Background The introduction of multiparameter MRI and novel biomarkers has greatly improved the prediction of clinically significant prostate cancer (csPCa). However, decision-making regarding prostate biopsy and prebiopsy examinations is still difficult. We aimed to establish a quick and economic tool to improve the detection of csPCa based on routinely performed clinical examinations through an automated machine learning platform (AutoML). Methods This study included a multicenter retrospective cohort and two prospective cohorts with 4747 cases from 9 hospitals across China. The multimodal data, including demographics, clinical characteristics, laboratory tests, and ultrasound reports, of consecutive participants were retrieved using extract-transform-load tools. AutoML was applied to explore potential data processing patterns and the most suitable algorithm to build the Prostate Cancer Artificial Intelligence Diagnostic System (PCAIDS). The diagnostic performance was determined by the receiver operating characteristic curve (ROC) for discriminating csPCa from insignificant prostate cancer (PCa) and benign disease. The clinical utility was evaluated by decision curve analysis (DCA) and waterfall plots. Results The random forest algorithm was applied in the feature selection, and the AutoML algorithm was applied for model establishment. The area under the curve (AUC) value in identifying csPCa was 0.853 in the training cohort, 0.820 in the validation cohort, 0.807 in the Changhai prospective cohort, and 0.850 in the Zhongda prospective cohort. DCA showed that the PCAIDS was superior to PSA or fPSA/tPSA for diagnosing csPCa with a higher net benefit for all threshold probabilities in all cohorts. Setting a fixed sensitivity of 95%, a total of 32.2%, 17.6%, and 26.3% of unnecessary biopsies could be avoided with less than 5% of csPCa missed in the validation cohort, Changhai and Zhongda prospective cohorts, respectively. Conclusions The PCAIDS was an effective tool to inform decision-making regarding the need for prostate biopsy and prebiopsy examinations such as mpMRI. Further prospective and international studies are warranted to validate the findings of this study. Trial registration Chinese Clinical Trial Registry ChiCTR2100048428. Registered on 06 July 2021.

Background: Markers are needed to increase the diagnostic accuracy of prostate-specific antigen (PSA) in prostate cancer (PCa) screening. Mounting evidence has shown that plasma proteins can be hopeful biomarkers for cancer diagnosis.Methods: Tandem mass tag (TMT)-based proteomics and parallel reaction monitoring (PRM) analysis were used to screen the differential proteins and further validated in four independent studies (n=791). Receiver operating characteristic (ROC), decision curves and nomograms were applied to assess the diagnostic accuracy of biomarkers.Findings: Three candidate proteins (DBP, LCAT and ORM2) were preliminarily screened. Subsequent validation studies revealed significant upregulation of ORM2 in PCa patients across 4 independent cohorts. ORM2 yielded excellent discriminative power for PCa from benign prostatic hyperplasia (BPH) patients (AUC=0.861 and 0.814 in validation phases 2a and 2b, respectively), with a slightly decreased performance in distinguishing PCa from healthy controls (AUC=0.652 and 0.626 in phases 3a and 3b). Importantly, the combination of ORM2 and PSA gave better predictive accuracy than PSA alone. We incorporated age, PSA and ORM2 into a nomogram, which yielded c-indices of 0.883 in validation phase 2a and 0.922 in phase 2b.Interpretation: Our study suggests that ORM2 could be treated as a complementary biomarker for PSA in PCa detection.Funding: This work was supported by the Natural Science Foundation of Jiangsu Province (BK20190600; BK20190555), National Natural Science Foundation of China (81903390; 81802880), and Huai’an City Science and Technology Project (HAB202051).Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Institutional Review Board of each participating institution. All participants provided their informed consent to participate.

