Pub Date : 2025-07-25DOI: 10.1038/s41391-025-01006-2
Vincenzo Li Marzi, Stefania Musco, Riccardo Lombardo, Antonio Cicione, Luca Gemma, Simone Morselli, Maria Lucia Gallo, Sergio Serni, Riccardo Campi, Cosimo De Nunzio, Italian Society of Urodynamics (SIUD) Young Research Group
{"title":"Correction: Prevalence of lower urinary tract symptoms in taxi drivers: a cross-sectional web-based survey","authors":"Vincenzo Li Marzi, Stefania Musco, Riccardo Lombardo, Antonio Cicione, Luca Gemma, Simone Morselli, Maria Lucia Gallo, Sergio Serni, Riccardo Campi, Cosimo De Nunzio, Italian Society of Urodynamics (SIUD) Young Research Group","doi":"10.1038/s41391-025-01006-2","DOIUrl":"10.1038/s41391-025-01006-2","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"28 4","pages":"1029-1029"},"PeriodicalIF":5.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41391-025-01006-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aims to evaluate the efficacy and advantages of MR navigation system in robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer (PCa). We retrospectively studied 147 patients with high-risk PCa based on D’Amico risk criteria from July 2021 to November 2023. All patients chose MR-assisted RARP (MR-RARP) or standard RARP (S-RARP) after receiving comprehensive counseling on the benefits and risks of both procedures. After propensity score-matching, 57 patients were included in each group. Perioperative, functional and oncological outcomes were compared. Logistic and Cox regression models were used to identify predictors of positive surgical margin (PSM), biochemical recurrence (BCR), continence and potency recovery. The MR-RARP group had higher nerve-sparing (NS) rates (78.9% vs 54.4%, P = 0.021) and lower PSM rates (10.5% vs 26.3%, P = 0.030). Continence recovery rates were higher in the MR-RARP group at catheter removal (40.4% vs 22.8%, P = 0.044), 1 month (61.4% vs 38.6%, P = 0.015) and 3 months (73.7% vs 47.4%, P = 0.004), with no significant differences at 6 months (82.5% vs 73.7%, P = 0.258) and 12 months (93.0% vs 87.7%, P = 0.341). Furthermore, the MR-RARP group demonstrated higher potency rates at 1 month (42.1% vs 21.1%, P = 0.016) and 3 months (57.9% vs 36.8%, P = 0.024), whereas outcomes were comparable at 6 months (66.7% vs 56.1%, P = 0.248) and 12 months (77.2% vs 66.7%, P = 0.211). With a median follow-up of 28 months, BCR-free survival showed no significant differences (P = 0.295). Multivariate analyses confirmed MR navigation as an independent predictor of PSM, continence, and potency recovery (all P < 0.05). Statistical power analysis indicated a power of 0.847. Real-time intraoperative MR navigation enhances surgical precision, facilitates NS techniques, and optimizes early continence and potency recovery without compromising oncological safety.
