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<b><i>Background:</i></b> Large cell neuroendocrine carcinoma (LCNEC) of the prostate is an extremely rare entity, and the clinicopathological course, potential effective treatment, and prognosis are yet to be elucidated. <b><i>Materials and Methods:</i></b> A systematic search in Pubmed, Embase, and Ovid from inception to January 2019 was conducted. We reviewed each individual case of prostatic LCNEC and summarized specific features and outcomes for this rare pathologic entity. <b><i>Results:</i></b> Thirteen studies with a total of 20 patients (mean age: 70.3, range 43–87) were included in our review. Seventeen patients harbored primary LCNEC of the prostate, of which 9 patients were diagnosed with <i>de novo</i> carcinoma, and 8 patients were with a history of prostatic adenocarcinoma treated with hormonal therapy (mean duration: 2.9 years, range 2–5). The other 3 patients were diagnosed with metastatic LCNEC originating from lung (2 cases) and bladder (1 case). All patients met the diagnostic criteria of the typical morphological features as well as immunohistochemical staining results. Nearly all primary <i>de novo</i> LCNEC of the prostate were at a late stage at initial diagnosis. The pattern of distant metastasis resembled that of prostatic adenocarcinoma with the most common sites as bone spread (8/16, 50%). Most patients received systematic chemotherapy after diagnosis; however, the prognosis remained poor and patients deteriorated rapidly but with exception. Three reported cases in the context of <i>de novo</i> LCNEC admixed with prostatic adenocarcinoma kept sustained response to androgen deprivation therapy (ADT) and achieved obviously better survival outcomes compared with other patients. <b><i>Conclusions:</i></b> LCNEC of the prostate is a rare entity that mostly occurs after long-standing hormonal therapy of prostatic adenocarcinoma. The prognosis was universally poor irrespective of the systematic chemotherapy. However, patients of <i>de novo</i> tumor mixed with prostatic adenocarcinoma may respond to ADT and harbor a better outcome than those of pure <i>de novo</i> or post-ADT LCNEC of the prostate.

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Purpose: To evaluate the accuracy of 68 Ga-PSMA positron emission tomography/computerized tomography (PET/CT) for preoperative lymph node staging using histopathological results of pelvic lymph node dissection (PLND) as reference standard in patients with intermediate/high risk of prostate cancer. Material and Methods: A systematic search of PubMed, Embase, and the Cochrane Library was completed up to May 2020. We included studies investigating accuracy of 68 Ga-PSMA PET/CT in primary lymph node staging before radical prostatectomy and PLND. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and the summary receiver operating characteristic (SROC) curve with an area under the curve (AUC) were synthesized. Results: Eleven studies comprising 904 patients were identified. Based on per-patient analysis, the pooled sensitivity and specificity reached 0.63 (95% CI: 0.46–0.78) and 0.93 (95% CI: 0.88–0.96), respectively, with the DOR of 22 (95% CI: 10–47). An overall accuracy was revealed by the SROC curve with AUC of 0.91 (95% CI: 0.88–0.93). Using the lymph node as unit, the pooled sensitivity and specificity were 0.70 (95% CI: 0.49–0.85) and 0.99 (95% CI: 0.96–1.00), respectively. And the DOR reached 167 (95% CI: 40–695) with an AUC of 0.96 (95% CI: 0.94–0.98). The pooled PPV and NPV all reached above 0.8 on basis of per-patient or per-node analysis. Conclusions: 68 Ga-PSMA PET/CT represented as a promising test for preoperative lymph node staging and patients without lymph node metastatic status can rarely be misdiagnosed. However, its sensitivity ought to be improved before forgoing PLND.

Introduction: Intraocular foreign bodies (IOFBs) are a serious subset of open-globe injury that can result in visual loss. This study analyzed the epidemiology, clinical characteristics and visual outcomes of patients with IOFBs in Southwest China. Methods: This retrospective study comprised 1176 patients with the primary diagnosis of IOFBs who resided in Sichuan Province over a 10-year period. All data were collected from medical records and analyzed statistically. Results: The annual incidence for IOFBs was 0.14 per 100,000 (95% CI 0.12–0.16 per 100,000) people in Southwest China. In that period, IOFBs accounted for 22.3% of all open-globe injuries. Working-age male patients accounted for 79.1% of all IOFBs patients and there had significant differences in age distributions between genders(P<0.001). Metallic IOFBs was the most common (74.6%) IOFB, but there were significant differences in the materials of IOFBs between adults and children of different age groups (P<0.001). At discharge, 277 (23.6%) patients had increased visual acuity (VA) and 95 (8.0%) had no light perception. Initial visual acuity (VA) < 20/200 (OR, 5.5; P<0.001), increasing wound size (OR, 1.3; P=0.004), IOFBs in the posterior segment (OR, 2.6; P=0.002) and existing complications (traumatic cataract, endophthalmitis, retinal detachment or retinal break) were independent risk factors for final VA < 20/200. Conclusion: The incidence of IOFBs in Southwest China differed from global statistics. Adults and children had different clinical characteristics. Thus, their prevention strategies should be different.

Objective: To investigate the diagnostic role of magnetic resonance imaging (MRI)-targeted biopsy (TB) for prostate cancer (PCa) in biopsy-naïve men. Materials and Methods: Own control studies and randomized controlled trials (RCTs) up to December 2018 were identified via a systematic search of PubMed, Embase, Ovid, and the Cochrane Library. We pooled relative sensitivity (or risk ratio [RR]) to compare diagnostic efficiency for PCa and clinically significant PCa (csPCa) between TB and systematic biopsy (SB). The independent role of either biopsy pathway was evaluated for participants with positive/negative MRI. Results: Thirty-one studies consisting of 25 own control studies and 6 RCTs were included. We identified 4,020 biopsy-naïve men with positive MRI who underwent two biopsies concurrently, with PCa/csPCa detection rates of 65.90 and 45.13%, respectively. TB and SB did not differ in the detection of any PCa (RR 0.98, 95% confidence interval [CI] 0.92-1.05). However, TB detected more csPCa (RR 1.19, 95% CI 1.10-1.30) and more PCa with a Gleason score ≥3+4 (RR 1.20, 95% CI 1.07-1.34). Using a combined test as a reference, omitting SB resulted in detecting 12.81% less csPCa and 20.76% less clinically insignificant PCa (cinsPCa), and omitting TB resulted in detecting 25.69% less csPCa and 10.8% more cinsPCa. For patients with negative MRI, omitting SB led to underdetection of 30.29% of any PCa (10.9% of csPCa). Conclusions: Combining TB and SB increased the diagnostic accuracy of csPCa for biopsy-naïve men with positive MRI, and omitting SB for patients with a negative MRI would lead to the underdetection of nearly 10% of csPCa.

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