[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to evaluate the value of systematic 12- and 13-core biopsies, guided by transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI), with regard to the prostate cancer detection rate (PCDR). Between July 1999 and June 2012, 2,707 patients were recruited to the Department of Urology, The First Affiliated Hospital of Nanjing Medical University (Nanjing, China). Prostate biopsies were performed via systematic 12- or 13-core biopsy and guided by either TRUS or MRI. The PCDR was established by retrospectively analyzing the distribution of positive cores, and it was assumed that all patients had undergone four biopsy schemes: Medial 6-core, lateral 6-core, 12-core and entire 13-core. In addition, the positive rate of the biopsies with the extra 13th core and the mean positive rate of systematic 12-core biopsies were compared. The PCDR of an entire 13-core biopsy was significantly higher than that of a lateral 6-core biopsy. The positive rate of the extra 13th core, which identified abnormal TRUS or MRI findings, was significantly higher when compared with that of the mean positive rate of the systematic 12-core biopsy. The results of the present study demonstrated that the entire 13-core biopsy was superior to the 6-core biopsy with regard to the PCDR. Therefore, the systematic 12-core biopsy with an extra 13th core is considered to be beneficial towards improving the PCDR.
[Show abstract][Hide abstract] ABSTRACT: To describe a modified retroperitoneoscopic renal pedicle lymphatic disconnection (MRRPLD) and to compare the efficacy and safety of MRRPLD with traditional retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD).
From September 2008 to July 2012, RRPLD and MRRPLD were performed respectively on 18 and 14 patients at our center. Comparison was conducted including operative time, intraoperative blood loss, postoperative time of bed rest, hospital stay, postoperative urine chyle test, and complications. All operations were completed without conversion to open surgery. The mean operative time, intraoperative blood loss, postoperative time of bed rest, and hospital stay from MRRPLD group were all decreased compared with data from RRPLD group. There was significant difference in operative time, postoperative time of bed rest, and hospital stay (P <.05). Complications occurred only in 1 patient receiving RRPLD. Chyluria disappeared in all patients after the operation. No recurrence was observed during the follow-up.
MRRPLD has a good effect and safety for chyluria. It is a simpler, more minimally invasive, and more economic surgical therapy compared with traditional RRPLD.
[Show abstract][Hide abstract] ABSTRACT: Interdigitating dendritic cell sarcoma (IDCS) and retroperitoneal leiomyosarcoma are rare tumors. The optimal diagnosis, treatment and prognosis remain unknown. The current case report presents a 46-year-old male who exhibited with a left renal mass combined with a periprostatic mass. The patient underwent surgery twice, respectively for the resection of the two masses. The postoperative pathological examination confirmed the diagnosis of IDCS presenting in the kidney and retroperitoneal leiomyosarcoma in the pelvis. To the best of our knowledge, it is the first report of IDCS in the kidney and of the combined appearance of IDCS and retroperitoneal leiomyosarcoma in the same patient.
[Show abstract][Hide abstract] ABSTRACT: The nomograms used for prostate cancer risk assessment in Western countries are not directly applicable to Chinese males; consequently, we have developed a new model to evaluate the risk of them developing this disease.
A total of 1104 patients who had undergone trans-rectal ultrasound (TRUS)-guided 12 + 1-core prostate biopsy were retrospectively evaluated in the first stage of the study. Age, prostate-specific antigen (PSA), the free/total PSA ratio (f/t), digital rectal examination (DRE) findings, the presence of a hypoechoic mass revealed using ultrasound, ultrasonic detection of microcalcifications, prostate volume (PV) and PSA density were considered as predictive factors. Multiple logistic regression analysis involving a backward elimination selection procedure was used to select independent predictors. We compared positive rates regarding 6-core and 12-core biopsy schemes at different risk levels. In the second stage of the study, 238 cases were evaluated using our nomogram. In higher risk patients, we employed a 6 + 1 core biopsy. Positive rates in the first and second stages of the study were compared.
