Prostate Cancer and Prostatic Diseases最新文献

Introduction: Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) can significantly impair a man's quality of life. While traditional surgical treatments are effective, they often pose risks to sexual function, particularly in the form of ejaculatory and/or erectile dysfunction. Minimally invasive surgical treatments (MISTs) have emerged as alternative procedures that aim to alleviate LUTS while preserving sexual function.

Objective: Investigate the impact of MISTs for BPH on sexual function including erectile and ejaculatory function.

Methods: In May 2025, a systematic review and meta-analysis of sexual function outcomes in MISTs was performed using the Ovid, Embase, and Medline/PubMed databases. Articles were included if they were in English, assessed a MIST, and incorporated sexual function outcomes. Articles were excluded if they included pooled analyses, were abstracts without full text, and/or were ongoing incomplete clinical trials. We included studies on water vapor thermal therapy (Rezum), prostatic urethral lift (Urolift), prostatic artery embolization (PAE), temporary implantable nitinol device (iTIND), Optilume BPH catheter system, and transperineal laser ablation (TPLA). Outcomes included erectile function using International Index of Erectile Function (IIEF) scores and ejaculatory function using the Male Sexual Health Questionnaire (MSHQ).

Results: The initial search yielded 2646 studies. After screening and full text review, 77 studies met inclusion criteria encompassing a total of 11,477 patients. Based on the pooled analyses, IIEF scores significantly improved after Rezum and Urolift. Urolift significantly improved MSHQ-function and bother scores, while Rezum only improved MSHQ-bother scores. PAE, iTind, Optilume, and TPLA did not significantly impact erectile or ejaculatory function.

Conclusions: MISTs are a promising option for management of BPH in patients interested in maintaining sexual function, preserving or even improving erectile and ejaculatory function.

The EMBARK trial demonstrated improved survival with enzalutamide plus androgen deprivation therapy (ADT) in non-metastatic hormone-sensitive prostate cancer patients with high-risk biochemical recurrence (BCR), although staged using conventional imaging. Given the higher sensitivity of PSMA-PET, many of these patients could harbor metastatic disease. We retrospectively analyzed 587 patients with first BCR after radical treatment who underwent PSMA-PET. Patients were stratified according to EMBARK criteria for high-risk BCR. 169 patients (29%) met EMBARK criteria. They more often showed PSMA-PET positivity for any localization (82% vs 39%; p < 0.001) and metastatic disease (46% vs 15%; p < 0.001). Median PSA was higher and PSA doubling-time (PSADT) shorter (2.23 vs 0.43 ng/mL; 4.3 vs 9 months). Most High-risk BCR patients have a positive PSMA-PET, and many of these harbor metastatic disease at molecular imaging. Given the survival benefit from intensified systemic treatment with ARPI in this cohort, how to best combine systemic therapy with PSMA-PET guided metastases-directed-treatments remains an important future area of research.

Introduction: The Mona Lisa 2.0 robotic platform integrates MRI/ultrasound fusion, AI-based prostate segmentation, and automated needle trajectory planning to optimize transperineal targeted biopsy (TB) precision.

Case presentation: We report the first European experience in 10 consecutive patients undergoing robot-assisted TB, with optional systematic cores. Clinically significant prostate cancer was detected in all rTB procedures. Standard cores added limited diagnostic yield and mainly sampled perilesional "penumbra" areas. Mean biopsy duration was 12.9 min, no peri- or post-procedural complications occurred, and high-quality tissue samples were consistently obtained.

Conclusions: These preliminary data confirm feasibility, safety, and reproducibility of Mona Lisa 2.0 robotic platform, as a new kid on the block in urologic robotic armamentarium.

Background: The management of metastatic prostate cancer (mPCa) has undergone revolutionary changes over the past two decades with the introduction of novel hormonal agents, chemotherapy combinations, PARP inhibitors, and radioligand therapies. This study evaluates the real-world impact of these therapeutic advances on overall survival (OS) in Germany.

Methods: We analyzed data from the German national cancer registry covering 657,499 prostate cancer cases diagnosed between 1999 and 2021. After exclusions, 54,890 patients with de novo metastatic disease (M1) were included. Primary outcome was median OS. Secondary outcomes included 3-, 5-, and 10-year survival rates. Time series analysis assessed temporal trends using augmented Dickey-Fuller tests and joinpoint regression.

Results: Median OS for M1 patients improved from 31.0 months (95% CI: 29.8-32.2) in 1999 to 37.0 months (35.6-38.4) in 2019 (p < 0.001). This 19.4% improvement exceeded general life expectancy gains. Age-stratified analysis revealed disparate benefits: patients < 70 years experienced improvement from 34.0 to 49.0 months ( + 44.1%), while those ≥ 70 years showed minimal change (28.0 to 29.0 months, +3.6%). Three-year survival increased from 45.1% to 50.9% (p = 0.004), with younger patients achieving 61.3% versus 44.0% for older patients by 2019. Multivariate Cox regression confirmed diagnosis year as an independent predictor (HR 0.96, 95% CI: 0.96-0.97, p < 0.001).

