective To retrospectively analyze the clinical data of 3 middle-aged and elderly cases with inflammatory myofibroblastic tumor (IMT) of the kidney,in order to improve its diagnosis and treatment.Methods The records of 3 patients who were diagnosed as IMT of the kidney by pathology in our hospital from Jan 2005 to Jun 2014 were reviewed to identify the characteristics including age,gender,clinical manifestation,tumor imaging and pathological features,treatment and prognosis.Results The mean age of the patients was 60 years.One patient underwent partial nephrectorny,1 patient underwent radical nephrectomy,and another patient received nephroureterectomy with bladder cuff excision.Patients were followed up for 8 months to 10 years,and no tumor recurrence was found.Conclusions IMT of the kidney is the tumor of low malignant potential with a good prognosis.Surgery is the first choice for the diagnosis and treatment.

OBJECTIVE:To study the effects of Buyang huanwu decoction on the contents of CD40 and CD40L in the serum of rats with cerebral ischemia. METHODS:Rats were randomized into a sham-operation(normal saline)group,a model(normal saline)group,a positive control [6.75 mg/(kg·d)clopidogrel hydrogen sulfate] group and Buyang huanwu decoction high-dose and low-dose [26 and 6.5 g/(kg·d)] groups,with 20 rats in each group. Suture occlusion of middle cerebral artery was used to establish the rat models of focal cerebral ischemia,which were given drugs ig on the 2nd day after the operation and for 14 consecutive days. Then pathological changes in the cerebral tissues of all groups of rats were observed and the contents of CD40 and CD40L in the serum thereof were detected by euzyme-linked immunosorbent assay. RESULTS:The rats in the model group demonstrated isch-emia-like pathological change in the cerebral tissue on the side of lesion. The ischemia-like cerebral tissue on the side of lesion in the positive control group and Buyang huanwu decoction high-dose group were improved compared to the model group. The patho-logical change in the cerebral tissue on the side of lesion in Buyang huanwu decoction low-dose group was similar to that in the model group. The contents of CD40 and CD40L in the serum of rats in the model group were higher than in the sham-operation group. The content of CD40L in the serum of rats in positive control group and Buyang huanwu decoction high-dose group were lower than the model group. There were statistical differences(P<0.01 or P<0.05). Except as described above,no other statistical-ly significant differences (P>0.05) were noted. CONCLUSIONS:Buyang huanwu decoction can improve brain cell morphology and reduce cerebral ischemic tissue injury in model rat with cerebral ischemia by a mechanism which may be related to decreasing the content of CD40L.

OBJECTIVETo evaluate the outcomes of T3a prostate cancer treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy, and analyse the influence of preoperative factors on prognosis.

METHODSFrom January 2003 to December 2008, 38 pactients with T3a prostate cancer aged from 48 to 81 years (mean: 71 years) were enrolled, with serum prostate specific antigen (PSA) levels ranged from 10.000 to 99.800 µg/L (mean: 56.300 µg/L), Gleason score from 5 to 9 (mean: 7.6) and percentage of positive biopsy cores from 10.0% to 100% (mean: 65.3%). All patients were treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy. Survival curves were calculated using the Kaplan-Meier method. The predictive factors including patient's age, prostate volume, serum pre-treatment PSA, Gleason score and percentage of positive biopsy cores were used for univariate analysis on biochemical failure-free, distant metastasis-free and overall survival.

RESULTSThe mean follow-up was 69 months (range: 9-109 months).Nineteen patients experienced biochemical failure. The average biochemical failure time was 13.4 months (range: 1-40 months). There were 13 patients developed as distant metastatic prostate cancer since average 19.7 months (range: 1-70 months) after brachytherapy. Of all patients, 9 died of prostate cancer recurrence, while 6 passed away because of other reasons, with an average of 52.2 months (range: 9.0- 98.5 months). The 5-year biochemical failure-free survival (BFFS), distant metastasis free survival (DMFS), cancer specific survival (CSS) and overall survival (OS) rate were 44.1%, 68.6%, 82.4 and 75.8%, respectively. Twenty-nine patients experienced grade 1-2 gastrointestinal toxicity and 18 patients experienced grade 1-2 genitourinary toxicity. In univariate analysis, the percentage of positive biopsy cores was significantly correlated with BFFS (χ(2) = 17.240, P = 0.000), DMFS (χ(2) = 18.641, P = 0.000) and OS (χ(2) = 8.970, P = 0.003); the Gleason score was significantly correlated with DMFS (χ(2) = 12.484, P = 0.000) and OS (χ(2) = 6.575, P = 0.010); and patient's age was significantly correlated with OS (χ(2) = 5.179, P = 0.023).

CONCLUSIONSPermanent interstitial brachytherapy combined with external radiotherapy and hormone therapy is alternative for T3a prostate cancer. The percentage of positive biopsy cores is correlated with BFFS, DMFS and OS.

Aged ; Aged, 80 and over ; Brachytherapy ; methods ; Combined Modality Therapy ; Hormones ; therapeutic use ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; drug therapy ; mortality ; radiotherapy ; Radiotherapy ; methods ; Survival Rate ; Treatment Outcome