Prostate Cancer and Prostatic Diseases最新文献

Background: Prostate cancer (PCa) remains a leading cause of cancer-related mortality in men. While multiparametric MRI (mpMRI) is an established tool for detecting clinically significant PCa (csPCa), it is limited by cost, access, and acquisition time. Micro-ultrasound (Micro-US) offers real-time imaging with potential advantages in accessibility and integration into routine care. This systematic review and meta-analysis (SR/MA) aimed to compare the diagnostic accuracy of Micro-US versus mpMRI in detecting csPCa, based exclusively on prospective evidence.

Methods: A protocol-registered SR/MA (INPLASY202540027) was conducted following PRISMA and PICOTT frameworks. Prospective cohort studies and randomized controlled trials published between 2012 and March 2025 comparing micro-US and mpMRI for csPCa detection, using biopsy or prostatectomy specimens as reference standards, were included. Bivariate random-effects models were used to estimate pooled sensitivity, specificity, and summary ROC curves. Positive/negative predictive values (PPV/NPV) were calculated using pooled prevalence and literature-based prevalence values. Meta-regression assessed modality differences and potential effect modifiers.

Results: Eight prospective studies (n = 2626 patients) met the inclusion criteria, 1 randomized controlled trial and 7 prospective cohorts. Micro-US demonstrated a pooled sensitivity of 0.87 (95%CI: 0.80-0.92) and specificity of 0.25 (95% CI: 0.17-0.36), while mpMRI showed a sensitivity of 0.88 (95% CI: 0.81-0.93) and specificity of 0.30 (95% CI: 0.18-0.46). sROC confidence regions overlapped for both modalities. Meta-regression detected no significant difference in sensitivity (P = 0.72) but a significant difference in specificity favoring mpMRI (P = 0.003). PPVs were modest (0.41-0.46), and NPVs were high (0.72-0.80) across prevalence scenarios.

Conclusion: Micro-US demonstrates sensitivity comparable to mpMRI for csPCa screening before confirmatory biopsy, although mpMRI retains superior specificity. Micro-US may serve as an accessible alternative or complementary modality, but further high-quality prospective studies are needed to strengthen comparative evidence.

Goal: Fecal incontinence (FI) is an underrecognized but clinically significant late gastrointestinal toxicity following radiotherapy (RT) for prostate cancer. This systematic review aimed to synthesize current knowledge on the definition and pathophysiology of post-radiation anal continence, as well as prevention strategies, technical considerations, and therapeutic approaches.

Method: A systematic literature search was conducted according to PRISMA guidelines using the keywords: "Fecal incontinence," "Radiation therapy," and "Prostatic neoplasms." Eligible studies included randomized phase III trials and prospective or retrospective series reporting on FI after definitive or adjuvant/salvage prostate RT. Fifty-four articles were included in the final analysis.

Results: FI after prostate RT results from functional, morphological, and neurogenic alterations of the anorectal system. Reported incidence ranges from 1 to 12%, most often presenting as flatulence or liquid stool leakage, while severe forms requiring pads are uncommon. Variability is largely explained by heterogeneity in definitions and assessment tools, as no standardized scoring system is universally applied. Risk factors include advanced age, prior abdominal surgery, vascular comorbidities, chronic inflammatory bowel disease, hemorrhoids, and rectal urgency during RT. Dosimetric analyses indicate that low-to-intermediate doses to the anal canal and high doses to the rectum contribute differentially to FI. Based on current evidence, the mean dose to the anal canal should be kept below 37 Gy, though further studies are needed to define precise constraints for both structures. Preventive strategies such as MRI-based contouring and endorectal balloon placement, perirectal hydrogel spacers placement show promise. Management is multidisciplinary, including dietary measures, medications, pelvic floor therapy, neuromodulation, and, in severe cases, diversion procedures.

Conclusion: FI after prostate RT is likely underestimated due to the absence of a standardized assessment. Developing a validated, universally applicable scoring system is a priority to improve evaluation, enable cross-study comparisons, refine preventive measures, and guide therapeutic strategies.

Background: Recent advancements in radiological imaging have raised the possibility of diagnosing prostate cancer (PCa) without biopsy; however, the safety, feasibility, and diagnostic accuracy of this approach require comprehensive evaluation. This study proposes and evaluates an initial decision-making algorithm using PSMA PET/CT and mpMRI for selecting candidates suitable for radical prostatectomy without prior biopsy (RP-WPB).

