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Objective: To investigate the changes in the size of the penis after radical prostatectomy (RP) and the possible influencing factors., Methods: This study included 45 cases of RP for PCa performed by the same surgeon from January to June 2019. Before and at 2 weeks after surgery, we measured the stretched penile length (SPL), flaccid penile length (FPL) and penile circumference of the patients. We conducted an IIEF-5 questionnaire investigation on the preoperative characteristics of the patients and their attitudes towards postoperative penile rehabilitation. We also analyzed the factors associated with the postoperative changes in the size of the penis., Results: Compared with the baseline, the postoperative SPL (［9.72 ± 1.87］ vs ［7.80 ± 1.57］ cm, P = 0), FPL (［6.26 ± 1.14］ vs ［5.13 ± 1.10］ cm, P = 0) and penile circumference (［7.69 ± 0.83］ vs ［7.26 ± 0.78］ cm, P = 0.012) were decreased significantly, by (1.92 ± 0.12) cm, (1.13 ± 0.09) cm and (0.43 ± 0.08) cm, respectively. The age of the patients was significantly correlated with the change of the FPL (P = 0.042), but not the other factors with the change of the penile size. Twenty-six (57.7%) cases of severe and moderate ED were observed in the patients postoperatively. Those with better preoperative sexual function took a more positive attitude towards penile rehabilitation and treatment postoperatively (n = 3, 75.0%)., Conclusions: The penile size of the PCa patient is decreased markedly after radical prostatectomy, with a significant correlation between the patient's age and the postoperative change of the flaccid penile length. The patients with better preoperative sexual function are more likely to seek penile rehabilitation and treatment postoperatively.

This study aimed to assess the role of the National Comprehensive Cancer Network (NCCN) risk classification in predicting biochemical recurrence (BCR) after radical prostatectomy (RP) in Chinese prostate cancer patients. We included a consecutive cohort of 385 patients with prostate cancer who underwent RP at Fudan University Shanghai Cancer Center (Shanghai, China) from March 2011 to December 2014. Gleason grade groups were applied at analysis according to the 2014 International Society of Urological Pathology Consensus. Risk groups were stratified according to the NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer version 1, 2017. All 385 patients were divided into BCR and non-BCR groups. The clinicopathological characteristics were compared using an independent sample t-test, Chi-squared test, and Fisher's exact test. BCR-free survival was compared using the log-rank test and multivariable Cox proportional hazard analysis. During median follow-up of 48 months (range: 1-78 months), 31 (8.05%) patients experienced BCR. The BCR group had higher prostate-specific antigen level at diagnosis (46.54 ± 39.58 ng ml -1 vs 21.02 ± 21.06 ng ml -1 , P= 0.001), more advanced pT stage (P = 0.002), and higher pN1 rate (P < 0.001). NCCN risk classification was a significant predictor of BCR (P = 0.0006) and BCR-free survival (P = 0.003) after RP. As NCCN risk level increased, there was a significant decreasing trend in BCR-free survival rate (P trend = 0.0002). This study confirmed and validated that NCCN risk classification was a significant predictor of BCR and BCR-free survival after RP., Competing Interests: None

Objective: To determine the performance of the prostate health index (PHI) in predicting pathologic outcomes of radical prostatectomy (RP) in Chinese patients with low-risk prostate cancer (PCa)., Methods: Of all consecutive patients who underwent RP in one tertiary center from September 2013 to January 2017, we prospectively examined the data of 140 patients with low-risk PCa based on the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria. All patients were eligible for active surveillance, but underwent RP. Clinical and pathological data were collected. Logistic regression was used to evaluate the associations between the PHI and outcome of RP. The area under the receiver operating curve (AUC) was used to evaluate the accuracy of different models. Decision curve analysis was used to evaluate the potential clinical usefulness of making model-based decisions., Results: Only 44 (31.4%) patients were finally confirmed to have organ-confined Gleason ≤6 PCa. A low PHI was significantly predictive of organ-confined Gleason ≤6 PCa (p = 0.001), while tPSA and f/tPSA were not associated with final pathology. In the multivariate analyses, addition of the PHI significantly increased the predictive accuracy (AUC = 0.767, 95% Cl 0.685-0.849, p < 0.001)., Conclusion: The PRIAS criteria for active surveillance may not suitable for Chinese patients with PCa. Addition of the PHI to the PRIAS models improved the prognostic performance. If confirmed in future larger and multicenter studies, PHI may help us to identify patients eligible for AS in China.

