Background/objectives: Recent advances in prostate cancer management have improved overall survival and quality of life for those afflicted. However, these patients continue to suffer from a high burden of cardiovascular disease through a variety of mechanisms, including both the cancer itself as well as prostate cancer-specific treatments.
Subjects/methods: Cardiovascular disease is now the leading cause of death in this population, and current data suggests that many patients remain sub-optimally controlled from a risk factor standpoint. There is a lack of consensus and standardized guidelines on cardiovascular risk stratification and specific management strategies in the urology, medical oncology, radiation oncology, and primary care settings.
Results/conclusions: We review available literature and provide a cardiovascular risk stratification schema for prostate cancer patients that clinicians in each of these settings can utilize. We also highlight a shared decision-making model, consistent risk restratification, and social determinants of health as care priorities to optimize cardiovascular health for this at-risk population.
{"title":"Cardiovascular risks in men with prostate cancer: a pragmatic, clinician-oriented review of risk stratification and management strategies.","authors":"Aditya Bhave, Harikrishnan Hyma Kunhiraman, Tarek Nahle, Ritu Reddy, Omar Makram, Priyanshu Nain, Viraj Shah, Umang Swami, Sagar A Patel, Ashanda Esdaille, Martha Terris, Avirup Guha","doi":"10.1038/s41391-025-00998-1","DOIUrl":"https://doi.org/10.1038/s41391-025-00998-1","url":null,"abstract":"<p><strong>Background/objectives: </strong>Recent advances in prostate cancer management have improved overall survival and quality of life for those afflicted. However, these patients continue to suffer from a high burden of cardiovascular disease through a variety of mechanisms, including both the cancer itself as well as prostate cancer-specific treatments.</p><p><strong>Subjects/methods: </strong>Cardiovascular disease is now the leading cause of death in this population, and current data suggests that many patients remain sub-optimally controlled from a risk factor standpoint. There is a lack of consensus and standardized guidelines on cardiovascular risk stratification and specific management strategies in the urology, medical oncology, radiation oncology, and primary care settings.</p><p><strong>Results/conclusions: </strong>We review available literature and provide a cardiovascular risk stratification schema for prostate cancer patients that clinicians in each of these settings can utilize. We also highlight a shared decision-making model, consistent risk restratification, and social determinants of health as care priorities to optimize cardiovascular health for this at-risk population.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-08DOI: 10.1038/s41391-025-00996-3
Hazem Elmansy, Saud Alhelal, Oksana Blahitko, Ryan Kelly, Amr Hodhod, Ruba Abdul Hadi, Husain Alaradi, Khaled Alotaibi, Ahmed Mousa, Ahmed S. Zakaria
We aimed to compare intraoperative and one-year postoperative outcomes of patients treated for benign prostatic hyperplasia (BPH) with holmium laser enucleation of the prostate using MOSESTM technology (M-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP). We included 104 patients who underwent M-HoLEP or ThuFLEP between June 2022 and January 2024 in this randomized controlled trial. Patients’ preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes were analyzed over the 12-month follow-up period. Fifty-two patients underwent M-HoLEP, and 52 were managed with ThuFLEP. There were no statistically significant differences in the preoperative characteristics between the groups. M-HoLEP had a shorter median enucleation time (50 vs. 57.5 minutes, p < 0.001) and demonstrated significantly higher enucleation efficiency than ThuFLEP (1.97 vs. 1.49 g/min, p < 0.001). Significant differences were observed favoring M-HoLEP regarding continuous bladder irrigation time, hematuria scale, duration of postoperative hematuria, catheterization time, and hospital stay. Approximately 30.8% of ThuFLEP patients were admitted with immediate postoperative hematuria versus 7.7% in the M-HoLEP group, p = 0.003). The postoperative outcomes were comparable between the cohorts up to 12 months. Thulium fiber laser (TFL) and MOSESTM technology achieved satisfactory intraoperative and postoperative functional outcomes in endoscopic enucleation of the prostate. However, MOSESTM technology demonstrated superior results in terms of enucleation time and efficiency, catheterization time, and hospital stay. M-HoLEP facilitates same-day trial-of-void and reduces postoperative hospital admissions.
