Prostate Cancer and Prostatic Diseases最新文献

Background: Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) is a widely accepted treatment option for metastatic castration-resistant prostate cancer (mCRPC). However, synthesized evidence regarding potential prognostic factors for oncologic outcomes in patients treated with PSMA-RLT is lacking. We aimed to synthesize prognosticators of oncologic outcomes in patients with mCRPC treated with PSMA-RLT.

Methods: PubMed®, Web of Science™, and Embase® databases were systemically searched in March 2025 for studies. Eligible studies investigated pretreatment clinical, hematologic, or radiographical prognostic factors for oncologic outcomes, such as progression-free (PFS) or overall survivals (OS) in patients with mCRPC treated with PSMA-RLT. Only parameters assessed through multivariable analysis adjusting for potential confounders were synthesized. (CRD42024598718) RESULTS: A total of 39 studies (n = 4819) were included in the systematic review and 32 studies (n = 3038) were included in the meta-analysis. Prior chemotherapy (pooled HR: 1.43, 95%CI: 1.10-1.85), visceral metastases (pooled HR: 1.41, 95%CI: 1.05-1.89), and liver metastasis (pooled HR: 1.75, 95%CI: 1.37-2.25) were associated with worse PFS. Poor performance status (PS) (pooled HR: 1.99, 95%CI: 1.45-2.74), prior chemotherapy (pooled HR: 1.39, 95%CI: 1.19-1.63), visceral metastasis (pooled HR: 1.65, 95%CI: 1.33-2.05), bone metastasis (pooled HR: 2.09, 95%CI: 1.39-3.13), liver metastasis (pooled HR: 2.15, 95%CI: 1.84-2.50), and lower pretreatment hemoglobin levels (pooled HR: 1.25, 95%CI: 1.09-1.43) were associated with poorer OS. Higher pretreatment SUV_mean was associated with improved OS benefit (pooled HR: 0.91, 95%CI: 0.85-0.97). PSA decline after treatment initiation, particularly ≥50%, was associated with improved PFS and OS.

Conclusions: Prior chemotherapy use and location of metastases influence the prognosis of patients with mCRPC treated with PSMA-RLT. A higher pre-treatment SUV_mean is predictive of better PSMA-RLT efficacy, and a greater PSA 'response is associated with improved survival outcomes. These findings may help guide clinical decision-making regarding PSMA-RLT and support prognostication of its oncological benefits.

Background: Life expectancy (LE) is essential for triage between aggressive and conservative management for all prostate cancer risk subtypes. We sought to investigate differences in how Black and Hispanic men interpret LE in treatment decision-making.

Methods: We used targeted crowdsourcing to sample a cohort reflecting sociodemographics of a US prostate cancer population. Subjects completed a conjoint analysis exercise where they iteratively chose between aggressive treatment versus conservative management across levels of 4 tradeoffs-tumor risk (lives saved by aggressive treatment at 5/10/20 year); erectile dysfunction; urinary incontinence; and irritative urinary symptoms-while considering their LE as calculated by the Prostate Cancer Comorbidity Index. Multinomial conditional logistic regression compared odds of choosing aggressive vs. conservative treatment across LEs ranging from 0 to 20 years overall and across racial/ethnic subgroups.

Results: Of 2046 men, 435 (22%) were Black and 230 (11%) were Hispanic. Across all men, the odds of aggressive treatment choice increased by 17% for every 5 years of additional LE (OR = 1.17, 95%CI = 1.12-1.22, p < 0.001). Men were significantly more likely to choose aggressive treatment at LE > 13 y and non-aggressive treatment at LE ≤ 10 y. Among Black men, LE was not associated with treatment choice, as they consistently preferred aggressive treatment across all LE categories. Among Hispanic men, increased LE was associated with a higher likelihood of choosing aggressive treatment, with significant preference for aggressive treatment observed only when LE > 10 years. These patterns remained consistent when further stratified by tumor risk.

Conclusions: LE had no impact on treatment decisions in Black men, in contrast to other races and ethnicities. Future research is needed to identify reasons for this phenomenon and to inform culturally relevant approaches to communicating competing mortality risks.