Age, the baseline median natural logarithm of PSA (Ln[PSA]), Ln(PV), f/t, rate of abnormal DRE findings and rate of hypoechoic masses detected using TRUS were the factors that were finally submitted into our nomogram. A significantly greater area under the receiver-operating characteristic curve was obtained for the nomogram than for PSA level alone (0.853 vs. 0.761). A cancer probability cutoff value of 0.5 suggested no significant difference between the 6-core and 12-core biopsy schemes at higher risk levels. In the second stage of the study we verified that in patients with a cancer probability cutoff value >0.5, a 6 + 1-core biopsy could be used without a reduction in the positive detection rate, and significantly reducing the number of biopsy cores required.
A nomogram based on data from Chinese males was developed to predict the positive detection rate, ratio of positive cores and Gleason score at each risk level. According to this nomogram, a reasonable biopsy strategy could be constituted to reduce the number of biopsy cores required in subjects at high risk.
[Show abstract][Hide abstract] ABSTRACT: Insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) are members of the insulin-like growth factor (IGF) family that play important roles in carcinogenesis. We hypothesized that the functional polymorphisms in IGF-I and IGFBP-3 may be associated with the risk of prostate cancer (PCa) in the Chinese population. This hospital-based case-control study included 664 PCa patients and 702 cancer-free controls. Nine SNPs in IGF-I and IGFBP-3 were genotyped using the TaqMan assay. The genetic associations between the pathogenesis and progression of PCa were assessed by logistic regression. We found that the genotype and allele frequency distribution of rs6218, rs35767 and rs5742612 were significantly different when comparing PCa cases to controls (P = 0.005, 0.005 and 0.020, respectively). In the combined analysis, individuals with 2-6 risk alleles had an elevated risk of PCa compared to those with 0-1 risk alleles. We also found that the association between the combined risk alleles and the risk of PCa appeared stronger in the following subgroups: individuals older than 71 years of age (OR = 1.41, 95%CI = 1.05-1.91, P = 0.020), nonsmokers (OR = 1.68, 95%CI = 1.21-2.32, P = 0.002), nondrinkers (OR = 1.32, 95%CI = 1.02-1.61, P = 0.002), and those with a negative family history of PCa (OR = 1.28, 95%CI = 1.02-1.71, P = 0.022). Our results indicate that the three SNPs (rs6218, rs35767 and rs5742612) and the joint genotypes with 2-6 risk alleles, may contribute to the susceptibility to PCa, but not the progression, in the Chinese population.
PLoS ONE 01/2014; 9(2):e85609. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to develop a follow-up strategy based on the new model to reduce unnecessary prostate biopsies in patients with prostate specific antigen (PSA) ranging from 4 to 10 ng/ml.
PLoS ONE 01/2014; 9(9):e106933. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To present our techniques and experience with retroperitoneal laparoscopic ureteroureterostomy (LUUS) in 15 patients with retrocaval ureter. MethodologyA total of 15 patients with retrocaval ureter underwent retroperitoneal LUUS. A 4-port, finger and balloon-dissecting, retroperitoneal approach was used. Follow-up studies were performed with renal ultrasonography and intravenous pyelography (IVP). ResultsAll operations were completed laparoscopically without conversion to open surgery. The mean operative time was 120 (90～170) minutes. The mean blood loss was 30 (15～50) mL. All patients achieved an uneventful recovery. No intraoperative or postoperative complications occurred. At a follow-up of three and six months after discharge, remarkable improvement in the ureteral obstruction was observed. Conclusions
Our results indicated that retroperitoneal LUUS is a safe and effective minimally invasive treatment for retrocaval ureter. Laparoscopic surgery can be the preferred treatment for retrocaval ureter.
[Show abstract][Hide abstract] ABSTRACT: To summarize the diagnosis and treatment of cystic renal cell carcinoma (CRCC).