背景：我们的目的是比较MOSESTM技术（M-HoLEP）和铥纤维激光前列腺去核（ThuFLEP）治疗良性前列腺增生（BPH）患者术中和术后一年的结果。方法：在这项随机对照试验中，我们纳入了104名在2022年6月至2024年1月期间接受M-HoLEP或ThuFLEP治疗的患者。评估患者术前和前列腺数据。在12个月的随访期间分析术中数据和围手术期结果。结果：M-HoLEP治疗52例，ThuFLEP治疗52例。两组术前特征差异无统计学意义。M-HoLEP的中位去核时间较短（50 vs. 57.5分钟），p结论：铥光纤激光（TFL）和MOSESTM技术在内镜下前列腺去核术中及术后均获得满意的功能结果。然而，MOSESTM技术在去核时间和效率、置管时间和住院时间方面表现出优越的结果。M-HoLEP促进当日无效试验，减少术后住院。
{"title":"Thulium fiber laser versus holmium MOSESTM laser enucleation of the prostate for the treatment of benign prostatic hyperplasia: a randomized prospective clinical study","authors":"Hazem Elmansy, Saud Alhelal, Oksana Blahitko, Ryan Kelly, Amr Hodhod, Ruba Abdul Hadi, Husain Alaradi, Khaled Alotaibi, Ahmed Mousa, Ahmed S. Zakaria","doi":"10.1038/s41391-025-00996-3","DOIUrl":"10.1038/s41391-025-00996-3","url":null,"abstract":"We aimed to compare intraoperative and one-year postoperative outcomes of patients treated for benign prostatic hyperplasia (BPH) with holmium laser enucleation of the prostate using MOSESTM technology (M-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP). We included 104 patients who underwent M-HoLEP or ThuFLEP between June 2022 and January 2024 in this randomized controlled trial. Patients’ preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes were analyzed over the 12-month follow-up period. Fifty-two patients underwent M-HoLEP, and 52 were managed with ThuFLEP. There were no statistically significant differences in the preoperative characteristics between the groups. M-HoLEP had a shorter median enucleation time (50 vs. 57.5 minutes, p < 0.001) and demonstrated significantly higher enucleation efficiency than ThuFLEP (1.97 vs. 1.49 g/min, p < 0.001). Significant differences were observed favoring M-HoLEP regarding continuous bladder irrigation time, hematuria scale, duration of postoperative hematuria, catheterization time, and hospital stay. Approximately 30.8% of ThuFLEP patients were admitted with immediate postoperative hematuria versus 7.7% in the M-HoLEP group, p = 0.003). The postoperative outcomes were comparable between the cohorts up to 12 months. Thulium fiber laser (TFL) and MOSESTM technology achieved satisfactory intraoperative and postoperative functional outcomes in endoscopic enucleation of the prostate. However, MOSESTM technology demonstrated superior results in terms of enucleation time and efficiency, catheterization time, and hospital stay. M-HoLEP facilitates same-day trial-of-void and reduces postoperative hospital admissions.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"152-158"},"PeriodicalIF":5.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-04DOI: 10.1038/s41391-025-00995-4
Nadine A. Friedrich, Jessica L. Janes, Joshua Parrish, Amanda M. De Hoedt, Janis Pruett, Mark Fallick, Raj Gandhi, Agnes Hong, Nicholas P. Tatonetti, Stephen J. Freedland
For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1 L) systemic treatment. However, some patients receive ADT alone, leading to tumor progression requiring 2nd line therapy. Despite racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1 L ADT. We performed a retrospective population-level analysis to assess the association between race and time to subsequent treatment after ADT in the Veterans Affairs Health Care System. Primary outcome was time from ADT monotherapy to subsequent treatment, defined as receipt of androgen receptor pathway inhibitor (ARPI), non-steroidal first-generation anti-androgen (NSAA), chemotherapy, or other treatments. We used Cox competing risks models and Kaplan-Meier (KM) analyses to estimate subsequent treatment rates by Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic and Other patients, adjusted for baseline covariates. From 2001–2021, 141,495 PC patients received ADT alone. During median (IQR) follow-up of 51.1 (22.8, 97.2) months, 28,144 patients (20%) had subsequent treatment: 11,319 (40%) ARPIs, 12,990 (46%) NSAAs, 3402 (12%) chemotherapy and 433 (2%) other 2nd line therapies. NHB had significantly lower subsequent treatment rates (HR = 0.82, 95% CI = 0.80–0.85) vs. NHW. Both Hispanic (HR = 0.93, 95%CI = 0.88–0.98) and Other men (HR = 0.91, 95%CI = 0.84–0.98), also had lower subsequent treatment rates. When stratified by age, associations between race/ethnicity and time to subsequent treatment were stronger in younger patients. All races examined had significantly lower rates of subsequent treatment after 1 L ADT relative to NHW, especially in younger patients. Further investigation is needed to determine if these lower rates of subsequent treatment reflect lower rate of progression or undertreatment of progressing patients.