背景：本研究旨在评估MR导航系统在机器人辅助根治性前列腺切除术（RARP）治疗高危前列腺癌（PCa）中的疗效和优势。方法：我们回顾性研究了从2021年7月至2023年11月147例基于D'Amico风险标准的高危PCa患者。所有患者在接受了两种方法的利弊综合咨询后，均选择了MR-RARP （MR-RARP）或S-RARP （S-RARP）。倾向评分匹配后，每组57例。比较围手术期、功能和肿瘤预后。采用Logistic和Cox回归模型确定手术切缘阳性（PSM）、生化复发（BCR）、尿失禁和药力恢复的预测因子。结果：MR-RARP组神经保留率较高（78.9% vs 54.4%, P = 0.021）， PSM率较低（10.5% vs 26.3%, P = 0.030）。MR-RARP组在拔管时尿失禁恢复率较高（40.4% vs 22.8%, P = 0.044）， 1个月（61.4% vs 38.6%, P = 0.015）和3个月（73.7% vs 47.4%, P = 0.004）， 6个月（82.5% vs 73.7%, P = 0.258）和12个月（93.0% vs 87.7%, P = 0.341）无显著差异。此外，MR-RARP组在1个月（42.1%对21.1%,P = 0.016）和3个月（57.9%对36.8%,P = 0.024）时表现出更高的效力率，而6个月（66.7%对56.1%,P = 0.248）和12个月（77.2%对66.7%,P = 0.211）时的结果具有可比性。中位随访28个月，无bcr生存率无显著差异（P = 0.295）。多变量分析证实MR导航是PSM、尿失禁和药力恢复的独立预测因子（均为P）。结论：术中实时MR导航提高了手术精度，促进了NS技术，并在不影响肿瘤安全性的情况下优化了早期尿失禁和药力恢复。
{"title":"The application of mixed reality navigation system in robot-assisted radical prostatectomy for high-risk prostate cancer: a propensity score‑matched cohort study","authors":"Wangmin Liu, Siyu Zhou, Xueyang Yu, Yufei Yu, Hongbo Su, Qi Miao, Meng Gao, Zhiqiang Cao, Jianbin Bi, Lizhu Chen, Jian Wang, Mo Zhang","doi":"10.1038/s41391-025-01003-5","DOIUrl":"10.1038/s41391-025-01003-5","url":null,"abstract":"This study aims to evaluate the efficacy and advantages of MR navigation system in robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer (PCa). We retrospectively studied 147 patients with high-risk PCa based on D’Amico risk criteria from July 2021 to November 2023. All patients chose MR-assisted RARP (MR-RARP) or standard RARP (S-RARP) after receiving comprehensive counseling on the benefits and risks of both procedures. After propensity score-matching, 57 patients were included in each group. Perioperative, functional and oncological outcomes were compared. Logistic and Cox regression models were used to identify predictors of positive surgical margin (PSM), biochemical recurrence (BCR), continence and potency recovery. The MR-RARP group had higher nerve-sparing (NS) rates (78.9% vs 54.4%, P = 0.021) and lower PSM rates (10.5% vs 26.3%, P = 0.030). Continence recovery rates were higher in the MR-RARP group at catheter removal (40.4% vs 22.8%, P = 0.044), 1 month (61.4% vs 38.6%, P = 0.015) and 3 months (73.7% vs 47.4%, P = 0.004), with no significant differences at 6 months (82.5% vs 73.7%, P = 0.258) and 12 months (93.0% vs 87.7%, P = 0.341). Furthermore, the MR-RARP group demonstrated higher potency rates at 1 month (42.1% vs 21.1%, P = 0.016) and 3 months (57.9% vs 36.8%, P = 0.024), whereas outcomes were comparable at 6 months (66.7% vs 56.1%, P = 0.248) and 12 months (77.2% vs 66.7%, P = 0.211). With a median follow-up of 28 months, BCR-free survival showed no significant differences (P = 0.295). Multivariate analyses confirmed MR navigation as an independent predictor of PSM, continence, and potency recovery (all P < 0.05). Statistical power analysis indicated a power of 0.847. Real-time intraoperative MR navigation enhances surgical precision, facilitates NS techniques, and optimizes early continence and potency recovery without compromising oncological safety.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"144-151"},"PeriodicalIF":5.