With the release of the 2025-NCCN （V1） Prostate Cancer Diagnosis and Treatment Guidelines，this article interprets the recent updates of the NCCN Prostate Cancer Diagnosis and Treatment Guidelines.The main content of the guidelines updates is the treatment recommendations for very low-risk prostate cancer，recurrence after radical radiotherapy or radical surgery，and metastatic castration resistant prostate cancer.Another focus is the prevention and treatment of bone related adverse events in prostate cancer.Interpreting the new version of the guidelines can provide clinicians with better strategies and treatment choices for the standardized diagnosis and treatment of prostate cancer，thereby further improving patient survival benefits.

The low infiltration of immune cells，especially T cells，in prostate cancer often leads to its classification as an "immune desert"，resulting in poor outcomes with immunotherapy，including immune checkpoint inhibitors.The development of mRNA vaccines has progressed rapidly in recent years.mRNA cancer vaccines have been shown to induce tumor-specific T cells and humoral immune responses that enhance the cytotoxicity against tumor cells.This paper reviews the progress and challenges of mRNA vaccines in prostate cancer，providing references for future research and the development of mRNA therapeutics.

Objective

To evaluate effectiveness of the 1 470nm laser enucleation in the management of benign prostatic hyperplasia.

Methods

The clinical data of 46 patients with BPH who underwent 1 470 nm laser enucleation and 40 patients who underwent TURP in the First Hospital of China Medical University from January 2019 to June 2022 were retrospectively analyzed.Age，level of PSA，volume of the prostate，IPSS，QOL，RUV，Q_max，operative time，blood loss，sodium loss of blood，time of bladder irrigation，time of indwelling catheter，in-hospital time and complications were collected.The age，level of PSA，volume of the prostate，IPSS，QOL，RUV，Q_max between the two groups showed no significant difference before operation （P＞0.05）.

Results

All patients received operation successfully.Postoperative follow-up was conducted for 6-30 months.The 1 470 nm group showed advantages in operative time，blood loss volume，the sodium loss of blood，the time of bladder irrigation，the time of indwelling catheter，inhospital time and IPSS after 6 months follow-up （P＜0.05），but the QOL and RUV 6 months after operation showed no difference （P＞0.05）.

Conclusions

1 470 nm enucleation of the prostate is safe，effective，and minimal invasive for the management of benign prostatic hyperplasia.

Benign prostatic hyperplasia （BPH） is one of the common diseases in elderly men，often leading to severe bladder outlet obstruction，resulting in recurrent urinary retention，infections，and renal function impairment.The preferred treatment option for rapid symptom relief is surgical intervention.There are many surgical treatment options for BPH，including open resection，minimally invasive transurethral resection，enucleation，vaporization，ablation，stent placement，and robotic surgery.The indications and efficacy of different surgical treatment options vary，and it is essential to individualize the selection of the best surgical approach based on the expertise of the urologic surgeon and the characteristics of the patient.This article reviews the selection of surgical treatment methods for BPH，providing reference for clinical decision-making.

【视频简介】本例患者男性，54 岁。以“体检发现左肾囊实性占位1 个月”为主诉入院，无不适症状。双肾CT 提示：左肾上极病变，以低密度为主，病灶边缘及内部可见多发斑片状钙质密度影，大小约8.9 cm×9.3 cm×8.5 cm，其内可见结节状轻度-中度强化，大部分区域未见明显强化。术前诊断：左肾囊实性占位（Bosniak Ⅲ-Ⅳ级）。

患者及家属积极要求保肾。手术难点包括：（1）肿瘤巨大，占位效应明显，操作空间严重受限；（2）囊性肿瘤易破裂，增加肿瘤种植转移风险；（3）手术切除创面大，切除及缝合时间延长，热缺血时间延长；（4）瘤体位置深，紧贴集合系统。手术策略：采用达芬奇机器人辅助腹腔镜左侧巨大囊性肿瘤肾部分切除术（经腹腔入路）。注意事项：（1）对于囊性巨大瘤体，采用经腹入路可获得较大的操作空间，结合达芬奇机器人手术系统，可更精准辨别肿瘤包膜，精准切割与快捷缝合，有效缩短热缺血时间；（2）游离及切除囊性巨大瘤体时，操作需轻柔，采用“排雷式”方法，谨慎分离，避免包膜破裂；（3）切除囊性瘤体时，根据术前阅片确定安全切开位置，运用“钝锐结合、小步快走”手法，完整分离瘤体；（4）需游离动静脉，彻底阻断血管，保持术野清晰，以便在不切破瘤体的同时，最大限度保留正常肾实质；（5）集合系统破损及血管断端处缝合需精细，髓质破损处为缝合重点，可适度密缝，防止术后内漏或动静脉瘘。术后病理显示切缘阴性，诊断为肾细胞癌。

Immunohistochemistry is an important adjunct to the diagnosis， classification， and prediction of the efficacy of targeted therapy and immunotherapy in bladder cancer.This paper presents the commonly used immunohistochemical markers in pathological reports of bladder cancer.In the future， with the application of immunohistochemistry-based molecular subtypes of urothelial carcinoma and artificial intelligence technology，immunohistochemistry will further promote the development of precision diagnosis and treatment of bladder cancer.

