OBJECTIVE:To evaluate the feasibility and preliminary perioperative outcomes of a traction pre-bladder suturing technique for managing the intramural ureter during single-position robot-assisted laparoscopic nephroureterectomy (RALNU) in patients with early-stage upper tract urothelial carcinoma (UTUC). METHODS:10 consecutive patients with early-stage UTUC underwent RALNU (Oct 2022-Aug 2023). The technique involves four steps: mucosal tenting, a purse-string suture for containment, en bloc resection of the protruding mucosa and ureter, and reinforced double-layer bladder closure. RESULTS:All procedures were successful. Mean operative time was 145 min, with 38 min dedicated to the intramural segment. Mean blood loss was 35 mL, with no conversions or major complications. Pathology confirmed R0 resection of low-grade noninvasive carcinoma. Two metachronous bladder recurrences occurred during a median 12-month follow-up. CONCLUSION:This technique appears to be a feasible approach in patients with early-stage UTUC, with the potential to minimise urine spillage and facilitate secure bladder closure during RALNU.

BACKGROUND:This study compares outcomes of robotic Robotic-assisted left renal vein (LRV) transposition with and without proximal left gonadal vein (LGV) transposition for Nutcracker Syndrome (NCS). METHODS:A retrospective analysis was conducted on 24 NCS patients. Group A (n = 13) had LRV transposition. Group B (n = 11) had combined LRV+ proximal LGV transposition. Outcomes including operative details, complications, symptom resolution, and renocaval pressure gradient (RPG) reduction. RESULTS:Operative time and hospital stay were similar between the groups. However, group B had a higher lymphatic leakage rate (64% vs. 8%; p = 0.0078) and required longer drainage (median 5 vs. 3 days; p = 0.02). Clinical symptoms improved in both groups. Group B achieved substantially greater RPG reduction (70% ± 15% vs. 55% ± 8%; p = 0.004). CONCLUSIONS:Robotic LRV and proximal LGV transposition for significant dilation is safe and effective. Despite higher short-term lymphatic morbidity, the combined approach offers greater reduction in RPG, providing a valuable alternative for selected patients. TRIAL REGISTRATION:This research was also registered at the Chinese Clinical Trial Registry. The registration number is ChiCTR2500099335 (Link: https://www.chictr.org.cn/bin/project/edit?pid=261879).

The grading classification of clear cell renal cell carcinoma (CCRCC) is a crucial prognostic factor. However, manual observation can lead to subjective and inconsistent diagnoses. In this study, we aimed to develop a deep-learning-based grading system for CCRCC using whole-slide image (WSI) and to predict disease progression. A total of 305 CCRCC cases were used to develop the renal cell carcinoma artificial intelligence diagnosis (RCCAID) model for grading (188 training, 47 verification, and 70 testing cases) and the renal cell carcinoma artificial intelligence prognostic (RCCAIP) progression prediction model (288 cases). Progression was defined as the presence of distant and/or lymph node metastasis. Xception, ResNet50, and Inception V3 were employed. Model performance was assessed via confusion matrix, receiver operator characteristic curve (ROC) curve, and classification map. RCCAID achieved area under the curve (AUC) values of 0.987 (internal), 0.996 (in-house), and 0.967 (external). The quadratic weighted Cohen’s kappa was 0.864, comparable to senior pathologists (0.871). RCCAIP achieved an AUC of 0.94 for progression prediction. Higher grades correlated with worse prognosis. RCCAID can accurately grade CCRCC in whole-slide images, and RCCAIP is effective in progression prediction, even for low-grade tumors.