Background: The combination of multiparametric magnetic resonance imaging (MP-MRI) and ultrasound-guided fusion biopsy is increasingly recognized as a valuable tool for diagnosing prostate cancer. However, up to 80% of PI-RADS 3 lesions and 50% of PI-RADS 4 lesions are benign. This study evaluates whether lesion echogenicity observed during MRI-ultrasound fusion biopsy is associated with detecting clinically significant prostate cancer (csPCa).

Methods: In this retrospective analysis (March 2017-February 2022), we reviewed patients who underwent both standard 12-core random biopsies and targeted MP-MRI/US fusion-guided biopsies at our institution. Lesions were categorized as strongly hypoechoic, weakly hypoechoic, or non-hypoechoic based on ultrasound echogenicity. CsPCa was defined as a Gleason score ≥7.

Results: Among 222 biopsy patients, 59.3% were diagnosed with PCa, and 68% had csPCa. Of 420 lesions, 19.1% were strongly hypoechoic (45% csPCa), 29.5% were weakly hypoechoic (25% csPCa), and 51.4% were non-hypoechoic (11.8% csPCa) (p < 0.001). Echogenicity improved csPCa detection for PI-RADS ≤ 3 lesions from 7.5% (non-hypoechoic) to 27.5% (strongly hypoechoic), for PI-RADS 4 from 13.1% to 35.1%, and for PI-RADS 5 from 42% to 63.5%. The ROC analysis demonstrated AUCs of 0.6958 for PI-RADS, 0.6929 for echogenicity, and 0.7434 for their combination (all p < 0.001).

Conclusion: Lesion echogenicity observed during MRI-ultrasound fusion biopsy enhances csPCa detection and complements PI-RADS scoring. Incorporating echogenicity into risk assessment may improve biopsy decision-making and diagnostic accuracy.

Background: Despite advancements in treatment, metastatic prostate cancer remains a lethal disease. As prostate cancer becomes resistant to standard of care treatments like androgen receptor pathway inhibitors (ARPIs) and chemotherapy, cell surface tumor antigens and receptors become increasingly heterogeneous and diverse, dependent on androgen receptor dependency with relevance for both diagnostic positron emission tomography (PET) imaging and cell surface targeting therapeutics. Our review aims to describe emerging theranostic targets and agents in cell surface imaging and therapies.

Methods: A literature search was carried out in March 2025, on Pubmed, as well as Clinicaltrials.gov to determine cell surface targets with viable trials for imaging and/or therapeutic agents. Keyword searches included "Prostate Cancer" AND "CRPC" AND "Cell Surface Targets."

Results: Among the literature, 13 novel targets with robust supporting literature were found. Targets were subsequently divided into targets of interest in AR-positive and AR-negative (NEPC and/or double negative) mCRPC. Ongoing and completed trials for imaging and/or therapeutics leveraging these targets was described.

Conclusion: Numerous prostate cancer cell surface markers are emerging as theranostic targets. For patients ineligible for or developing progression following PSMA-targeting therapies, extending cell surface targeting therapeutics, whether they are ADCs, cellular therapies, or RPTs, is increasingly vital.

Background: Pelvic lymph node dissection (PLND) is integral to prostate cancer staging, but its therapeutic value remains debated. PSMA PET/CT has shown high accuracy in detecting lymph node metastasis (LNM). This study evaluates the feasibility of performing PLND based on PSMA PET/CT findings during robotic-assisted radical prostatectomy (RARP).

Methods: In this prospective, randomized study, biopsy-confirmed prostate cancer (PCa) patients with intermediate or high risk were enrolled. Patients with distant metastasis or prior endocrine therapy were excluded. All underwent 18F-PSMA PET/CT imaging, and those with LNM were assigned to Group A. Patients without LNM were randomized in a 1:1 ratio into Groups B and C. All patients underwent RARP and Groups A and B with PLND while Group C without. The primary outcomes were PSMA PET/CT accuracy in detecting LNM and oncological results. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR2200063256).