Methods: Patient enrollment was conducted strictly according to the prospectively established decision-making algorithm. Candidates for RP-WPB were required to fulfill four essential criteria: PSA > 4 ng/mL, PI-RADS score≥4, miPSMA score≥2, and co-positive lesions identified on mpMRI and PSMA PET/CT. Patients staged as cT3-4, cN1, or cM1 (solitary metastasis) underwent RP-WPB directly. For patients with stage cT2N0M0, PSA levels were further stratified: those with PSA ranging from 4 to 30 ng/mL were invited to participate in the prospective study, whereas individuals with PSA ≥ 30 ng/mL qualified for RP-WPB only if they satisfied additional conditions, including age≥75 years, PSA density (PSAD) ≥ 0.2 ng/mL/cm³, and willingness to undergo non-neurovascular-bundle-sparing surgery.

Results: From January 2022 to February 2024, 150 patients were prospectively enrolled following the algorithm; 30 patients withdrew, and 120 underwent RP-WPB. Among the latter, 84 patients were classified as cT2N0M0, 27 as cT3-4, 10 as cN1, and 9 as cM1. The detection rate of clinically significant PCa (csPCa) (ISUP grade ≥2) patients was 100% (95% CI: 0.97-1.00, p = 0.176), and pathological concordance was achieved in all cases. No perioperative complications greater than Clavien-Dindo grade Ⅱ occurred.

Conclusions: The proposed algorithm based on PSMA PET/CT and mpMRI for performing RP-WPB demonstrates safety, feasibility, and high diagnostic accuracy, presenting a promising option for selected PCa patients.

Objective: To evaluate the therapeutic efficacy and clinical applicability of the novel P100 extracorporeal shock wave therapy (ESWT) device in the treatment of type IIIB chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Methods: In this randomized, single-blind, sham-controlled trial, 83 patients with type IIIB CP/CPPS were enrolled and randomly assigned to either the P100 treatment group (n = 51) or the control group (n = 32). Patients in the treatment group received four weekly low-intensity ESWT sessions (0.2 mJ/mm²), while the control group received identical procedures with shock transmission blocked. The primary endpoint was the clinical response rate (≥6-point reduction in NIH-CPSI score) at week 4; week 8 outcomes were further analyzed to assess sustained efficacy. Secondary endpoints included IPSS, IIEF-5, and VAS scores.

Results: At week 4, the clinical response rate was 78.4% in the P100 group compared with 25% in the control group (P < 0.001). Median NIH-CPSI scores decreased from 35 at baseline to 13 at week 4 and 12 at week 8, indicating sustained improvement. Significant reductions in PDS, IPSS, and VAS scores were observed as early as week 2 (P < 0.05), and symptom relief remained stable through week 8 without rebound. Exploratory analyses suggest that lower baseline estradiol levels and lower E2/T ratios may be associated with more sustained improvements in erectile function. No treatment-related adverse events were reported.

Conclusion: The P100 ESWT device provided rapid, significant, and sustained symptom relief for type IIIB CP/CPPS, particularly in pain and urinary domains. Hormonal balance (E2/T) may influence the long-term maintenance of erectile function after ESWT. These findings support P100 as a safe and effective non-invasive therapeutic option for CP/CPPS, warranting further validation in larger studies with longer-term follow-up.

Background: Addition of an androgen receptor pathway inhibitor (ARPI) to androgen deprivation therapy (ADT) (ADT + ARPI, i.e., maximal androgen blockade, MAB) improves survival outcomes compared to ADT monotherapy in patients with prostate cancer (PC). It is known that ADT increases the risk of fractures in patients with PC, but it is unclear if this risk is higher with MAB. The aim of this study is to conduct a systematic review and meta-analysis to determine if MAB increases the incidence of fractures compared to ADT alone, and if the incidence of fractures was influenced by the type of ARPI.

Methods: Clinical trials assessing MAB versus ADT alone in patients with PC were identified using the PubMed/Medline and Cochrane library databases. The pooled odds ratio of developing fractures with MAB versus ADT alone was calculated for each type of ARPI in selected studies by random-effects modeling. The number of patients receiving bone-protecting agent (BPA) was also evaluated.

