Prostate Cancer and Prostatic Diseases最新文献

Purpose: Non-White patients are poorly represented in prostate cancer trials. MRI PI-RADS scoring was developed in primarily White populations, but prostate cancer differs in non-White men. We aimed to explore differences in PI-RADS calibration for Asian and Black men.

Materials and methods: This is a secondary analysis of PREVENT, a multi-institutional study of infection rates for transrectal vs. transperineal biopsy. We compared cancer detection for self-identifying Asian and Black men. We compared detection rates on a per-person basis, stratified by index PI-RADS lesion, to White men, using Fisher's exact and logistic regression.

Results: Of 665/752 trial patients with PI-RADS 3-5 lesions, 88 (13%) were Black and 36 (6%) were Asian. Black men were younger at diagnosis with increased rates of overall (70% vs. 43%%, P = 0.004) and clinically significant prostate cancer (60% vs. 27%, P = 0.003) and Asian men had decreased rates of overall (0% vs. 47%, P = 0.004) and clinically significant prostate cancer (0% vs. 27%, P = 0.003) in PI-RADS 3 lesions compared to White men. On multivariable regression, Black men with PI-RADS 3/4 lesions had higher odds of overall (OR 1.17, P = 0.009) and clinically significant prostate cancer (OR 1.20, P = 0.004) and Asian men had lower odds of overall (OR 0.79, P = 0.01) but not clinically significant prostate cancer (OR 0.94, P = 0.5).

Conclusions: Black men with PI-RADS 3/4 lesions had 20% higher odds of clinically significant prostate cancer than White men while all PI-RADS 3 lesions in Asian men were negative. These findings suggest PI-RADS may require differential interpretation when assessing prostate cancer risk in non-White men.

Trial registration: Registered at ClinicalTrials.gov ( NCT04843566 , https://clinicaltrials.gov/study/NCT04843566 ).

Background: AI is increasingly integrated within prostate cancer diagnosis pathway.

Purpose: To provide estimates of diagnostic accuracy of AI assistance for clinically significant prostate cancer (csPCa) via MRI.

Materials and methods: A systematic search of PubMed, Embase, Cochrane, Scopus and Web of Science from January 2017 to October 2024 was performed for studies on the diagnostic utility of AI for prostate MRI. Diagnostic performance metrics were synthesized through hierarchical summary receiver operating characteristic modeling with random-effects assumptions. Specially, to test inferiority and potential superiority of AI, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), cancer detection rate (CDR), and accuracy was pairwisely compared between AI and radiologists in study level using odds ratios (ORs) with Z-statistics.

Results: 7398 patients from 29 studies with AI-vs-human pairwise comparison were included. When acting as an assistant to human readers, AI demonstrated superior performance compared to stand-alone human readers in diagnosing csPCa via MRI, specifically with higher sensitivity (86.5% vs 82.6%, P = 0.001), specificity (57.8% vs 50.0%, P = 0.028), PPV (64.3% vs 58.9%, P = 0.001), and NPV (82.9% vs 76.5%, P = 0.001) while maintaining comparable CDR (40.5% vs 38.6%, P = 0.093). When used as standalone readers, AI exhibited higher specificity (58.7% vs 48.7%, P = 0.026) but at the cost of reduced sensitivity (87.2% vs 90.1%, P = 0.017). Subgroup analysis indicated that readers of varying experience levels could all improve their diagnostic performance with AI assistance.

Conclusion: Integrating AI as an assistant in csPCa diagnostic workflows could enhance accuracy, particularly for less experienced readers.

Clinical trial registration information: Trial Name: The efficiency comparison of radiologists with or without assistance of artificial intelligence in prostate cancer diagnosis: a meta-analysis. Registration date: April 17, 2024.

Registration number: CRD42024533016. Registration information available at: https://www.crd.york.ac.uk/PROSPERO/ .

Background: Prostate cancer (PC) heterogeneity and treatment resistance remain major clinical challenges, with emerging evidence implicating the microbiome as a key modulator of disease pathogenesis. While microbial dysbiosis has been linked to PC diagnosis, progression, and therapeutic outcomes, the mechanisms underlying these associations are poorly understood. This review synthesizes current evidence on the diagnostic, prognostic, and therapeutic potential of the microbiome in PC.