{"title":"Assessing racial differences in time to subsequent treatment following androgen deprivation therapy among Veterans with prostate cancer","authors":"Nadine A. Friedrich, Jessica L. Janes, Joshua Parrish, Amanda M. De Hoedt, Janis Pruett, Mark Fallick, Raj Gandhi, Agnes Hong, Nicholas P. Tatonetti, Stephen J. Freedland","doi":"10.1038/s41391-025-00995-4","DOIUrl":"10.1038/s41391-025-00995-4","url":null,"abstract":"For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1 L) systemic treatment. However, some patients receive ADT alone, leading to tumor progression requiring 2nd line therapy. Despite racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1 L ADT. We performed a retrospective population-level analysis to assess the association between race and time to subsequent treatment after ADT in the Veterans Affairs Health Care System. Primary outcome was time from ADT monotherapy to subsequent treatment, defined as receipt of androgen receptor pathway inhibitor (ARPI), non-steroidal first-generation anti-androgen (NSAA), chemotherapy, or other treatments. We used Cox competing risks models and Kaplan-Meier (KM) analyses to estimate subsequent treatment rates by Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic and Other patients, adjusted for baseline covariates. From 2001–2021, 141,495 PC patients received ADT alone. During median (IQR) follow-up of 51.1 (22.8, 97.2) months, 28,144 patients (20%) had subsequent treatment: 11,319 (40%) ARPIs, 12,990 (46%) NSAAs, 3402 (12%) chemotherapy and 433 (2%) other 2nd line therapies. NHB had significantly lower subsequent treatment rates (HR = 0.82, 95% CI = 0.80–0.85) vs. NHW. Both Hispanic (HR = 0.93, 95%CI = 0.88–0.98) and Other men (HR = 0.91, 95%CI = 0.84–0.98), also had lower subsequent treatment rates. When stratified by age, associations between race/ethnicity and time to subsequent treatment were stronger in younger patients. All races examined had significantly lower rates of subsequent treatment after 1 L ADT relative to NHW, especially in younger patients. Further investigation is needed to determine if these lower rates of subsequent treatment reflect lower rate of progression or undertreatment of progressing patients.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"103-110"},"PeriodicalIF":5.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41391-025-00995-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-26DOI: 10.1038/s41391-025-00993-6
Hailin Yang, Xuhen Liu, Ju Guo
{"title":"Integrating clinical and public health perspectives on statin use and prostate cancer risk: addressing key limitations and future directions","authors":"Hailin Yang, Xuhen Liu, Ju Guo","doi":"10.1038/s41391-025-00993-6","DOIUrl":"10.1038/s41391-025-00993-6","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"28 4","pages":"1019-1019"},"PeriodicalIF":5.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-21DOI: 10.1038/s41391-025-00994-5
Mayuko Kanayama, Emeline Colomba, Yusra Shao, Sarah M Nielsen, Edward D Esplin, Changxue Lu, William B Isaacs, John C Henegan, Elisabeth I Heath, Jun Luo, Régine Marlin, Emmanuel S Antonarakis
Background: Recently, a germline HOXB13 variant, X285K was identified as a risk factor for prostate cancer in men of African ancestry. While this variant is likely associated with more aggressive prostate cancer, there has not yet been an in-depth clinical description of individual patients carrying this variant and their response to systemic therapies.
Methods: We studied six cases of germline X285K carriers with metastatic hormone-sensitive prostate cancer to characterize their hormonal sensitivity or resistance.
Conclusions: Longitudinal outcome analysis indicates that patients carrying X285K generally show favorable responses to therapies targeting the androgen receptor (AR), a finding that requires confirmation.