OBJECTIVE:To evaluate the feasibility of a novel robotic-assisted laparoscopic technique-side clamp two-step vascular method-for left renal vein (LRV) transposition in nutcracker syndrome (NCS). METHODS:Between May and December 2023, three male NCS patients (median age: 14 years) underwent robot-assisted LRV transposition using the Di's technique. The key procedure included a side clamp two-step technique to selectively occlude the infrarenal inferior vena cava and LRV without right renal vein manipulation. Surgical outcomes, including operative time, blood loss, anastomosis duration, and postoperative complications, were retrospectively analysed. RESULTS:All procedures were successfully completed. Median operative time was 125 min, with LRV anastomosis completed in 23 min. Postoperative imaging confirmed the resolution of LRV compression, with pressure gradients reduced to < 3 mmHg. Symptoms resolved completely within 4 weeks. CONCLUSIONS:The robotic-assisted side clamp two-step technique offers a minimally invasive alternative for LRV transposition in NCS, minimising vascular dissection and preserving right renal venous flow. TRIAL REGISTRATION:This clinical trial has been registered in the Chinese Clinical Trial Registry (ChiCTR, registration number: ChiCTR2500099335).

This study aimed to investigate the value of integrating computed tomography (CT)-based tumor radiomics features with clinical parameters for preoperative prediction of microvascular invasion (MVI) in clear cell renal cell carcinoma (ccRCC). We retrospectively analyzed data from a single-center cohort of ccRCC patients. Radiomics features were extracted from preoperative multiphasic CT scans (unenhanced, corticomedullary, and nephrographic phases). Following dimensionality reduction and feature selection, eight machine learning algorithms were evaluated to identify the optimal radiomics model. Independent clinical predictors were determined through univariate and multivariate analyses. A nomogram integrating the radiomics signature (rad-score) with significant clinical parameters was subsequently developed. Model performance was assessed using the area under the curve (AUC), decision curve analysis (DCA), and calibration curve analysis (CAC). Of 143 initially enrolled patients, 110 met inclusion criteria after screening, with 5502 radiomics features extracted. The support vector classifier (SVM) model demonstrated the highest discriminative ability, achieving mean AUCs of 0.976 (training cohort) and 0.892 (test cohort), significantly outperforming the clinical model (training AUC = 0.935, test AUC = 0.933). The nomogram showed superior diagnostic performance, with AUCs of 0.958 (test). DCA and CAC confirmed its clinical utility and robustness. Multiparametric CT radiomics models enable non-invasive prediction of MVI status in ccRCC, with the SVM-based algorithm showing optimal performance. The integrated nomogram provides excellent and consistent diagnostic accuracy, offering a valuable preoperative tool for clinical decision-making.

OBJECTIVE:To evaluate the feasibility and outcomes of a novel robotic-assisted laparoscopic technique-Di's II robotic-assisted left renal vein (LRV) transposition with distal gonadal vein (GV) anastomosis-creating dual venous drainage for treating nutcracker syndrome (NCS). METHODS:Between December 2023 and October 2024, three male patients (median age, 14 years) with NCS underwent robotic-assisted LRV transposition using the Di's II technique. Key procedural innovations included selective occlusion of the infrarenal inferior vena cava (IVC) and LRV without right renal vein clamping, combined with distal GV anastomosis to enhance venous drainage. Operative parameters, including anastomosis time, blood loss, and postoperative outcomes, were analyzed retrospectively. RESULTS:All procedures were successfully completed robotically. Median total operative time was 145 minutes (range, 135-160 minutes), with LRV and GV anastomosis times of 25 minutes (range, 24-27 minutes). The median estimated blood loss was 40 mL (range, 30-50 mL). Postoperative imaging confirmed resolution of LRV compression, with pressure gradients reduced to ≤2.8 mm Hg. Symptoms (hematuria, proteinuria, and varicocele) resolved within 6 months, and no perioperative complications occurred during follow-up. CONCLUSIONS:The Di's II technique represents a safe and effective minimally invasive approach for NCS, combining robotic precision with dual venous drainage to alleviate LRV hypertension and pelvic congestion. Preliminary outcomes demonstrate technical feasibility, a lower ischemia risk, and symptom resolution, supporting further validation in larger cohorts.