Objective

To explore the prognostic and therapeutic significance of cholesterol biosynthesis-related genes （CBRG） in prostate cancer （PCa）.

Methods

The differential expression of cholesterol biosynthesis-related genes in PCa and normal tissues was analyzed using the TCGA database.A risk score prognostic model was constructed through LASSO and multivariate Cox regression analysis.The independent prognostic value of the model for PCa was further validated using univariate and multivariate Cox regression analyses.PCa patients were divided into high-risk and low-risk groups based on the median value of the risk score.GSEA analysis was used to observe the differentially enriched pathways between the high-risk and low-risk groups.The CIBERSORT algorithm was employed to assess tumor immune cell infiltration in the high-risk and low-risk groups.Potential drugs associated with the risk score were screened using the GDSC database，and the correlation between the risk score and the half-maximal inhibitory concentration （IC50） of the drugs was analyzed using the Spearman test.Kaplan-Meier analysis compared the disease-free survival （DFS） of patients with high and low expression of characteristic genes.The Wilcoxon test was used to analyze the expression differences of characteristic genes in enzalutamideresistant versus non-resistant cases.

Results

A prognostic model was constructed that included the genes PMVK，ACSL3，ABCG1，HMGCS2，and CYP11A1.This model had areas under the curve （AUC） of 0.74，0.76，and 0.72 for predicting 1-year，3-year，and 5-year DFS，respectively，with AUCs of 0.70 and 0.69 in the validation dataset for 3-year and 5-year DFS，respectively.Clinical independence analysis revealed that this prognostic model has the ability to independently predict DFS in PCa patients，outperforming other clinical pathological features.Further analysis of tumor immune cell infiltration levels in high-risk and lowrisk groups of PCa patients showed that the infiltration levels of CD8⁺ T cells，follicular helper T cells，and activated NK cells were significantly reduced in the high-risk group，while the infiltration levels of naïve B cells，resting CD4⁺ memory T cells，regulatory T cells，and neutrophils were significantly increased.Drug sensitivity analysis found that the resistance to six drugs，including enzalutamide and lapatinib，was positively correlated with the risk score.GSEA analysis indicated that the high-risk group was primarily enriched in pathways related to oxidative phosphorylation，ribosomes，and proteasomes.Additionally，survival analysis revealed a significant correlation between the expression of the HMGCS2 gene and patients' DFS，indicating a positive effect on tumor prognosis，and it was significantly downregulated in enzalutamide-resistant patients.

Conclusion

Cholesterol biosynthesis-related characteristic genes are independent prognostic markers for prostate cancer，and the HMGCS2 gene may serve as a potential therapeutic target，providing new insights for precision treatment of prostate cancer.

Objective

To analyze the various factors affecting the efficacy of emergency ultrasound-guided extracorporeal shock wave lithotripsy （ESWL） in the treatment of ureteral calculi.

Methods

1 139 patients with emergency ureteral or pelevis calculi who underwent ultrasound-guided ESWL in the Third People's Hospital of Xindu District， Chengdu from May 2020 to April 2022 were selected.And 988 patients were successfully followed up， among them， 929 cases were ureteral calculi.Based on the success or failure of the ESWL， the patients were divided into two groups.Univariate and multivariate analyses were conducted to identify the factors influencing the efficacy of emergency ESWL.

Results

The total success rate of ESWL was 80.41（747/929）， and the one-time success rate of ESWL was 73.18%.Some of patients had mild gross hematuria， subcutaneous hemorrhage， renal colic and other complications， and the symptoms disappeared immediately after ESWL.Univariate analysis showed statistically significant differences in the size， location， CT value， and time from symptom onset to lithotripsis were associated with the efficacy of emergency ESWL （P＜0.05）， while multivariate analysis only showed statistically significant differences in CT value of calculi （P＜0.05）.

Conclusions

Emergency ESWL treatment is a safe and effective minimally invasive method.The CT value of calculi is important factor affecting the effect of lithotripsy.