{"title":"Case series exploring hormonal sensitivity in prostate cancer patients harboring the germline African-ancestry HOXB13 X285K variant.","authors":"Mayuko Kanayama, Emeline Colomba, Yusra Shao, Sarah M Nielsen, Edward D Esplin, Changxue Lu, William B Isaacs, John C Henegan, Elisabeth I Heath, Jun Luo, Régine Marlin, Emmanuel S Antonarakis","doi":"10.1038/s41391-025-00994-5","DOIUrl":"10.1038/s41391-025-00994-5","url":null,"abstract":"<p><strong>Background: </strong>Recently, a germline HOXB13 variant, X285K was identified as a risk factor for prostate cancer in men of African ancestry. While this variant is likely associated with more aggressive prostate cancer, there has not yet been an in-depth clinical description of individual patients carrying this variant and their response to systemic therapies.</p><p><strong>Methods: </strong>We studied six cases of germline X285K carriers with metastatic hormone-sensitive prostate cancer to characterize their hormonal sensitivity or resistance.</p><p><strong>Conclusions: </strong>Longitudinal outcome analysis indicates that patients carrying X285K generally show favorable responses to therapies targeting the androgen receptor (AR), a finding that requires confirmation.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-12DOI: 10.1038/s41391-025-00988-3
Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard Horton, Kati Juva, Jose F. Lapena Jr, Robert Mash, Olga Mironova, Arun Mitra, Carlos Monteiro, Elena N. Naumova, David Onazi, Tilman Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga, Chris Zielinski
{"title":"Ending nuclear weapons, before they end us","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard Horton, Kati Juva, Jose F. Lapena Jr, Robert Mash, Olga Mironova, Arun Mitra, Carlos Monteiro, Elena N. Naumova, David Onazi, Tilman Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga, Chris Zielinski","doi":"10.1038/s41391-025-00988-3","DOIUrl":"10.1038/s41391-025-00988-3","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"1-2"},"PeriodicalIF":5.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41391-025-00988-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-10DOI: 10.1038/s41391-025-00989-2
M. J. van Harten, S. Remmers, R. C. N. van den Bergh, M. J. Roobol
{"title":"Prostate cancer screening in Europe: future directions and perspectives","authors":"M. J. van Harten, S. Remmers, R. C. N. van den Bergh, M. J. Roobol","doi":"10.1038/s41391-025-00989-2","DOIUrl":"10.1038/s41391-025-00989-2","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"100-102"},"PeriodicalIF":5.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-04DOI: 10.1038/s41391-025-00992-7
Fabian Falkenbach, Lukas Hohenhorst, Mykyta Kachanov, Tim Inderhees, Dirk Beyersdorff, Daniel Koehler, Sami-Ramzi Leyh-Bannurah, Tobias Maurer, Markus Graefen, Lars Budäus
{"title":"Perspective transition from transrectal to transperineal MRI-fusion biopsy under local anesthesia - the institutional TREXIT learning curve of the new gold standard.","authors":"Fabian Falkenbach, Lukas Hohenhorst, Mykyta Kachanov, Tim Inderhees, Dirk Beyersdorff, Daniel Koehler, Sami-Ramzi Leyh-Bannurah, Tobias Maurer, Markus Graefen, Lars Budäus","doi":"10.1038/s41391-025-00992-7","DOIUrl":"https://doi.org/10.1038/s41391-025-00992-7","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-02DOI: 10.1038/s41391-025-00987-4
Leonardo Quarta, Armando Stabile, Francesco Pellegrino, Pietro Scilipoti, Mattia Longoni, Donato Cannoletta, Paolo Zaurito, Alfonso Santangelo, Alessandro Viti, Francesco Barletta, Simone Scuderi, Riccardo Leni, Antony Pellegrino, Elio Mazzone, Luigi Nocera, Giorgio Brembilla, Francesco De Cobelli, Robert Jeffrey Karnes, Morgan Rouprêt, Francesco Montorsi, Giorgio Gandaglia, Alberto Briganti
The use of prostate-specific antigen density (PSAd) in combination with multiparametric magnetic resonance imaging (mpMRI) of the prostate can improve accuracy of the prostate cancer (PCa) diagnostic pathway. However, it is not clear whether the performance characteristics of PSAd vary according to the index lesion location (ILL) on mpMRI. Overall, 2140 patients with positive mpMRI (prostate imaging reporting and data system [PI-RADS] ≥ 3) underwent mpMRI-targeted biopsy (TBx) plus systematic biopsy (SBx) at three tertiary referral centers. Multivariable logistic regression analysis (MVA) tested the interaction between PSAd and ILL (peripheral zone [PZ] vs transitional zone [TZ]) in predicting clinically significant PCa (csPCa, defined as ISUP grade group ≥2) at TBx. Non-parametric locally weighted scatterplots smoothing approach (LOWESS) explored the relationship between PSAd and csPCa according to ILL and stratifying by PI-RADS score. Median PSA was 6.7 ng/ml. ILL was PZ and TZ in 77% and 23% patients, respectively. Overall, 39% of csPCa cases were diagnosed at TBx. The association between PSAd and csPCa varied according to ILL (interaction test: p < 0.01). In patients with PI-RADS 3 lesions, csPCa incidence was <10% in cases of PSAd values < 0.05 ng/ml/ml and <0.13 ng/ml/ml for PZ and TZ lesions, respectively. Differently, in patients with PI-RADS ≥ 4, csPCa incidence was ≥20% regardless of PSAd value and ILL. The likelihood of detecting csPCa in patients with PI-RADS 3 lesions is influenced by the combination of PSAd and ILL. Specifically, patients with PZ and TZ PI-RADS 3 lesions have an increased risk of csPCa for PSAd values ≥ 0.05 ng/ml/ml and ≥0.13 ng/ml/ml, respectively. Conversely, patients with PI-RADS ≥ 4 lesions have a non-negligible risk of csPCa regardless of PSAd and ILL.