Results: Between September 2022 and August 2023, 120 PCa patients were enrolled. The sensitivity, specificity, accuracy, positive predictive value (PPV), and NPV of PSMA PET/CT were 76.5%, 86.8%, 65.0%, 92.0%, and 84.3%. There were no significant differences in clinical parameters, progression-free survival (PFS) or PSA persistence between Groups B and C. However, PLND patients had longer surgical times, hospital stays, and higher complication rates.

Conclusions: PSMA PET/CT offers high specificity and NPV in detecting LNM.LND may be unnecessary for node-negative patients identified by PSMA PET/CT, with close follow-up recommended for those not undergoing LND.

Introduction: Simulation-based training (SBT) is designed to mimic real-life surgeries and help surgeons develop skills they can transfer to the operating room in a risk-free environment. With the emergence of numerous surgical therapies for benign prostatic hyperplasia (BPH), a need has developed for new learning tools in addition to standard clinical exposure. In this scoping review, we aimed to provide a comprehensive and updated outline of available endoscopic BPH simulators.

Methods: We conducted a scoping review in accordance with the Joanna Briggs Institute methodology. References were identified through searches of MEDLINE, Embase, Web of Science, and CINAHL from inception to March 2025. A search of Google Scholar was also conducted to identify grey literature references. Keywords searched included those related to simulators, medical education and BPH surgeries. Studies included were original articles on simulators used for endoscopic BPH surgery. Data pertaining to simulator validity, acceptability and feasibility were collected.

Results: Forty-five records were included, with one reference consisting of a multi-modality curriculum used for simulating two BPH surgeries. Thirty studies assessed transurethral resection of prostate (TURP) simulators, six studies for GreenLight laser prostatectomy (PVP), eight studies for anatomic endoscopic enucleation of the prostate (AEEP) procedures, and two articles for Urolift. For TURP simulators, four bench-top models, nine virtual reality simulators, two food-based phantoms, and one porcine model were identified. For HoLEP simulators, three bench-top models, two VR simulators, and one human cadaver prostate model were assessed. Furthermore, virtual simulation was the only modality tested for PVP (two simulators), ThuLEP (one simulator), and Urolift (one simulator).

Conclusion: Our results suggest a need for developing SBT models other than TURP. Future iterations of BPH surgical models should be evaluated using the modern definition of validity with the goal of integration into surgical curriculum.

Background: In the last two decades, several Da Vinci robotic platforms have been released. The new generation DaVinci-5 robot (DV5) promises hardware and software improvements with the potential for enhanced operative performance. The study aimed to compare the intraoperative performances and short-term perioperative outcomes between the DV5 and DaVinci-Xi robotic platforms in patients undergoing robotic-assisted radical prostatectomy (RARP).

Methods: We conducted a single-center retrospective cohort study from April to May 2024, during a unique 4-week period when both the Da Vinci 5 (DV5) and Da Vinci Xi (DV-Xi) platforms were available. A total of 103 patients who underwent robotic-assisted radical prostatectomy with the DV5 were retrospectively compared to 101 patients operated on with the DV-Xi during the same time frame. The primary endpoint was the comparison of intraoperative performance metrics between groups, including operative time, estimated blood loss, and intraoperative complications.

Results: The DV5 had shorter median console time (80 min, IQR [80-90] vs 90 min, IQR [80-90], median difference = 10 min, p < 0.001) and shorter median total operative time (96 min, IQR [90-103] vs 100 min, IQR [98-105], median difference = 4 min, p < 0.001). Neither group had any device malfunctions, intraoperative complications, or blood transfusions. We could not find the difference in hospital length-of-stay, postoperative complication rate, and surgical margin status. This study was done at a high-volume prostate cancer referral centre, which may limit the study findings' generalizability.

Conclusion: This is the first study comparing outcomes of the DV5 and DVXi robotic platforms in patients undergoing RARP. The use of the DV5 robot was associated with modest gains in some perioperative outcomes, but these values were not clinically significant in our routine. Due to the short-term follow-up, we are still evaluating the long-term impacts of this new platform on these patient's outcomes.