Prostate Cancer and Prostatic Diseases最新文献

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.

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.