BackgroundMitochondrial damage contributes to apoptosis, oxidative stress, and inflammation, which collectively impact the immune system’s function and the tumor microenvironment (TME). These processes, in turn, influence tumor cell growth, migration, and response to treatment.ObjectiveWe conducted a bibliometric analysis to elucidate the complex interactions between mitochondrial damage, the immune system, and the TME.MethodsData were sourced from the Science Citation Index Core Collection (WoSCC) and analyzed using advanced tools like VOSviewer and Citespace. Our focus was on literature published between 1999 and 2023 concerning the interactions between mitochondrial damage and the TME, as well as immune responses to tumors. The analysis included regional contributions, journal influence, institutional collaborations, authorship, co-cited authors, and keyword citation bursts.ResultsOur research encompassed 2,039 publications, revealing an increasing trend in annual output exploring the relationship between mitochondrial damage, TME dynamics, and immune responses. China, the United States, and South Korea emerged as the leading contributors. Prominent institutions included Institut National de la Santé et de la Recherche Médicale, University of Texas System, China Medical University, and Sun Yat-sen University. Key journals in this field are the International Journal of Molecular Sciences, Mitochondrion, and the European Journal of Pharmacology. Liang H and Wallace DC were identified as the most productive and co-cited authors, respectively. Keyword analysis highlighted the critical roles of inflammatory responses, oxidative stress, and the immune system in recent research.ConclusionThis bibliometric analysis provides a comprehensive overview of historical and current research trends, underscoring the pivotal role of mitochondrial damage in the TME and immune system.

Metastatic prostate cancer (PCa) remains incurable and causes considerably diminished overall survival. Despite significant progress in pharmacotherapy, the disease prognosis remains unchanged. Immune checkpoint inhibitors (ICIs) have demonstrated effectiveness in treating various advanced malignancies, but their efficacy in metastatic PCa is relatively limited. Previous studies have confirmed the immunosuppressive role of tumor-infiltrating B cells (TIL-Bs) in the PCa microenvironment, which accounts for their poor immunogenic potency. In this study, we demonstrated that an oral kinase agent, ibrutinib, strongly potentiated anti-PD-1 checkpoint blockade efficacy and successfully controlled tumor growth in a murine orthotopic PCa model constructed using a metastatic and hormone-independent cell line (RM-1). We identified close relationships between TIL-Bs, Bruton's tyrosine kinase (BTK), and immunosuppressive molecules by bioinformatics and histological analysis. An in vitro study showed that a low dose of ibrutinib significantly inhibited B cell proliferation and activation as well as IL-10 production through the BTK pathway. Moreover, ibrutinib-treated B cells promoted CD8+ T cell proliferation and inhibitory receptor (IR) expression. However, the same dose of ibrutinib was insufficient to induce apoptosis in cancer cells. An in vivo study showed that ibrutinib monotherapy failed to achieve tumor regression in murine models but decreased B cell infiltration and inhibited activation and IL-10 production. More importantly, CD8+ T cell infiltration increased with high IR expression. Ibrutinib synergized with anti-PD-1 checkpoint blockade enormously improved antitumor immunity, thereby reducing tumor volume in the same scenario. These data set the scene for the clinical development of ibrutinib as an immunogenic trigger to potentiate anti-PD-1 checkpoint blockade for metastatic PCa immunotherapy.

Rationale: Renal nutcracker syndrome is a rare phenomenon that often causes various disability symptoms. The treatment protocol has been explored for a long time, but no consensus has been reached. Patient concerns: Here, we report the case of a 19-year-old male suffering with nutcracker syndrome, including left-sided flank pain and intermittent gross hematuria. Diagnoses: The patient was diagnosed with renal nutcracker syndrome, and the pressure gradient between the left renal vein and inferior vena cava was >5 mm Hg. Interventions: The patient underwentrobotic-assisted combined transposition of left renal vein and gonadal vein. Outcomes: Flank pain and gross hematuria ceased spontaneously after surgery without occurrence. Lessons: Robotic-assisted combined transposition of the left renal vein and gonadal vein is a safe and promising option for this condition.

