International Journal of Urology最新文献

Objective: We evaluated the long-term outcomes in health-related quality of life (QOL) after robot-assisted radical prostatectomy (RARP) and the factors influencing them.

Methods: Overall, 246 patients who underwent RARP were included. The Expanded Prostate Cancer Index Composite (EPIC) and Short Form-8 (SF-8) questionnaires were utilized. Continence was defined as a score of ≤ 1 on question 1 of the International Consultation on Incontinence Questionnaire-Short Form. Questionnaires were collected preoperatively until 84 months postoperatively. For EPIC, each score was compared to preoperative values to examine the changes in HRQOL. For SF-8, the change in each score was examined separately for groups with and without urinary incontinence. Furthermore, factors influencing the SF-8 scores at 60 and 84 months postoperatively were analyzed.

Results: In EPIC urinary function, urinary incontinence, and sexual function scores decreased significantly beginning from 1 month postoperatively and did not return to preoperative levels even after 84 months. In SF-8, social function, mental health, and mental health summary scores were significantly lower postoperatively in those with urinary incontinence. Multivariate analysis showed that urinary incontinence was a significant factor that affected the SF-8 scores at 60 and 84 months postoperatively (p = 0.003 and p = 0.039, respectively).

Conclusions: The QOL related to urinary and sexual function showed a sustained decline up to 84 months postoperatively compared to preoperative levels. Urinary incontinence was a significant predictor of HRQOL at 60 and 84 months postoperatively.

The incidence of prostate cancer (PC) has recently increased in Japan. Androgen deprivation therapy (ADT) has been a key treatment in patients with castration-sensitive PC (CSPC); however, resistance typically emerges through multiple mechanisms, leading to metastatic castration-resistant PC (mCRPC). Taxane-based therapy (i.e., docetaxel, cabazitaxel) has been standard care in patients with mCRPC. New evidence supporting the addition of androgen receptor signaling inhibitors (ARSIs, e.g., enzalutamide, abiraterone) to docetaxel and ADT for patients with metastatic CSPC (mCSPC) raises questions about the role of taxane-based therapies and their optimal sequencing, as well as how to identify patients who may benefit from taxane-based therapy. Here we review the evidence on taxane-based therapy, including cabazitaxel, in the treatment of PC, with a focus on clinical and real-world evidence from Japan. Cabazitaxel has proven effective for patients with mCRPC who have a history of ARSI and docetaxel use, and it is preferable to a second alternative ARSI, as indicated in the CARD study. The safety profile of cabazitaxel (particularly, the incidence of neutropenia) can be managed through prophylactic use of granulocyte colony-stimulating factor, as well as a lower dosage and possibly variation of the dosage interval. However, a certain dose intensity is required because neutropenia has been identified as a potential prognostic indicator for treatment effectiveness. In the ARSI era for mCSPC, evidence on mCRPC treatment sequencing is limited. A better understanding of PC biology and the collection of real-world data is essential for effective treatment and improved safety-benefit outcomes.

Objectives: To test the feasibility of combining percentage prostate-specific antigen (PSA) reduction and multiparametric magnetic resonance imaging (mpMRI) to determine the clinical scenario in which follow-up biopsy could be avoided after focal therapy (FT) with high-intensity focused ultrasound (HIFU) for prostate cancer.

Methods: We reviewed 90 men treated with FT. Percentage PSA reduction was calculated by PSA nadir within postoperative 6 months. mpMRI was arranged at postoperative 6 months, followed by routine biopsy. Logistic regression analyses were performed to identify predictors for clinically significant prostate cancer (csPC) on follow-up biopsy. Receiver operating characteristic curve analysis was done to assess the area under the curve (AUC). The diagnostic performance of percentage PSA reduction and mpMRI to predict csPC was also calculated.

Results: Eight patients had csPC recurrence. Percentage PSA reduction and Prostate Imaging-Reporting and Data System (PI-RADS) ≥ 3 at postoperative 6 months were predictors for csPC (p = 0.033 and p = 0.02, respectively). The AUC of mpMRI, percentage PSA reduction, and their combination were 0.95, 0.816, and 0.982, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of PSA reduction < 70% and PI-RADS ≥ 3 to predict csPC were 87.5%, 69.5%, 21.9%, 98.3%, and 87.5%, 96.3%, 70%, 98.8%, respectively. Using the criteria of PSA reduction < 70% or PI-RADS ≥ 3 to determine biopsy candidates could avoid 60% of biopsies, without missing csPC.

Conclusion: For patients whose PSA reduction > 70% and PI-RADS < 3, we suggested avoiding routine biopsy at 6 months after FT with HIFU.