Several studies have evaluated the risk factors influencing biochemical recurrence (BCR) of prostate cancer in patients receiving salvage radiotherapy (SRT) for BCR after radical prostatectomy (RP), but the results remain conflicting. In this study, we performed a meta-analysis to resolve this conflict. We searched the following databases: PubMed, Embase, and Web of Science using the following terms in "All fields": "salvage radiation therapy," "salvage IMRT," "S-IMRT," "salvage radiotherapy," "SRT," "radical prostatectomy," "RP," "biochemical recurrence," "BCR," "biochemical relapse." Eleven studies, with a total of 1383 patients, were included in our meta-analysis. Of all the variables, only Gleason score (GS) ≥7 (odds ratio [OR]: 3.82; 95% confidence interval [CI]: 2.60-5.64) and pathological tumor (pT) stage ≥3a (OR: 1.82; 95% CI: 1.36-2.42) were positively correlated with BCR. However, SRT combined with androgen deprivation therapy (ADT) (OR: 0.63; 95% CI: 0.44-0.90) and radiation therapy (RT) dose ≥64 Gy (OR: 0.35; 95% CI: 0.19-0.64) were negatively correlated with BCR. Perineural invasion (OR: 2.64; 95% CI: 1.11-6.26), preoperative prostate-specific antigen (PSA) ≥10 ng ml-1 (OR: 1.36; 95% CI: 0.94-1.96), positive surgical margin (OR: 0.92; 95% CI: 0.7-1.19), and seminal vesicle involvement (SVI) (OR: 1.09; 95% CI: 0.83-1.43) had no effect on BCR. Our meta-analysis indicated that pT stage, GS, RT dose, and SRT combined with ADT may influence BCR, while preoperative PSA, surgical margin, perineural invasion, and SVI have only a weak effect on BCR.

Radical retropubic prostatectomy (RRP) has been one of the most effective treatments for prostate cancer. This study is designed to identify the related predictive risk factors for complications in patients following RRP. Between 2000 and 2012 in Department of Urology, Fudan University Shanghai Cancer Center, 421 cases undergoing RRP for localized prostate cancer by one surgeon were included in this retrospective analysis. We reviewed various risk factors that were correlated with perioperative complications, including patient characteristics [age, body mass index (BMI), co-morbidities], clinical findings (preoperative PSA level, Gleason score, clinical stage, pathological grade), and surgeon's own clinical practice. Charlson comorbidity index (CCI) was used to explain comorbidities. The total rate of perioperative complications was 23.2% (98/421). There were 45/421 (10.7%), 28/421 (6.6%), 24/421 (5.7%) and 1/421 (0.2%) in grade I, II, III, IV respectively, and 323/421 (76.8%) cases had none of these complications. Statistical analysis of multiple potential risk factors revealed that BMI >30 (P=0.014), Charlson score ≥1 (P<0.001) and surgical experience (P=0.0252) were predictors of perioperative complications. Age, PSA level, Gleason score, TNM stage, operation time, blood loss, and blood transfusion were not correlated with perioperative complications (P>0.05). It was concluded that patients' own factors and surgeons' technical factors are related with an increased risk of development of perioperative complications following radical prostatectomy. Knowing these predictors can both favor risk stratification of patients undergoing RRP and help surgeons make treatment decisions.

