The [-2]proPSA （p2PSA） and its derivatives, the p2PSA-to-free PSA ratio （%p2PSA）, and the Prostate Health Index （PHI） have greatly improved discrimination between men with and without prostate cancer （PCa） in ...The [-2]proPSA （p2PSA） and its derivatives, the p2PSA-to-free PSA ratio （%p2PSA）, and the Prostate Health Index （PHI） have greatly improved discrimination between men with and without prostate cancer （PCa） in prostate biopsies. However, little is known about their performance in cases where a digital rectal examination （DRE） and transrectal ultrasonography （TRUS） are negative. A prospective cohort of 261 consecutive patients in China with negative DRE and TRUS were recruited and underwent prostate biopsies. A serum sample had collected before the biopsy was used to measure various PSA derivatives, including total prostate-specific antigen （tPSA）, free PSA, and p2PSA. For each patient, the free-to-total PSA ratio （%fPSA）, PSA density （PSAD）, p2PSA-to-free PSA ratio （%p2PSA）, and PHI were calculated. Discriminative performance was assessed using the area under the receiver operating characteristic curve （AUC） and the biopsy rate at 91% sensitivity. The AUC scores within the entire cohort with respect to age, tPSA, %fPSA, PSAD, p2PSA, %p2PSA, and PHI were 0.598, 0.751, 0.646, 0.789, 0.814, 0.808, and 0.853, respectively. PHI was the best predictor of prostate biopsy results, especially in patients with a tPSA of 10.1-20 ng ml-1. Compared with other markers, at a sensitivity of 91%, PHI was the most useful for determining which men did not need to undergo biopsy, thereby avoiding unnecessary procedures. The use of PHI could improve the accuracy of PCa detection by predicting prostate biopsy outcomes among men with a negative DRE and TRUS in China.展开更多
The long-term survival outcomes of radical prostatectomy(RP)in Chinese prostate cancer(PCa)patients are poorly understood.We conducted a single-center,retrospective analysis of patients undergoing RP to study the prog...The long-term survival outcomes of radical prostatectomy(RP)in Chinese prostate cancer(PCa)patients are poorly understood.We conducted a single-center,retrospective analysis of patients undergoing RP to study the prognostic value of pathological and surgical information.From April 1998 to February 2022,782 patients undergoing RP at Queen Mary Hospital of The University of Hong Kong(Hong Kong,China)were included in our study.Multivariable Cox regression analysis and Kaplan–Meier analysis with stratification were performed.The 5-year,10-year,and 15-year overall survival(OS)rates were 96.6%,86.8%,and 70.6%,respectively,while the 5-year,10-year,and 15-year PCa-specific survival(PSS)rates were 99.7%,98.6%,and 97.8%,respectively.Surgical International Society of Urological Pathology PCa grades(ISUP Grade Group)≥4 was significantly associated with poorer PSS(hazard ratio[HR]=8.52,95%confidence interval[CI]:1.42–51.25,P=0.02).Pathological T3 stage was not significantly associated with PSS or OS in our cohort.Lymph node invasion and extracapsular extension might be associated with worse PSS(HR=20.30,95%CI:1.22–336.38,P=0.04;and HR=7.29,95%CI:1.22–43.64,P=0.03,respectively).Different surgical approaches(open,laparoscopic,or robotic-assisted)had similar outcomes in terms of PSS and OS.In conclusion,we report the longest timespan follow-up of Chinese PCa patients after RP with different approaches.展开更多
In the postscreening era, physicians are in need of methods to discriminate aggressive from nonaggressive prostate cancer （PCa） to reduce overdiagnosis and overtreatment. However, studies have shown that prognoses ...In the postscreening era, physicians are in need of methods to discriminate aggressive from nonaggressive prostate cancer （PCa） to reduce overdiagnosis and overtreatment. However, studies have shown that prognoses （e.g., progression and mortality） differ even among individuals with similar clinical and pathological characteristics. Existing risk classifiers （TMN grading system, Gleason score, etc.） are not accurately enough to represent the biological features of PCa. Using new genomic technologies, novel biomarkers and classifiers have been developed and shown to add value to clinical or pathological risk factors for predicting aggressive disease. Among them, RNA testing （gene expression analysis） is useful because it can not only reflect genetic variations but also reflect epigenetic regulations. Commercially available RNA profiling tests （Oncotype Dx, Prolaris, and Decipher） have demonstrated strong abilities to discriminate PCa with poor prognosis from less aggressive diseases. For instance, these RNA profiling tests can predict disease progression in active surveillance patients or early recurrence after radical treatments. These tests may offer more dependable methods for PCa prognosis prediction to make more accurate and personal medical decisions.展开更多