Objective:To explore the technical essentials of robot-assisted radical prostatectomy via posterior and completely intrafascial for organ-confined prostate cancer, and to evaluate the oncological and functional outcomes.Methods:Fifteen prostate cancer patients with T1-2bN0M0 were scheduled for robot-assisted radical prostatectomy via posterior and completely intrafascial approach, and their international index of erectile function (IIEF) were performed before operation. All patient was placed in a supine position and the robotic system was established. Firstly, expose the Douglas fossa, free bilateral vas deferens and seminal vesicles, blunt dissection of the Denonvillier fascia, severed lateral ligament and visceral pelvic fascia, then exposed and disconnected urethra, continuous suture bladder neck urethra. Perioperative complications and functional outcome data were recorded. All patients were regularly followed up for tPSA testing, daily urine pads and IIEF-5 scores.Results:All of the 15 patients were successfully completed the operations. The median (range) operation time was 86(65-116) min, and estimated blood loss was 20 (10-60) ml, and no serious complications occurred. Postoperative pathology was 18.Conclusions:Robot-assisted radical prostatectomy via posterior and completely intrafascial approach is technically feasible for patients with low-risk localized prostate cancer and demonstrates promising functional outcomes regarding continence and potency.

Prostate cancer (PCa) is one of the most frequent cancers in men, and its biomolecular targets have been extensively studied. This study aimed to analyze the expression of toll-like receptor 9 (TLR9) and vascular endothelial growth factor C (VEGF-C) and the clinical value of the coexpression of TLR9 and VEGF-C in PCa. We retrospectively evaluated 55 patients with clinically localized, intermediate-risk, or high-risk PCa who underwent laparoscopic radical prostatectomy (LRP) and extended pelvic lymph node dissection (ePLND) without neoadjuvant hormonal therapy at a single institution from June 2013 to December 2016. In all 55 patients, the median number of lymph nodes (LNs) resected was 23 (range: 18–31), and a total of 1269 LNs were removed, of which 78 LNs were positive. Seventeen patients had positive LNs, with a positive rate of 30.9%. In addition, the immunohistochemical results in the above patients revealed that high TLR9 expression was correlated with higher Gleason score (GS) (P = 0.049), increased LN metastasis (P = 0.004), and more perineural invasion (PNI) (P = 0.033). Moreover, VEGF-C expression was associated with GS (P = 0.040), pathological stage (pT stage) (P = 0.022), LN metastasis (P = 0.003), and PNI (P = 0.001). Furthermore, a significant positive correlation between TLR9 and VEGF-C was found (P < 0.001), and the TLR9/VEGF-C phenotype was associated with LN metastasis (P = 0.047). Collectively, we propose that TLR9 stimulation may promote LN metastasis in PCa cells through the upregulation of VEGF-C expression, thereby affecting the prognosis of PCa patients. Therefore, these markers may serve as valuable targets for the treatment of PCa.

