This paper analyzes current issues in general practitioners (GP) education (e.g., inadequate systems, faculty shortages, misaligned training with community needs, low workforce attractiveness) and proposes strategies for reform in the new development era. Key recommendations include: strengthening academic discipline building in general practice within medical universities; innovating curricula to integrate prevention with treatment and emphasize practical skills; leveraging institutional resources to foster clinician-educator-researcher roles; tailoring training pathways to regional contexts; deepening collaboration between medical education and healthcare delivery systems; and building a robust lifelong learning framework for GPs. Furthermore, the paper details the comprehensive reform initiatives undertaken by Guangzhou Medical University (GMU). These include establishing integrated education platforms spanning university, hospital, and community settings. GMU′s experience offers valuable insights for enhancing GP training quality and scalability in China.

This paper analyzes current issues in general practitioners (GP) education (e.g., inadequate systems, faculty shortages, misaligned training with community needs, low workforce attractiveness) and proposes strategies for reform in the new development era. Key recommendations include: strengthening academic discipline building in general practice within medical universities; innovating curricula to integrate prevention with treatment and emphasize practical skills; leveraging institutional resources to foster clinician-educator-researcher roles; tailoring training pathways to regional contexts; deepening collaboration between medical education and healthcare delivery systems; and building a robust lifelong learning framework for GPs. Furthermore, the paper details the comprehensive reform initiatives undertaken by Guangzhou Medical University (GMU). These include establishing integrated education platforms spanning university, hospital, and community settings. GMU′s experience offers valuable insights for enhancing GP training quality and scalability in China.

Tumor seeding is rare in prostate cancer. We reported a case of trocar-site metastasis detected at 5 months after robot-assisted laparoscopic radical prostatectomy in a prostate cancer patient with a mixed histology of small cell carcinoma and adenocarcinoma. The patient received 6 cycles of a combination of chemotherapy and immunotherapy and a maintenance regimen of androgen deprivation therapy and immunotherapy at our center. The maintenance of immunotherapy suspended at 10 months after the first dosage due to adverse effect. Three months after the end of chemotherapy, imaging evaluation showed that the tumor had achieved complete remission. Tumor relapse was not detected at 15 months after the suspension of immunotherapy.

ObjectiveTo analyze the epidemiological characteristics of newly diagnosed occupational welder's pneumoconiosis (OWP) in the shipbuilding industry in Guangzhou City from 2006 to 2022. Methods Data on newly diagnosed OWP cases in the shipbuilding industry in Guangzhou City from 2006 to 2022 was collected and ananlyzed from the Health Hazard Monitoring Information System subsystem of the Chinese Disease Prevention and Control System. ResultA total of 250 cases of new welder's pneumoconiosis were diagnosed in the shipbuilding industry in Guangzhou City from 2006 to 2022. The number of new cases per year showed an initial increase followed by a rapid decline, reaching a peak in 2013 (65 cases). Most of the cases were male, accounted for 99.2%. There were 220 cases reported the OWP stage, with the stage Ⅰ and stage Ⅱ cases accounted for 93.6% and 6.4%, respectively, but no stage Ⅲ cases were reported. The median (M) age and the 25th and 75th percentiles (P₂₅, P₇₅) at diagnosis was 43.0 (39.0, 47.0) years and the dust exposure years M (P₂₅, P₇₅) was 11.2 (8.1, 14.7) years. The M of age at diagnosis of new OWP cases in 2015-2018 and 2019-2022 were higher than those in 2006-2010 and 2011-2014, respectively (all P<0.05). The M of dust exposure duration of new OWP cases from 2006-2010 and 2019-2022 was higher than that in cases from 2015-2018 and 2011-2014, respectively (all P<0.05). Most of the small shadows of the cases were circular small p shadows and distributed in the bilateral middle and lower lung zones, with a density mostly of 1/1, according to the X-ray chest films. Conclusion The hazard of welding fumes in the shipbuilding industry in Guangzhou City has been controlled, but the prevention and control of OWP among welders remains severe.

