Prostate Cancer and Prostatic Diseases最新文献

Background: International guidelines recommend germline genetic testing for men with metastatic prostate cancer. If offered to all patients by genetic healthcare professionals, there will be insufficient capacity to cope with the high patient numbers. In a mainstreaming pathway, non-genetic healthcare professionals (ngHCPs) discuss and order germline genetic testing instead of referring patients to genetic healthcare professionals. We aimed to evaluate the experience of ngHCPs with pre-test genetic counselling and to explore the feasibility from the ngHCPs' perspective.

Methods: We carried out a prospective cohort study in 15 hospitals in the Netherlands. All participating ngHCPs (i.e. urologists, medical oncologists, specialist nurses and nurse practitioners) completed an online training module of 45 min. The ngHCPs completed a questionnaire both before the training and at three and nine months after it. Paired analyses were used to compare the first with the last questionnaires on attitude, confidence in the ability to discuss and order germline genetic testing, and perceived and actual knowledge of genetics and genetic testing.

Results: 167 ngHCPs were invited to participate of whom 69 completed the first questionnaire and started or completed the last one. They had a positive attitude towards offering genetic testing themselves. After nine months of providing pre-test genetic counselling, significantly more ngHCPs considered mainstreaming helpful (94% after versus 81% before, p = 0.01). Both perceived and actual knowledge increased significantly. Pre-test genetic counselling took less than 10 minutes for 82% of ngHCPs and the majority (88%) were in favour of continuing the mainstream pathway. Only six participating ngHCPs considered mainstreaming possible without completing a training module beforehand.

Conclusions: After completing a short online training module, ngHCPs feel well-prepared to discuss germline genetic testing with metastatic prostate cancer patients.

Background: To systematically evaluate the available evidence regarding the effect of salvage irreversible electroporation (IRE) in patients with local recurrent prostate cancer (PCa) after definitive radiotherapy (RT).

Methods: A systematic search was conducted in the electronic databases PubMed-MEDLINE and the Web of Science. The following search terms were used: "irreversible electroporation AND recurrent prostate cancer", ''salvage irreversible electroporation AND prostate cancer AND radiation", "nanoknife AND recurrent prostate cancer", and ''salvage irreversible electroporation AND prostate cancer" by combining PICO (population, intervention, comparison, and outcome) terms.

Results: We identified 5 eligible studies. Following IRE, local oncological control was ranging from 67 to 78%. In-field and out-field lesion recurrences after IRE were ranging from 3 to 10% and from 8 to 14%, respectively. Only one study reported an overall metastasis-free survival rate of 91% and a 5-year progression-free survival rate of 60%. The post-IRE continence status ranged 73-100%. Two studies reported a decline in the proportion of patients maintaining erections sufficient for sexual intercourse and two studies reported 50% preservation of erection. The majority of complications were of a low-to-mild nature, classified as Clavien-Dindo grade I-II, with the exception of the development of a rectal fistula in a single case.

Conclusions: IRE represents an alternative salvage treatment option for patients with localised recurrent PCa following RT. The procedure offers a favourable safety profile and effective preservation of urinary function. The oncological results are promising, but further investigation is required.

Background: To evaluate clinical outcomes of focal therapy using high-intensity focused ultrasound (HIFU) with intraoperative prostate compression for patients with localized prostate cancer (PC).

Methods: Patients were included if they had prostate specific antigen levels of ≤20 ng/mL and clinically significant PC (CSPC) within the left or right half, or upper or lower half of the prostate. CSPC was detected using magnetic resonance imaging-transrectal ultrasound fusion image-guided target biopsy and a 12-core systematic biopsy. Focal therapy using HIFU with intraoperative prostate compression was administered to lesions visible on the magnetic resonance imaging. Biochemical failure was defined by the Phoenix ASTRO definition. Pathological failure was defined as having CSPC in the biopsy at the time of biochemical failure.

Results: The patients (n = 240; median age, 69 years old; median prostate specific antigen level, 6.42 ng/mL) were divided according to the D'Amico risk classification into: 'low' (n = 51), 'intermediate' (n = 107), and 'high' (n = 82) groups. The biochemical and the pathological disease-free survival rates after a single treatment for the low-, intermediate-, and high-risk groups were 93.7% and 92.2%, 88.5% and 91.6%, and 84.8% and 86.6%, respectively. The radical or systematic treatment-free survival rates were 96.1%, 94.4%, and 95.1%, respectively. Median follow-up period was 48 months (range 24-84). The urinary and sexual function at 1 month post-treatment had deteriorated but returned to preoperative levels at 3 or 6 months after treatment.