The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU1005 prospectively evaluated two regimens of maximum androgen blockage  or bicalutamide 150 mg daily as immediate adjuvant therapy for high-risk localized prostate cancer. Overall, 209 consecutive patients were recruited in this study, 107 of whom received 9 months of adjuvant maximum androgen blockage, whereas 102 received 9 months of adjuvant bicalutamide 150 mg. The median postoperative follow-up time was 27.0 months. The primary endpoint was biochemical recurrence. Of the 209 patients, 59 patients developed biochemical recurrence. There was no difference between the two groups with respect to clinical characteristics, including age, pretreatment prostate-specific antigen, Gleason score, surgical margin status, or pathological stages. The maximum androgen blockage group experienced longer biochemical recurrence-free survival (P = 0.004) compared with the bicalutamide 150 mg group. Side-effects in the two groups were similar and could be moderately tolerated in all patients. In conclusion, immediate, 9-month maximum androgen blockage should be considered as an alternative to bicalutamide 150 mg as adjuvant treatment for high-risk localized prostate cancer patients after radical prostatectomy.

The pretreatment neutrophil-to-lymphocyte ratio (NLR) is reportedly associated with the clinical outcomes of many cancers. However, it has not been widely investigated whether the pretreatment NLR is associated with the pathological characteristics of prostate cancer (PCa) and biochemical recurrence in PCa patients receiving radical prostatectomy (RP).In this cohort study, a total of 1688 PCa patients who had undergone RP were analyzed retrospectively, and a subset of 237 of these patients were evaluated to determine the relationship between pretreatment NLR and biochemical recurrence. Patients were divided into a high-NLR group (NLR ≥2.36) and a low-NLR group (NLR < 2.36) according to the pretreatment NLR. The association between the pretreatment NLR and pathological stage and lymph node involvement was evaluated using logistic regression analysis. Time of biochemical recurrence was determined using the Kaplan-Meier method. Cox's proportional hazard regression model was used to compare the time of biochemical recurrence between the groups.As compared with patients in the low-NLR group, those in the high-NLR group had an increased risk of pT3-4 disease (odds ratio (OR), 1.883; 95% confidence interval (CI), 1.419-2.500; P < 0.001), and a 1.7-fold increased risk of lymph node involvement (OR, 1.685; 95% CI, 1.101-2.579; P = 0.016). For the subset of 237 patients, those with a high NLR showed a significantly shorter median biochemical recurrence-free survival time (51.9 months) than those with a low NLR (76.5 months; log-rank test, P = 0.019). However, multivariate analysis indicated that the NLR was not an independent predictor of biochemical recurrence (hazard ratio, 1.388; 95% CI, 0.909-2.118; P = 0.129).Our findings suggest that the pretreatment NLR may be associated with pathological stage and lymph node involvement in PCa patients receiving RP, and that PCa patients with a high NLR may have a higher rate of biochemical recurrence following RP than those with a low NLR.

The global incidence of metabolic syndrome (MetS) is dramatically increasing. Considerable interest has been devoted to the relationship between MetS and prostate cancer (PCa) risk. However, few studies have examined the association between MetS and PCa progression. This retrospective study consisted of 1016 patients with PCa who received radical prostatectomy. The association between MetS and pathological features was evaluated using logistic regression analysis. Compared with patients without MetS, those with MetS indicated an increased risk of prostatectomy Gleason score (GS) ≥8 (odds ratio [OR] =1.670, 95% confidence interval (CI) 1.096-2.545, P= 0.017), and a 1.5-fold increased risk of pT3-4 disease (OR = 1.583, 95% CI 1.106-2.266, P= 0.012). The presence of MetS was an independent predictor of lymph node involvement (OR = 1.751, 95% CI 1.038-2.955, P= 0.036). Furthermore, as the number of MetS components accumulated, the risk of a GS ≥ 8 increased. The present study indicates a significant association between MetS and advanced PCa. The results need to be evaluated in large-scale prospective cohorts.

