Objective To investigate the HPV DNA prevalence and genotype distribution among penile cancer in China. To identify association between HPV prevalence, different histological subtypes, tumor stage, tumor grade, demographics, comorbidity and phimosis incidence trend. Standardized HPV DNA detection and p16INK4a expression were used in a multi-center series of 340 penile squamous cell carcinomas diagnosed from 2006-2017. Materials and Methods HPV DNA detection and genotyping were examined by a validated kit for 23 different HPV subtypes (PCR-RDB HPV test). The cases with positive HPV DNA were additional tested for p16INK4a expression to confirm the HPV infection. Results Using the PCR-RDB HPV test, overall HPV prevalence was 48.8% (166/340) and that of p16INK4a expression was 45.6%. In this studied population, HPV16 was the most frequent HPV type detected in HPV-positive cancers (76.5%). HPV18 was the second most common type in penile cancers (15.1%). After pathology review, 307 cases were confirmed as invasive penile cancer, and the other 33 were non-invasive caners. The histologic subtypes of warty, basaloid, clear cell papillary, adenosquamaous and pseudohyperplastic were showed high HPV DNA prevalence. Among invasive cancers, no statistically significant differences in prevalence were observed by tumor grade, tumor stage or lymphnode stage at diagnosis. HPV positive penile cancer incidence significantly increase and the phimosis incidence significantly decrease from 2006 to 2017. Conclusions About a half of penile cancers were related to HPV infection. Our findings highlight the phimosis related penile cancers have been declining, the HPV related in the development of penile cancer and a fully aware of regional differences in HPV genotype distribution are tasks for penile cancer control and prevention.
Our study aims to evaluate the anesthetic efficacy of multiparametric magnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted periprostatic nerve block (PNB) for transperineal template-guided prostate biopsy (TTPB).The patients who underwent mpMRI/TRUS fusion-guided prostate biopsy from May 2018 to March 2019 were randomized into two groups using a random number table. The intervention group (n=47) and the control group (n=45) received targeted PNB and traditional PNB, respectively. Visual analog scale (VAS) and visual numeric scale (VNS) scores were used to assess the patients' pain and quantify their satisfaction.The total detection rate for prostate cancer was 45.7%, with a comparable positive rate between the intervention group (42.6%) and the control group (48.9%), which meant there was no significant difference between the groups (P=0.542). Patient age, prostate-specific antigen, prostate volume, suspicious lesions on mpMRI, number of cores, operation time, and biopsy time were comparable between the groups. The VAS scores during biopsy were significantly lower in the intervention group than in the control group [2 (1 to 3) vs. 2 (1 to 4), P=0.019]. Conversely, the VNS scores during biopsy were higher in the intervention group [3 (2 to 4) vs. 3 (2 to 3), P=0.015]. There were no significant differences in the pain scores or the satisfaction scores at 30 min after the procedure between the two groups. There were no significant differences between the groups for complications, such as hematuria, urinary retention, infection, hemospermia, and vasovagal reaction (P>0.05).Targeted PNB significantly relieved the pain and did not increase the incidence of complications for patients when compared with traditional PNB.
Background Cushing's disease is a pituitary-dependent type of Cushing's syndrome. Treatment consists of pituitary surgery or radiotherapy, but the recurrence rate at 10 years is as high as 40%. Adrenalectomy is considered an effective treatment to refractory Cushing's disease. The objective of this study was to examine the efficacy of laparoscopic adrenalectomy and open adrenalectomy in Cushing's disease, focusing on reversing the sequelae of hypercortisolism and improving patients’ quality of life. Methods Forty-three patients (29 women, 14 men) with recurrent Cushing's disease after transsphenoidal operation underwent laparoscopic ( n =32) or open ( n =11) adrenalectomy from 2000 to 2008. Surgical results were evaluated for all the 43 patients. Patients completed a follow-up survey, including the short-form 36-item (SF-36) health survey. Results All the 43 patients achieved clinical reversal of hypercortisolism after adrenalectomy. Time to symptom resolution varied from a few weeks to up to 3 years. Most physical changes had resolved by a mean of 8 months after surgery. These conditions were not significantly different between the laparoscopy and open groups. Median length of hospital stay was shorter in the laparoscopy group (4 vs. 9 days; P <0.001). Median follow-up was 48.5 months. Of the 34 (79%) patients available for follow-up, 22 (65%) had adrenocorticotropic hormone levels >200 ng/ml and 6 (27%) had clinical Nelson syndrome. Four patients died by 75 months after surgery. Using SF-36, 30 (88%) patients reported they felt their health status was good to excellent compared with 1 year before adrenalectomy; however, they showed significantly lower scores in all the 8 SF-36 parameters compared with the general population. No significant difference emerged in SF-36 scores between the laparoscopy and open groups. Conclusions Adrenalectomy showed high survival and clinical benefits in recurrent Cushing's disease patients. Despite patient-reported improvement in health after adrenalectomy, patients continue to experience poor health status compared with the general population.
Abstract Objective : To reduce the risks of transperineal prostate biopsy complications and to identify the causes of hair embedding in prostate tissue. Methods : Hair embedded in the puncture canal was observed in two cases of transurethral resection of the prostate following transperineal puncture biopsy with a Bard MC1820 disposable biopsy needle. In vitro experiments were used to analyze and reconstruct the process of hair embedding in prostate tissue. Results: The simulation experiment confirmed that the hair was clamped between the needle core and the coaxial needle sheath. In addition, the puncture needle broke the skin and entered the tissue. After activating the trigger, the hair outside the coaxial needle sheath was pushed into the puncture passage and remained there. Conclusion: Hair embedding caused by perineal prostate biopsy is a consumable-related adverse event, and skin preparation prior to transperineal prostate biopsy is recommended.
