【摘要】 目的 观察低频超声（20 kHz）辐照联合静脉注射微泡造影剂SonoVue对裸鼠前列腺癌（Du145）移植瘤的抑瘤效应，并探讨其可能的抑瘤机制。 方法 通过细胞移植和瘤块移植方法建立24只裸鼠前列腺癌Du145移植瘤模型，随机分为超声微泡组、单纯超声组、单纯微泡组和对照组，每组各6只。超声微泡组：尾静脉注射0.2 mL SonoVue的同时对瘤体行20 kHz超声辐照，辐照强度200 mW/cm2；单纯超声组：尾静脉注射生理盐水0.2 mL，同时超声辐照2 min；单纯微泡组：尾静脉注射SonoVue 0.2 mL同时行假照，各组均隔天1次，共3次，对照组不做任何处理。治疗后测量瘤体大小，绘制瘤体生长曲线，计算抑瘤率。首次治疗后14 d剥离瘤体，通过光学显微镜、电子显微镜观察肿瘤组织病理改变。免疫组织化学方法观察CD34阳性染色血管，计算肿瘤微血管密度（micro vessel density，MVD），比较各组间MVD的差异。 结果 24只裸鼠均成功植瘤。治疗后超声微泡组瘤体体积均数明显小于其他3组（Plt;0.05），抑瘤率为62.7%。光学显微镜下超声微泡组瘤体组织大部分损伤坏死，电子显微镜下超声微泡组肿瘤内微血管的内皮细胞损伤，线粒体肿大，基底膜断裂。超声微泡组瘤体内CD34阳性染色微血管数减少，其MVD值显著低于其他各组。 结论 20 kHz低频超声辐照联合微泡造影剂SonoVue可有效抑制裸鼠人前列腺癌移植瘤的生长，其抑瘤机制可能是通过超声空化效应破坏肿瘤的微血管实现的。【Abstract】 Objective To investigate the anti-tumor effect induced by low-frequency ultrasound (20 kHz) radiation combined with intravenous injection of microbubbles on human prostate carcinoma xenograft in nude mice, and to discuss its probable mechanism. Methods Human prostate carcinoma xenograft model in 24 nude mice were established with human prostate carcinoma Du145 cells inoculation and sub-graft through mice, which were randomly divided into ultrasound+microbubble, ultrasound, microbubble, and control group, with 6 mice in each group. In the ultrasound+microbubble group, 0.2 mL SonoVue was injected intravenously, followed by 20 kHz ultrasound exposure of 200 mW/cm2 at every other day for 3 times totally. Mice in the ultrasound group and the microbubbles group were only treated with ultrasound radiation and microbubbles injection, respectively. The volume of gross tumors was measured, and tumor growth curve was drawn. The ratio of anti-tumor growth was calculated. The mice were sacrificed 14 days after the last ultrasound exposure. Specimens of the exposed tumor tissues were obtained and observed pathologically under light microscope and transmission electron microscope. CD34 positive vessels were counted in all the tumor slices by immunohistochemistry, and the micro-vessels density（MVD）of the tumor was also calculated. Results Du145 prostate tumor model was successfully established in all the mice. The average gross tumor volume of the ultrasound+microbubble group was significant lower compared with the other two groups after treatment (Plt;0.05), and the ratio of anti-tumor growth was 62.7%. Histological examination showed signs cell injury in the ultrasound+microbubble group. Electron microscopic examination revealed that the endothelium of vessels in the tumor was injured. The amount of CD34 positive vessels and MVD of the ultrasound+microbubble group was less than that of the other two groups. Conclusion The low-frequency ultrasound of 20 kHz exposure combined with microbubbles can be used to ablate human prostate carcinoma xenograft in nude mice, which is probably realized through micro-vessels destroyed by cavitation effect of ultrasound.
Through searching and evaluating the evidence on advanced prostate cancer, we found that different types of androgen deprivation had similar effect, and immediate androgen deprivation had survival benefit. For the patient with hormone-refractory prostate cancer, therapies including mitoxantrone, prednisone, docetaxel and surmine were more effective. Strontium-89 provided more effective pain relief than external beam radiation. And bisphophonate had no effect. Antiandrogen withdrawal suggested prostate specific antigen would decline, but the clinical outcome wasn’t reported.
Prostate cancer is the most common malignant tumor in male urinary system, and the morbidity and mortality rate are increasing year by year. Traditional imaging examinations have some limitations in the diagnosis of prostate cancer, and the advent of molecular imaging probes and imaging technology have provided new ideas for the integration of diagnosis and treatment of prostate cancer. In recent years, prostate-specific membrane antigen (PSMA) has attracted much attention as a target for imaging and treatment of prostate cancer. PSMA ligand positron emission tomography (PET) has important reference value in the diagnosis, initial staging, detection of biochemical recurrence and metastasis, clinical decision-making guidance and efficacy evaluation of prostate cancer. This article briefly reviews the clinical research and application progress on PSMA ligand PET imaging in prostate cancer in recent years, so as to raise the efficiency of clinical applications.
