Prostate Cancer and Prostatic Diseases最新文献

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.

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.