Objective
To investigate the efficacy and safety of salvage radical prostatectomy for men with recurrent prostate cancer (PCa) after radiotherapy.
Method
Ten pathologically confirmed PCa patients who relapsed after radiotherapy from Jan. 2008 to Dec. 2013 were retrospectively reviewed. The mean age was (64.7 ±3.7) years, with range from 56 to 72 year. Local recurrence was confirmed by re-transrectal biopsy. All patients had increased PSA and/or lower urinary tract symptoms. Pelvis MRI and bone scan were performed to detect lymph node involvement and bone metastasis. All patients received radical prostatectomy with standard pelvic lymphadenectomy. Seven received open surgery (open group), three patients underwent laparoscopic surgery (laparoscopic group). Postoperative complication and PSA level were compared.
Results
Salvage radical prostatectomies with lymph node dissection were performed in all patients without major complications. The mean operation time of open group versus laparoscopic group were (225 ± 57)min vs. (210 ± 80)min and the mean blood loss was (275 ± 49)ml vs.(260 ± 93)ml, both of which were with no significant difference (P>0.05). The average length of stay was (14 ± 4) vs. (8 ± 2) day with significant difference (P<0.05). No rectal injury was observed. Two (20%) patients were with positive margin, and three (30%) patients had postoperative complications, including one case of deep vein thrombosis, one case of incision infection and and one case of anastomotic leakage. After a mean of 20.6 months' follow-up, two patients (25%) reached biochemical recurrence.
Conclusion
Both open and laparoscopic salvage radical prostatectomies after radiotherapy failure were feasible. Large-scaled prospective studies were needed to verify the long-term effectiveness.
Key words:
Radiotherapy; Radiotherapy failure; Salvage radical prostatectomy
To investigate the causes of missed diagnosis in transrectal ultrasound-guided transperineal prostate biopsy.The biopsy results of total 278 patients who received transrectal ultrasound-guided transperineal prostate biopsy from January 2012 to December 2014 in Subei People's Hospital were retrospectively analyzed, using 11 systemic divisions.One hundred and twenty-nine patients were diagnosed with prostate cancer, and 149 patients were hyperplasia of prostate. Fifty-six patients with biopsy-negative and obvious symptoms of lower urinary tract obstruction were underwent transurethral resection of the prostate. Four of which were found to be prostate cancer.Early-stage prostate cancer, special prostate tumor location, inadequate biopsy tissue, special patients in limited position, and dissatisfied anesthesia may increase the risk of missed diagnosis. Targeted and individualized puncture may improve the effectiveness.
Objective
To evaluate the clinical efficacy of brachytherapy with 125I seeds implantation in patients with castration resistant prostate cancer (CRPC).
Methods
Twenty-eight patients with CRPC from February 2010 to December 2015 in Northern Jiangsu People′s Hospital were analyzed retrospectively. Patients were divided into 2 groups according to different treatment methods. Control group (n=13) received endocrine therapy, and study group (n=15) underwent brachytherapy combined with endocrine therapy. The progression was defined as posttreatment prostate specific antigen (PSA)≥ 125% PSA of baseline level. PSA-progression-free survival (PFS), overall survival (OS) and quality of life (physical functioning, social functioning, general health, general physical discomfort, urinary symptoms and treatment-related symptoms) of 2 groups were compared using Kaplan-Meier analysis and log-rank test.
Results
The median PSA-PFS and OS of study group were 29(24, 37) months and 37(32, 50) months respectively, both of them were longer than those of control group (13(7, 21) months, 19(14, 23) months; χ2=13.300, 19.362, both P<0.01). Comparing with control group, the physical functioning, social functioning, general health and general physical discomfort of study group were improved.
Conclusion
Brachytherapy can effectively prolong the survival of CRPC patients and improve the patients′ life quality.
Key words:
Prostatic neoplasms; Brachytherapy; Iodine radioisotopes
Molecular prognostic factors for individualized treatment of squamous cell carcinoma (SCC) are poorly defined. Our study developed and validated a novel molecular tools aid in preinguinal and postinguinal lymphadenectomy risk stratification in node-positive penile SCC. Patients with node-positive penile SCC who underwent inguinal or ilioinguinal lymphadenectomy were divided into three cohorts: a discovery set, a development set and a validation set. The local ethics committee approved the study. The primary endpoint was cancer-specific survival (CSS). At the discovery stage, 17 CpG sites were significantly associated with CSS. In the development set, we constructed a 3-CpG-based prognostic score for survival prediction. The hazard ratio (HR) of the panel (dichotomized using the optimal cutoff) was 5.8 in the multivariate analyses (P < .001). The addition of the methylation score significantly improved the pN-stage C-index from 0.70 to 0.79 (incremental C = 0.09, P < .001). In the validation set, the methylation panel showed a HR of 9.9 in the multivariate analyses. The addition of the molecular marker improved the pN-stage C-index from 0.69 to 0.78 (incremental C = 0.09, P < .001). The methylation score remarkably separated survival curves in different pN stages, which indicate that the tool can be applied to tailor the treatment in both preinguinal and postinguinal lymphadenectomy settings. We developed and validated a prognostic methylation panel for node-positive penile SCC. The tool may aid in the risk stratification of the population with heterogeneous outcomes and needs prospective validation. Patients in high-risk group may benefit from more aggressive therapy or clinical trials.
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