【视频简介】 前列腺癌是老年男性最常见的恶性肿瘤之一。近年来，前列腺癌在我国的发病率迅速上升，据2024 年国家癌症中心发布的2022 年中国癌症发病率和死亡率最新数据显示，其发病率约占成年男性恶性肿瘤的4.7%，粗发病率为18.61/10 万，粗死亡率为6.59/10 万，已成为严重影响中国男性健康的重要疾病。放射治疗是前列腺癌的主要治疗方式之一，在不同分期前列腺癌的治疗过程中均扮演了重要的角色，精准放疗技术推动前列腺癌放疗朝着更精准、更低毒、更高效的方向发展。

本视频介绍放射治疗在前列腺癌不同阶段中的作用及国内外最新研究进展。放射治疗用于根治局限期前列腺癌疗效确切，剂量提升和疗程缩短是近年的发展趋势。其中，短至5 次的极低分割放疗凭借高性价比而受到青睐，用于治疗早期前列腺癌，其疗效和副反应与常规分割相当。在术后放疗方面，时机的把握仍尤为重要，应根据复发风险高低合理地选择术后治疗策略。到了挽救性放疗阶段，需联合长程内分泌治疗以进一步改善疗效。在转移性前列腺癌减瘤性放疗时，在强化系统治疗的基础上，原发灶放疗仍显示出降低局部临床事件，延缓进展至激素耐药的时间等重要作用。对于低转移瘤负荷的患者，全覆盖放疗甚至可能成为一种潜在疾病治愈方式。

Exosome was first discovered in 1983，it was thought to be a mechanism used by cells to excrete waste in the 1990s.Recent studies have shown that exosomes carry complex components，including proteins，nucleic acids，lipids and other metabolites.Exosomes transport these complex components to nearby or distant cells，participate in cell-to-cell substance exchange and cell communication，and regulate cell homeostasis，immune response and aging.Almost all cells secrete exosomes，so exosomes are also components of the tumor microenvironment，and play an important role in tumor development，metastasis，immune response and therapy.Prostate cancer is one of the most common malignant tumors in male genitourinary system.Exosomes play the role of substance exchange and signal transmission between cells through their contents，which mediates the immune escape process of prostate cancer cells，promotes the development and metastasis of prostate cancer.This article reviews the recent research progress of exosomes in immune escape of prostate cancer cell.

【视频简介】下腔静脉后输尿管（retrocaval ureter，RU）是一种因下腔静脉发育异常而导致输尿管位置及走行异常的罕见先天性泌尿系畸形。RU 形成的原因与胚胎发育过程中后主静脉异常持续存在密切相关。当腔静脉后输尿管引起输尿管梗阻时，可出现腰痛、腰胀、反复泌尿系感染或并发结石等症状。对于合并肾、输尿管积水及出现相关临床症状的RU 患者，腹腔镜下腔静脉后输尿管矫形术是目前RU 主要的治疗方式。

本视频患者为右侧下腔静脉后输尿管，且合并右侧肾、输尿管积水。结合患者实际情况，我们制定了下列手术策略：（1）选择经腹腔途径，因其解剖标志明显、操作空间大、可充分暴露下腔静脉及输尿管；（2）切开侧腹膜，将降结肠和十二指肠向中线游离以暴露下腔静脉；在髂血管处切开腹膜，分离输尿管；沿输尿管往上游离，可见输尿管走行入腔静脉后；在腔静脉外侧分离出扩张的上段输尿管和肾盂；（3）游离腔静脉后段的输尿管，尽量分离腔静脉与输尿管，在扩张输尿管段用剪刀斜面切断近端输尿管，将梗阻远端输尿管从腔静脉后牵至腔静脉前，若输尿管与腔静脉粘连而分离困难，可在腔静脉两段切断输尿管，旷置腔静脉后输尿管；（4）适当剪除远端多余输尿管，劈开输尿管，用4-0 可吸收线间断或连续全层Y-V 缝合两输尿管断端；创缘必须对合整齐，切勿外翻或内翻，确保吻合口无张力；（5）关闭侧腹膜，留置腹腔引流管一根，缝合腹壁戳孔。

本例患者因输尿管与腔静脉严重粘连，我们旷置了腔静脉后段输尿管，并对右肾进行了下降固定术，以确保输尿管无张力吻合。总之，在下腔静脉后输尿管矫形术中，术者需确保输尿管无张力吻合，同时尽可能保护输尿管血供。结合手术经验和患者的实际情况制定个体化手术策略，是手术成功的重要保证。