A retrospective study was conducted on 13 patients with CRCC at our center from August 2004 to April 2012. The pathologic features, clinical manifestation, imaging characteristics, treatment, and prognosis of CRCC were summarized according to available literature.
Of the 13 patients, 11 were diagnosed with CRCC by preoperative B ultrasonography and computed tomography (CT) scan. The remaining two cases were initially misdiagnosed with simple renal cysts. Open radical nephrectomy was performed on two of the 13 cases, laparoscopic radical nephrectomy on seven cases, and open partial nephrectomy on four cases. All diagnoses of CRCC were confirmed by pathological examination. After the operation, all patients had an uneventful recovery. During the follow-up (range, 6--60 months), the serum creatinine concentrations and GFR of the partially removed kidneys remained stable within the normal range. No tumor recurrence or metastasis occurred.
By combining imaging examinations (B ultrasonography and CT scan) with intraoperative pathological examination, most cases of CRCC can be diagnosed and treated promptly and accurately. Nephrectomy is the first-line therapy. Nephron-sparing surgery should be preferred for CRCC. After a successful operation, the prognosis of CRCC is good.
World Journal of Surgical Oncology 07/2013; 11(1):158. · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epithelial-mesenchymal transition (EMT) is a crucial process that plays an important role in the invasion and metastasis of human cancers. High-mobility group AT-hook 2 (HMGA2) has been found to be involved in the EMT program, with its aberrant expression having been observed in a variety of malignant tumors. However, the mechanisms regulating HMGA2 expression remain incompletely understood. The objective of this study was to investigate whether mir-154 plays a critical role in EMT by regulating HMGA2. The expression levels of HMGA2 were examined in four samples of prostate cancer (PCa) tissue and adjacent non-tumorous tissue by Western blot analysis. The effects of forced expression of miR-154 or HMGA2 knockdown on PCa cells were evaluated by cell migration and invasion assays and Western blot analysis. HMGA2 was upregulated in the PCa tissue samples compared with the adjacent normal ones. Forced expression of miR-154 or HMGA2 knockdown significantly reduced the migratory and invasive capabilities of PCa cells in vitro and inhibited EMT gene expression, increased the levels of E-cadherin, an epithelial marker, and decreased the levels of vimentin, a mesenchymal marker. HMGA2 is a direct target gene of miR-154 by dual-luciferase reporter assay. Our findings suggest that miR-154 plays a role in regulating EMT by targeting HMGA2. Understanding the targets and regulating pathways of miR-154 may provide new insights into the underlying pathogenesis of PCa.
Molecular and Cellular Biochemistry 04/2013; · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fenofibrate, a peroxisome proliferator-androgen receptor-alpha agonist, is widely used in treating different forms of hyperlipidemia and hypercholesterolemia. Recent reports have indicated that fenofibrate exerts anti-proliferative and pro-apoptotic properties. This study aims to investigate the effects of fenofibrate on the prostate cancer (PCa) cell line LNCaP. The effects of fenofibrate on LNCaP cells were evaluated by flow cytometry, reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assays, Western blot analysis, and dual-luciferase reporter assay. Fenofibrate induces cell cycle arrest in G1 phase and apoptosis in LNCaP cells, reduces the expressions of androgen receptor (AR) and AR target genes (prostate-specific antigen and TMPRSS2), and inhibits Akt phosphorylation. Fenofibrate can induce the accumulation of intracellular reactive oxygen species and malondialdehyde, and decrease the activities of total anti-oxidant and superoxide dismutase in LNCaP cells. Fenofibrate exerts an anti-proliferative property by inhibiting the expression of AR and induces apoptosis by causing oxidative stress. Therefore, our data suggest fenofibrate may have beneficial effects in fenofibrate users by preventing prostate cancer growth through inhibition of androgen activation and expression.
