1, the introduction of subspecialty Urological development is inseparable from the reform of the clinical model of health care and the training of young people, Professor Huang Yiran will be categorized as “small experts” model. The development of modern medicine, has reached the stage of specialty segmentation, urology, for example, in the past, urology is a general surgery department, and then due to the development of subspecialties more and more in-depth, many hospitals will be independent of urology, the establishment of a complete team of talent. And in recent years, urology under the development of more subdivided specialties, such as urinary stones, kidney tumors, bladder diseases, prostate diseases, etc., “medical knowledge is changing rapidly, no one can be familiar with a variety of diseases, only to specialize in one area, in order to walk in the forefront of the industry”. In such a law, Huang Yiran in the department of innovative mechanisms to allow young doctors to focus on a disease as early as possible, to train them to become a “small expert”. “The traditional department management model, is a ‘pyramid’ model, a large number of young doctors around the big experts, which is a setback for the enthusiasm of young people.” Large tertiary hospitals for many years along the practice is that a medical student graduated through the residency stage to become an attending physician, can not yet independently set up their own team specializing in a sub-specialty, only in the promotion of deputy chief physician, that is, the patient’s mouth, “experts”, there is so much room for development. But Huang Yiran requirements, attending physicians should have their own professional focus, pull up their own “team”, to study one or two diseases. The “small expert” model also allows young doctors to get the “accidental” harvest of scientific research. Due to the research on specialized diseases, the number of cases and the volume of operations of “small specialists” on specific diseases are very large, and they also have the energy to improve the follow-up data of patients, so that “small specialists” have accumulated a large amount of very valuable clinical data in their hands. These data are the basis of scientific research and are considered by researchers as “treasures”. With these data “treasures”, “small experts” can look for scientific research institutions to cooperate in research, and gradually there are also scientific research institutions to take the initiative to seek his cooperation. “Patient-centeredness” is the focus of modern medicine, and the “small expert” model is one of the ways to achieve this goal. The emergence of “small specialists” is, first of all, an increase in the total amount of excellent medical resources, on the basis of which doctors specialize in one kind of disease, the quality of surgery is improved, surgical complications are reduced, hospitalization time is greatly shortened, the treatment effect is improved, and the patient’s costs are reduced accordingly. Prostate enlargement surgery, in the past, the use of electrocutaneous technology, the patient’s average hospitalization time is 4 days, laser prostate gouge out the application of new technology, the average hospitalization time is only 1.5 days. Advances in technology have not only lowered patients’ medical costs, but also allowed limited medical resources to serve more patients. Another important change is that when a doctor focuses on one disease, he can have the energy to master a richer range of treatments and provide patients with a more thoughtful treatment plan. People generally have the impression that surgeons can only operate, and many tumor patients have such confusion: they can only find surgeons to operate, and internal medicine doctors to provide only radiotherapy and chemotherapy. The sub-specialties of modern medicine are becoming more and more delicate, which brings the side effect of “not seeing the forest for the trees”. For example, the treatment options for kidney tumors include traditional open surgery, minimally invasive laparoscopic surgery, robotic-assisted surgery, in addition to laser, microwave, radiofrequency, cryotherapy, and other technologies have matured. What kind of treatment plan should the doctor give to the patient? Or should the doctor choose whatever technique he or she knows? Doctors can’t be good at everything. “There is no one technique that can do everything.” This is where “small specialists” and “big specialists”, urology and collaborating departments, in-hospital and out-of-hospital, are needed to conduct comprehensive multidisciplinary collaborative case discussions. The urology department sets aside a fixed amount of time each week to discuss cases, and the whole department consults with young doctors who have problems and can consult with senior experts at any time. Communication within the department has not only formed a system, but also a cultural atmosphere. Multidisciplinary consultation is not limited to within the department, a tumor case in urology may gather doctors from oncology, radiotherapy and pathology for consultation, a form known as multidisciplinary diagnosis and treatment (MDT mode). “Utilizing collective wisdom, we discuss, brainstorm and reach consensus. When we doctors think it through, the patient suffers a lot less and spends less naturally.” 2, Introduction to Prostate Cancer With the aging of the population, environmental changes and increasingly westernized lifestyles, the incidence of urological tumors in China has been rising year after year. In recent years, prostate cancer, which has developed most rapidly, ranks fifth in the incidence of male malignant tumors in China, and shows a rising trend year by year. However, in this situation, the survival rate of national urological tumors is not optimistic. Take prostate cancer as an example, the 5-year survival rate of prostate cancer patients in China is only 53.8%, while the figure in Europe and the United States is 90%, which is a far cry. It is necessary to change the problem of diagnosis and treatment of prostate cancer in China, standardized early diagnosis and multidisciplinary comprehensive treatment will effectively improve the diagnosis and treatment of prostate tumor in China. Early and accurate diagnosis of prostate tumor Early detection is of great significance to the clinical efficacy of prostate tumor. The 5-year survival rate of middle and late stage prostate cancer patients is only 35%, while the 10-year survival rate of early stage prostate cancer patients can be more than 95% if they receive radical treatment in time. Although all walks of life have been calling for early detection and treatment of urological tumors, the detection of prostate tumors in China is still not early enough. Compared with Europe and the United States, the proportion of patients with advanced prostate tumors in China remains high, and the proportion of patients with advanced prostate cancer accounts for more than 80%, which means that the vast majority of patients can not be cured, while in the United States, this figure is less