Results: We identified 17 studies comprising 16162 patients for the systematic review and meta-analysis (9240 patients treated with MAB, 6922 patients treated with ADT alone). Each type of ADT + ARPI resulted in a statistically significant increased risk of fractures compared to ADT alone (pooled OR ranging from 1.5 to 2.4). There was no difference in the magnitude of the risk of fractures among the different ARPIs. Only 7 studies reported the number of patients treated with a BPA.

Conclusions: In our meta-analysis, MAB resulted in a statistically significant increase in fracture risk compared to ADT alone, regardless of the type of ARPI. Since long-term MAB represents the standard of care in various settings of PC, the use of a BPA should be generally recommended. Dosing and frequency of BPA need to be adapted according to the specific PC setting.

Introduction: Prostate cancer (PCa) screening is increasingly guided by imaging. High-resolution 29 MHz Micro-Ultrasound (MUS) offers a promising alternative to magnetic resonance imaging (MRI).

Methods: We retrospectively analyzed 682 consecutive men undergoing MUS and PSA testing during routine examination. Biopsy and MRI were performed according to guideline recommendations. PSA density (PSAD)-modified negative MUS included PRI-MUS categories 1, 2, or 3 with PSAD < 0.15 ng/mL²; PSAD-modified positive MUS included PRI-MUS categories 3 with PSAD ≥ 0.15 ng/mL², 4 or 5.

Results: Median age was 59 years; median PSA 1.2 ng/mL (IQR: 0.6-3.5). Biopsies were performed in 62 men, detecting PCa in 29 (47%), including 18 (29%) clinically significant PCa (csPCa). 88 men (13%) had PSAD-modified positive MUS, yielding 15 csPCa and 7 non-clinically significant PCa (ncsPCa). Among 594 men (87%) with PSAD-modified negative MUS, 3 csPCa and 4 ncsPCa were detected. Compared to PSA-based biopsy indication ≥3 ng/mL, PSAD-modified negative MUS would have avoided 13 negative, missing two csPCa and four ncsPCa. Compared to the MRI-based biopsy indication (PI-RADS ≥ 3, n = 38), PSAD-modified negative MUS (n = 594) would have spared 3 negative biopsies, as well as 17 (24.7% of 69) MRIs due to negative biopsy, while missing 0 cases of csPCa. Additionally, MRI could have been omitted in 1csPCa case and 9 ncsPCa cases with positive MUS, and in 13 csPCa and 7 ncsPCa cases based on PSAD-modified positive MUS. The PSAD-modified-PRI-MUS-based screening pathway showed a 6.29-fold (OR = 0.16) reduction in overdiagnosis and 7.22-fold (OR = 0.14) reduction in negative biopsies/ncsPCa. MUS without PSA demonstrated an OR of 7.30 to detect csPCa. PSAD-modified-PRI-MUS score demonstrated a sensitivity of 83.3%, a specificity of 59.1%, a positive predictive value of 45.5% and a negative predictive value of 89.7% for distinguishing csPCa from benign/ncsPCa findings.

Conclusion: MUS enables effective PCa risk stratification in an opportunistic screening setting supporting prospective trial development.

Trial registration: This study is part of the PROSTAMUS trial, registered in the DRKS/WHO registry.

Background: To prospectively compare the image quality and diagnostic performance of ultra-high-field 5 T MRI with that of standard 3 T in patients with suspected prostate cancer (PCa).

Methods: Sixty-seven consecutive patients received prostate scan at both 5 T and 3 T MRI systems. Two radiologists independently evaluated the images in a double-blind manner. A head-to-head comparison of 5 T and 3 T MRI was conducted from both qualitative and quantitative perspectives. Pathological results from prostate biopsy and radical prostatectomy were used as the gold standard to evaluate the diagnostic performance.

Results: 5 T MRI demonstrated superior image quality and enhanced visualization of prostatic anatomical structures, including prostatic capsule, seminal vesicle and neurovascular bundles. The lesion delineation was significantly improved in 5 T MRI. The elevated field strength resulted in a significantly higher signal-to-noise ratio, contrast-to-noise ratio, edge rise distance and lesion slope profile in both T2WI and DWI sequences without introducing additional artifacts. Moreover, 5 T MRI demonstrated improved diagnostic performance for biopsy outcomes and pathological features than 3 T.

Conclusion: 5 T MRI effectively improves PCa assessment compared to 3 T. Our study provides preliminary evidence for the feasibility of 5 T MRI in PCa diagnosis and evaluation.