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41391-025-01003-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Extraprostatic extension (EPE) in prostate cancer (PCa) has implications for nerve-sparing approaches. mpMRI-based nomograms show modest accuracy, highlighting the need for improved predictive models. This study evaluates 18F-DCFPyL prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET/CT) for predicting side-specific EPE using maximum standardized uptake value (SUVmax). This single-center cohort study included patients undergoing RALP by a single surgeon (AKT) from January 2022 to September 2024. Baseline variables included demographics, PSA, biopsy, MRI, and PSMA parameters (SUVmax, EPE, SVI). The primary endpoint was side-specific EPE on final pathology. Univariable and multivariable logistic regression identified significant predictors. A nomogram was built based on this. To evaluate model performance, a 1000-iteration bootstrap approach was used to compare (1) the institutional MRI-only 2018 model, (2) an MRI + PSMA Fixed Model, and (3) a retrained MRI + PSMA Model built on each bootstrap sample. Three hundred fifty-five patients were analyzed. EPE was detected in 18.9% by MRI and 5.4% by PSMA PET. Median intraprostatic SUVmax was 11.30. EPE-positive sides were more likely to have MRI/PSMA-detected EPE (p < 0.001), PIRADS 5 lesions (p < 0.001), aggressive biopsy GGG (p < 0.001), higher positive cores (p < 0.001), and greater percent tumor involvement (p < 0.001). Median SUVmax was significantly higher in the EPE group (9.1 vs. 5.4; p < 0.001). Multivariable analysis identified PSA, MRI-detected EPE, GGG, tumor involvement percentage, and SUVmax ≥13 as significant predictors. The PSMA + MRI Fixed Model outperformed the MRI-only model (median AUC: 0.7542 vs. 0.7350) with p < 0.001. Calibration plots showed strong agreement between predicted and observed probabilities, and decision curve analysis demonstrated greater net clinical benefit across relevant thresholds. We developed a nomogram integrating PSMA PET with MRI and clinicopathological variables, outperforming our institutional model. PSMA uptake strongly predicts side-specific EPE, which can enhance preoperative assessment and improve postoperative functional outcomes.
{"title":"Predicting side-specific extraprostatic extension in prostate cancer using an 18F-DCFPyL PSMA-PET/CT–based nomogram","authors":"Neeraja Tillu, Ashutosh Maheshwari, Kaushik Kolanukuduru, Manish Choudhary, Yashaswini Agarwal, Himanshu Joshi, Shokhi Goel, Hannah Sur, Reuben Ben- David, Basil Kaufmann, Asher Mandel, Henry Jodka, Brenda Hug, Lianne Ohayon, Susanna Baek, Coskun Kacagan, Vinayak Wagaskar, Murilo de Almeida Luz, Ashutosh Tewari","doi":"10.1038/s41391-025-01001-7","DOIUrl":"10.1038/s41391-025-01001-7","url":null,"abstract":"Extraprostatic extension (EPE) in prostate cancer (PCa) has implications for nerve-sparing approaches. mpMRI-based nomograms show modest accuracy, highlighting the need for improved predictive models. This study evaluates 18F-DCFPyL prostate-specific membrane antigen (PSMA) positron emission tomography/ computed tomography (PET/CT) for predicting side-specific EPE using maximum standardized uptake value (SUVmax). This single-center cohort study included patients undergoing RALP by a single surgeon (AKT) from January 2022 to September 2024. Baseline variables included demographics, PSA, biopsy, MRI, and PSMA parameters (SUVmax, EPE, SVI). The primary endpoint was side-specific EPE on final pathology. Univariable and multivariable logistic regression identified significant predictors. A nomogram was built based on this. To evaluate model performance, a 1000-iteration bootstrap approach was used to compare (1) the institutional MRI-only 2018 model, (2) an MRI + PSMA Fixed Model, and (3) a retrained MRI + PSMA Model built on each bootstrap sample. Three hundred fifty-five patients were analyzed. EPE was detected in 18.9% by MRI and 