Prostate cancer, bladder cancer, and rectal cancer are common malignancies in the male pelvis. The incidence rate of erectile dysfunction (ED) following radical prostatectomy, cystectomy or rectal cancer surgery is about 25% - 100%. The main cause of post-surgery ED is mainly attributed to injury of neurovascular bundles, which may lead to reduced oxygenation in and fibrosis of the penile tissue. Early penile rehabilitation after surgery can improve or restore the erectile function of the patients. This article focuses on penile rehabilitation after radical pelvic surgery.

This study aimed to evaluate the role of serum lipid profiles as novel biomarkers in predicting pathological characteristics of prostate cancer (PCa). We retrospectively analyzed 322 consecutive patients with clinically localized PCa receiving radical prostatectomy (RP) and extended pelvic lymphadenectomy. Unconditional logistic regression was used to estimate the prostatectomy Gleason score (pGS), pathological stage and lymph node involvement (LNI) in RP specimens. Preoperative prostate-specific antigen (PSA) levels, biopsy GS (bGS), and preoperative tumor, node, metastasis staging were used as basic variables to predict postoperative pathological characteristics. Preoperative serum lipid profiles were introduced as potential predictors. A receiver operating characteristic (ROC) curve was used to determine predictive efficacy. Significant differences in pathological characteristics were observed among patients with normal and abnormal total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) levels, with the exception of pGS in the TG group. Multivariable regression analysis revealed that the odds ratio for high levels of TC for LNI compared with normal TC levels was 6.386 (95% confidence interval [CI] 1.510-27.010), 3.270 (95% CI: 1.470-7.278) for high levels of TG for pT3-4 disease, and 2.670 (95% CI: 1.134-6.287) for high levels of LDL for pGS. The area under the ROC curve of the models with dyslipidemia was larger than that in models without dyslipidemia, in predicting pathological characteristics. Abnormal TC, TG, and LDL levels are significantly associated with postoperative pathological status in PCa patients. Together with preoperative PSA levels, bGS, and clinical stage, dyslipidemia is more accurate in predicting pathological characteristics.

The predictive factors of prognosis and treatment strategies for small-cell carcinoma (SCC) of the urinary tract are controversial. This study was aimed to investigate the clinical experience and management of patients with SCC of the urinary tract. We collected data of patients who were diagnosed with genitourinary SCC (GSCC) between 2002 and 2013 and were treated in the Fudan University Shanghai Cancer Center. A total of 18 patients were diagnosed with GSCC of which 10 originated from the prostate, seven from the bladder and one from the adrenal gland. The mean follow-up time was 15.5 months and progression-free survival (PFS) was 9.3 months. Primary tumor resection was attempted in 13 of 18 patients (72.2%) in whom radical surgery was performed in six of 14 (42.9%) limited disease patients. Most of the patients (13, 72.2%) received cisplatin-based chemotherapy. Patients who had normal lactic dehydrogenase (LDH) levels showed a significantly higher median PFS and overall survival (OS) compared with patients with high LDH levels (P = 0.030, P= 0.010). Patients with limited disease treated with a radical operation experienced a non-significant (P = 0.211) longer PFS compared with patients who were not treated, but this reached statistical significance after analyzing OS (P = 0.211, P= 0.039). Our patients showed a poor prognosis as reported previously. Serum LDH levels beyond the normal range indicate a poor prognosis. For GSCC patients who are diagnosed with limited disease, radical surgery is strongly recommended along with cisplatin-based chemotherapy.