Biochemical and Biophysical Research Communications 02/2013; · 2.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Evidence is accumulating that cyclooxygenase-2 (COX-2) may play an important role in prostate cancer (PCa). Recently, gene polymorphisms in COX-2 have been implicated to alter the risk of PCa and overexpression of COX-2 may be associated with clinical and prognostic significance in PCa. However, the results of these studies are inconclusive or controversial. To derive a more precise estimation of the relationships, we performed an updated meta-analysis. A comprehensive search was conducted to examine all the eligible studies of COX-2 polymorphism and expression in PCa. We used odds ratios (ORs) to assess the strength of the association and the 95 % confidence intervals (CIs) give a sense of the precision of the estimate. Overall, no significant associations between COX-2 polymorphism and PCa risk were found. However, high expression of COX-2 was significantly higher in T3-T4 stages of PCa than in T1-T2 stages of PCa (OR = 2.33, 95 %CI: 1.54-3.53, P < 0.0001). COX-2 might play an important role in the progress of PCa, overexpression of COX-2 correlates with T3-T4 stages of PCa. COX-2 might be a potential therapy target for PCa and work as a prognostic factor for PCa patients.
[Show abstract][Hide abstract] ABSTRACT: Castleman's disease (CD) is an uncommon disorder of the lymphoid hyperplasia. It is especially rare in the retroperitoneum or perirenal area. We report the case of a 62-year-old woman who had an abdominal mass localized above the right kidney in the region of the right adrenal gland found by computed tomography scan. The patient subsequently underwent an exploratory laparotomy. Pathological examination revealed retroperitoneal localized CD (LCD) of the hyaline vascular type. Diversity of disease sites and nonspecificity of clinical manifestations lead to diagnostic difficulties. Therefore, diagnosis is mainly achieved via lymph node biopsy or pathological examination. Like in the reported case, LCD usually has a good prognosis after complete resection of the lesion.
Urologia Internationalis 09/2012; · 1.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Therapies for hemangiomas of the penis include surgical excision, electrofulguration, cryotherapy, sclerotherapy, and neodymium:yttrium aluminum garnet laser treatment. Urologists often face difficulties in deciding whether to use surgery in penile hemangioma cases. In this study, we investigated the safety and feasibility of surgical treatment of hemangioma in the penis. The study included 6 patients, 19 to 42 years of age (median age 23 years), with hemangiomas on the dorsal aspect of the penis. All patients were treated with surgery. All operations were successful, and no complications were observed. Patients were followed up for 2 to 5 years (median 2.5 years) after discharge from the hospital. Five patients were assessed for sexual function. Lesions healed completely, and all patients were satisfied with the aesthetic results. All patients had returned to normal sexual activity within 3 months of the operation. Sexual function and sexual satisfaction were well maintained after the operation. A therapeutic reference standard for the treatment of penile hemangioma is still lacking because of the rarity of the disease. The results of our experience confirm that surgical treatment for penile hemangioma represents a safe radical curative procedure. Surgical treatment offers an alternative to the more conservative therapy previously advocated.
Journal of Andrology 03/2012; 33(5):921-6. · 3.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Castration-resistant prostate cancer (CRPC) is a leading cause of cancer-related deaths in elder men. This disease has limited therapeutic options and poor prognosis as the underlying molecular mechanisms are not clearly understood. Given the emerging roles of microRNA (miRNA) as a key regulator, we postulated that miRNA may play a significant role in CRPC formation.
miR-146a levels in 15 androgen-dependent prostate cancer (ADPC) tissues and 5 CRPC tissues were measured by qRT-PCR. Effects of miR-146a in cell proliferation and migration in vitro and in vivo were evaluated by MTT assay, colony formation assay, transwell migratory assay, and tumor formation assay, respectively.
we found that miR-146a expression was significantly decreased in CRPC tissues compared to ADPC tissues. Functional analyses showed that ectopic overexpression of miR-146a in androgen-independent cell lines not only inhibited cell growth, colony formation, and migration in vitro, but also reduced tumorigenicity and angiogenesis in vivo. Mechanistic studies revealed that miR-146a repressed the expression of EGFR through binding to its 3'-untranslated region. Also, miR-146a inhibited the expression of MMP2, one of the most important genes in tumor progression. Moreover, downregulation of p-ERK expression significantly abrogated miR-146a-induced prostate cancer cell proliferation.