5.4% by PSMA PET. Median intraprostatic SUVmax was 11.30. EPE-positive sides were more likely to have MRI/PSMA-detected EPE (p < 0.001), PIRADS 5 lesions (p < 0.001), aggressive biopsy GGG (p < 0.001), higher positive cores (p < 0.001), and greater percent tumor involvement (p < 0.001). Median SUVmax was significantly higher in the EPE group (9.1 vs. 5.4; p < 0.001). Multivariable analysis identified PSA, MRI-detected EPE, GGG, tumor involvement percentage, and SUVmax ≥13 as significant predictors. The PSMA + MRI Fixed Model outperformed the MRI-only model (median AUC: 0.7542 vs. 0.7350) with p < 0.001. Calibration plots showed strong agreement between predicted and observed probabilities, and decision curve analysis demonstrated greater net clinical benefit across relevant thresholds. We developed a nomogram integrating PSMA PET with MRI and clinicopathological variables, outperforming our institutional model. PSMA uptake strongly predicts side-specific EPE, which can enhance preoperative assessment and improve postoperative functional outcomes.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"124-131"},"PeriodicalIF":5.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-22DOI: 10.1038/s41391-025-00999-0
Carlos A. Garcia-Becerra, Maria I. Arias-Gallardo, Jesus E. Juarez-Garcia, Veronica Soltero-Molinar, Mariabelen I. Rivera-Rocha, Luis F. Parra-Camaño, Natalia Garcia-Becerra, Carlos M. García-Gutiérrez
Prostate Cancer (PCa) is a leading cause of cancer-related mortality globally. Clinically significant PCa (CsPCa) is associated with more aggressive disease, making accurate diagnosis crucial. Multiparametric Magnetic Resonance Imaging (Mp-MRI) is a well-established tool for PCa detection, but the dynamic contrast-enhanced (DCE) sequence raises concerns due to cost, risks, and patient experience. Biparametric MRI (Bp-MRI) has emerged as an alternative, but its diagnostic performance compared to Mp-MRI has not been thoroughly examined through a systematic review and meta-analysis in recent years. A systematic review and meta-analysis were conducted to compare the diagnostic accuracy of Bp-MRI and Mp-MRI for detecting CsPCa by assessing the databases MEDLINE/PubMed, CENTRAL Cochrane, and ClinicalTrials.gov. Studies published between 2012 and 2024 that compared Bp-MRI and Mp-MRI using histopathological analysis as the reference standard were included. Data were extracted to obtain diagnostic test accuracy measurements (sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) and study characteristics. Statistical analysis involved two bivariate random-effects models, a summary Receiver Operating Characteristic (sROC) curve, and meta-regression models assessing the comparison of both diagnostic test accuracies and the interaction of different study-level covariates. Nineteen studies involving 5,173 patients were included. Mp-MRI demonstrated a pooled sensitivity of 0.90 (95% CI: 0.87–0.93) and a specificity of 0.64 (95% CI: 0.50–0.76), while Bp-MRI showed a pooled sensitivity of 0.89 (95% CI: 0.85–0.92) and a specificity of 0.73 (95% CI: 0.62–0.82). Both modalities showed similar diagnostic performance with overlapping sROC curves. Meta-regression revealed no statistically significant difference between the two tools, and the study-level covariates did not influence the results. Bp-MRI is a viable alternative to Mp-MRI for detecting CsPCa, with comparable diagnostic accuracy, especially when contrast agents are a concern. Further prospective randomized studies are needed to confirm these findings. PROSPERO (CRD42024552125).