{"title":"Tailored use of PSA density according to multiparametric MRI index lesion location: results of a large, multi-institutional series","authors":"Leonardo Quarta, Armando Stabile, Francesco Pellegrino, Pietro Scilipoti, Mattia Longoni, Donato Cannoletta, Paolo Zaurito, Alfonso Santangelo, Alessandro Viti, Francesco Barletta, Simone Scuderi, Riccardo Leni, Antony Pellegrino, Elio Mazzone, Luigi Nocera, Giorgio Brembilla, Francesco De Cobelli, Robert Jeffrey Karnes, Morgan Rouprêt, Francesco Montorsi, Giorgio Gandaglia, Alberto Briganti","doi":"10.1038/s41391-025-00987-4","DOIUrl":"10.1038/s41391-025-00987-4","url":null,"abstract":"The use of prostate-specific antigen density (PSAd) in combination with multiparametric magnetic resonance imaging (mpMRI) of the prostate can improve accuracy of the prostate cancer (PCa) diagnostic pathway. However, it is not clear whether the performance characteristics of PSAd vary according to the index lesion location (ILL) on mpMRI. Overall, 2140 patients with positive mpMRI (prostate imaging reporting and data system [PI-RADS] ≥ 3) underwent mpMRI-targeted biopsy (TBx) plus systematic biopsy (SBx) at three tertiary referral centers. Multivariable logistic regression analysis (MVA) tested the interaction between PSAd and ILL (peripheral zone [PZ] vs transitional zone [TZ]) in predicting clinically significant PCa (csPCa, defined as ISUP grade group ≥2) at TBx. Non-parametric locally weighted scatterplots smoothing approach (LOWESS) explored the relationship between PSAd and csPCa according to ILL and stratifying by PI-RADS score. Median PSA was 6.7 ng/ml. ILL was PZ and TZ in 77% and 23% patients, respectively. Overall, 39% of csPCa cases were diagnosed at TBx. The association between PSAd and csPCa varied according to ILL (interaction test: p < 0.01). In patients with PI-RADS 3 lesions, csPCa incidence was <10% in cases of PSAd values < 0.05 ng/ml/ml and <0.13 ng/ml/ml for PZ and TZ lesions, respectively. Differently, in patients with PI-RADS ≥ 4, csPCa incidence was ≥20% regardless of PSAd value and ILL. The likelihood of detecting csPCa in patients with PI-RADS 3 lesions is influenced by the combination of PSAd and ILL. Specifically, patients with PZ and TZ PI-RADS 3 lesions have an increased risk of csPCa for PSAd values ≥ 0.05 ng/ml/ml and ≥0.13 ng/ml/ml, respectively. Conversely, patients with PI-RADS ≥ 4 lesions have a non-negligible risk of csPCa regardless of PSAd and ILL.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"111-115"},"PeriodicalIF":5.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-02DOI: 10.1038/s41391-025-00990-9
Ryan C Au, Pocharapong Jenjitranant, Derek W Cool, Jonathan Izawa, Brant Inman, Aaron Ward, Joseph L Chin
{"title":"Artificial intelligence may enhance the role of magnetic resonance imaging in prostate cancer focal therapy.","authors":"Ryan C Au, Pocharapong Jenjitranant, Derek W Cool, Jonathan Izawa, Brant Inman, Aaron Ward, Joseph L Chin","doi":"10.1038/s41391-025-00990-9","DOIUrl":"https://doi.org/10.1038/s41391-025-00990-9","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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