Our findings suggest that ubiquitous loss of miR-146a is a critical mechanism for overexpression of EGFR in CRPC, which is crucial to better understanding the pathogenesis of CRPC.
The Prostate 12/2011; 72(11):1171-8. · 3.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this study, we investigated the safety and feasibility of glans-preserving surgery for superficial penile squamous cell carcinoma. Young patients with penile primary tumors exhibiting favorable histologic features were best suited for organ-sparing procedures, enabling them to avoid sexual disturbances. The study included 12 patients, 38-53 years of age (median age 46 years), with superficial lesions involving the glans penis, coronary sulcus, or shaft skin. After clinical staging and grading, those patients were offered a glans-preserving procedure to preserve the normal appearance and functional integrity of the glans penis. Of the 12 patients referred, the tumors were TaG1 in 4 patients, TaG2 in 3, TisG1 in 1, TisG2 in 1, T1G1 in 2, and T1G2 in 1. All patients returned to normal sexual activity 1 month postoperatively. Sexual function and sexual satisfaction were well maintained after surgery. The cosmetic results were considered satisfying/very satisfying by 83% (10 of 12 patients). Follow-up data were available on 12 patients at a mean follow-up of 62.5 months. Only 1 patient had recurrence 6 months after surgery, which was managed by a second glans-preserving surgery without recurrence. With careful patient selection and vigilant follow-up, anatomically suitable superficial penile cancer can be offered this glans-preserving surgery, while preserving function of the penis wherever possible.
Journal of Andrology 08/2011; 33(3):435-40. · 3.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recently, a C>T polymorphism (rs1434536) in a miR-125b binding site in the 3' untranslated region (3'UTR) of bone morphogenetic protein membrane receptor type IB gene (BMPR1B) has been found to contribute to cancer susceptibility. To investigate whether it plays an important role in the development of prostate cancer in southern Chinese Han population, we performed a case-control study. 247 prostate cancer and 278 control subjects were included in the cancer association study and dual-luciferase reporter assay was used to test the binding ability of miR-125b to BMPR1B-C or -T vectors. The effect of CT/TT genotype on prostate cancer risk was found to be significant for localized disease (OR=1.60, 95% CI=1.01-2.53, P=0.044) and among subgroups of aged>70 years (OR=1.90, 95% CI=1.15-3.15, P=0.015) compared with CC genotype. Moreover, C-allele gave a reduced luciferase activity relative to T-allele in dual-luciferase reporter assay. Our findings show that rs1434536 in the 3'UTR of BMPR1B gene affects the binding ability of miR-125b to BMPR1B mRNA and contributes to the genetic predisposition to localized prostate cancer and patients aged>70 years.
[Show abstract][Hide abstract] ABSTRACT: To identify predictors for repeat biopsies in Chinese men with increasing prostate-specific antigen (PSA) levels or other risk factors for prostate cancer.
The study included 129 patients who underwent transrectal sonography-guided repeat biopsies. Potential predictors, including age, body mass index, symptoms, digital rectal examination (DRE), total PSA, free PSA, free/total PSA ratio, prostate volume, PSA density, PSA velocity, PSA doubling time, and volume/biopsy ratio, were subjected to univariate analysis. Multivariate stepwise logistic regression was performed to identify major independent predictors for repeat biopsies, and a scoring system for predicting cancer was devised. A receiver operating characteristic (ROC) curve was constructed to test the sensitivity and specificity of the scoring system.