Fast detection of low-concentration exosomes in body fluids is of great significance in understanding the pathogenesis and disease diagnosis but is quite a challenging work due to the complex matrix, tedious pretreatment, and relatively poor sensitivity without the aid of instruments. In this work, by simply using a filter membrane to enrich the exosomes at low concentrations and the use of CuS nanoparticles as labels, we were able to detect exosomes at concentrations as low as 2 × 103 particles/μL in a complex matrix by the naked eye. Due to its high sensitivity, specificity, and simplicity, it can be used for the diagnosis of direct prostate cancer via a 5 mL urine sample within 2 h without the use of any instrument. This method can also be applicable for the detection of other biological nanoparticles, such as viruses, at low concentrations in a complex matrix, offering a promising candidate for point-of-care disease diagnosis with low cost.

OBJECTIVE:To search for the potential genes associated with the recurrence of prostate cancer (PCa) after radical prostatectomy so as to improve the prognosis of the patient.METHODS:The GSE25136 microarray dataset was downloaded from the Gene Expression Omnibus (GEO), involving 39 recurrent and 40 non-recurrent PCa samples. Differentially expressed genes were identified with the Limma package and screened by hierarchical cluster analysis using the Pheatmap package. The potential functions of the differentiated genes were predicted by gene ontology functional enrichment analysis with the ClueGO module of the Cytoscape software. A protein-protein interaction (PPI) network of the genes was constructed in the Cytoscape using the String website, and the module was analyzed using CytoHubba to understand the interactions between these differential genes and identify the key genes in the protein network. The expressions of the identified genes were verified in PCa and normal prostatic tissues by immunohistochemical staining.RESULTS:Totally 167 differentially expressed genes were up-regulated and 91 down-regulated (P ≤ 0.05) in the recurrent PCa samples, with statistically significant differences from the non-recurrent ones. In the top 50 genes that were most significantly up- or down-regulated and mainly involved in the development of the limbic system and the interferon-gamma-mediated signaling pathway, CASP3 and STAT1 were found to be the key genes in the protein network and confirmed to be differentially expressed in the PCa and normal prostatic tissues by immunohistochemistry.CONCLUSIONS:Strong genetic characteristics were found in the progression of recurrent to non-recurrent PCa. The development of the limbic system and the interferon-gamma-mediated signaling pathway are closely related to the development of recurrent PCa. In addition, CASP3 and STAT1, as the key genes, may play an important role in the diagnosis and treatment of recurrent PCa.

OBJECTIVE:To explore the safety of modified sandwich urethral reconstruction (MSUR) in laparoscopic radical prostatectomy (LRP) and its effect on the early recovery of urinary continence.METHODS:We retrospectively analyzed the clinical data on 20 patients treated by LRP with MSUR (the MSUR group) and another 21 cases of LRP without MSUR (the conventional control group) from January 2018 to September 2019. We compared the two groups of patients in the general data, anastomosis time, operation time and urinary continence recovery.RESULTS:There were no statistically significant differences between the two groups of patients in the age, body mass index, Gleason scores, prostate volume and baseline PSA level (P > 0.05) or in operation time, intraoperative blood loss, drainage tube indwelling time, postoperative feeding time and postoperative hospital stay (P > 0.05). Anastomotic stenosis occurred in 1 case in the MSUR group postoperatively, which was cured after regular urethral dilation, and anastomotic fistula developed in 1 case in the control group, which was healed after 5 days of prolonged catheterization. The recovery rate of urinary continence at 12 weeks after catheter removal was significantly higher in the MSUR than in the control group (80.0% vs 47.6%, P < 0.05).CONCLUSIONS:Modified sandwich urethral reconstruction in LRP is a safe, effective and feasible surgical strategy, which can significantly improve postoperative urinary continence recovery of the patient.