Conclusions: Focal therapy using HIFU with intraoperative prostate compression would improve medium-term oncological outcomes without the risk of functional deterioration.

Background: Serum PSA and digital rectal examination remain the key diagnostic tools for detecting prostate cancer. However, due to the limited specificity of serum PSA, the applicability of this marker continues to be controversial. Recent use of image-guided biopsy along with pathological assessment and the use of biomarkers has dramatically improved the diagnosis of clinically significant cancer. Despite the two modalities working together for diagnosis biomarker research often fails to correlate findings with imaging.

Methods and results: We looked at 21 prostate cancer biomarkers correlating our results with mpMRI data to investigate the hypothesis that biomarkers along with mpMRI data make a powerful tool to detect clinically significant prostate cancer. Biomarkers were selected based on the existing literature. Using a tissue microarray comprised of samples from the PICTURE study, with biopsies at 5 mm intervals and mpMRI data we analysed which biomarkers could differentiate benign and malignant tissue. Biomarker data were also correlated with pathological grading, mpMRI, serum PSA, age and family history. AGR2, CD10 and EGR protein expression was significantly different in both matched malignant and benign tissues. AMACR, ANPEP, GDF15, MSMB, PSMA, PTEN, TBL1XR1, TP63, VPS13A and VPS28 showed significantly different expression between Gleason grades in malignant tissue. The majority of the biomarkers tested did not correlate with mpMRI data. However, CD10, KHDRBS3, PCLAF, PSMA, SIK2 and GDF15 were differentially expressed with prostate cancer progression. AMACR and PTEN were identified in both pathological and image data evaluation.

Conclusions: There is a high demand to develop biomarkers that would help the diagnosis and prognosis of prostate cancer. Tissue biomarkers are of particular interest since immunohistochemistry remains a cheap, reliable method that is widely available in pathology departments. These results demonstrate that testing biomarkers in a cohort consistent with the current diagnostic pathway is crucial to identifying biomarker with potential clinical utility.

Background: Small cell prostate cancer (SCPC) is a rare, aggressive disease with limited clinical data to guide treatment. In this retrospective study, we evaluated clinical, treatment, and outcomes data for patients with SCPC.

Methods: Patients with SCPC were selected from CancerLinQ Discovery^®, a United States-based de-identified clinical database derived from the electronic health records of over 60 medical oncology organizations. A diagnosis of SCPC was made based on a tumor histology code of small cell carcinoma. The primary outcome of this study was assessing first-line systemic therapy within 1 year of diagnosis of SCPC.

Results: 74 patients with SCPC who received systemic therapy between 2010-2023 were identified. The majority had documented metastatic disease (45 patients, 60.8%) and a low PSA (median 2.8 ng/dL) at SCPC diagnosis. Platinum chemotherapy plus etoposide was the most common systemic treatment (62, 83.8%) and carboplatin plus etoposide was the most common regimen (42, 56.8%) used in the first line. Median overall survival (OS) was 8.3 months for patients with metastatic SCPC. Patients treated with cisplatin plus etoposide had improved survival versus those receiving carboplatin plus etoposide (odds ratio 3.15, 95% CI 1.57-6.30; p = 0.001). 45.9% of patients with SCPC received second-line systemic therapies, which were highly varied.

Conclusions: This contemporary real-world data represent one of the largest descriptions of the treatment of SCPC. Clear consensus on the optimal systemic therapy for SCPC is lacking. While additional research is needed, real-world practice patterns can serve as a resource when considering a treatment approach for this rare disease.

Background: Robot-Assisted Simple Prostatectomy (RASP) is recommended for the treatment of large prostate glands. The introduction of the Single-Port (SP) platform in 2018 has enabled transvesical approach to SP-RASP with promising outcomes. Our aim was to describe the functional and urinary continence outcomes of SP-RASP.

Methods: Clinical and surgical data from all consecutive patients who underwent transvesical SP-RASP between February 2020 and March 2024 were collected in a prospectively maintained institutional dataset and retrospectively analyzed. All procedures were performed using the da Vinci SP platform without any conversions to open surgery. Postoperative outcomes were gathered and analyzed, with a particular focus on the incidence of urinary incontinence (UI) and the time to continence recovery.