than 10%. Therefore, the diagnosis of prostate cancer requires the collaboration of many parties, including urology, diagnostic radiology, ultrasound, laboratory, nuclear medicine, etc. Accurate tumor markers combined with advanced imaging technology, as well as the improvement of personal health awareness, will strive for more prostate cancer patients to get the chance of radical treatment. Data show that annual PSA examination for middle-aged men over 50 years old is of great value for early detection of prostate cancer. In daily life, once PSA level is found to be elevated, hematuria is found in the naked eye or abnormal lesions are found in imaging examination, they should go to specialized hospitals to receive standardized diagnosis and treatment in a timely manner. The main examinations include: ECT bone scan, chest CT, ultrasound of internal organs, pelvic MRI or CT. The purpose of these examinations is to make a comprehensive assessment of the condition, to determine whether the disease is early or advanced, and whether the tumor is confined to the prostate or has metastasized to distant organs or lymph nodes. For example, chest CT can observe whether there is any lung metastasis; ultrasound of internal organs can observe whether there is any metastasis in the liver, spleen, kidneys and other important organs; ECT bone scan is even more important to identify whether there is any bone metastasis; pelvic MRI or pelvic CT can determine whether there is any enlargement of the pelvic lymph nodes; and MRI can further observe whether there is any local invasion of the prostate gland outwardly to seminal vesicle glands, the rectum and the neck of the bladder. The results of these examinations play a decisive role in the selection of the patient’s treatment plan. Pathologic examination of tissue from a puncture biopsy of the prostate is currently the gold standard for the definitive diagnosis of prostate cancer. The so-called pathological diagnosis is to analyze the final diagnosis of the tumor by removing the tumor completely or cutting a part of the tumor tissue, and after many steps of processing, the morphology of the tissue cells and other internal characteristics are observed by the pathologist through the microscope. And puncture is now becoming the focus of attention of urology, imaging and ultrasound departments. The way of puncture, the timing of puncture, the selection of target point of puncture and the number of needles of puncture have all become hot topics of discussion. At present, ultrasound-guided transperineal prostate aspiration biopsy is increasingly used internationally. The probability of infection and bleeding of this procedure is greatly reduced, no special bowel preparation is needed, and it can be combined with MRI and other imaging techniques to perform neck precise targeted puncture, laying a solid foundation for the next step of targeted treatment. Renji Hospital also provides painless puncture, so that our patients are free from the tension and anxiety caused by puncture, and better accept the puncture examination for early and clear diagnosis of prostate tumor! Targeted local therapy for prostate tumor In order to achieve the effect of eradicating the tumor and improve the quality of life, the concept of modern tumor treatment has shifted from the traditional “fighting on their own” to the individualized multidisciplinary comprehensive treatment mode. Experts from various disciplines, such as surgical oncology, internal medicine, radiotherapy, pathology, imaging, etc., organically combine various diagnosis and treatment plans according to the specific conditions of the patients, biological characteristics of the tumor and individual needs, so as to make more patients benefit from the “tailor-made”. In recent years, advanced diagnostic and treatment methods for urological tumors have been emerging, such as 3D minimally invasive lumenscopic surgery, cryosurgery and radiofrequency therapy, which provide strong technical support for the diagnosis and treatment of prostate cancer, renal cancer, bladder cancer, penile cancer and other urological tumors. Among them, prostate cryosurgery has become an effective option for prostate tumors. Cryosurgery of the prostate (CSAP) is a minimally invasive treatment technique developed in the United States in the last decade or so. Due to its features of small trauma, good effect, few complications, fast recovery and easy to repeat treatment, CSAP has been widely applied in developed countries such as the United States and has become one of the preferred treatment methods, especially for the elderly men who are not suitable for radical surgery. Elderly male patients who are not suitable for radical surgery or prostate cancer patients with local recurrence after radiotherapy have special value in view of its characteristics of small trauma and precise efficacy. Although CSAP started late in China, it has begun to receive attention. The Department of Urology of Shanghai Renji Hospital is actively exploring and carrying out CSAP treatment, hoping that the introduction of this new technology and robotic surgery will contribute to the improvement of the status quo of the treatment of PCa in China and improve the overall treatment level of PCa. The application of freezing technology in the treatment of prostate diseases has a history of half a century. 1993, the United States (Endocare) company developed argon-helium cryotherapy system, which makes the precise control of temperature a reality and makes minimally invasive treatment of tumors possible. The technology was approved by FDA in 1998, mainly used for prostate cancer treatment, thus, entering a brand new development stage. Currently, CSAP is guided by transrectal ultrasound, positioning the cryoprobe percutaneously perineum to puncture to the target tumor area, starting argon gas, and adjusting the output power between 100%~10% to control the freezing range. 12~15 minutes later helium warms up and completes a treatment cycle. A total of 2 cycles were performed. During the operation, circulating warm saline method was used to protect the urethra, and all operations were performed under rectal ultrasound monitoring with targeted therapeutic properties. In December 2008, the American Urological Association (AUA) released the Statement of Best Practices for Cryotherapy of Prostate Cancer, which evaluated the efficacy, safety and indications of CSAP as the preferred treatment for patients with early-stage PCa or as salvage treatment for patients with recurrence, and recognized the therapeutic effect of CSAP. At the same time, the Statement also formulated the best clinical practice methods related to treatment, which has important clinical guidance and reference significance. 2008, American scholars Cohen (Cohen) and other research on CSAP treatment of 370 cases of prostate cancer patients showed that the results of CSAP can be comparable to surgical results of long-term follow-up, and incontinence, urethro-rectal fistula and other complications occurring at a low rate, which has a broad clinical It has a wide clinical prospect.