To evaluate whether prostate volume(PV)would provide additional predictive utility to the prostate health index(phi)for predicting prostate cancer(PCa)or clinically significant prostate cancer,we designed a prospectiv...To evaluate whether prostate volume(PV)would provide additional predictive utility to the prostate health index(phi)for predicting prostate cancer(PCa)or clinically significant prostate cancer,we designed a prospective,observational multicenter study in two prostate biopsy cohorts.Cohort 1 included 595 patients from three medical centers from 2012 to 2013,and Cohort 2 included 1025 patients from four medical centers from 2013 to 2014.Area under the receiver operating characteristic curves(AUC)and logistic regression models were used to evaluate the predictive performance of PV-based derivatives and models.Linear regression analysis showed that both total prostate-specific antigen(tPSA)and free PSA(fPSA)were significantly correlated with PV(all P<0.05).[-2]proPSA(p2PSA)was significantly correlated with PV in Cohort 2(P<0.001)but not in Cohort 1(P=0.309),while no significant association was observed between phi and PV.When combining phi with PV,phi density(PHID)and another phi derivative(PHIV,calculated as phi/PV°5)did not outperform phi for predicting PCa or clinically significant PCa in either Cohort 1 or Cohort 2.Logistic regression analysis also showed that phi and PV were independent predictors for both PCa and clinically significant PCa(all P<0.05);however,PV did not provide additional predictive value to phi when combining these derivatives in a regression model(all models vs phi were not statistically significant,all P>0.05).In conclusion,PV-based derivatives(both PHIV and PHID)and models incorporating PV did not improve the predictive abilities of phi for either PCa or clinically significant PCa.展开更多
We aim to evaluate prostate health index as an additional risk-stratification tool in patients with Prostate Imaging Reporting and Data System score 3 lesions on multiparametric magnetic resonance imaging.Men with bio...We aim to evaluate prostate health index as an additional risk-stratification tool in patients with Prostate Imaging Reporting and Data System score 3 lesions on multiparametric magnetic resonance imaging.Men with biochemical or clinical suspicion of having prostate cancer who underwent multiparametric magnetic resonance imaging in two tertiary centers(Queen Mary Hospital and Princess Margaret Hospital,Hong Kong,China)between January 2017 and June 2022 were included.Ultrasound-magnetic resonance imaging fusion biopsies were performed after prostate health index testing.Those who only had Prostate Imaging Reporting and Data System score 3 lesions were further stratified into four prostate health index risk groups and the cancer detection rates were analyzed.Out of the 747 patients,47.3%had Prostate Imaging Reporting and Data System score 3 lesions only.The detection rate of clinically significant prostate cancer in this group was 15.0%.The cancer detection rates of clinically significant prostate cancer had statistically significant differences:5.3%in prostate health index<25.0,7.4%in prostate health index 25.0-34.9,17.9%in prostate health index 35.0-54.9,and 52.6%in prostate health index≥55.0(P<0.01).Among the patients,26.9%could have avoided a biopsy with a prostate health index<25.0,at the expense of a 5.3%risk of missing clinically significant prostate cancer.Prostate health index could be used as an additional risk stratification tool for patients with Prostate Imaging Reporting and Data System score 3 lesions.Biopsies could be avoided in patients with low prostate health index,with a small risk of missing clinically significant prostate cancer.展开更多
为解决综合能源系统(integrated energy systems,IES)难以量质协同运行,且求解时间较长的问题,该文提出了一种计及[火用]效率的电-气-热综合能源系统多目标优化调度方法。首先,该文构建了IES模型,结合热力学第一、二定律,推导了该IES不...为解决综合能源系统(integrated energy systems,IES)难以量质协同运行,且求解时间较长的问题,该文提出了一种计及[火用]效率的电-气-热综合能源系统多目标优化调度方法。首先,该文构建了IES模型,结合热力学第一、二定律,推导了该IES不同能源网络的源侧和负荷侧的[火用]方程以及[火用]效率等表达式;其次,为降低求解时间,提出了一个基于线性权重法的多目标函数求解与决策方法;最后,通过算例分析,验证了所提模型与方法的有效性。分析结果表明,相比于传统IES的优化问题,模型中考虑[火用]效率的多目标函数保证了能源品质的传输,促进了IES的量质协同运行,且该文所提求解方法的求解时间相比于遍历权重法降低了90.22%。展开更多
基金We would like to thank all the study participants, urologists, and study coordinators for participating in the study. This work was partially funded by the National Key Basic Research Program Grant 973 （2012CB518301）, the Key Project of the National Natural Science Foundation of China （81130047）, National Natural Science Foundation of China （81202001, 81272835）, China Scholarship Council （CSC）, intramural grants from Fudan University and Huashan Hospital, and a research grant from Beckman Coulter, Inc.