{"title":"Head-to-head comparison of diagnostic test accuracy between biparametric and multiparametric MRI: an updated systematic review and bivariate meta-analysis","authors":"Carlos A. Garcia-Becerra, Maria I. Arias-Gallardo, Jesus E. Juarez-Garcia, Veronica Soltero-Molinar, Mariabelen I. Rivera-Rocha, Luis F. Parra-Camaño, Natalia Garcia-Becerra, Carlos M. García-Gutiérrez","doi":"10.1038/s41391-025-00999-0","DOIUrl":"10.1038/s41391-025-00999-0","url":null,"abstract":"Prostate Cancer (PCa) is a leading cause of cancer-related mortality globally. Clinically significant PCa (CsPCa) is associated with more aggressive disease, making accurate diagnosis crucial. Multiparametric Magnetic Resonance Imaging (Mp-MRI) is a well-established tool for PCa detection, but the dynamic contrast-enhanced (DCE) sequence raises concerns due to cost, risks, and patient experience. Biparametric MRI (Bp-MRI) has emerged as an alternative, but its diagnostic performance compared to Mp-MRI has not been thoroughly examined through a systematic review and meta-analysis in recent years. A systematic review and meta-analysis were conducted to compare the diagnostic accuracy of Bp-MRI and Mp-MRI for detecting CsPCa by assessing the databases MEDLINE/PubMed, CENTRAL Cochrane, and ClinicalTrials.gov. Studies published between 2012 and 2024 that compared Bp-MRI and Mp-MRI using histopathological analysis as the reference standard were included. Data were extracted to obtain diagnostic test accuracy measurements (sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) and study characteristics. Statistical analysis involved two bivariate random-effects models, a summary Receiver Operating Characteristic (sROC) curve, and meta-regression models assessing the comparison of both diagnostic test accuracies and the interaction of different study-level covariates. Nineteen studies involving 5,173 patients were included. Mp-MRI demonstrated a pooled sensitivity of 0.90 (95% CI: 0.87–0.93) and a specificity of 0.64 (95% CI: 0.50–0.76), while Bp-MRI showed a pooled sensitivity of 0.89 (95% CI: 0.85–0.92) and a specificity of 0.73 (95% CI: 0.62–0.82). Both modalities showed similar diagnostic performance with overlapping sROC curves. Meta-regression revealed no statistically significant difference between the two tools, and the study-level covariates did not influence the results. Bp-MRI is a viable alternative to Mp-MRI for detecting CsPCa, with comparable diagnostic accuracy, especially when contrast agents are a concern. Further prospective randomized studies are needed to confirm these findings. PROSPERO (CRD42024552125).","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"28 4","pages":"993-1004"},"PeriodicalIF":5.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-21DOI: 10.1038/s41391-025-01002-6
Eric V. Li, Ashley E. Ross, Hiten D. Patel
{"title":"Re: Prostate MRI and clinicopathologic risk calculator to predict laterality of extraprostatic extension at radical prostatectomy","authors":"Eric V. Li, Ashley E. Ross, Hiten D. Patel","doi":"10.1038/s41391-025-01002-6","DOIUrl":"10.1038/s41391-025-01002-6","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"28 4","pages":"1020-1020"},"PeriodicalIF":5.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/objectives: Recent advances in prostate cancer management have improved overall survival and quality of life for those afflicted. However, these patients continue to suffer from a high burden of cardiovascular disease through a variety of mechanisms, including both the cancer itself as well as prostate cancer-specific treatments.
Subjects/methods: Cardiovascular disease is now the leading cause of death in this population, and current data suggests that many patients remain sub-optimally controlled from a risk factor standpoint. There is a lack of consensus and standardized guidelines on cardiovascular risk stratification and specific management strategies in the urology, medical oncology, radiation oncology, and primary care settings.
Results/conclusions: We review available literature and provide a cardiovascular risk stratification schema for prostate cancer patients that clinicians in each of these settings can utilize. We also highlight a shared decision-making model, consistent risk restratification, and social determinants of health as care priorities to optimize cardiovascular health for this at-risk population.