Prostate cancer ranks second among the causes of death of malignant tumors in middle-aged and elderly men. A considerable number of patients are not easily detected in early-stage prostate cancer. Although traditional imaging examinations are of high value in the diagnosis and staging of prostate cancer, they also have certain limitations. With the development of nuclear medicine instruments and molecular probes, molecular imaging is playing an increasingly important role in the diagnosis and treatment of prostate cancer. Positron emission tomography and computed tomography (PET/CT) using prostate-specific membrane antigen (PSMA) as a probe has gained increasing recognition. This article will review the latest progress in the application of PET/CT using probes for targeting PSMA to imaging and treatment of prostate cancer, in order to provide a theoretical basis for the application of probes for targeting PSMA in the diagnosis and treatment of prostate cancer.
【摘要】 目的 探讨在耻骨后前列腺癌根治术中尿控功能和性功能保护的手术技巧和疗效。 方法 2001年8月-2010年1月，行耻骨后前列腺癌根治术21例，其中2例经腹腔镜。所有患者均早期控制缝扎背静脉复合体，并妥善处理前列腺尖和尿道。21例通过保护控尿神经、尿道横纹括约肌，保护了尿控功能；17例通过保留神经血管束技术（12例保留双侧，5例保留一侧）保护性功能。 结果 手术均成功完成，无围手术期严重并发症。2周拔出尿管后，排尿通畅，无尿道狭窄。术后3、12个月内恢复尿控能力患者分别为6、13例，持续性轻-中度尿失禁2例。21例患者中，术前勃起功能正常；术中保留神经血管束17例，术后3、12个月内勃起功能恢复分别为2、8例，4例勃起功能减弱，3例不能勃起。术后病理报告均为前列腺癌，未侵及精囊、膀胱颈、双侧淋巴结阴性。后尿道切缘阳性1例。术后6、24、54个月各有1例出现生化复发。 结论 手术精细解剖并注意技巧，可有效保护尿控功能和性功能，并达到肿瘤根治的疗效。【Abstract】 Objective To evaluate the surgical technique for the protection of urinary continence and erectile function in radical prostatectomy for prostate cancer and observe its clinical efficacy. Methods Twenty-one patients with prostate cancer had undergone radical prostatectomy during August 2001 to January 2010, in which two patients were operated through extraperitoneal laparoscope. Dorsal vein complex was sewed and ligated at early stage of surgery and prostate apex along with urethra were appropriately handled in all patients. By a serial measures consisting of protection for continence nerve and striated urethral sphincter, the function of urinary continence was managed to be spared in twenty-one patients, erectile function was managed to be spared through reservation of neurovascular bundle in seventeen patients (Bilateral neurovascular bundles were reserved in twelve patients, unilateral neurovascular bundle was reserved in five patients). Results All surgeries were successful without severe perioperative complications. The catheters were removed fourteen days after surgery in all patients, and it was observed that micturition was fluent in twenty-one patients. Functional recovery of urinary continence occurred within three months after surgery in six patients and twleve months in thirteen patients, continuous mild-moderate incontinece occurred in two patients. Erectile function was normal before surgery and neurovascular bundle was reserved during surgery in seventeen patients. The recovery of erectile function occurred within three months after surgery in two patients and twelve months in eight patients, erectile function was impaired in four patients, erectile dysfunction occurred in three patients, pathological diagnosis indicated prostate adenocarcinoma in all cases, while seminal vesicle and bladder neck were not invaded and bilateral pelvic lymph nodes were not metastasized, moreover, the pathological diagnosis of resected edge of posterior urethra was positive in one patient. One patient of bio-chemical recurrence occurred respectively within six months, twenty-four months and fifty-four months after surgery. Conclusion During radical prostatectomy for prostate cancer, delicately anatomizing and appropriate surgical technique could effectively protect erectile function and urinary continence and consequently achieve radical resection of tumor at the same time.
Prostate cancer is a common disease in the USA and Europe, with a gradually increasing incidence in China, and presents a significant health burden for older men. The lack of modifiable risk factors has made early detection as a strategy to reduce mortality. Current methods of screening involve the measurement of serum prostate-specific antigen (PSA) and digital rectal examination followed by biopsy. With PSA screening evidence of level I absent, the evidence on the use of PSA as a screening test is still highly controversial. Furthermore, there is controversy over whether screen-detected lesions will become clinically significant. There are three major treatment options for localized disease: radical prostatectomy, radical radiotherapy and monitoring with treatment if required. There is no evidence of randomized controlled trial (RCT) to suggest a survival advantage of any of these treatments. Opinions about the related benefits and risks of screening vary widely. In the absence of RCT of benefit for screening, many now suggest “informed consensus” screening, which encourages a discussion between the patient and his physician with both sides informed of all of the issues.