文摘The [-2]proPSA （p2PSA） and its derivatives, the p2PSA-to-free PSA ratio （%p2PSA）, and the Prostate Health Index （PHI） have greatly improved discrimination between men with and without prostate cancer （PCa） in prostate biopsies. However, little is known about their performance in cases where a digital rectal examination （DRE） and transrectal ultrasonography （TRUS） are negative. A prospective cohort of 261 consecutive patients in China with negative DRE and TRUS were recruited and underwent prostate biopsies. A serum sample had collected before the biopsy was used to measure various PSA derivatives, including total prostate-specific antigen （tPSA）, free PSA, and p2PSA. For each patient, the free-to-total PSA ratio （%fPSA）, PSA density （PSAD）, p2PSA-to-free PSA ratio （%p2PSA）, and PHI were calculated. Discriminative performance was assessed using the area under the receiver operating characteristic curve （AUC） and the biopsy rate at 91% sensitivity. The AUC scores within the entire cohort with respect to age, tPSA, %fPSA, PSAD, p2PSA, %p2PSA, and PHI were 0.598, 0.751, 0.646, 0.789, 0.814, 0.808, and 0.853, respectively. PHI was the best predictor of prostate biopsy results, especially in patients with a tPSA of 10.1-20 ng ml-1. Compared with other markers, at a sensitivity of 91%, PHI was the most useful for determining which men did not need to undergo biopsy, thereby avoiding unnecessary procedures. The use of PHI could improve the accuracy of PCa detection by predicting prostate biopsy outcomes among men with a negative DRE and TRUS in China.
基金This work was in supported by grants from National Natural Science Foundation of China(grant No.81772741,No.81972405,and No.81972645)Shanghai Youth Talent Support Program,and the Shanghai Sailing Program(22YF1440500)。
文摘The long-term survival outcomes of radical prostatectomy(RP)in Chinese prostate cancer(PCa)patients are poorly understood.We conducted a single-center,retrospective analysis of patients undergoing RP to study the prognostic value of pathological and surgical information.From April 1998 to February 2022,782 patients undergoing RP at Queen Mary Hospital of The University of Hong Kong(Hong Kong,China)were included in our study.Multivariable Cox regression analysis and Kaplan–Meier analysis with stratification were performed.The 5-year,10-year,and 15-year overall survival(OS)rates were 96.6%,86.8%,and 70.6%,respectively,while the 5-year,10-year,and 15-year PCa-specific survival(PSS)rates were 99.7%,98.6%,and 97.8%,respectively.Surgical International Society of Urological Pathology PCa grades(ISUP Grade Group)≥4 was significantly associated with poorer PSS(hazard ratio[HR]=8.52,95%confidence interval[CI]:1.42–51.25,P=0.02).Pathological T3 stage was not significantly associated with PSS or OS in our cohort.Lymph node invasion and extracapsular extension might be associated with worse PSS(HR=20.30,95%CI:1.22–336.38,P=0.04;and HR=7.29,95%CI:1.22–43.64,P=0.03,respectively).Different surgical approaches(open,laparoscopic,or robotic-assisted)had similar outcomes in terms of PSS and OS.In conclusion,we report the longest timespan follow-up of Chinese PCa patients after RP with different approaches.
基金The work was supported by the National Natural Science Foundation of China （Grant No. 81402339）.
文摘In the postscreening era, physicians are in need of methods to discriminate aggressive from nonaggressive prostate cancer （PCa） to reduce overdiagnosis and overtreatment. However, studies have shown that prognoses （e.g., progression and mortality） differ even among individuals with similar clinical and pathological characteristics. Existing risk classifiers （TMN grading system, Gleason score, etc.） are not accurately enough to represent the biological features of PCa. Using new genomic technologies, novel biomarkers and classifiers have been developed and shown to add value to clinical or pathological risk factors for predicting aggressive disease. Among them, RNA testing （gene expression analysis） is useful because it can not only reflect genetic variations but also reflect epigenetic regulations. Commercially available RNA profiling tests （Oncotype Dx, Prolaris, and Decipher） have demonstrated strong abilities to discriminate PCa with poor prognosis from less aggressive diseases. For instance, these RNA profiling tests can predict disease progression in active surveillance patients or early recurrence after radical treatments. These tests may offer more dependable methods for PCa prognosis prediction to make more accurate and personal medical decisions.