OBJECTIVE:To investigate the application value of magnetic resonance-ultrasound fusion (MR-USF) guided transperineal prostate biopsy (TPPB) in the diagnosis of prostate cancer.METHODS:Relevant data were collected retrospectively from 77 patients undergoing MR-USF guided TPPB (n = 22) or 12-core systematic prostate biopsy (SPB) (n = 55) in Binhai People's Hospital from May to July 2019 and statistically analyzed using the software Graphad Prism 7.0 and SPSS 22.0.RESULTS:The patients were aged 51－91 (70.5 ± 9.7) years, with a mean PSA level of (35.1 ± 115.4) μg/L (1.02－959 μg/L) and an average prostate volume of (48.81 ± 38.4) cm3 (7.54－307.61 cm3). There were no statistically significant differences in age, PSA, and BMI between the two groups of patients (P > 0.05). Prostate cancer was confirmed in 31 of the cases, with a positive rate of 40.26% (31/77), significantly higher in the TPPB (45.45% ［10/22］ than in the SPB group (38.18% ［21/55］, P < 0.01). Based on the PI-RADS scores, the Gleason grade was also higher in the former than in the latter group.CONCLUSIONS:MR-USF guided TPPB can improve the biopsy performance. Whether it should be used is based on the patient's PSA level and PI-RADS scores.

You have accessJournal of UrologyProstate Cancer: Basic Research & Pathophysiology III (MP81)1 Apr 2019MP81-14 LNCRNA CCAT1 PROMOTES PROSTATE CANCER CELL PROLIFERATION BY INTERACTING WITH DDX5 AND MIR-28-5P Zonghao You*, Chunhui Liu, Can Wang, Bin Xu, Han Guan, and Ming Chen Zonghao You*Zonghao You* More articles by this author , Chunhui LiuChunhui Liu More articles by this author , Can WangCan Wang More articles by this author , Bin XuBin Xu More articles by this author , Han GuanHan Guan More articles by this author , and Ming ChenMing Chen More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557433.41195.d2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Accumulated evidence indicates that CCAT1 functions as an oncogene in the progression of a variety of tumors. However, little is known as to how CCAT1 impacts tumorigenesis in human prostate cancer.Our purpose is to explore the role of CCAT1 in the malignant progression of prostate cancer and the mechanism of the influence. METHODS: Employing qRT-PCR, ISH, and a re-analysis of The Cancer Genome Atlas (TCGA) and The Memorial Sloan Kettering Cancer Center (MSKCC) data, we compared CCAT1 expression between castration-resistant prostate cancer (CRPC) tissues and androgen dependent prostate cancer (ADPC) tissues. Kaplan-Meier method was applied to analysis the prognostic value. The impacts of CCAT1 on biological function were evaluated by in vitro assays and in vivo nude mice model. RNA pulldown, RIP and ChIP-qPCR assays were adopted to explore the regulatory mechanisms of CCAT1 in the progression of CRPC. RESULTS: CCAT1 could promote PCa cell proliferation and accelerate the tumor growth of PCa xenografts. At a molecular level, CCAT1 sponged miR-28-5p to reverse the anti-cancer effect. Additionally, RNA pulldown, RIP and ChIP-qPCR assays revealed CCAT1 acts as a scaffold for DDX5 (P68) and the AR transcriptional complex, thus stimulating CRPC progression. CONCLUSIONS: Our findings indicated CCAT1 acts as one of oncogenic factors in the progression of CRPC by performing different regulatory mechanisms in the nucleus and cytoplasm of cells. Source of Funding: This study was funded by The National Natural Science Foundation of China (No. 81872089, 81370849, 81300472, 81070592, 81202268, 81202034), Natural Science Foundation of Jiangsu Province (BK 20150642), National Science Foundation of Anhui Province (KJ2018A0214). Nanjing, China, People's Republic of; Bengbu, China, People's Republic of; Nanjing, China, People's Republic of© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1176-e1177 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zonghao You* More articles by this author Chunhui Liu More articles by this author Can Wang More articles by this author Bin Xu More articles by this author Han Guan More articles by this author Ming Chen More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Basic Research & Pathophysiology III (MP81)1 Apr 2019MP81-15 LNCRNA MEG3 FUNCTIONS AS A TUMOR-SUPPRESSOR IN PROSTATE CANCER Bin Xu, Ruifang Liu, Ming Chen, and Dean G. Tang* Bin XuBin Xu More articles by this author , Ruifang LiuRuifang Liu More articles by this author , Ming ChenMing Chen More articles by this author , and Dean G. Tang*Dean G. Tang* More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557434.41195.1cAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Long noncoding RNAs (lncRNAs) have been implicated in many biological processes and mainly function through epigenetic mechanisms. Our previous study, comparing prostate basal and luminal cells via RNA-seq analysis, found that over 20% of the differentially expressed transcripts are lncRNAs.To explore the biological function and molecular mechanism of dysregulated lncRNAs in prostate cancer (PCa) METHODS: The change of maternal expressed gene 3 (MEG3) gene level in PCa patients was analyzed from multiple dimensions and databases. The consequence of MEG3 dysregulation was determined by its influence on cell proliferation, metastasis and interacting with target genes.Tumor suppressive function was measured through in vivo tumor regeneration assay and in vitro cell viability and mobility assays. The interaction of MEG3 and target was tested by RNA immunoprecipitation (RIP) and RNA pulldown assays. Statistical difference and variances were determined by Student t test or Chi-squared test. RESULTS: MEG3 is predominantly expressed in human prostate basal cells when compared to prostate luminal cells and PCa tissues and its loss of expression significantly correlated with metastasis, higher clinical stage, and poor overall survival of PCa patients. Additionally, MEG3 overexpression suppressed PCa cell proliferation, colony and sphere formation, and metastasis. Furthermore, loss of MEG3 lessened the suppressive function of EZH2, including a stronger suppression to EZH2 repressed genes (MKX, ADRB2, CDKN2A, DAB2IP) and increased expression of EZH2 induced gene (CCND1). CONCLUSIONS: We found MEG3 loss is common among PCa patients. MEG3 plays tumor suppressive function in PCa may via interacting with EZH2 and fine-tuning its target gene. Source of Funding: none Nanjing, China, People's Republic of; Buffalo, NY; Nanjing, China, People's Republic of; Buffalo, NY© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1178-e1178 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bin Xu More articles by this author Ruifang Liu More articles by this author Ming Chen More articles by this author Dean G. Tang* More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To investigate the attitudes of the parents toward circumcision for 6－14 years old children and their satisfaction with the results.METHODS:We performed circumcision in the Department of Urology of Zhongda Hospital for 220 children aged 6－14 years from 220 families between January 2010 and August 2016, including 70 cases of traditional and 150 cases of Shang Ring circumcision. We conducted telephone follow-ups among the parents of the patients concerning the decision-maker, reasons and regret for circumcision, acceptance of a second operation, source of information, satisfaction with surgical results, and reasons for dissatisfaction.RESULTS:Most decisions for circumcision were made by the father, chiefly for health and hygiene. Their main sources of information on circumcision were Internet and friends. The parents of 29 patients were dissatisfied for long recovery or peri- and post-operative pain, including 19 cases (27.1%， 19/70) of traditional and 10 cases (6.7%， 10/150) of Shang Ring circumcision, with statistically significant differences between the two groups (P <0.05).CONCLUSIONS:Most parents were satisfied with circumcision, and the main reasons for dissatisfaction were long recovery and pain. The rate of satisfaction with Shang Ring circumcision was higher than that with traditional circumcision. Shang Ring circumcision is recommended for children aged 6－14 years old.