Thirty-four patients (26.36%) had cancer. On univariate analysis, the DRE (P = .002), total PSA (P = .020), free/total PSA ratio (P < .001), prostate volume (P < .001), PSA density (P = .003), and volume/biopsy ratio (P < .001) were significant predictors of cancer. On multivariate analysis, the DRE, total PSA, free/total PSA ratio, and volume/biopsy ratio were independently significant predictors, with odds ratios and 95% confidence intervals of 4.61 (1.62-13.07), 1.02 (1.00-1.04), 0.87 (0.78-0.96), and 0.56 (0.43-0.79). Using ROC analysis, we determined a cutoff value of 2.5 for the scores, at which the sensitivity and specificity of the scoring system for predicting positive repeat biopsy results were 76.50% and 74.70%, with an area under the curve of 0.816 (P < .001). Patients with scores of 3 to 5 had higher cancer detection rates than those with scores of 0 to 2 (52.00% versus 10.13%; P < .001).
Key predictors may exist to help formulate a scoring system to identify Chinese men who need repeat prostate biopsies. More studies are required to learn its applicability to broader populations.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 04/2011; 30(4):503-8. · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous studies have suggested that implementation of PSA screening in China is of crucial importance. This study compared clinical and pathological characteristics of screen-detected and clinically diagnosed prostate cancers and evaluated the effectiveness of PSA screening for early detection of prostate cancer in Nanjing. Between July 2004 and December 2005, 8,562 men aged ≥ 50 years were included for PSA screening. Participants with serum PSA ≥ 4.0 ng/ml were recommended for transrectal ultrasonography (TRUS)-guided prostate needle biopsy (TRNB). During the same period, 82 consecutive clinically diagnosed prostate cancers were included as controls. The clinical and pathological features of the screened versus clinically diagnosed cancers were evaluated. A total of 719 (8.4%) of screened men had PSA levels ≥ 4.0 ng/ml. Biopsy was performed in 295 men, and 58 prostate cancers were detected. The biopsy rate, positive predictive value (PPV), and detection rate were 41.0, 19.7, and 0.68%, respectively. More screened patients were found with PSA levels <20 ng/ml (55.2 vs. 22.4%, P < 0.001), Gleason scores <7 (60.3 vs. 34.1%, P = 0.002), organ-confined tumors (87.9 vs. 26.8%, P < 0.001), and opportunities for radical prostatectomy (50.0 vs. 18.3%, P < 0.001) than that in clinically diagnosed patients. PSA screening is effective for early detection of prostate cancer in Chinese elderly men. Favorable PSA levels, Gleason scores, clinical stages, and chances for radical prostatectomy are associated with PSA screening. Further studies are needed to evaluate the effect of screening on treatment outcomes and mortality of prostate cancer in Chinese.
Medical Oncology 03/2011; 28(1):357-64. · 2.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: MicroRNAs have been implicated in regulating diverse cellular pathways. Emerging evidence indicates that miR-143 plays causal roles in cancer tumorigenesis as a tumor suppress gene; however, its role in prostate cancer tumorigenesis remains largely unknown. The aims of this study were to verify the effect of miR-143 on proliferation and migration abilities of prostate cancer cells. The expression level of miR-143 and its target gene KRAS were measured by realtime PCR and western blotting, respectively. Effects of miR-143 in cell proliferation, migration and chemosensitivity were evaluated by MTT assay, FACS cell cycle analysis, colony formation assay, and transwell migratory assay. Our results revealed an inverse correlation of expression between miR-143 and KRAS protein in prostate cancer samples (Pearson's correlation scatter plots: R = -0.707, P < 0.05). Moreover, over-expression of miR-143 in prostate cancer cells suppressed their proliferation and migration and increased their sensitivity to docetaxel by targeting EGFR/RAS/MAPK pathway. These findings suggest that miR-143 plays an important role in prostate cancer proliferation, migration and chemosensitivity by suppressing KRAS and subsequent inactivation of MAPK pathway, which provides a potential development of a new approach for the treatment of prostate cancer.
Molecular and Cellular Biochemistry 01/2011; 350(1-2):207-13. · 2.33 Impact Factor