Prostate cancer (PCa) is one of the most common tumors in men.In recent years, various researches on this disease and clinical applications have benefited patients.Exosome is a subclass of extracellular vesicles (EVs).Many studies have explored the mechanisms of exosome in mediating epithelial mesenchymal transformation, angiogenesis, tumor microenvironment establishment, immune escape and drug resistance acquisition in PCa, which provides a new perspective for finding new diagnostic markers.This article reviews the role of exosome in the pathogenesis of PCa and its diagnostic application.

Objective:To analyze the clinical characteristics and prognostic value of prostate-specific antigen (PSA) dynamic features in patients with metastatic castration resistant prostate cancer (mCRPC) received abiraterone acetate (AA) therapy.Methods:The data of 89 patients with mCRPC who received AA therapy from January 2017 to June 2021 in Shanghai Tongji Hospital were retrospectively reviewed. The age of patients was (75.7 ± 8.3) years old, median PSA before AA was 56.88 (19.31, 143.75) ng/ml. The PSA dynamic features included PSA nadir (PSAN) and PSAN time. PSAN was defined as the lowest value of PSA after treatment, and PSAN time was defined as time to PSAN after AA treatment. PSAN was divided into 3 groups: PSAN1 (<0.1 ng/ml), PSAN2 (0.1- 4.0 ng/ml) and PSAN3 (>4.0 ng/ml) groups. PSA response was defined as a maximum PSA decline rate ≥50%, and no PSA decline after treatment was defined as primary resistance. Cox regressions adjusted to clinical factors were performed to evaluate the influence of PSA dynamic features on patients' radiographic progression-free survival (rPFS) and overall survival (OS). Log-rank test was used to evaluate the survival time of patients in different PSAN groups. Receiver operator characteristic (ROC) curve and area under the curve (AUC) were performed to analyze the predictive value of PSA dynamic features on survival outcomes of patients.Results:The follow-up time was 17 (12, 23) months, and 75 (84.3%) patients showed PSA responses. The median PSAN was 1.82 (0.01, 11.70) ng/ml, median PSAN time was 5.0(3.0, 9.5)months. Multivariate Cox regression indicated that PSAN was an independent risk factor for rPFS ( PSAN2: HR=5.308, P=0.017; PSAN3: HR=13.209, P<0.001), and PSAN time ≥ 5 months( HR=0.309, P<0.001)was an independent protective factor for rPFS. Also, the PSAN3 was an independent risk factor for OS( HR=9.459, P=0.048). Log-rank test indicated that the rPFS of PSAN1 group (median not reached) was significantly longer than PSAN2 [median 13.0(95% CI 8.2-17.8) months, P=0.001] and PSAN3 [8.0 (95% CI 4.1-11.9) months, P<0.001] groups. ROC curve and AUC showed that PSAN had a higher predictive value in rPFS outcomes compared with T stage, metastatic disease volume, and Eastern Cooperative Oncology Group (ECOG) score (0.82 vs. 0.69, 0.68, 0.53, P<0.05). PSAN had a higher predictive value in OS outcomes than metastatic disease volume and ECOG(0.83 vs. 0.63, 0.58, P<0.05). Conclusions:Lower PSAN needs longer PSAN time. PSAN is an independent risk factor for rPFS and OS, and PSAN time is an independent protective factor for rPFS.

Photoacoustic imaging is a hybrid model biomedical imaging method based on photoacoustic effect. It can reflect prostate anatomy and molecular information in real time, and is low-cost and radiation-free. In recent years, photoacoustic detection based on photoacoustic imaging has developed rapidly, and great progress has been made in term of technology, depth, scope and machine learning. In the diagnosis of prostate cancer, breakthroughs has been made in the research of prostate cancer cell lines, human prostate cancer in vitro specimens and animal tumor xenograft models. It has also been experimentally used in vivo diagnosis of prostate cancer patients, which has great potential for clinical transformation.

