Prostate Cancer and Prostatic Diseases最新文献

Background: For men with low-risk prostate cancer (PCa) on active surveillance (AS), there remain limited and conflicting data regarding whether physical activity may influence disease progression evidenced by grade reclassification (GR). Furthermore, it is unclear whether physical activity affects the risk independently of other lifestyle factors such as diet and smoking.

Methods: This is a prospective cohort study of men diagnosed with Grade Group (GG) 1 PCa undergoing AS. Patients completed diet and physical activity questionnaires upon AS enrollment. Physical activity level was evaluated as metabolic equivalent of task hours per week (MET-h/wk), and diet quality as energy-adjusted Healthy Eating Index (E-HEI) score. Multivariable competing risk regressions were utilized to examine the association of baseline physical activity level with GR to ≥GG2 and to ≥GG3, adjusting for established clinicopathological risk factors, diet quality, and smoking history.

Results: We included 828 men with a median follow up of 6.4 years (quartiles: 4.0-9.1). In multivariable regression models adjusted for covariates, increased baseline physical activity levels (3 to <9 MET-h/wk versus <3: subdistribution hazard ratio [SHR] 0.18, 95% confidence interval [CI] 0.05-0.61; 9 to <18 MET-h/wk versus <3: SHR 0.26, 95% CI 0.10-0.68; ≥18 MET-h/wk versus <3: SHR 0.31, 95% CI 0.12-0.80) were associated with significantly decreased risks of GR to ≥GG3. Increased physical activity levels were associated with non-significant decreases in GR to ≥GG2. An increased E-HEI score was also significantly associated with decreased GR to ≥GG3, and non-significant reduction in GR to ≥GG2. Smoking history was not associated with either GR outcome.

Conclusions: In a large prospective cohort with longitudinal follow-up of men pursuing AS for GG1 PCa, increased baseline physical activity levels, compared to a sedentary lifestyle defined as <3 MET-h/wk, was independently associated with a lower risk of progression to ≥GG3 disease.

Background: In ARAMIS, darolutamide statistically significantly prolonged metastasis-free survival by 2 years and reduced the risk of death by 31% in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC). We report post hoc analyses of ARAMIS evaluating patterns of disease progression overall and by prostate-specific antigen (PSA) response.

Methods: Patients were randomized 2:1 to darolutamide (n = 955) or placebo (n = 554), with androgen-deprivation therapy (ADT). Progression included metastases on conventional imaging, PSA progression based on Prostate Cancer Working Group 2 criteria or any rise in PSA, and pain progression. Radiological progression was compared between patients who reached undetectable PSA < 0.2 ng/ml at any time and those who did not.

Results: Metastatic progression occurred in 14% of patients receiving darolutamide versus 29% of patients receiving placebo, with a consistent pattern mostly isolated to bone (46%; 39%) or lymph nodes (32%; 40%). At 12 months, fewer patients receiving darolutamide versus placebo had PSA progression alone (7.8% vs. 35.9%) or both PSA and radiological progression (5.4% vs. 21.4%). Radiological progression without PSA progression occurred in 35% of metastatic events in the darolutamide group and 23% of metastatic events in the placebo group. Darolutamide led to deep PSA response (< 0.2 ng/ml) versus placebo (25.1% vs. 0.5%), and patients receiving darolutamide who reached PSA < 0.2 ng/ml experienced less radiological progression than those who did not (24 months: 8.7% vs. 33%; 36 months: 8.7% vs. 50%).

Conclusions: Darolutamide plus ADT reduced the risk of metastatic progression and improved overall survival versus placebo plus ADT without changing patterns of disease progression through Month 24. Metastasis occurred without PSA progression in approximately 30% of metastatic events overall. Undetectable PSA with darolutamide was associated with reduced radiological progression that was maintained over time. These results highlight the importance of both imaging and PSA monitoring to identify disease progression in patients with nmCRPC.

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.