Effectiveness and economic outcomes in patients undergoing laparoscopic radical prostatectomy with a new surgical shear with an integrated energy system:A retrospective study based on a tertiary hospital database in China

ObjectiveThis study aimed to demonstrate a new surgical shear with an integrated energy system(Harmonic ACE^(®)+7)value by determining its effectiveness and economic outcomes compared with conventional ultrasonic shears(CUSs)in a real-world setting.MethodsThis was a retrospective study of adults with prostate cancer undergoing laparoscopic radical prostatectomy with the ACE^(®)+7 shear or CUSs between August 2019 and April 2021 at Shanghai Ruijin Hospital(the headquarters and Luwan Center in China).Demographic and diagnosis information,intraoperative and postoperative clinical outcomes,and total and categorical costs were collected.Propensity score matching was performed to form the study population for each clinical group.Data were compared between the two groups using t-test and Chi-squared test.ResultsThe ACE^(®)+7 was associated with a lower mean number of hemostatic clips used per surgery compared with CUSs(12.8 vs.19.8,p<0.001),a moderate but not significant difference in mean postoperative drainage duration(6.6[standard deviation,SD 2.2]days vs.7.9[SD 4.1]days,p=0.082),a reduction on mean total drainage volume(275.5[SD 374.3] mL vs.492.9[SD 1495.0]mL,p=0.321),and a lower mean rate of postoperative hemostatic drug usage(16.0%vs.52.0%,p<0.001).There was no significant difference in total costs between the ACE^(®)+7 and CUS groups.ConclusionThis study provides real-world data demonstrating that the ACE^(®)+7 shear with an integrated energy system improves clinical outcomes compared with CUSs and can offer cost savings for hospitals and health systems.Using the ACE^(®)+7 during laparoscopic radical prostatectomy allows physicians to help their patients achieve better outcomes and not spend additional money.

Diagnostic value comparison of the combination of prostate-specific membrane antigen-body PET/MR and the prostate health index with each alone in early diagnosis of prostate cancer

ObjectiveThis study aimed to figure out whether the combination of the prostate health index(PHI)and prostate-specific membrane antigen(PSMA)-PET/MR could improve the diagnostic accuracy for prostate cancer(PCa)than that of each individual method used alone.MethodsIn this prospective,observational study,41 patients who underwent the systematic prostate biopsy between June 2019 and September 2022 were enrolled.Both the PHI test and ^(18)F-PSMA-1007-PET/MR were performed prior to biopsies.The diagnostic accuracy of different models was compared by logistic regression,areas under the curve(AUCs)of the receiver operating characteristic,and net reclassification index(NRI).ResultsAmong the 41 patients,14(34.1%)were pathologically diagnosed with PCa.The PHI in the PCa group was significantly higher than that in the benign group(44.4 vs.35.0,p=0.048).Similarly,all the patients in the PCa group received positive results of ^(18)F-PSMA-1007-PET/MR,of which the positive rate was significantly higher than that in benign group(100%vs.62.96%,p=0.025).The ^(18)F-PSMA-1007-PET/MR provided additional diagnostic values to the PHI(AUC:0.802 vs.0.692,p=0.025).However,there was no significant difference between the combination model and the ^(18)F-PSMA-1007-PET/MR alone(AUC 0.802 vs.0.685,p=0.071).The optimal PHI cutoff of the combination model is 32,with which the model could significantly reduce unnecessary biopsies(NRI:22.22%,95%confidence interval:6.54%–37.90%,p=0.005).However,among patients with the PHI of≥43.5,there was no significant difference between the combination model and the PHI alone(NRI:11.11%,95%confidence interval:−0.74%–22.97%,p=0.066).ConclusionThe combination of the PHI and ^(18)F-PSMA-1007-PET/MR outperforms the PHI alone for predicting PCa,especially in avoiding unnecessary biopsies.However,for patients with the PHI of≥43.5,the addition of ^(18)F-PSMA-1007-PET/MR to the PHI does not yield additional benefits.

Prostate cancer in Asia:A collaborative report

The incidence of prostate cancer(PCa)within Asian population used to be much lower than in the Western population;however,in recent years the incidence and mortality rate of PCa in some Asian countries have grown rapidly.This collaborative report summarized the latest epidemiology information,risk factors,and racial differences in PCa diagnosis,current status and new trends in surgery management and novel agents for castration-resistant prostate cancer.We believe such information would be helpful in clinical decision making for urologists and oncologists,health-care ministries and medical researchers.