There are few reports on the use of Allium stents in the treatment of membranous urethral stricture in China. Its safety and effectiveness need to be observed. This study retrospectively analyzed the data of 5 patients admitted to our hospital for the treatment of membranous urethral stricture using Allium-covered metal urethral stents in the past 5 years. The preoperative International Prostatic Symptom Score (IPSS) score was 8.80±1.30, quality of life(QOL)score was 4.20 ±0.84, and the International Index of Erectile Function-5(IIEF-5) score was 20.20 ± 1.92, respectively. Six months after the operation, the IPSS score was 3.60±1.52, the QOL score was 1, and the IIEF-5 score was 19.80±1.48. This operation is easy with little invasion. It can alleviate the dysuria of patients with membranous urethral stricture and has little impact on the sexual function of patients. It is generally safe and controllable, but the appropriate time for implantation still needs to be explored.

Objective:To investigate the clinical characters and prognostic value of PSA flare and bone flare in metastatic castration resistant prostate cancer(mCRPC) patients received Abiterone acetate(AA) therapy.Methods:A retrospective study was conducted for 93 mCRPC patients treated with AA from Jul.2016 to Dec.2020. Mean age was (75.4±8.9)years, median PSA was 58.2 (16.4, 148.6)ng/ml. Patients received at least 6 months of AA treatment. PSA flare was defined as an increase of PSA after AA therapy followed by a decrease. Bone flare was defined as disease progression after 3 months of therapy, typically based on increased lesion intensity or number, and reevaluation 6-9 months later showed improvement in the scan. The clinical characters and prognostic value of the flare phenomenon was evaluated and analyzed respectively.Results:The median follow up time was 16 months(6, 54 months), fourteen patients showed PSA flare at first month after AA treatment, and median time of duration was 2 months(1, 7 months). The serum alkaline phosphatase (ALP) had a similar rising trend along with PSA flare[115.5(98.0, 198.5)U/L vs. 119.0(97.0, 288.8)U/L, P=0.016]. Seven patients showed bone flare and 3 cases co-existed with PSA flare. Multivariate Cox regression analysis indicated bone flare was an independent protective factor for progression free survival(PFS)( HR=0.117, 95% CI 0.015-0.895, P=0.039), PSA flare had no significant influence on PFS ( HR=1.314, 95% CI 0.554-3.121, P=0.536)and overall survival(OS)( HR=1.348, 95% CI 0.393-4.263, P=0.635). Log-rank test showed patients with bone flare had a longer PFS( P=0.016) and OS( P=0.047) compared with patients without bone flare. Conclusions:PSA flare always faded away after 2 months AA therapy and had no influence on PFS and OS. Bone flare maybe an indication for better prognosis.

Prostate cancer with metastasis to the kidney is rare. Here, we report a case of prostate cancer metastasizing to renal cell carcinoma. A 67-year-old male presented with low back pain for 3 months, aggravated with persistent fever for 2 weeks in June 2018.Histopathological diagnosis of prostate adenocarcinoma was established. Meanwhile, contrasted CT of the abdomen showed a 3.0 cm×2.5 cm×2.5 cm enhanced solid mass on the lower pole of the right kidney. Nephron-sparing surgery was performed for the renal mass. Histopathology revealed a Grade 2 renal clear cell carcinoma with focal prostate carcinoma metastasis to the tumor. Then the patient received abiraterone acetate (AA) therapy. The patient did not encounter tumor recurrence in right kidney 18 months after surgery. However, PSA progression occurred 6 months later after AA therapy, then docetaxel chemotherapy and Sr 89 therapy were performed with limited efficacy. The patient died after 30 months.

Scrotal angiokeratoma(Fordyce angiokeratoma)is often seen in elderly men presenting nodular hemorrhage. In this study, 8 cases of scrotal angiokeratoma were treated with 980nm diode laser. All the operations were successfully completed under local anesthesia without obvious complications and local symptoms improved. The results showed that 980nm diode laser is an alternative operation for the treatment of scrotal angiokeratoma.