【Objective】 To explore the effectiveness and safety of different salvage therapies for local recurrence of tumor following primary prostate cryoablation so as to provide the reference for the treatment of prostate similar cases. 【Methods】 The clinical data of patients with prostate cancer (cT1c-4N0M0) who received salvage therapy for local recurrence of tumor following primary prostate cryoablation in the Sun Yat-Sen University Cancer Center during June 2014 and Dec. 2020 were retrospectively analyzed. Salvage therapies included local therapy (salvage radiotherapy, salvage cryoablation or salvage radical prostatectomy) and androgen deprivation therapy (ADT). 【Results】 Altogether 8 patients were involved. The median age was 71(63-76) years, the median prostate specific antigen (PSA) at the first diagnosis was 17.650(10.380-325.100) ng/mL, the median nadir post-cryoablation PSA was 0.041(0.003-0.541) ng/mL, and the median PSA at local recurrence was 3.030(2.090-19.180) ng/mL. Abnormal digital rectal examination was found in 3 cases, and radiographic evidence of local recurrence was found in 7 cases. Prostate biopsy was performed in 4 cases, 2 of which had positive results. The median follow-up after salvage therapy lasted for 54 (9-75) months. Four cases received salvage radiotherapy, 2 of which developed bloody stool, hematuresis and urinary tract infection, and recovered after conservative treatment; 1 case received salvage cryoablation without side effects; 1 case underwent radical prostatectomy and radiotherapy, developed lymphorrhagia and recovered after conservative treatment; 2 cases received ADT alone, one experienced hot flashes and recovered after conservative treatment, and the other progressed into castration-resistant prostate cancer after 63 months. No other progression or death occurred at the termination of follow-up. 【Conclusion】 Salvase therapy (salvage radiotherapy, salvage cryoablation, salvage radical prostatectomy) and ADT can be used for local recurrence of tumor following primary prostate cryoablation. However, large-scale prospective research is needed to confirm the effectiveness and safety of different therapies.

Radical prostatectomy(RP)was commonly used in localized prostate cancer. For patients with adverse pathological features (APF) after RP, it was controversial about choosing adjuvant radiotherapy or salvage radiotherapy (SRT). Recent studies have found that early salvage radiotherapy(ESRT) had both the same cancer control and reduced overtreatment compared to adjuvant radiotherapy. Nomogram and Gene Classifier(GC) could predict the risk of recurrence after RP and contribute to choose adjuvant radiotherapy or ESRT. PSMA PET/CT was more sensitive to detect distant metastasis after biochemical recurrence, which was helpful to decide whether to implement SRT.

Objective:To investigate the prognosis after salvage radiotherapy with or without hormone therapy for prostate cancer.Methods:From May 2014 to December 2020, 248 patients undergoing salvage radiotherapy due to prostate-specific antigen (PSA)persistence or biochemical progression after radical prostatectomy at Sun Yat-sen University Cancer Center (n=157) and West China Hospital, Sichuan University (n=91) were analyzed. Median age was 66 (45-78) years old. Median PSA was 23.50 (0.18-845.00) ng/ml. The number of PSA persistence and biochemical progression were 143 (59%) and 105 (42%). The number of pT 2, pT 3a, pT 3b, pT 4, and unknown T stage was 99, 49, 78, 15 and 7 cases.The number of N 0, N 1 and unknown N stage was 153, 44 and 51 cases. 165 cases had positive surgical margin. Gleason score of 6, 7, 8, >8 score and unknown was in 12, 104, 34, 90 and 8 patients. Early and late salvage radiotherapy was performed in 117 and 131 patients, and 70 patients (28%) were CRPC. Hormone therapy was used combined with radiotherapy in 182 patients (73%). PSA decline after radiotherapy was compared with Chi-squre test. Kaplan-Meier method and log-rank test were used to compare progression free-survival (PFS)after radiotherapy. Univariate and multivariate analyses of PFS were performed using Cox proportional hazards model. Early salvage radiotherapy was defined as PSA≤0.5 ng/ml before radiotherapy, and late salvage radiotherapy was defined as PSA>0.5ng/ml. Results:PSA response (PSA decline ≥50%) rate was 94% (233/248), and 82% (203/248) patients had PSA decline ≥ 90%. Twelve (5%) patients had rising PSA after completing radiotherapy, but only 4 (2%) had real progression. The median PFS was 69 months (95% CI 68-70), and 3-year and 5-year PFS rate were 80% and 67%. PFS of PSA persistence and biochemical progression were similar ( HR =0.71, 95% CI 0.37-1.37, P=0.311). Compared with late salvage radiotherapy, early salvage radiotherapy had better PFS [69 (95% CI 68-70) vs. 59 (95% CI 44-74) months, P<0.001]. Compared with hormone sensitive, castration-resistant was associated with worse PFS (5-year PFS rate 74% vs. 51%, P<0.001). In multivariate analysis, Gleason score>8, castration-resistant and late salvage radiotherapy were unfavorable prognostic factors. Conclusions:In patients receiving salvage radiotherapy with or without hormone therapy for PSA persistence and biochemical progression after radical prostatectomy, high PSA level before radiotherapy and castration resistant is associated with poor prognosis.