Percent free prostate-specific antigen for prostate cancer diagnosis in Chinese men with a PSA of 4.0-10.0 ng/mL:Results from the Chinese Prostate Cancer Consortium

Objective:To test the diagnostic performance of percent free prostate-specific antigen(%fPSA)in predicting any prostate cancer(PCa)and high-grade prostate cancer(HGPCa)in a retrospective multi-center biopsy cohort with a PSA level of 4.0e10.0 ng/mL in China.Methods:Consecutive patients with a PSA of 4.0-10.0 ng/mL who underwent transrectal ultrasound-guided biopsy were enrolled at 16 Chinese medical centers from January 1st,2010 to December 31st,2013.Total and free serum PSA determinations were performed using three types of electro-chemiluminescence immunoassays recalibrated to the World Health Organization(WHO)standard.The diagnostic accuracy of PSA,%fPSA,and %fPSA in combination with PSA(%fPSA t PSA)was determined using the area under the receiver operating characteristic(ROC)curve(AUC).Results:A total of 2310 consecutive men with PSA levels between 4.0 and 10.0 ng/mL were included,and the detection rate of PCa was 25.1%.The AUC of%fPSA and %fPSA t PSA in predicting any PCa was superior to PSA alone in men aged≥60 years(0.623 vs.0.534,p<0.0001)but not in men aged 40e59 years(0.517 vs.0.518,p=0.939).Similar result was yield in predicting HGPCa.Conclusion:In a clinical setting of Chinese men with 4.0e10.0 ng/mL PSA undergoing initial prostate biopsy,adding %fPSA to PSA can moderately improve the diagnostic accuracy for any PCa and HGPCa compared with PSA alone in patients≥60 but not in patients aged 40-59 years.

Application of fluorescence in situ hybridization in the detection of bladder transitional-cell carcinoma: A multi-center clinical study based on Chinese population

Objective:To evaluate the diagnostic value of fluorescence in situ hybridization(FISH)in bladder cancer.Methods:We enrolled healthy volunteers and patients who were clinically suspected to have bladder cancer and conducted FISH tests and cytology examinations from August 2007 to December 2008.Receiver operating characteristic(ROC)curve analysis was performed and the area under curve(AUC)values were calculated for both the FISH and urine cytology tests.Results:A cohort of 988 healthy volunteers was enrolled to establish a reference range for the normal population.A total of 4807 patients with hematuria were prospectively,randomly enrolled for the simultaneous analysis of urine cytology,FISH testing,and a final diagnosis as determined by the pathologic findings of a biopsy or a surgically-excised specimen.Overall,the sensitivity of FISH in detecting transitional-cell carcinoma was 82.7%,while that of cytology was 33.4%(p<0.001).The sensitivity values of FISH for non-muscle invasive and muscle invasive bladder transitional-cell carcinoma were 81.7%and 89.6%,respectively(p=0.004).The sensitivity values of FISH for low and high grade bladder cancer were 82.6%and 90.1%,respectively(p=0.002).Conclusion:FISH is significantly more sensitive than voided urine cytology for detecting bladder cancer in patients evaluated for gross hematuria at all cancer grades and stages.Higher sensitivity using FISH was obtained in high grade and muscle invasive tumors.

Relationship between urodynamic patterns and lower urinary tract symptoms in Chinese women with a non-neurogenic bladder

Objective:To investigate the urodynamic study(UDS)patterns,obstruction status,continence status,and their correlations among neurologically intact women with lower urinary tract symptoms(LUTS)through an epidemiological and logistic regression analyses.Methods:We retrospectively analyzed the UDS data of 3265 neurologically intact women with LUTS(2002e2014).Five UDS patterns were identified:normo-active detrusor/sphincter(NA,or DSI,detrusor/sphincter intact),idiopathic detrusor overactivity(IDO),idiopathic sphincter overactivity(ISO),IDO+ISO,and detrusor underactivity(DUA).Analyses of UDS pattern distribution and stratification were performed(based on a modification of the European Urological Association-Madersbacher classification system),and their correlations with bladder outlet obstruction(BOO)and stress urinary incontinence(SUI)status were evaluated via logistic regression analysis.Results:NA,IDO,IDO+ISO,ISO,and DUA were noted in 927(28.4%),678(20.8%),320(9.8%),689(21.1%),and 651(19.9%)cases,respectively.Moreover,storage,storage+voiding,and voiding symptoms were noted in 62.4%,21.1%,and 16.5% cases,respectively,whereas BOO and SUI were observed in 12.1%and 29.0%cases,respectively.The risk factors for BOO included NA,IDO,ISO,and IDO+ISO,whereas the protective factors against BOO included storage symptoms,SUI,storage+voiding symptoms,and complaint duration within 1e12 months.NA was the only risk factor for SUI,whereas BOO,storage+voiding symptoms,IDO,and storage symptoms were protective factors for SUI.Conclusion:Five UDS patterns were identified among neurologically intact women with LUTS.Functional abnormalities of the detrusor and/or sphincter were the main causes of LUTS,and were correlated with the BOO or SUI status.Thus,the UDS pattern can provide additional information regarding the risk factors for BOO or SUI status,as compared to symptomatic typing.