Objective:To investigate the effect of modified transanal approach in the repair of vesicorectal fistula after radical prostatectomy.Methods:From September 2011 to December 2019, 32 cases of vesicorectal fistula after radical prostatectomy were retrospectively analyzed. All patients underwent cystostomy before repair operation. The average diameter of the fistulas was 19 (3-40) mm. There was only one fistula in 24 cases and 8 cases with more than 2 fistulas. The operation was performed in the jack knife position, and the fistula was prepared by resection of the fistula through the anus with bipolar resectoscope. Then bladder wall and rectum wall were separated by the loop and sutured respectively. After operation, the patients were treated with antispasmodic and anti-infective treatment, and the catheter was retained. Cystography and cystoscopy were reexamined 3 months after operation. Catheter was removed in the successful cases, and the failure was repaired again.Results:All operations were completed successfully. The mean operation time was 67(55-125) min, and the median follow-up was 22 (6-30) months. Thirty-one cases (96.8%) were successfully repaired, of which 25 cases were successfully repaired at the first operation, and 6 cases were successfully repaired again (all by transanal route). One case failed to be repaired. He had received external pelvic radiotherapy before operation. After the failure of repair, cystoscopy showed large fistula and stiff surrounding tissue. Then bilateral ureteral skin stoma and cystectomy were performed.Conclusions:Modified transanal approach in the repair of vesicorectal fistula after radical prostatectomy is an effective method. This kind of operation has less trauma, fewer complications and can be operated repeatedly. It is suitable for patients with low position, small fistula and without radiotherapy.

This study aims to investigate the effect of non-transecting anastomotic urethroplasty for treatment of posterior urethral stricture.A total of 23 patients with traumatic posterior urethral stricture were enrolled and then divided into two groups.In one group,12 patients underwent non-transecting anastomotic urethroplasty.In the other group,11 patients underwent conventional posterior urethra end-to-end anastomosis.The effect of operation was evaluated using the following parameters:the bleeding amount during operation,operation time,IIEF-5 scores after operation,maximum flow rate (Qmax),and rating scale of quality of life (QoL).The comparison between the conventional posterior urethra end-to-end anastomosis group and the non-transecting anastomotic urethroplasty group showed no significant difference with regard to average operation time.However,a significant difference was observed between the groups with regard to the bleeding amount during operation.The patients in the group of non-transecting anastomotic urethroplasty urinated smoothly after the removal of catheter.Meanwhile,one patient from the group of conventional posterior urethra end-to-end anastomosis had difficulty urinating after the removal of catheter.Furthermore,significant differences in the operation time,bleeding amount during operation,IIEF-5 scores after operation,and rating scale of QoL were observed,whereas no significant difference was observed between urine flow rates of the two groups after operation.Overall,nontransecting anastomotic urethroplasty is effective for posterior urethra reconstruction,and it can reduce the occurrence rate of erectile dysfunction after operation.

Objective:To evaluate the effects of vitamin D supplement on the mortality and incidence rate of adverse events of prostate cancer.Methods:Date from PubMed,The Cochrane Library,CNKI,Wanfang Data and VIP database during the date of database establishment and April 2014 were searched online,while relevant journals were searched manually,for all rando-mized controlled trials (RCTs)of comparison between vitamin D and placebo in the treatment of prostate cancer.The data ex-traction and quality assessment were conducted according to inclusion and exclusion criteria by two reviewers independently with RevMan5.2.Results:A total of 3 RCTs involving 2243 cases met the inclusion criteria.Vitamin D could reduce the mor-tality of prostate cancer[OR=0.23,95%CI:0.1 8-0.29],as meta-analysis demonstrated.There was no report on adverse e-vents.Conclusions:Vitamin D could reduce the mortality of prostate cancer.However,the analysis is secondary study,of which the included literatures differ in quality,and there may be bias in analytical process.Thus,basic and clinical researches with large-scale and high-quality should be performed to confirm the above conclusion.