Methods: A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials (through April 2024) was conducted following PRISMA guidelines (PROSPERO: CRD42024534899). Controlled and observational studies investigating microbial roles in PC diagnosis (e.g., ISUP grading group), prognosis, or treatment response were included. Data extraction and quality assessment used the QUIPS tool. From 810 screened records, 42 studies met inclusion criteria.

Results: Distinct microbial profiles differentiated PC from controls, with Mycoplasma genitalium and Staphylococcus spp. enriched in prostate tumors (3.1- and 2.7-fold, respectively) and correlated with inflammation (IL-6: r = 0.38, p = 0.002). Urinary microbiota showed diagnostic potential (sensitivity: 58-82%), though sampling methods influenced variability. Prognostically, Betaproteobacteria gut enrichment predicted earlier castration-resistant progression (5.2 months; HR 1.8, 95% CI 1.3-2.5), while ADT-induced dysbiosis (e.g., Klebsiella overgrowth) accelerated resistance (2.1-fold risk). Therapies altered microbial ecology: radiotherapy depleted Bacteroides (linked to proctitis; OR 3.1), and immunotherapy responders harbored higher Akkermansia muciniphila. Microbial androgen synthesis and endotoxin production emerged as resistance mechanisms.

Conclusions: The microbiome influences PC detection, aggressiveness, and treatment efficacy through direct (tissue-resident) and indirect (gut-derived) mechanisms. Standardized profiling and microbiome-modulating strategies (e.g., probiotics during ADT) may personalize management. Prospective trials are needed to validate causality and translate microbial biomarkers into clinical practice.

Background and objective: Intraoperative identification of suspicious lymph node metastases (LNM) detected at PSMA-PET is key to achieve optimal surgical outcomes of robot-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND). We aim to describe a novel technique of augmented reality (AR)-PSMA-3D guided PLND based on preoperative PSMA-PET for real-time identification of LNM.

Methods: Thirteen patients with high-risk PCa and miN1-2 or miM1a disease at PSMA-PET were prospectively enrolled. 3D segmentation model including suspicious LNM was created from PSMA-PET images.

Intervention: Patients underwent RARP with AR-PSMA-3D guided PLND for real-time intraoperative identification of suspicious LNM. Pathologic examination was used as reference standard.

Key findings and limitations: Four (30%) men had suspicious LNM at PSMA-PET outside the field of the PLND template. The AR-PSMA-3D guided PLND allow to dissect each region with suspected LNM at PSMA-PET with no intraoperative complications. Nine (69%) patients had pN1 disease and three (23%) men had nodal metastases outside the PLND template. The sensitivity, specificity, PPV, NPV and AUC of AR-PSMA-3D guided PLND at a per-region analysis were 69%, 90%, 52%, 95% and 0.79, respectively.

Limitations: low spatial resolution of PSMA-PET for micro-metastases and the need for manual alignment of the 3D model.

Conclusions and clinical implications: AR-PSMA-3D guidance for PLND in patients with miN1-N2-M1a disease at PSMA-PET allows to facilitate the resection of suspicious LNM including those outside the PLND template. We propose a novel technique combining AR and PSMA-PET 3D models to guide PLND during RARP in PCa patients. The AR-PSMA-3D guidance for PLND allows a promising real-time identification of suspicious nodes, even outside the PLND template.

Objective: To compare en-bloc HoLEP with conventional lobe-by-lobe (LBL) HoLEP technique in terms of surgical efficiency, perioperative outcomes, and early continence recovery through a randomized controlled trial.

Patients and methods: This single-center randomized controlled trial included patients with prostate volume >80 mL undergoing HoLEP for bladder outlet obstruction secondary to benign prostatic hyperplasia. Eligible patients were randomized to either en-bloc or LBL HoLEP. All procedures incorporated early apical release and sphincteric mucosal preservation. Assessments were performed preoperatively and at 1, 3, and 6 months postoperatively. primary outcome was enucleation efficiency (resected weight/enucleation time). Secondary outcomes included operative efficiency, laser energy use, blood loss, hospital stay, complications, and functional outcomes (IPSS, QoL, Qmax, PVR, and transient stress urinary incontinence [SUI]).