{"title":"Cardiovascular risks in men with prostate cancer: a pragmatic, clinician-oriented review of risk stratification and management strategies.","authors":"Aditya Bhave, Harikrishnan Hyma Kunhiraman, Tarek Nahle, Ritu Reddy, Omar Makram, Priyanshu Nain, Viraj Shah, Umang Swami, Sagar A Patel, Ashanda Esdaille, Martha Terris, Avirup Guha","doi":"10.1038/s41391-025-00998-1","DOIUrl":"https://doi.org/10.1038/s41391-025-00998-1","url":null,"abstract":"<p><strong>Background/objectives: </strong>Recent advances in prostate cancer management have improved overall survival and quality of life for those afflicted. However, these patients continue to suffer from a high burden of cardiovascular disease through a variety of mechanisms, including both the cancer itself as well as prostate cancer-specific treatments.</p><p><strong>Subjects/methods: </strong>Cardiovascular disease is now the leading cause of death in this population, and current data suggests that many patients remain sub-optimally controlled from a risk factor standpoint. There is a lack of consensus and standardized guidelines on cardiovascular risk stratification and specific management strategies in the urology, medical oncology, radiation oncology, and primary care settings.</p><p><strong>Results/conclusions: </strong>We review available literature and provide a cardiovascular risk stratification schema for prostate cancer patients that clinicians in each of these settings can utilize. We also highlight a shared decision-making model, consistent risk restratification, and social determinants of health as care priorities to optimize cardiovascular health for this at-risk population.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-08DOI: 10.1038/s41391-025-00996-3
Hazem Elmansy, Saud Alhelal, Oksana Blahitko, Ryan Kelly, Amr Hodhod, Ruba Abdul Hadi, Husain Alaradi, Khaled Alotaibi, Ahmed Mousa, Ahmed S. Zakaria
We aimed to compare intraoperative and one-year postoperative outcomes of patients treated for benign prostatic hyperplasia (BPH) with holmium laser enucleation of the prostate using MOSESTM technology (M-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP). We included 104 patients who underwent M-HoLEP or ThuFLEP between June 2022 and January 2024 in this randomized controlled trial. Patients’ preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes were analyzed over the 12-month follow-up period. Fifty-two patients underwent M-HoLEP, and 52 were managed with ThuFLEP. There were no statistically significant differences in the preoperative characteristics between the groups. M-HoLEP had a shorter median enucleation time (50 vs. 57.5 minutes, p < 0.001) and demonstrated significantly higher enucleation efficiency than ThuFLEP (1.97 vs. 1.49 g/min, p < 0.001). Significant differences were observed favoring M-HoLEP regarding continuous bladder irrigation time, hematuria scale, duration of postoperative hematuria, catheterization time, and hospital stay. Approximately 30.8% of ThuFLEP patients were admitted with immediate postoperative hematuria versus 7.7% in the M-HoLEP group, p = 0.003). The postoperative outcomes were comparable between the cohorts up to 12 months. Thulium fiber laser (TFL) and MOSESTM technology achieved satisfactory intraoperative and postoperative functional outcomes in endoscopic enucleation of the prostate. However, MOSESTM technology demonstrated superior results in terms of enucleation time and efficiency, catheterization time, and hospital stay. M-HoLEP facilitates same-day trial-of-void and reduces postoperative hospital admissions.
背景：我们的目的是比较MOSESTM技术（M-HoLEP）和铥纤维激光前列腺去核（ThuFLEP）治疗良性前列腺增生（BPH）患者术中和术后一年的结果。方法：在这项随机对照试验中，我们纳入了104名在2022年6月至2024年1月期间接受M-HoLEP或ThuFLEP治疗的患者。评估患者术前和前列腺数据。在12个月的随访期间分析术中数据和围手术期结果。结果：M-HoLEP治疗52例，ThuFLEP治疗52例。两组术前特征差异无统计学意义。M-HoLEP的中位去核时间较短（50 vs. 57.5分钟），p结论：铥光纤激光（TFL）和MOSESTM技术在内镜下前列腺去核术中及术后均获得满意的功能结果。然而，MOSESTM技术在去核时间和效率、置管时间和住院时间方面表现出优越的结果。M-HoLEP促进当日无效试验，减少术后住院。
