Zhien Zhou

Comparison of lesions detected and undetected by template‐guided transperineal saturation prostate biopsy

To compare the characteristics of lesions detected or undetected by template‐guided transperineal saturation prostate biopsy and to evaluate the potential impact of undetected lesions.

Transperineal template-guided prostate biopsy: 10 years of experience

To assess the efficacy and safety of transperineal template‐guided prostate biopsy.

The biological functions and mechanism of miR‑212 in prostate cancer proliferation, migration and invasion via targeting Engrailed-2

Accumulating evidence indicates that Engrailed-2 (EN-2), which is a homeobox-containing transcription factor, act as a candidate oncogene in prostate cancer (PCa). Even though there are some treatments targeting EN-2, however, it is limited because the mechanism of EN-2 upregulation in PCa cells is still unknown. In this study, we investigate the role of miR-212 on EN-2 expression and explored the mechanism of prostate cancer survival and metastasis. The relative expression levels of miR-212 and EN-2 in PCa samples and adjacent normal tissues as well as in PCa cell lines were detected by using quantitative real-time PCR. CCK-8, TUNEL and Transwell assays were used to analyze cell proliferation, apoptosis and invasion, respectively. EN-2 was identified as a direct target of miR-212 via luciferase reporter and western blot assays. Results showed that the expression level of miR-212 was downregulated in both PCa samples and PCa cell lines when compared with prostate epithelial cells and the adjacent no tumor tissues. Moreover, we found that overexpression of miR-212 suppressed PCa cell proliferation and invasion, promoted PCa cell apoptosis. EN-2 was identified as a direct target gene of miR-212 by using luciferase reporter and western blot assays. Also, the expression of EN-2 and miR-212 in the PCa cells had an opposite correlation. The critical role of miR-212 in inhibiting prostate tumor growth was verified in xenograft models of prostate cancer. These findings highlighted the role of miR-212 in PCa progression. More importantly, we speculate that EN-2 is a direct target gene of miR-212.

Long-term outcome of early stage prostate cancer treated with brachytherapy analysis after a mean follow-up of 7 years

PurposeTo investigate the long-term efficacy of 125I brachytherapy in early-stage prostate cancer and to identify correlating factors.MethodsThis study included 117 cases of early stage prostate cancer. The patients ranged in age from 51 to 84 years, with a mean of 73 years. The features of the study population were as follows: the PSA ranged from 0.4 to 47.6 ng/ml (median, 14.7); the Gleason score ranged from 4 to 9 (mean, 6.4); the clinical stage ranged from T1b to T2c; and the positive biopsy rate ranged from 0.08 to 1.0 (mean, 0.45). The mean D90 was 142 Gy and ranged from 106 Gy to 170 Gy. The numbers of low-risk, intermediate-risk and high-risk prostate cancer cases were 22, 29 and 66, respectively. The biochemical no evidence of disease (bNED) rate and overall survival were recorded. Factors that correlated with the outcomes were evaluated.ResultsWith a mean follow up of 84 months, 33 cases had biochemical recurrence, with a bNED rate of 72%. The overall survival rate was 90%, and the cancer-specific survival rate was 97%. The bNED rates in the low-risk, intermediate-risk and high-risk groups were 86%, 79% and 64%, respectively (P = 0.040). The patients with PSA <20 ng/ml, a positive biopsy rate lower than 0.5, and D90 ≥ 140 Gy had lower biochemical recurrence (P = 0.028, 0.006, 0.009, respectively).ConclusionsThe long-term efficacy of 125I brachytherapy in early stage prostate cancer was shown. bNED is related to risk stratification, PSA level, positive biopsy rate and D90.

An Unusual Right-sided Suprarenal Accessory Spleen Misdiagnosed as an Atypical Pheochromocytoma

Compared with left suprarenal splenosis, a right suprarenal accessory spleen is more likely to be misdiagnosed as an adrenal tumor because of its extreme rarity. Especially when splenosis mimics an atypical pheochromocytoma, preoperative diagnosis may become more difficult and elusive. Herein we report the case of a female patient with a right suprarenal mass, which was suspected to be an atypical pheochromocytoma based on a history of the classic triad and positive somatostatin receptor scintigraphy, but histopathology suggested a final diagnosis of right suprarenal splenosis.

Tetramethylpyrazine inhibits prostate cancer progression by downregulation of forkhead box M1

Tetramethylpyrazine (TMP) has exhibited various anticancer effects. However, its ability to inhibit proliferation, migration, and invasion of prostate cancer (PCa) PC-3 cells is still unclear. In the present study, different concentrations of TMP were co-incubated with PC-3 cells. The pcDNA-FOXM1 plasmid was transfected into cells before treatment with 500 µg/l TMP. The proliferative, migratory and invasive abilities of PC-3 cells were tested by MTT assay, wound healing assay and colony formation assay. Western blotting was used to investigate the expression of FOXM1. We found that, compared with the control, the proliferative, migratory and invasive abilities of PC-3 cells were decreased after incubation with different concentrations of TMP (P<0.01). The expression of FOXM1 was decreased in TMP-treated PC-3 cells (P<0.01). In addition, overexpression of FOXM1 reversed TMP-mediated inhibition of proliferation, migration and invasion of PC-3 cells. We also found that TMP inhibited PCa growth in vivo in a dose-dependent manner. These results suggest that TMP inhibits PC-3 cell proliferation, migration and invasion by downregulation of FOXM1.

