Prostate Cancer and Prostatic Diseases最新文献

Background: Incidental prostate cancer (IPC) is not uncommon in patients undergoing surgery for benign prostate enlargement (BPE). However, the associated risk factors remain incompletely understood. This study aimed to evaluate potential clinical predictors of IPC.

Methods: A systematic search of MEDLINE, Embase, and Web of Science was conducted in January 2025 to identify studies assessing risk factors for IPC. Pairwise meta-analyses were performed using a random-effects model, pooling adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable analyses. Risk of bias was evaluated using the ROBINS-I tool. (PROSPERO: CRD42024588776).

Results: Twenty-five studies comprising 247,966 patients were included. IPC was identified in 6,748 patients, with reported rates ranging from 2.2% to 49.6%. Significant risk factors for IPC included: Elevated PSA level (OR: 1.03; 95% CI: 1.01-1.05; p = 0.01), PSA density >0.15 ng/mL/cc (OR: 3.02; 95% CI: 1.50-6.07; p = 0.01), Older age (OR: 1.05; 95% CI: 1.01-1.08; p = 0.01), and Higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02-1.18; p = 0.01). Prostate volume, diabetes, and dyslipidemia were not associated with IPC risk. Notably, use of 5-alpha reductase inhibitors (5-ARIs) was linked to a significantly reduced risk (OR: 0.53; 95% CI: 0.33-0.85; p = 0.01). Study limitations included heterogeneity across studies, retrospective designs, and incomplete reporting of key variables.

Conclusions: Elevated PSA, high PSA density, older age, and increased BMI were associated with a higher risk of IPC in patients undergoing surgery for BPE. Conversely, preoperative use of 5-ARIs was associated with a reduced risk. These findings may support improved preoperative risk stratification and help identify patients in whom additional diagnostic evaluations could be considered or avoided. Further research is needed to better define predictors of clinically significant IPC.

Objective: The aim of this study was to meta-analyze published data on the diagnostic performance of PSMA PET/CT in detecting lymph node invasion (LNI) in intermediate-risk prostate cancer (PCa) patients, and to discuss whether pelvic lymph node dissection (PLND) can be spared in patients with negative PSMA PET scan.

Patients and methods: The PubMed and Embase databases were searched through November 2025 to identify relevant articles. Methodological quality of each study was assessed. Patient-based sensitivity and specificity were pooled using the bivariate random-effects model. Patient-based negative predictive value (NPV) was pooled using the DerSimonian-Laird model. Histopathology from PLND and clinical follow-up served as the reference standard.

Results: Twelve eligible studies, comprising a total of 1619 patients with intermediate-risk PCa, were included. Overall, the studies were of moderate methodological quality. The sensitivity and specificity of PSMA PET/CT for the detection of LNI ranged from 0% to 100% and from 87% to 99%, respectively, with pooled estimates of 49% [95% confidence interval (CI) 27-72%] and 95% (95% CI 93-97%), respectively. The NPV of PSMA PET/CT for the detection of LNI ranged from 74% to 100%, with pooled estimates of 95% (95% CI 91-98%).

Conclusion: This meta-analysis of current diagnostic evidence suggests that intermediate-risk PCa patients with negative PSMA PET scan may omit PLND at the time of radical prostatectomy. However, the moderate sensitivity of PSMA PET and the associated risk of missing micrometastatic disease underscore the need for cautious application and shared decision-making. Further large-scale prospective validation studies and future follow-up results focusing on the clinical outcomes of these patients will lend stronger support to this approach.

Background: The real-world retrospective DEAR study in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) demonstrated darolutamide was associated with lower risks of discontinuation and progression to metastatic castration-resistant disease vs enzalutamide and apalutamide. This analysis expands on DEAR, including additional patients and follow-up, comparing prostate-specific antigen (PSA) response, metastasis-free survival (MFS), and overall survival (OS).

Methods: DEAR-EXT was a chart review of electronic medical records from patients in US urology practices who initiated androgen receptor inhibitors (ARIs) for nmCRPC from August 2019-March 2023. Outcomes included time to initial drug discontinuation, time to metastatic castration-resistant prostate cancer (mCRPC), PSA response, MFS, OS, and safety. Adjusted Cox proportional hazards models were used for the primary analysis and inverse probability of treatment weighting and other sensitivity analyses were performed to evaluate the impact of potential selection bias and confounding factors.

Results: Patients (N = 1375) received darolutamide (n = 565, 41%), enzalutamide (n = 609, 44%), or apalutamide (n = 201, 15%). Baseline characteristics were mainly similar across groups. Adjusted risk of discontinuation was significantly lower with darolutamide vs enzalutamide (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.61-0.88) and vs apalutamide (HR 0.69, 95% CI 0.54-0.89). Adjusted risk of progression to mCRPC was lower with darolutamide vs enzalutamide (HR 0.63, 95% CI 0.50-0.80) and vs apalutamide (HR 0.72, 95% CI 0.53-0.98). MFS was significantly longer for darolutamide vs enzalutamide (HR 0.65, 95% CI 0.53-0.79) and vs apalutamide (HR 0.72, 95% CI 0.55-0.93). The estimated MFS rates at 24/36 months were 72.3%/60.2% with darolutamide, 59.2%/48.3% with enzalutamide, and 63.9%/47.6% with apalutamide. Darolutamide appeared to be associated with higher PSA response, improved survival, and fewer adverse events vs other ARIs in a real-world setting. Results were consistent in a sensitivity analysis.

Conclusion: Darolutamide demonstrated lower discontinuation rates, longer time to progression, and longer MFS vs other ARIs, highlighting its potential to enhance real-world patient outcomes.