Objective:To investigate the expression level of excision repair cross complementary gene 1 (ERCC 1) in PC-3 cells and prostate samples and its relationship with prognosis.Methods:After siRNA ERCC 1 was transfected into PC-3 cells, the expression level of ERCC 1 protein was detected by Western blot. The MTT method detected cell proliferation activity, andthe Transwell test detected cell migration and invasion capabilities. Immunohistochemistry (IHC) was used to detect the expression level of ERCC 1 protein in 80 PCa and 30 BPH samples, and its relationship with pathological characteristics and prognosis was analyzed.Results:After siRNA ERCC 1 plasmid was transfected into PC-3 cells, Western blot showed that the expression level of ERCC 1 was significantly reduced. Transwell test showed that the migration and invasion ability of PC-3 cells after siRNA ERCC 1 expression was significantly decreased (P<0.05). IHC indicated that the positive expression rate of ERCC 1 in PCa samples was 71.3%(57/80), and the high expression rate was 23.8%(19/80; IRS≥6); the positive expression rate in BPH samples was 10% (3/30), all are low expression (IRS<6). The expression of ERCC 1 was significantly correlated with preoperative PSA value, Gleason score, pathological stage (pT), lymph node metastasis and positive margins in PCa patients (P<0.05), but not significantly correlated with age (P>0.05). In PCa patients, the biochemical relapse-free survival (BRFS) with low ERCC 1 expression was significantly longer than that of patients with high ERCC 1 expression (P<0.05). Univariate and multivariate COX regression analysis showed that high ERCC 1 expression and pT were independent risk factors with BRFS.Conclusion:SiRNA ERCC 1 inhibit the proliferation, migration and invasion of PC-3 cells. The positive expression rate of ERCC 1 in PCa samples is higher, which related to poor differentiation and high invasive characteristics. The high expression of ERCC 1 may be one of the independent risk factors for the prognosis of PCa patients.

胡桃夹综合征（nutcracker syndrome，NCS），是由于左肾静脉（left renal vein，LRV）穿行于肠系膜上动脉（multifactorial superior mesenteric artery，SMA）与主动脉之间或主动脉与椎体之间受到机械性压迫所导致的一系列症候群[1,2]。主要表现为腹部或左腰部疼痛、血尿、蛋白尿、男性左侧精索静脉曲张、女性盆腔充血综合征和慢性疲劳综合征等[3]。多种治疗方法已被报道用于保守治疗无效的NCS，但金标准仍然是LRV移位术。随着微创技术的发展，全腹腔镜下LRV移位术也成为NCS的治疗选择之一。我们报道2例全腹腔镜下LRV移位术的手术经验。

胡桃夹综合征（nutcracker syndrome，NCS）是一种少见疾病，多因肠系膜上动脉（multifactorial superior mesentericartery，SMA）与主动脉夹角过小导致左肾静脉（left renal vein，LRV）受压，引起以血尿、直立性蛋白尿和疼痛等一系列表现的综合征。采用间接或直接手段缓解流出道压迫的治疗方法有多种，其中左肾静脉移位术疗效确切，但该手术损伤大、风险高、技术难度较大，一定程度限制了其在临床上开展[1]。机器人辅助腹腔镜手术大大减轻手术创伤，机器人手腕的灵活转动使得血管吻合更简单，效果确切。本中心最近成功开展了2例机器人辅助腹腔镜下左肾静脉移位术，现报道如下。