Results: Overall, 89 patients underwent SP-RASP, with a median prostate size of 110 grams (90-171.5) and a median PSA level of 5.5 mg/dl (2.77-10.93). All patients were on at least one prostate medication prior to surgery. Preoperative evaluations showed a median International Prostate Symptoms Score (IPSS) of 23 (20-27), Quality of Life (QoL) of 4 (3-5), and Post-voiding Residual (PVR) of 153 ml (60-400). The median operative time was 180 min (164-200), with a median estimated blood loss of 100 ml (30-180). Postoperatively, no patients required continuous bladder irrigation. The median postoperative opioid intake was 6.5 morphine equivalents (0-10), with over 78% not requiring narcotics after discharge. Overall, 77.5% were same day discharged. No Clavien-Dindo > 2 complications were recorded. The median follow-up time was 18 (7-35) months. At the last postoperative urological evaluation, the median IPSS was 5 (3-7), QoL was 1 (0-2), and PVR was 10 ml (0-25). Only 4 patients (4.5%) experienced UI postoperatively, and all were continent within 3 months.

Conclusions: The UI incidence rate and functional outcomes of SP-RASP are very encouraging, likely due to precise adenoma and urethra dissection and bladder neck reconstruction. This approach also allows for same-day discharge.

Background: Localized prostate cancer (PCa) is a largely heterogeneous disease regarding its clinical behavior. Current risk stratification relies on clinicopathological parameters and distinguishing between indolent and aggressive cases remains challenging. To improve risk stratification, we aimed to identify new prognostic markers for PCa.

Methods: We performed an in silico analysis on publicly available PCa transcriptome datasets. The top 20 prognostic genes were assessed in PCa tissue samples of our institutional cohort (n = 92) using the NanoString nCounter technology. The three most promising candidates were further assessed by immunohistochemistry (IHC) in an institutional (n = 121) and an independent validation cohort from the EMPACT consortium (n = 199). Cancer-specific survival (CSS) and progression-free survival (PFS) were used as endpoints.

Results: Our in silico analysis identified 113 prognostic genes. The prognostic values of seven of the top 20 genes were confirmed in our institutional radical prostatectomy (RPE) cohort. Low CENPO, P2RX5, ABCC5 as well as high ASF1B, NCAPH, UBE2C, and ZWINT gene expressions were associated with shorter CSS. IHC analysis confirmed the significant associations between NCAPH and UBE2C staining and worse CSS. In the external validation cohort, higher NCAPH and ZWINT protein expressions were associated with shorter PFS. The combination of the newly identified tissue protein markers improved standard risk stratification models, such as D'Amico, CAPRA, and Cambridge prognostic groups.

Conclusions: We identified and validated high tissue levels of NCAPH, UBE2C, and ZWINT as novel prognostic risk factors in clinically localized PCa patients. The use of these markers can improve routinely used risk estimation models.

Background: This review aims to identify and summarize the current literature on the use of prostatic stents or nitinol devices as minimally invasive techniques for the management of lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH).

Methods: A comprehensive search of the literature was conducted until October 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023474884).

Results: Thirty-eight articles were included (2618 patients). Generally, the risk of bias was deemed as high or very high. The most frequently investigated stents were the UroLume, followed by the Memokath/Memotherm. The mean age was 72.01 ± 5.6 years, with a mean prostate volume of 48.27 ± 12.8 cc and a mean urethral length of 40.53 ± 9.16 mm. Surgeries were usually performed under local anesthesia. The rates of catheter-free status and complications were 85.2% and 30.83%, respectively. The primary complications included urinary tract infections (17.2%), followed by calcifications (12.6%), irritative symptoms (12.2%), and acute urinary retention (10.4%). During a follow-up period of 12 months, the failure rate intended as stent removal or repositioning was 14.8%. The International Prostate Symptom Score (IPSS) showed an overall improvement of 9.85 points. The mean improvement in maximum flow rate and post-void residual volume were 6.62 ml/sec and 147 ml, respectively.

Conclusions: Prostatic stents remain an efficient choice for addressing obstructive symptoms from BPH, offering the advantage of being performed under local anaesthesia, relieving symptoms with good functional outcomes and a low incidence of major complications. Prospective studies are needed to corroborate these results.