Objective:To compare the pathological results and complications of limited and extended pelvic lymph node dissection among high-risk prostate cancer patients, and to explore the risk factors that affect the rate of lymph node metastasis in high-risk prostate cancer patients.Methods:The data of 800 high-risk prostate cancer patients who underwent radical prostatectomy and pelvic lymph node dissection from January 2016 to December 2020 in three affiliated hospital of Sun Yat-sen University were analyzed retrospectively. According to the scope of pelvic lymph node dissection, they were divided into limited pelvic lymph node dissection (LPLND) group and extended pelvic lymph node dissection (EPLND) group. There were 172 patients underwent LPLND, and 628 patients underwent EPLND.The age of the patients in the LPLND group was 67 (62, 72) years old, diagnosed PSA 20.7 (10.9, 54.8) ng/ml. The biopsy Gleason score 6 in 22 cases, 7 in 59 cases, 8 in 56 cases and 9-10 in 35 cases.The clinical T stage: T 1 in 29 cases, T 2 in 102 cases, T 3 in 37 cases, T 4 in 4 cases; N 0 in 160 cases and N 1 in 12 cases. 50 patients received neoadjuvant hormonal therapy. The age of patients in the EPLND group was 67 (63, 72) years old, diagnosed PSA was 23.9 (14.0, 46.8) ng/ml. Biopsy Gleason Score 6 in 51 cases, 7 in 194 cases, 8 in 218 cases and 9-10 in 165 cases. Clinical T stage: T 1 in 114 cases, T 2 in 341 cases, T 3 in 144 cases, T 4 in 29 cases; N 0 in 526 cases and N 1 in 102 cases.158 patients received neoadjuvant hormonal therapy. There were no significant differences in the age, PSA, puncture Gleason score, clinical T stage, and whether or not to receive neoadjuvant hormonal therapy between the two groups of patients ( P>0.05). The difference in clinical N staging was statistically significant ( P=0.002). The number of postoperative lymph nodes, positive pelvic lymph nodes and postoperative complications and other related clinical and pathological data of the two groups were analyzed. Multivariate logistic regression was used to analyze the risk factors of patients with positive lymph nodes. Results:The median number of lymph nodes harvested [13(8, 19)vs. 6(4, 13), P<0.001] and the rate of positive lymph node cases[31.2%(196/628) vs. 10.5%(18/172), P<0.001] in the EPLND group was significantly higher than those in the LPLND group. Preoperative PSA, clinical N staging, Gleason score, and way of lymph node dissection were independent risk factors for postoperative positive pelvic lymph node in high-risk prostate cancer patients. Compared with the LPLND group, the ELPND group had a higher postoperative complication rate [19.9%(125/628) vs. 11.0%(11/172), P=0.007]. Conclusions:Compared with the LPLND, EPLND in high-risk prostate cancer patients can harvest more lymph nodes and increase the detection rate of positive lymph nodes. The complications of EPLND were higher than those of LPLND. Preoperative PSA, clinical N stage, Gleason score, and the way of lymph node dissection are independent risk factors for positive pelvic lymph node dissection.

Prostate cancer is one of the most common cancers threatening the health of males. The incidence of prostate cancer in China is on the rise. Non-metastatic castration-resistant stage is a special disease stage during the progression of prostate cancer, early identification of nmCRPC and prompt intervention can help delay disease progression and prolong patient survival. In recent years, many studies demonstrated the efficacy of novel androgen receptor inhibitors such as apalutamide, in prolonging metastasis-free survival and time to symptomatic progression in patients with non-metastatic castration-resistant prostate cancer (nmCRPC). This article reviews the recent progress of novel androgen receptor inhibitors for nmCRPC.

Several phase Ⅲ clinical trials have confirmed that androgen deprivation therapy combined with novel hormone therapy can prolong the survival of patients with metastatic prostate cancer. It has become a commonly used scheme in clinical practice. The physical condition, concomitant diseases and economic status of patients, side effects, accessibility, costs and approved indications of drugs should also be considered when selecting the novel hormone therapy drugs for these patients. The sequential use of novel hormone therapy drugs and the conversion of corticosteroids benefit some patients, which can be selected carefully.