{"title":"Thulium fiber laser versus holmium MOSESTM laser enucleation of the prostate for the treatment of benign prostatic hyperplasia: a randomized prospective clinical study","authors":"Hazem Elmansy, Saud Alhelal, Oksana Blahitko, Ryan Kelly, Amr Hodhod, Ruba Abdul Hadi, Husain Alaradi, Khaled Alotaibi, Ahmed Mousa, Ahmed S. Zakaria","doi":"10.1038/s41391-025-00996-3","DOIUrl":"10.1038/s41391-025-00996-3","url":null,"abstract":"We aimed to compare intraoperative and one-year postoperative outcomes of patients treated for benign prostatic hyperplasia (BPH) with holmium laser enucleation of the prostate using MOSESTM technology (M-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP). We included 104 patients who underwent M-HoLEP or ThuFLEP between June 2022 and January 2024 in this randomized controlled trial. Patients’ preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes were analyzed over the 12-month follow-up period. Fifty-two patients underwent M-HoLEP, and 52 were managed with ThuFLEP. There were no statistically significant differences in the preoperative characteristics between the groups. M-HoLEP had a shorter median enucleation time (50 vs. 57.5 minutes, p < 0.001) and demonstrated significantly higher enucleation efficiency than ThuFLEP (1.97 vs. 1.49 g/min, p < 0.001). Significant differences were observed favoring M-HoLEP regarding continuous bladder irrigation time, hematuria scale, duration of postoperative hematuria, catheterization time, and hospital stay. Approximately 30.8% of ThuFLEP patients were admitted with immediate postoperative hematuria versus 7.7% in the M-HoLEP group, p = 0.003). The postoperative outcomes were comparable between the cohorts up to 12 months. Thulium fiber laser (TFL) and MOSESTM technology achieved satisfactory intraoperative and postoperative functional outcomes in endoscopic enucleation of the prostate. However, MOSESTM technology demonstrated superior results in terms of enucleation time and efficiency, catheterization time, and hospital stay. M-HoLEP facilitates same-day trial-of-void and reduces postoperative hospital admissions.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"152-158"},"PeriodicalIF":5.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-04DOI: 10.1038/s41391-025-00995-4
Nadine A. Friedrich, Jessica L. Janes, Joshua Parrish, Amanda M. De Hoedt, Janis Pruett, Mark Fallick, Raj Gandhi, Agnes Hong, Nicholas P. Tatonetti, Stephen J. Freedland
For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1 L) systemic treatment. However, some patients receive ADT alone, leading to tumor progression requiring 2nd line therapy. Despite racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1 L ADT. We performed a retrospective population-level analysis to assess the association between race and time to subsequent treatment after ADT in the Veterans Affairs Health Care System. Primary outcome was time from ADT monotherapy to subsequent treatment, defined as receipt of androgen receptor pathway inhibitor (ARPI), non-steroidal first-generation anti-androgen (NSAA), chemotherapy, or other treatments. We used Cox competing risks models and Kaplan-Meier (KM) analyses to estimate subsequent treatment rates by Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic and Other patients, adjusted for baseline covariates. From 2001–2021, 141,495 PC patients received ADT alone. During median (IQR) follow-up of 51.1 (22.8, 97.2) months, 28,144 patients (20%) had subsequent treatment: 11,319 (40%) ARPIs, 12,990 (46%) NSAAs, 3402 (12%) chemotherapy and 433 (2%) other 2nd line therapies. NHB had significantly lower subsequent treatment rates (HR = 0.82, 95% CI = 0.80–0.85) vs. NHW. Both Hispanic (HR = 0.93, 95%CI = 0.88–0.98) and Other men (HR = 0.91, 95%CI = 0.84–0.98), also had lower subsequent treatment rates. When stratified by age, associations between race/ethnicity and time to subsequent treatment were stronger in younger patients. All races examined had significantly lower rates of subsequent treatment after 1 L ADT relative to NHW, especially in younger patients. Further investigation is needed to determine if these lower rates of subsequent treatment reflect lower rate of progression or undertreatment of progressing patients.