You have accessJournal of UrologyReconstruction1 Apr 2015V12-06 RETROPERITONEAL LAPAROSCOPIC REIMPLANTATION OF THE LEFT RENAL VEIN FOR NUTCRACKER SYNDROME Ming Chen, Tao Tao, Bin Xu, Lei Zhang, Shu-qiu Chen, Xiao-wen Zhang, and Yu Yang Ming ChenMing Chen More articles by this author , Tao TaoTao Tao More articles by this author , Bin XuBin Xu More articles by this author , Lei ZhangLei Zhang More articles by this author , Shu-qiu ChenShu-qiu Chen More articles by this author , Xiao-wen ZhangXiao-wen Zhang More articles by this author , and Yu YangYu Yang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2776AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To describe the feasibility of retroperitoneal laparoscopic reimplantation of the left renal vein (LRV) for nutcracker syndrome (NCS). METHODS One patient with NCS underwent the surgery. He complained of gross hematuria and flank discomfort that could not be relieved by resting. He was placed in a supine position and 5 ports were placed in the right abdominal wall. The procedures were performed with a retroperitoneal approach. The LRV was transected and then reimplanted into the distal inferior vena cava. RESULTS The procedures were performed successfully without any major complications. The total operation time was 110 min. Hematuria and flank discomfort were resolved after the surgery. Ultrasonography revealed a patent lumen without compression. CONCLUSIONS Retroperitoneal laparoscopic reimplantation of the LRV appears to be a feasible procedure with minimal invasion, rapid recovery and satisfactory short-term outcomes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e978 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ming Chen More articles by this author Tao Tao More articles by this author Bin Xu More articles by this author Lei Zhang More articles by this author Shu-qiu Chen More articles by this author Xiao-wen Zhang More articles by this author Yu Yang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The nutcracker syndrome (NCS) is because of the compression of the left renal vein when it passes between the aorta and the superior mesenteric artery. The treatment of NCS is controversial, and conservative, endovascular stent implantation, open surgical, and laparoscopic treatments have been previously described. In this study, we present a new method of conducting end-to-side anastomosis between the inferior mesenteric and left gonadal vein. The proposed method was proven feasible for treating NCS.