Clinical trial registration: ClinicalTrials.gov identifier: NCT06013475.

Background: Reprogrammed lipid metabolism with massive upregulation of tumor cell-autonomous synthesis of saturated fatty acids is a hallmark of prostate cancer (PCa) and is driven in part by aberrations in androgen receptor (AR) signaling. While lipid alterations are well described in primary PCa, the extent to which the circulating lipidome reflects tumor-associated metabolic changes in metastatic disease, and its role in therapy response, remains to be determined. This study aims to assess whether plasma lipid profiling captures tumor metabolic rewiring, and whether this reflects response to AR-targeting therapy, in metastatic castration-resistant PCa (mCRPC).

Methods: Quantitative plasma lipidomics was performed on plasma samples collected from patients with mCRPC (n = 50) and cancer-free subjects (C-FS, n = 14). Samples from patients with mCRPC were collected longitudinally at the time of progression on androgen deprivation therapy prior to initiation of first-line enzalutamide (Enza), after the start of treatment with Enza, before progression on Enza.

Results: Compared to C-FS, patients with mCRPC showed distinct lipidomic signatures, characterized by increased levels of monounsaturated lipids and altered composition of the phospholipid and sphingolipid pool, mimicking the aberrations known to occur in primary PCa tissue. Enza treatment markedly reduced total lipid levels, decreased major phospholipid classes and ceramides, while increasing sphingomyelins. Notably, quantitative differences in specific sphingolipid species occurring after Enza treatment correlated with survival outcomes.

Conclusions: Plasma lipidomics reflects key metabolic features of PCa and is profoundly impacted by AR inhibition, with prognostic relevance in patients with mCRPC. These findings support its potential as a non-invasive tool for monitoring disease activity and treatment response, and lay the groundwork for lipid-based biomarkers in mCRPC, while indicating that the lipidomic alterations observed may help inform ongoing and forthcoming research on metabolic targeting.

Purpose: We systematically reviewed the long-term outcomes of untreated prostate cancer across different risk categories to inform treatment decisions and active surveillance protocols. This comprehensive analysis synthesizes long-term progression data across tumor staging and grading systems.

Materials and methods: We conducted a systematic literature search of PubMed, EMBASE, and Cochrane databases (1990-2025) for studies reporting ≥10-year outcomes in untreated or conservatively managed prostate cancer patients. Eligible studies included observational cohorts, population registries, and meta-analyses. Primary endpoints included prostate cancer-specific mortality, metastatic progression, and competing mortality.

Results: Fifteen major studies encompassing 43,127 patients (median follow-up 15-30 years) demonstrated heterogeneous progression patterns. Ten-year prostate cancer-specific survival ranged from >95% for Gleason 6 tumors to <60% for Gleason 8-10 disease. Grade Group 1 tumors showed <5% metastatic risk over 15-20 years, while Grade Groups 4-5 exhibited rapid progression with median disease-specific survival <5 years. Across all risk groups, disease progression accelerated markedly after 15 years. Men diagnosed after age 75 faced substantial competing mortality (~57-60% 10-year non-cancer mortality), regardless of tumor grade.

Conclusions: Tumor grade is the strongest prognostic factor in the natural history of untreated prostate cancer. Low-grade disease often remains indolent for 15-20 years, whereas high-grade tumors frequently progress to lethal disease within a few years, warranting early intervention. These findings support contemporary active surveillance protocols for low-risk patients and inform evidence-based treatment decisions for higher-risk disease. Summary with methodological context.

Background: The management of antithrombotic therapy in patients undergoing endoscopic surgery for benign prostatic hyperplasia (BPH) remains challenging due to competing risks of thromboembolism and perioperative bleeding. This meta-analysis evaluated perioperative outcomes among patients undergoing endoscopic prostate procedures while continuing antiplatelet (APT) or anticoagulant (AC) therapy compared with patients not receiving antithrombotic treatment.

Methods: Literature search was conducted on 17th September 2025 including PubMed, Medline, Embase, and Scopus database, to identify comparative studies evaluating perioperative outcomes of endoscopic prostate procedures in patients on versus off APT/AC therapy were identified. Data were pooled using random-effects models to estimate mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI).

Results: Fifteen studies comprising 6091 patients (1900 on APT/AC, 4191 controls) were included. Operative time, postoperative hemoglobin decrease, catheterization duration, and continuous bladder irrigation time were comparable between groups across all surgical modalities. However, bleeding-related complications were significantly more frequent among APT/AC users undergoing transurethral resection of the prostate (TURP) (OR 1.90, 95% CI 1.05-3.41, p = 0.03) and enucleation (OR 2.91, 95% CI 1.71-4.93, p < 0.0001), particularly in the AC subgroup (OR 4.80, p = 0.0002). Enucleation also carried higher odds of bleeding requiring surgical hemostasis (OR 3.69, 95% CI 1.73-7.84, p = 0.0007) and acute urinary retention (OR 1.36, 95% CI 1.04-1.77, p = 0.02) among antithrombotic users. Conversely, photoselective vaporization (PVP) demonstrated comparable rates of transfusion, hemostasis, and urinary complications regardless of APT/AC therapy. Hospital stay was marginally longer after TURP and PVP among APT/AC users (p < 0.05).

Conclusions: Continuation of antithrombotic therapy during PVP appears safe, with perioperative outcomes comparable to those of non-antithrombotic patients. Conversely, its ongoing use-especially AC-significantly increases bleeding risks following TURP and enucleation. PVP may therefore represent the preferred modality for high-risk patients requiring uninterrupted antithrombotic therapy. Clinical decision-making should balance individual thromboembolic risk against anticipated bleeding risk, with multidisciplinary input when appropriate.