This study aimed to investigate the association between different anthropometric measures of obesity and clinicopathological characteristics in Chinese patients with clinically localized prostate cancer (PCa). A total of 734 patients with clinically localized PCa who underwent radical prostatectomy (RP) were included in this study. Clinical and pathological data from each patient were collected. Anthropometric measures of abdominal adiposity were measured from T2-weighted sagittal localisation images from magnetic resonance imaging (MRI) for 413 (56.3%) patients. Patient clinical and pathological characteristics were compared across body mass index (BMI) groups. Univariable and multivariable logistic regression models were used to address the influence of the preoperative total testosterone level and anthropometric measures of obesity on pathological outcomes. In the multivariate analysis, BMI was not significantly associated with any pathological outcomes. However, the percentage of visceral adipose tissue (VAT%) was an independent predictor of a pathological Gleason score ≥8 (P<0.001), extracapsular extension (ECE; P=0.002) and seminal vesicle invasion (SVI; P=0.007). More importantly, we found that the preoperative total testosterone level was significantly correlated with the VAT% (Pearson's correlation coefficient: -0.485, P<0.001) and subcutaneous adipose tissue (SAT; Pearson's correlation coefficient: 0.413, P<0.001). In conclusion, the results of this study suggest that abdominal fat distribution, and particularly VAT%, is associated with a risk of advanced PCa. Moreover, our present study confirms a significant inverse correlation between visceral adiposity and testosterone. Further studies are warranted to elucidate the biological mechanisms underlying the relationship between abdominal adiposity and the aggressiveness of PCa.

Androgen deprivation therapy (ADT) is a standard treatment for metastatic, recurrent and locally advanced prostate cancer (PCa). The aim of this study is to investigate the timing and extent of testosterone recovery in clinically localized PCa patients treated with radical prostatectomy (RP) and subsequent short-term adjuvant ADT. A total of 95 localized PCa patients underwent RP and 9-month adjuvant ADT were included in this prospective study. Serum testosterone level was measured before adjuvant ADT, at ADT cessation, and at 1, 3, 6, 9 and 12 months after cessation of ADT. A Cox proportional hazards model was used to assess variables associated with the time of testosterone normalization. The results showed that median patient age was 67 years and median testosterone level before adjuvant ADT was 361 (230-905) ng dl(-1). All patients finished 9-month adjuvant ADT and achieved castrate testosterone level. At 3 months after ADT cessation, testosterone recovered to supracastrate level in 97.9% patients and to normal level in 36.9% patients. The percentage of patients who recovered to normal testosterone level increased to 66.3%, 86.3% and 92.6% at 6, 9 and 12 months, respectively. Cox regression model found that higher baseline testosterone level (≥ 300 ng dl(-1)) was the only variable associated with a shorter time to testosterone normalization (hazard ratio: 1.98; P = 0.012). In conclusion, in most patients, testosterone recovered to supracastrate level at 3 months and to normal level at 12 months after 9-month adjuvant ADT cessation. Patients with higher baseline testosterone level need shorter time of testosterone normalization.

Radical prostatectomy (RP) continues to be an effective surgical therapy for prostate carcinoma, particularly for organ-confined prostate cancer (PCa). Recently, RP has also been used in the treatment of locally advanced prostate cancer. However, little research has been performed to elucidate the perioperative complications associated with RP in patients with clinically localized or locally advanced PCa. We sought to analyse the incidence of complications in these two groups after radical retropubic prostatectomy (RRP). From June 2002 to July 2010, we reviewed 379 PCa patients who underwent RRP in our hospital. Among these cases, 196 had clinically localized PCa (T1a-T2c: group 1), and 183 had locally advanced PCa (≥T3a: group 2). The overall complication incidence was 21.9%, which was lower than other studies have reported. Perioperative complications in patients with locally advanced PCa mirror those in patients with clinically localized PCa (26.2% vs. 17.8%, P=0.91). Our results showed that perioperative complications could not be regarded as a factor to consider in regarding RP in patients with cT3 or greater.

Purpose: To compare Partin tables (PTs) 1997, 2001, and 2007 for their clinical applicability in a Chinese cohort based upon a decision curve analysis (DCA)., Methods: Clinical and pathologic data of 264 consecutive Chinese patients with clinically localized prostate cancer were used. These patients underwent open radical prostatectomy between 2005 and 2011. DCA quantified the net benefit of different PT versions relating to specific threshold probabilities of established capsular penetration (ECP), seminal vesicle involvement (SVI), and lymph node involvement (LNI)., Results: Overall, ECP, SVI, and LNI were recorded in 23.1, 10.2, and 6.1%, respectively. When the threshold probability was below the prevalence for LNI and ECP predictions, the DCA favored the 2007 version versus the 1997 version for SVI., Conclusions: DCA indicates that for low threshold probability, decision models are useful to discriminate the performance differences of three PT versions, although net benefit differences were not apparent. For high threshold probability, there may not be an important benefit from the use of PTs and the current analysis cannot translate into meaningful net gains differences., (Copyright © 2013 S. Karger AG, Basel.)