OBJECTIVE:To compare the outcomes and complications of 3D versus 2D laparoscopic radical prostatectomy ( LRP) in the treatment of prostate cancer. METHODS:We retrospectively reviewed 18 cases of prostate cancer treated by 3D LRP and another 32 by 2D LRP. We compared the general data, intraoperative blood loss, postoperative drainage time and hospital stay, Gleason scores, and incidence of complications between the two groups of patients. RESULTS:All the operations were successful and none was transferred to open surgery. The two groups of patients were similar in terms of age, body mass index, Gleason scores, and clinical stages. However, compared with the 2D LRP group, the 3D LRP group showed significantly shorter operation time ([180.2 ± 69.1] vs [118.3 ± 55.1] min, P < 0.01), less blood loss ([236.5 ± 60.6] vs [89.1 ± 35.2] ml, P < 0.01), less postoperative drainage time ([7.1 ± 1.1] vs [5.3 ± 2.1] d, P < 0.01), shorter postoperative hospital stay ([20.2 ± 5.5] vs [14.4 ± 7.2] d, P < 0.01), and lower incidence of perioperative complications (3.1% vs 0, P < 0.01). The incisal margin was pathologically negative in both groups and urinary incontinence was found in neither at 6 months after surgery (P > 0.05). CONCLUSION:3D LRP, with its advantages of shorter operative time, faster recovery, and better outcomes than 2D LRP in the treatment of prostate cancer, deserves general application in lower-level hospitals.

Several genes encoding DNA repair molecules have been proposed as cancer-susceptibility genes. Many studies have suggested that SNPs in XRCC4 could be implicated in altering the risk of prostate cancer (PCa). We examined the role of the functional variant (−652T>G) in the XRCC4 promoter in PCa. The transcriptional activity of XRCC4 gene was measured by luciferase assay. We performed real-time PCR/immunohistochemical assay to verify the association between expression level of XRCC4 mRNA/protein and XRCC4 −652T>G polymorphism. In addition, electrophoretic mobility shift assay (EMSA) was used to confirm whether this polymorphism has an effect on binding ability of the transcription factor. We found that the G variant significantly increased the transcription activity of the XRCC4 gene and the binding ability of transcriptional factor GATA-1 to the XRCC4 promoter. Furthermore, the results suggested that the XRCC4 protein and mRNA were overexpressed in individuals who carried the −652G allele compared to carriers of the −652T allele. In addition, the expression of XRCC4 in PCa tissues was lower than in adjacent normal tissues. Our data suggest that the XRCC4 promoter −652G>T polymorphism is functional and may influence genetic susceptibility to prostate cancer. Case–control studies are required to validate our findings in the future.