Objective:To discuss the surgical techniques and evaluate the clinical effects of laparoscopic varicocelectomy with testicular artery preservation.Methods:In this retrospective study, we collected clinical data of 97 patients with varicocele who underwent laparoscopic varicocelectomy from January 2015 to June 2020. All operations were performed by the same experienced urologist. Conventional laparoscopic varicocelectomy without testicular artery preservation was performed in earlier 35 patients (January 2015 to December 2016), which were taken as control group. The latter 62 patients (January 2017 to June 2020) underwent laparoscopic varicocelectomy with testicular artery preservation were taken as observational group. In observational group, average age was (21.9±6.7)years, there were 47 cases on the left side, 3 cases on the right side and 12 cases bilaterally, totaling 74 sides. There were 22 sides of varicose veinsⅠ, 28 sides of varicose veinsⅡand 24 sides of varicose veins Ⅲ. Clinical manifestations such as scrotal discomfort, pain and scrotal vein masses were observed on 35 sides (47.3%), infertility was observed in 24 cases (38.7%). Average sperm density was (23.7±5.9)×10 6/ml, average sperm motility (grade a+ b) was (33.9±4.1)%. In control group, average age was (23.7±4.6) years, there were 26 cases on the left side, 2 cases on the right side, 7 cases bilaterally, totaling 42 sides. There were 10 sides of varicose veinsⅠ, 17 sides of varicose veinsⅡ, 15 sides of varicose veinsⅢ. Clinical manifestations of scrotal discomfort, pain and scrotal vein masses were observed on 19 sides (45.2%), infertility was observed in 14 cases (40.0%). Average sperm density was (22.3±6.2)×10 6/ml, average sperm motility (grade a+ b) was (32.6±4.8)%.There was no significant statistical difference in preoperative clinical data between two groups ( P>0.05). The observational group followed the procedural steps of freeing the spermatic cord, isolating the testicular artery, and ligating the spermatic vein. The testicular artery was separated by the separating forceps and the electric hook, with the separating forceps holding the spermatic cord fascia in place and the electric hook (without electricity) bluntly separating the blood vessels and lymphatic vessels in the spermatic cord. The operative time, complications, recurrence rate, improvement rate of scrotal symptoms and semen quality, spontaneous pregnancy rate of spouses within 2 years in infertile patients were compared between the two groups. Results:The mean operative time in observational group was longer than control group [(35.8±7.7)min vs.(16.5±5.5)min, P<0.001]. Occurrence of postoperative acute epididymitis was lower in observational group compared to control group [1.4% (1 side) vs. 11.9% (5 sides), P<0.05] . No testicular atrophy (0 side) occurred in observational group, however, this complication could be found in 7.1% (3 sides) of control group ( P<0.05). Improvement rate of scrotal symptoms and semen quality was higher in observational group than that in control group after operations [77.1% (27 sides) vs. 47.4% (9 sides), P<0.05; and 72.6% (45 cases) vs.51.4% (18 cases), P<0.05]. The rates of spousal natural pregnancy within 2 years in infertile patients was higher in observational group than that in control group [70.8% (17 cases) vs. 50.0% (7 cases), P<0.05]. The rates of hydrocele and scrotal edema were similar in two groups [9.5% (7 sides) vs. 9.5 (4 sides)%, P>0.05], and the recurrence rate of varicocele was similar [8.1% (6 sides) vs. 7.1% (3 sides), P>0.05), without statistically significant difference. Conclusions:Using separating forcep and electronic hook can help to separate the testicular artery when performing laparoscopic varicocelectomy. In this operation, to preserve the testicular artery can get better effects an less complications.

Background Multiple long non-coding RNAs (lncRNAs) have been demonstrated to function as vital regulators in the progression of prostate cancer (PCa). In the present study, we aimed to probe the function of lncRNA small nucleolar RNA host gene 8 (SNHG8) in PCa progression. Methods A quantitative real-time polymerase chain reaction and western blotting were utilized to measure SNHG8, microRNA-384 (miR-384) and homeobox B7 (HOXB7) expression. Call-couting kit-8 and bromodeoxyuridine experiments were employed to evaluate PCa cell proliferation. Transwell experiments were performed to detect PCa cell migration and invasion. Dual-luciferase reporter experiments and RNA immunoprecipitation experiments were conducted to determine the targeting relationships among miR-384, SNHG8 and HOXB7. Results SNHG8 was up-regulated in PCa tissues and cells. Silencing of SNHG8 suppressed the proliferation, migration and invasion of PCa cells. SNHG8 functioned as a molecular sponge to repress miR-384. The effects of SNHG8 knockdown on PCa cell proliferation, migration and invasion were counteracted by miR-384 inhibition. HOXB7 was confirmed to be a target gene of miR-384. SNHG8 knockdown repressed HOXB7 expression via targeting miR-384. Conclusions SNHG8 promotes PCa cell proliferation, migration and invasion via decoying miR-384 and up-regulating HOXB7.