Objective: To evaluate the incidence and severity of perioperative complications in elderly patients with radical prostatectomy (RP)., Methods: A total of 242 patents underwent RP for prostate cancer were retrospectively assessed, whose clinicopathologic factors and perioperative complications were retrieved from the medical records. The mean age in the elderly group (n = 163) and control group (n = 79) were (73.2 ± 2.4) and (63.2 ± 4.8) years, respectively. The clinicopathologic factors including Charlson comorbidity index and preoperative prostate specific antigen were statistically significant different. The difference of clinicopathologic factors and perioperative complications between the elderly group (≥ 70 years old) and control group were statistically analyzed using the SPSS 17.0., Results: The incidence of perioperative complications was 23.5% in the elderly group and 22.7% in the control group. Except for gross hematuria (there were 12 cases in elderly group and 1 case in control group, respectively, χ(2) = 3.89, P < 0.05) and perioperative transfusion (there were 36 cases in elderly group and 7 cases in control group, respectively, χ(2) = 6.37, P < 0.05), there was no significant difference in each kind or total of perioperative complications., Conclusion: The elderly patients underwent RP in experienced center are not associated with higher or more serious perioperative complications.

Objective: To investigate the efficacy and safety of vacuum erection device (VED) for erectile dysfunction (ED) after radical prostatectomy (RP)., Methods: Six cases of ED after open RP were reviewed. Three of the patients started a daily rehabilitation protocol using VED 10 min/d within 3 months after RP (group A, early intervention), while the other 3 initiated the same protocol after 12 months (group B, late intervention). We compared the IIEF-5 scores as well as stretched penile lengths and mid-shaft circumferences before and after 3 and 6 months of VED rehabilitation. We also assessed the safety of the device and sexual satisfaction of the patients and their partners., Results: The mean IIEF-5 score of the six cases was remarkably increased at 3 and 6 months of VED rehabilitation (P < 0.05), significantly higher in group A than in B at 3 months (8.7 +/- 0.6 vs 6.7 +/- 0.6, P < 0.05) and 6 months (13.0 +/- 1.0 vs 8.3 +/- 1.5, P < 0.05). After 6 months of VED rehabilitation, there were no significant changes in stretched penile length or mid-shaft circumference in group A, both significantly decreased in group B (P < 0.05), and sexual satisfaction of the patients and their partners were 83.3% and 50%, respectively. No serious adverse events were observed except mild complaint of pe- nile skin darkening in 1 case and numb feeling during the intercourse in 2., Conclusion: Early use of VED after RP improves erectile function and helps to preserve the length and mid-shaft circumference of the penis.