Unexpected hemorrhage of a rare vessel, a pubic branch of the external iliac artery, after laparoscopic radical prostatectomy: Case report

Rationale: Postoperative hemorrhage is a rare complication after laparoscopic radical prostatectomy (LRP), with no case reports of bleeding from the external iliac artery in the literature. Patient concerns: A 73-year-old man diagnosed with clinical stage 2c prostate cancer underwent LRP successfully with only approximately 200 mL of intraoperative blood loss. However, his blood pressure dropped from 135/74 to 80/49 mm Hg and his hemoglobin decreased by 66 g/L compared with the preoperative level within 5 hours. Diagnoses: Active hemorrhage from a pubic branch of the external iliac artery was found by digital subtraction angiography (DSA). Interventions: The patient was treated with superselective intraarterial embolization. Outcomes: The bleeding stopped and the patient recovered uneventfully with no further hemorrhage or other complications. Lessons: Although postoperative hemorrhage after LRP is exceptionally rare, it can occur not only in the internal iliac artery but also in the external iliac artery. In addition, contracted pelvis cases should be addressed with more caution by the laparoscope holder in case external iliac artery is injured.

Re: Jeffrey J. Tosoian, Debasish Sundi, Bruce J. Trock, et al. Pathologic Outcomes in Favorable-risk Prostate Cancer: Comparative Analysis of Men Electing Active Surveillance and Immediate Surgery. Eur Urol 2016;69:576–81

We read with great interest the report by Tosoian et al. [1] in which the authors compared adverse pathologic outcomes between men with favorable-risk prostate cancer who underwent delayed prostatectomy after active surveillance (DPAS) and men who elected to undergo immediate radical prostatectomy (IRP). The results showed that the decision to undergo DPAS was not independently associated with adverse pathologic outcomes. This research is meaningful and serves as a valuable reference for clinical practice. However, we wish to discuss the following thoughts. In the study, 57 of 89 patients in the DPAS group were not classified and chose to undergo surgery, while the remaining 32 underwent surgery because of grade and/or volume reclassification. The authors believed that in a previous study [2], the higher incidence of adverse pathologic outcomes in the DPAS group compared with the IRP group was related to a mismatch between these two groups, as patients in the DPAS group underwent surgery if reclassified as having progressive disease. To correct this situation, the authors selected 89 patients for the DPAS group who matched the patients in the IRP group, and the results showed that the incidence of adverse pathologic outcomes did not increase in the DPAS group relative to the IRP group. However, according to their Figure 2 [1], 124 patients who were reclassified ultimately underwent RP. Thus, we wonder whether a comparison of these 124 patients and the IRP group would lead to a conclusion similar to that reported in the literature; that is, would the incidence of adverse pathologic outcomes be higher in the DPAS group than in the IRP group? Such a result would further validate the study conclusions. Most reclassification cases were related to grade and/or volume reclassification, whereas volume reclassification

Outcomes of T3a Prostate Cancer with Unfavorable Prognostic Factors Treated with Brachytherapy Combined with External Radiotherapy and Hormone Therapy.

OBJECTIVE To evaluate the outcomes of T3a prostate cancer with unfavorable prognostic factors treated with permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy. METHODS From January 2003 to December 2008, 38 patients classified as T3a prostate cancer with unfavorable prognostic factors were treated with trimodality therapy (brachytherapy + external radiotherapy + hormone therapy). The prescription dose of brachytherapy and external radiotherapy were 110 Gy and 45 Gy, respectively. The duration of hormone therapy was 2-3 years. The endpoints of this study included biochemical failure-free survival (BFFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS). Survival curves were calculated using the Kaplan-Meier method. The Log-rank test was used to identify the prognostic predictors for univariate analysis. RESULTS The median follow-up was 71 months. The serum pre-treatment prostate-specific antigen (PSA) level ranged from 10.0 to 99.8 ng/ml (mean 56.3 ng/ml), the Gleason score ranged from 5 to 9 (median 8), and the percentage of positive biopsy cores ranged from 10% to 100% (mean 65%). The 5-year BFFS, DMFS, CSS, and OS rates were 44%, 69%, 82%, and 76%, respectively. All biochemical failures occurred within 40 months. The percentage of positive biopsy cores was significantly correlated with BFFS, DMFS, and OS (all P=0.000), and the Gleason score with DMFS (P=0.000) and OS (P=0.001). CONCLUSIONS T3a prostate cancer with unfavorable prognostic factors presents not so optimistic outcome. Hormone therapy should be applied to prolong the biochemical progression-free or metastasis-free survival. The percentage of positive biopsy cores and the Gleason score are significant prognostic factors.

Long-term outcome of high-risk prostate cancer treated with brachytherapy combined with external-beam radiation therapy and androgen deprivation therapy.

Aims and Background To evaluate long-term outcome and biochemical progressionfree survival (bPFS) in high-risk prostate cancer patients treated with brachytherapy combined with external-beam radiation therapy (EBRT) and androgen deprivation therapy (ADT). Methods and Study Design We retrospectively analyzed 97 high-risk prostate cancer patients treated with brachytherapy combined with EBRT and ADT. During follow-up, the post-operation prostate-specific antigen (PSA) level was monitored regularly and biochemical relapse, progression to castration-resistant prostate cancer or metastases, and causes of death were documented. We evaluated bPFS, cause-specific survival (CSS) and overall survival (OS). Results The bPFS, CSS and OS of the patients were 81.4%, 88.7% and 81.4%, respectively. The bPFS of the subcategories of patients stratified based on the presence or absence of a Gleason pattern 5 were 55.6% and 87.7%, respectively. Conclusion Brachytherapy combined with EBRT and ADT can effectively control PSA level and delay biochemical relapse in localized high-risk prostate cancer. However, patients presenting with a Gleason pattern 5 should be managed with further treatment intensification.