Objective:To investigate the role of Smad4 as a target gene regulated by microRNA (miRNA, miR)-301a and the mediating effect of high glucose in promoting the proliferation of prostate cancer cells.Methods:Real-time PCR was used to examine the expression of miR-301 in prostate cancer cells. Bioinformatics prediction by using software of TargetScan and PicTar and luciferase reporter gene assay was utilized for the identification of the target genes of miR-301. The expression of Smad4 was detected by real-time PCR and Western bloting [25 μg, 10% sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE)] after the miR-301 mimic was transfected 24 h later. After miR-301 mimics were transfected or co-transfected with Smad4 over-expression plasmid for 24 h, the proliferation and cell cycle of prostate cancer cells (PC-3 and DUl45) were examined by cell counting kit-8 (CCK-8) and flow cytometry, respectively.Results:Bioinformatics prediction and luciferase reporter gene assay demonstrated that Smad4 was the target of miR-301a. After up-regulating miR-301a, the expression of Smad4 mRNA and protein was significantly reduced. The cell proliferation ability increased by 160% ( P<0.05) after up-regulating the expression of both miR-301a and Smad4 for 96 h. MiR-301a could inhibit the expression of Smad4, thereby promoting the cell transition from the G 1 phase to the S phase. In PC-3 cells, before overexpression of miR-301a, the percentages of different phases were G 0/G 1 62.60%, S 28.00%, G 2/M 9.40%; after overexpression, the percentages were G 0/G 1 49.97%, S 41.04%, G 2/M 8.99%, the differences in the phases of G0 and S were significant ( P<0.05). In DU-145cells, before overexpression of miR-301a, the percentages of different phases were G 0/G 1 65.16%, S 24.54%, G 2/M 10.30%; after overexpression, the percentages were G 0/G 1 53.34%, S 36.67%, G 2/M 10.00%, the differences in the phases of G 0 and S were significant ( P<0.05). In addition, knockdown of Smad4 shortened the G 1 phase and prolonged the S phase, which was consistent with the results of miR-301a overexpression. Overexpression of Smad4 could block the effect of miR-301a inducing transformation of G 1/S phase. Conclusion:MiR-301 can regulate the proliferation of prostate cancer cells by targeting Smad4 gene. Smad4 plays an important role in the regulation of hyperglycemia associated prostate cancer.

Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND)and oncological outcome by fluorescence laparoscopic radical prostatectomy (FLRP) versus high-definition laparoscopic radical prostatectomy (HD-LRP) for men with locally advanced prostate cancer (LAPCa).Methods In a prospective trial,we recruited 51 patients with T3a-bNxM0 prostate cancer from July 2015 to April 2018.Patients were assigned to study group or control group according to random number method,and were underwent either FLRP + ePLND or HD-LRP + ePLND.21 in the study group were injected with 5 mg of indocyanine green (ICG) into the bilateral lobes of the prostate transperineally guiled by transrectal ultrasound 30 min before surgery for lymphography.During the surgical procedure a fluorescence laparoscope,optimized for detection in the near infrared range,was used to visualize the lymph nodes (green fluorescent) in the dissection region in the study group while a common laparoscopy introduced in control one.Lymph nodes were removed in the external iliac vessiles,internal iliac artery,obturator fossa regions,common iliac regions and presacral regions in both groups.Radical prostatectomy was completed in the both groups by similar steps.The operation time,blood loss,number of removed lymph nodes and positive lymph nodes,complication rate,biochemical recurrence (BCR) and metastasis free survival rates in 2 years were recorded and compared in the two groups.Results 51 eligible patients were selected,including 21 in the study group and 30 in the control group.The mean age of biopsy of study group and control one were (66.4 ± 7.7) and (66.8 ± 7.4),the mean age PSA (23.5 ± 16.8) ng/ml and (26.0 ± 20.1) ng/ml,the mean Gleason score of biopsy (8.1 ± 1.0) and (7.9 ± 0.9) respectively,and there was no statistical significant difference between two groups.The mean operation time of study group and control one were (45.9 ± 4.6) min and (56.4 ± 3.2) min,the mean removed lymph nodes were (27.7 ± 5.6) and (22.1 ±5.6) respectively,and there was statistical significant difference between two groups (all P ＜ 0.05).Lymph nodes invasion in pathology were reported in 8 cases(38.1％)in the study groups while 9 (30.0 ％) in the control one;the proportion of positive lymph node (metastasis) were 3.2％ (19/583) and 3.4％ (23/663) in the two groups respectively and no statistically significant difference was noted between the two groups.Lymphorrhagia occurred in 4 cases in the control group,and there was no serious complications in both groups.The median follow-up time was 20 (7-33) month and during this time,BCR observed of 1 (4.7％) in the study group and 8 (26.7％) in the control;meanwhile,the MFSR was recorded of 100.0％ (0)in the study group and 86.7％ (4)in the control one,showing a statistically significant difference between the two groups(P =0.04).Conclusions Comparing with LRP,FLRP achieved better results of LN dissection,which will improve oncological outcomes.