Conclusions: Real-world data confirm meaningful survival improvements in metastatic prostate cancer over two decades, validating the translation of clinical trial efficacy into routine practice. However, the pronounced age-related disparity suggests potential undertreatment of elderly patients and highlights the need for age-adapted treatment strategies.

Background/objectives: Generic competition has markedly reduced the cost of medications for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), potentially reshaping the value proposition of first-line therapy. We reviewed contemporary drug pricing and health-economic evidence to evaluate the cost-effectiveness of medical therapy as initial management for BPH/LUTS.

Subjects/methods: We synthesized evidence from randomized trials, meta-analyses, international guidelines, and published cost-effectiveness/cost-utility analyses comparing pharmacotherapy with common minimally invasive and surgical BPH interventions.

Results: Common generic agents (e.g., tamsulosin and finasteride) are available for approximately $2-$7 per month through discount programs. Clinical trial evidence demonstrates meaningful symptom improvement and reduced risk of progression with alpha-blockers and 5-alpha-reductase inhibitors, particularly in combination therapy. Published economic models consistently show favorable incremental cost-effectiveness ratios for medical management versus watchful waiting or surgery; under current generic pricing, medication costs rarely approach the one-time costs of procedural interventions within a typical lifespan.

Conclusions: Contemporary clinical and economic evidence supports medical therapy as a highly cost-effective first-line treatment for BPH/LUTS, with procedural interventions best reserved for medication failure, complications, or patient preference.

Introduction: Single-Port Transvesical Enucleation of the Prostate (STEP) is a minimally invasive robotic technique for managing benign prostatic hyperplasia (BPH), particularly in prostates ≧ 80 cc. However, its outcomes in very large prostates (>150 cc) remain under-characterized. We compared perioperative and functional outcomes of STEP between large (LP: 80-150 cc) and very large prostates (VLP: >150 cc).

Materials and methods: We retrospectively reviewed 183 patients who underwent STEP using the da Vinci Single-Port system (2019-2024). Patients were stratified into LP and VLP cohorts based on prostate volume (PV). Enucleation efficiency was defined as enucleated tissue weight divided by enucleation time (g/min). Outcomes were compared using descriptive statistics.

Results: A total of 179 patients were included (LP: 93; VLP: 86). Median PV was significantly greater in the VLP group (194 vs. 117 cc, p < 0.001). VLP patients had higher PSA (9.7 vs. 6.75 ng/mL, p = 0.002), longer enucleation (84 vs. 69 min, p = 0.002) and console times (115 vs. 98 min, p = 0.010), and improved enucleation efficiency (1.23 vs. 0.97 g/min, p = 0.025). Estimated blood loss was slightly higher in VLP (100 vs. 80 mL, p = 0.026). All procedures were completed without conversion or additional ports. Hospital stay, catheter duration, and same-day discharge rates were comparable. At 3 months, both groups had equivalent improvements in International Prostate Symptom Score (3 vs. 3, p = 0.913), quality-of-life scores (0 vs. 1, p = 0.965), and maximum flow rate (17.5 vs. 16 mL/s, p = 0.594). Complications were rare, with no readmissions and only two major postoperative events. Urinary continence was preserved in all patients, with transient incontinence occurring in 6 patients (LP: 2; VLP: 4), resolving completely by 3 months.

Conclusions: STEP is effective and scalable for prostates ≥ 80 cc, demonstrating improved enucleation efficiency in very large glands without compromising safety, recovery, or continence preservation.

Introduction: Telesurgery represents an emerging frontier in the surgical management of prostate cancer, offering innovative solutions to expand access to specialized care across geographic and institutional barriers. This systematic review aims to evaluate the feasibility, clinical outcomes, and technical considerations of telesurgical applications in the treatment of prostate cancer.

Methods: A comprehensive literature search was conducted across MEDLINE (via PubMed), Embase, Scopus, and Web of Science in June 2025 to identify all consecutive clinical studies published from 2001 through June 2025 that involved telesurgical approaches for the management of clinically significant, localized prostate cancer. Eligible studies were screened and reviewed according to PRISMA guidelines, and a narrative synthesis was performed.

Results: A total of six studies met the inclusion criteria, demonstrating successful telesurgical procedures involving 7 patients, with six procedures pertaining to Robot-Assisted Radical Prostatectomy (RARP) and one case of High-Intensity Focused Ultrasound (HIFU) focal therapy. All procedures were completed successfully over distances ranging between 1 and 11,412 km. The most commonly utilized network infrastructure included 5 G wireless and wired fiber-optic broadband systems. With a round-trip latency ranging between 6 ms and 464 ms, no technical failures and no clinically meaningful delays perceived by the surgeons were reported.

Conclusions: Herein, we demonstrated the feasibility and safety of radical and focal robotic telesurgical procedures for the management of prostate cancer. Despite its successes and benefits in democratizing patient care and surgical education, challenges surrounding its cost, regulatory frameworks, and standardization of care may continue to pose limitations, underscoring the need for further research and policy innovation.