ObjectiveTo explore the feasibility of targeted cryoablation for localized prostate cancer in day surgery.MethodThe clinical data of patients with localized prostate cancer who underwent cryoablation from April 2017 to May 2019 were retrospective analyzed. The patients’ satisfaction, postoperative complications, chronic pain and indwelling catheter term were recorded on the 1st (the next day after operation) and 7th day after the operation of follow-up.ResultsA total of 98 patients were included. All patients underwent the surgeries successfully. The average age of the patients was (73.43±7.86) years old. The average length of postoperative hospital stay was (1.55±0.43) days, including 34 cases (34.69%) discharged within 24 hours after the surgery. The satisfaction rate of patients was 100% on the 1st and 7th day after the operation. Twelve cases (12.24%) removed the catheter at the discharge, 83 cases (84.69%) removed the catheter on the 7th day after the operation. Because of the urinary retention, 3 cases (3.06%) removed the catheter 2 weeks after the operation. All patients were satisfied with urine control after the removal of the catheter. Ten cases (10.20%) had postoperative complications, including 3 of urinary tract infection, 3 of urinary retention, and 4 of perineal edema; the patients recovered after symptomatic treatment. On the day of surgery, 8 cases (8.16%) had slight postoperative pain in perineal (the Visual Analogue Scale scores were all 2). After oral analgesic treatment, the patients’ symptoms were alleviated.ConclusionTargeted cryoablation is a safe and effective method for the treatment of localized prostate cancer with a low incidence of postoperative complications, and it has certain feasibility in day surgery mode.
ObjectiveTo investigate the expression of tumor necrosis factor-α (TNF-α) in prostate cancer tissue and explore its relations with tumor angiogenesis. MethodsThe expression of TNF-α and CD105 were detected with two-step immunohistochemical staining technique in 20 cases of benign prostatic hyperplasia and 50 cases of prostate cancer between January 2010 and January 2012, and microvessel density (MVD) marked with CD105 was also measured. ResultsThe expressions of TNF-α and CD105 were higher in prostate cancer (41.72±8.67, 20.15±2.67) than those in benign prostatic hyperplasia (21.01±3.85, 4.34±1.67) (t'=13.990, P<0.001; t'=29.771, P<0.001). TNF-α and MVD were not correlated with age and size of tumor, but were positively correlated with tumor differentiation degree (rs=0.847, P<0.001; rs=0.776, P<0.001) and negatively correlated with clinical grades (rs=-0.769, P<0.001; rs=-0.842, P<0.001). ConclusionThe result indicates that over expression of TNF-α exists in prostate cancer. It may play an important role in the anginogenesis and carcinogenesis of prostate cancer.
目的 应用基于链式方程的填补方法处理医学研究中的数据缺失，并以填补后完全数据构建联合指标的logistic判别函数，判断其在前列腺癌的预测诊断中的应用价值。 方法 采用模拟研究，针对现实数据缺失情况模拟不同填补集结果，并以此对现实数据进行填补，以完整数据构建logistic判别，进行分析预测。 结果 填补结果随着填补次数的增加而逐渐接近真实值并趋于稳定。联合年龄、血清前列腺特异性抗原值、血流阻力指数及经直肠前列腺超声检查指标的logistic判别分析结果的灵敏度为82.39%，特异度为74.86%。 结论 联合指标分析可提高前列腺癌的诊断预测水平，以减轻患者穿刺痛苦。
ObjectiveTo assess whether hyperlipoidemia affects the occurrence and progression of prostate cancer (PCA). MethodsA hospital based retrospective study was carried out in Zhangzhou Affiliated Hospital of Fujian Medical University using data from a total of 112 cases of PCA, which underwent radical prostatectomy due to suspected PCA and confirmed by prostate biopsy pathology. ResultsOf the 112 PCA patients, 64 (57.14%) were PCA with hyperlipoidemia (PCA-H). Compared with PCA patients, the patients of PCA-H patients had younger onset age (65.0±5.0 vs. 67.8±3.7, P=0.001), increased prostate volume (75.0±11.7 mL vs. 54.5±8.5 mL, P < 0.001), increased level of TPSA (61.4±23.3 ng/mL vs. 33.4±14.9 ng/mL, P < 0.001), and Gleason grade (6.9±1.8 vs. 5.0±1.9, P < 0.001), later clinical stage (P < 0.001), shorter survival time (49.8±12.7 months vs. 57.3±6.2 months, P < 0.001) and decreased 5 years of survival rate (51.6% vs. 77.1%, P=0.006). The level of cholesterol, triglyceride and high density lipoprotein was significantly associated with the rejuvenation of onset age, the enlargement of prostate volume, increasing of serum TPSA, the progression of TNM clinical stage, increasing of Gleason grade, shorten of survival time and dropping of 5 years of survival rate (P < 0.05). In multiplefactor regression analysis, only hyperlipoidemia (OR=3.204, P=0.022) and Gleason grade (OR=8.611, P < 0.001) were the independent risk factors of prognosis. ConclusionThe situation of PCA with hyperlipoidemia is frequently noted in clinics, and hyperlipoidemia may be one of the risk factors in the processes of PCA growth and progression.