基金by grants from the innovation grant by Shanghai Hospital Development Center(SHDC12015105)to Jianfeng Xuthe National Natural Science Foundation of China(Grant No.81772741)+3 种基金Shanghai Rising-Star Program(Grant No.18QA1402800)the“Chen Guang”project supported by Shanghai Municipal Education CommissionShanghai Education Development FoundationShanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support(Grant No.20181701)to Rong Na.
文摘To evaluate whether prostate volume(PV)would provide additional predictive utility to the prostate health index(phi)for predicting prostate cancer(PCa)or clinically significant prostate cancer,we designed a prospective,observational multicenter study in two prostate biopsy cohorts.Cohort 1 included 595 patients from three medical centers from 2012 to 2013,and Cohort 2 included 1025 patients from four medical centers from 2013 to 2014.Area under the receiver operating characteristic curves(AUC)and logistic regression models were used to evaluate the predictive performance of PV-based derivatives and models.Linear regression analysis showed that both total prostate-specific antigen(tPSA)and free PSA(fPSA)were significantly correlated with PV(all P<0.05).[-2]proPSA(p2PSA)was significantly correlated with PV in Cohort 2(P<0.001)but not in Cohort 1(P=0.309),while no significant association was observed between phi and PV.When combining phi with PV,phi density(PHID)and another phi derivative(PHIV,calculated as phi/PV°5)did not outperform phi for predicting PCa or clinically significant PCa in either Cohort 1 or Cohort 2.Logistic regression analysis also showed that phi and PV were independent predictors for both PCa and clinically significant PCa(all P<0.05);however,PV did not provide additional predictive value to phi when combining these derivatives in a regression model(all models vs phi were not statistically significant,all P>0.05).In conclusion,PV-based derivatives(both PHIV and PHID)and models incorporating PV did not improve the predictive abilities of phi for either PCa or clinically significant PCa.
文摘We aim to evaluate prostate health index as an additional risk-stratification tool in patients with Prostate Imaging Reporting and Data System score 3 lesions on multiparametric magnetic resonance imaging.Men with biochemical or clinical suspicion of having prostate cancer who underwent multiparametric magnetic resonance imaging in two tertiary centers(Queen Mary Hospital and Princess Margaret Hospital,Hong Kong,China)between January 2017 and June 2022 were included.Ultrasound-magnetic resonance imaging fusion biopsies were performed after prostate health index testing.Those who only had Prostate Imaging Reporting and Data System score 3 lesions were further stratified into four prostate health index risk groups and the cancer detection rates were analyzed.Out of the 747 patients,47.3%had Prostate Imaging Reporting and Data System score 3 lesions only.The detection rate of clinically significant prostate cancer in this group was 15.0%.The cancer detection rates of clinically significant prostate cancer had statistically significant differences:5.3%in prostate health index<25.0,7.4%in prostate health index 25.0-34.9,17.9%in prostate health index 35.0-54.9,and 52.6%in prostate health index≥55.0(P<0.01).Among the patients,26.9%could have avoided a biopsy with a prostate health index<25.0,at the expense of a 5.3%risk of missing clinically significant prostate cancer.Prostate health index could be used as an additional risk stratification tool for patients with Prostate Imaging Reporting and Data System score 3 lesions.Biopsies could be avoided in patients with low prostate health index,with a small risk of missing clinically significant prostate cancer.
文摘为解决综合能源系统(integrated energy systems,IES)难以量质协同运行,且求解时间较长的问题,该文提出了一种计及[火用]效率的电-气-热综合能源系统多目标优化调度方法。首先,该文构建了IES模型,结合热力学第一、二定律,推导了该IES不同能源网络的源侧和负荷侧的[火用]方程以及[火用]效率等表达式;其次,为降低求解时间,提出了一个基于线性权重法的多目标函数求解与决策方法;最后,通过算例分析,验证了所提模型与方法的有效性。分析结果表明,相比于传统IES的优化问题,模型中考虑[火用]效率的多目标函数保证了能源品质的传输,促进了IES的量质协同运行,且该文所提求解方法的求解时间相比于遍历权重法降低了90.22%。