Prostate cancer (PCa) is a worldwide malignant tumor which seriously threats the reproductive health of middle-aged and senior male. Sperm-associated antigen 9 (SPAG9), which belongs to the cancer testis (CT) antigen, overexpressed in multiple human malignant tumors and promoted tumor proliferation, invasion and metastasis. However, little attention has been focused on the relationship between SPAG9 and PCa. SPAG9 protein level was measured by immunohistochemical staining in the PCa tissues. SPAG9 mRNA and protein expression were investigated in various PCa cells by qRT-PCR and Western blot. Depletion and overexpression of SPAG9 were proceeded in PCa cells to evaluate their effects by various malignant approaches in vitro and in vivo. SPAG9 was significantly upregulated in the PCa tissues, mainly expressed in the cytoplasm and occasionally in the nucleus of some cells, while SPAG9 was not detected in normal prostate tissue. SPAG9 protein was detected in three PCa cells. Furthermore, these results revealed that upregulation of SPAG9 could promote cell proliferation, migration, motility and cycle of PC-3 cell line, vice versa, downregulation of SPAG9 resulted in the opposite effect. In vivo, knockout of SPAG9 expression induced suppression of tumor growth in athymic nude mice. In summary, the present study indicated that SPAG9 was closely related to the Gleason scores of PCa. SPAG9 could promote cell proliferation, migration, motility and cell cycle via MAPK signaling pathway, suggesting that SPAG9 may be a potential therapeutic target for PCa.

The present study analyzed the predictive value of combined analysis of collapsin response mediator protein 4 (CRMP4) methylation levels and the Cancer of the Prostate Risk Assessment (CAPRA-S) Postsurgical score of patients who required adjuvant hormone therapy (AHT) after radical prostatectomy (RP). We retrospectively analyzed 305 patients with prostate cancer (PCa) who received RP and subsequent androgen deprivation therapy (ADT). Two hundred and thirty patients with clinically high-risk PCa underwent immediate ADT, and 75 patients with intermediate risk PCa underwent deferred ADT. CRMP4 methylation levels in biopsies were determined, and CAPRA-S scores were calculated. In the deferred ADT group, the values of the hazard ratios for tumor progression and cancer-specific mortality (CSM) in patients with ≥15% CRMP4 methylation were 6.81 (95% CI: 2.34-19.80) and 12.83 (95% CI: 2.16-26.10), respectively. Receiver-operating characteristic curve analysis indicated that CRMP4 methylation levels ≥15% served as a significant prognostic marker of tumor progression and CSM. In the immediate ADT group, CAPRA-S scores ≥6 and CRMP4 methylation levels ≥15% were independent predictors of these outcomes (uni- and multi-variable Cox regression analyses). The differences in the 5-year progression-free survival between each combination were statistically significant. Combining CAPRA-S score and CRMP4 methylation levels improved the area under the curve compared with the CRMP4 or CAPRA-S model. Therefore, CRMP4 methylation levels ≥15% were significantly associated with a poor prognosis and their combination with CAPRA-S score accurately predicted tumor progression and metastasis for patients requiring AHT after RP.