Results: A total of 123 patients were randomized (en-bloc: 60; LBL: 63). En-bloc HoLEP was associated with shorter enucleation time (62.5 vs. 74.3 min, P = 0.02), operative time (78.6 vs. 94.9 min, P = 0.0007), and lower laser energy use (135 vs. 154 KJ, P = 0.014). Enucleation efficiency was comparable (1.25 ± 0.49 vs. 1.17 ± 0.62 g/min; P = 0.42). Both techniques resulted in significant postoperative improvements in IPSS, QoL, Qmax, and PVR (all P < 0.0001). Complication rates were similar (14.6% vs. 14%; P = 0.8). At 3 months, transient SUI rates were low and comparable (3.8% en-bloc vs. 4% LBL; P = 0.3).

Conclusion: En-bloc HoLEP reduces enucleation time, operative time, and laser energy consumption compared to LBL HoLEP, while maintaining comparable safety, efficacy, and early continence outcomes when performed with modern technical refinements.

Background: Abnormal PSA test results leading to MRI scans is mainstream practice in prostate cancer diagnosis. However, a similar algorithm may lead to under-detection of clinically significant prostate cancer (csPCa) in disease screening. We compare cancer detection rates (CDR) in screening with MRI prostate only ('primary' MRI) compared to MRI scans triggered by abnormal serum PSA levels ('PSA-gated' MRI).

Methods: Pubmed, Embase, Web of Science, CENTRAL, Scopus and Google Scholar were searched using key terms of "MRI", "prostate cancer", and "screening" from 01/1/2000-20/4/2024. We included studies investigating the general adult male population not otherwise risk stratified, and extracted outcomes of CDR for csPCa (ISUP Grade Group ≥ 2) and clinically insignificant prostate cancer (ciPCa) (ISUP Grade Group 1), and biopsy rate.

Results: 17 studies were included for final analysis. When including all studies, primary MRI had a higher CDR compared to PSA-gated MRI for all prostate cancer (8.49% vs. 1.88%, p = 0.0223) and csPCa (5.93% vs. 1.15%, p = 0.0180) detection respectively. There was no statistically significant difference in CDR for ciPCa between both groups. In studies directly comparing primary and PSA-gated MRI, primary MRI demonstrated higher odds of detection for all prostate cancer (OR 2.77, 95%CI: 1.71-4.49), csPCa (OR 2.32, 95%CI: 1.37-3.96) and ciPCa (OR 3.11, 95%CI: 1.08-8.97). Limitations include verification bias and heterogeneity between studies.

Conclusions: Primary MRI screening demonstrated higher CDR for csPCa than PSA-gated MRI screening triggered at PSA thresholds of 3-4 ng/ml. There is also higher CDR of ciPCa and adoption of needle biopsies. More granular cost-effectiveness outcomes are required before mainstream implementation is possible.

Background: The glucocorticoid receptor (GR) is a nuclear receptor protein for cortisol and other glucocorticoids and regulates the transcription of thousands of genes involved in metabolism, development, stress and inflammatory response. In prostate cancer, GR may confer resistance to anti-androgen receptor therapies by bypassing AR blockade. However, only few data are available on the prognostic role of GR expression in prostate cancer.

Methods: To estimate the prognostic value of GR, a tissue microarray containing 17,747 prostate cancers with associated follow-up and molecular data was analyzed by immunohistochemistry.

Results: All patients had undergone radical prostatectomy. GR immunostaining was found in 10,832 (89.1%) of 12,125 interpretable tumors, including 48.5% with weak, 29.8% with moderate and 11% with strong staining intensity. Increased GR staining was strongly linked to adverse feature of the disease, including high tumor stage (pT), high classical and quantitative Gleason grade, presence of nodal metastases (pN+), a positive surgical margin (R1) status, and early biochemical recurrence (p < 0.0001 each). A multivariate analysis showed that the prognostic value of strong GR staining was independent of pT, Gleason grade, pN and R status. High level GR staining was significantly linked to TMPRSS2:ERG fusion (p < 0.0001) and high androgen receptor expression (p < 0.0001 each). A combined analysis of the impact of GR and AR on patient prognosis identified the best prognosis for AR^neg/GR^neg cancers while AR^pos/GR^pos cancers showed the worst prognosis (p < 0.0001). Moreover, high GR expression was a strong predictor of poor prognosis in AR low, AR intermediate and AR high cancers (p < 0.0001 each).

Conclusion: High level expression of GR is strongly linked to prostate cancer aggressiveness in uni- and multivariate analysis. GR immunohistochemistry - alone or in combination with other markers - holds great potential to identify patients with a high risk for tumor progression.