Objective: To evaluate the role of electrical stimulation (ES) in the recovery of postprostatectomy urinary incontinence (UI)., Methods: We performed a meta-analysis of all available randomized controlled trials comparing ES enhanced pelvic floor muscle training (PFMT) with PFMT alone for postprostatectomy UI. We separated in the analysis the continence rate within 3 months or longer than 6 months after operation, which stand for the early and late recovery of UI after operation, respectively. Relative risk (RR) reductions and their 95% confidence intervals (CIs) were calculated for categorical outcomes., Results: Four studies randomizing 210 cases were included in the meta-analysis. Three studies enrolling 186 cases reported the continence rate within 3 months after radical prostatectomy. The pooled analysis did not show that ES improved early recovery of UI better than did PFMT (RR 1.21; 95% CI = 0.95-1.54, P = .12). All 4 studies provided data for 6-12 months after RP; the pooled analysis did not show a relative benefit (RR = 1.03; 95% CI = 0.88-1.20, P = .73)., Conclusion: Based on available evidence, ES enhanced PFMT did not improve the return to continence more than PFMT in men with postprostatectomy UI., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: There are many causative factors for the occurrence of post-prostatectomy incontinence. Objective clinical characteristics, surgical techniques and pelvic floor muscle therapy are the most important ones. The present study was to identify the risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP)., Methods: A total of 263 patients were recruited for this multivariate analysis. After a close follow-up, a series of pre-, peri- and post-operative factors were recorded and analyzed., Results: Urinary continence after radical prostatectomy was 14.8% at 4 weeks and 94.7% at 16 weeks. The most important recovery interval for urinary continence was 4 - 16 weeks post-operation. Multivariate analysis revealed that age (P = 0.015), blood transfusion (P = 0.017), previous TURP (transurethral resection of the prostate) (P = 0.006) and neoadjuvant hormonal therapy (P = 0.005) were the important risk factors for urinary incontinence., Conclusion: During RRP, optimized preservation of urethral rhabdosphincter length, nerve sparing and early postoperative functional exercises can improve the recovery of urinary continence. Age, blood transfusion and previous TURP are the independent prognostic factors. Neoadjuvant hormonal therapy may improve urinary continence through increasing the preoperative length of membranous urethra.

The purpose of this study is to investigate the frequency of prostate cancer (Pca) discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystectomy (PSC) for Asian patients. Ninety-two male bladder cancer patients who underwent radical cystoprostatectomy at our center between January 2003 and January 2008 were included in this study. The mean age of patients was 67.1 years (range: 32-75 years). Prostate-specific antigen (PSA) levels and digital rectal examination (DRE) results before surgery were obtained retrospectively. Prostates of all patients were embedded and sectioned at 5-mm intervals. The same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens. Finally, a structured literature review was performed using MEDLINE and PUBMED to estimate the occurrence of incidental Pca in Asia. Of the 92 patients, 3 (3.3%) were found to have Pca; in one out of three (33.3%) patients the disease was clinically significant due to a Gleason grade 4 carcinoma. Eight articles were included in our review. The overall incidence of Pca discovered incidentally in radical cystoprostatectomy specimens in Asia was 9.9% (64/642). When age was restricted to < 60 years, only 7 out of 222 (3.2%) patients were found to have synchronous Pca, and none of the cases was clinically significant. The occurrence of Pca in radical cystoprostatectomy specimens in Asia is much lower than that in Western countries. PSC might be feasible for Asian patients under a strict preoperative selection.

This study aimed to evaluate the major changes of the eighth edition of the American Joint Committee on Cancer (AJCC) pathologic staging for prostate cancer treated with radical prostatectomy. A total of 138,176 patients diagnosed with prostate adenocarcinoma undergoing radical prostatectomy were selected from the Surveillance, Epidemiology and End Results (SEER) database during 2004–2014 period. Excluded were cases with incomplete or unavailable staging, PSA and Gleason score information. Two subgroups were established: group a, T2 stage with PSA≥20ng/ml; group b, T2 stage with Gleason score grade group 5 and PSA<20ng/ml. The median follow-up time was 58 months. The median age at diagnosis for the overall group was 61 years, and the median PSA was 5.7ng/ml. Cancer-specific survival (CSS) at tenth years was 99.3% for T2a/T2b, 99.2% for T2c, respectively. The survival differences between T2a/T2b and T2c did not have statistical significance (P = .323). It was necessary for the current eighth edition to define a single pathologic T2 category, eliminating the subcategories, for all organ-confined disease.CSS at the tenth years was 98.4% for group a, 92.6% for group b, respectively. The prognosis of group a was worse than AJCC II (P = .002). The prognosis of group b was not only worse than AJCC II (P < .001), but also worse than AJCC IIIB. There was necessity to separate the disease with PSA≥20ng/ml or Gleason score grade group 5 from other organ-confined disease. The present study supported the scientificity of the eighth edition of AJCC pathologic staging for prostate cancer. [ABSTRACT FROM AUTHOR]