{"title":"Assessing racial differences in time to subsequent treatment following androgen deprivation therapy among Veterans with prostate cancer","authors":"Nadine A. Friedrich, Jessica L. Janes, Joshua Parrish, Amanda M. De Hoedt, Janis Pruett, Mark Fallick, Raj Gandhi, Agnes Hong, Nicholas P. Tatonetti, Stephen J. Freedland","doi":"10.1038/s41391-025-00995-4","DOIUrl":"10.1038/s41391-025-00995-4","url":null,"abstract":"For metastatic and certain advanced prostate cancer (PC), guidelines support intensified androgen deprivation therapy (ADT) as first-line (1 L) systemic treatment. However, some patients receive ADT alone, leading to tumor progression requiring 2nd line therapy. Despite racial disparities in PC outcomes, there are no population-level studies assessing racial differences in time to subsequent treatment after 1 L ADT. We performed a retrospective population-level analysis to assess the association between race and time to subsequent treatment after ADT in the Veterans Affairs Health Care System. Primary outcome was time from ADT monotherapy to subsequent treatment, defined as receipt of androgen receptor pathway inhibitor (ARPI), non-steroidal first-generation anti-androgen (NSAA), chemotherapy, or other treatments. We used Cox competing risks models and Kaplan-Meier (KM) analyses to estimate subsequent treatment rates by Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic and Other patients, adjusted for baseline covariates. From 2001–2021, 141,495 PC patients received ADT alone. During median (IQR) follow-up of 51.1 (22.8, 97.2) months, 28,144 patients (20%) had subsequent treatment: 11,319 (40%) ARPIs, 12,990 (46%) NSAAs, 3402 (12%) chemotherapy and 433 (2%) other 2nd line therapies. NHB had significantly lower subsequent treatment rates (HR = 0.82, 95% CI = 0.80–0.85) vs. NHW. Both Hispanic (HR = 0.93, 95%CI = 0.88–0.98) and Other men (HR = 0.91, 95%CI = 0.84–0.98), also had lower subsequent treatment rates. When stratified by age, associations between race/ethnicity and time to subsequent treatment were stronger in younger patients. All races examined had significantly lower rates of subsequent treatment after 1 L ADT relative to NHW, especially in younger patients. Further investigation is needed to determine if these lower rates of subsequent treatment reflect lower rate of progression or undertreatment of progressing patients.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 1","pages":"103-110"},"PeriodicalIF":5.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41391-025-00995-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-26DOI: 10.1038/s41391-025-00993-6
Hailin Yang, Xuhen Liu, Ju Guo
{"title":"Integrating clinical and public health perspectives on statin use and prostate cancer risk: addressing key limitations and future directions","authors":"Hailin Yang, Xuhen Liu, Ju Guo","doi":"10.1038/s41391-025-00993-6","DOIUrl":"10.1038/s41391-025-00993-6","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"28 4","pages":"1019-1019"},"PeriodicalIF":5.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-21DOI: 10.1038/s41391-025-00994-5
Mayuko Kanayama, Emeline Colomba, Yusra Shao, Sarah M Nielsen, Edward D Esplin, Changxue Lu, William B Isaacs, John C Henegan, Elisabeth I Heath, Jun Luo, Régine Marlin, Emmanuel S Antonarakis
Background: Recently, a germline HOXB13 variant, X285K was identified as a risk factor for prostate cancer in men of African ancestry. While this variant is likely associated with more aggressive prostate cancer, there has not yet been an in-depth clinical description of individual patients carrying this variant and their response to systemic therapies.
Methods: We studied six cases of germline X285K carriers with metastatic hormone-sensitive prostate cancer to characterize their hormonal sensitivity or resistance.
Conclusions: Longitudinal outcome analysis indicates that patients carrying X285K generally show favorable responses to therapies targeting the androgen receptor (AR), a finding that requires confirmation.
{"title":"Case series exploring hormonal sensitivity in prostate cancer patients harboring the germline African-ancestry HOXB13 X285K variant.","authors":"Mayuko Kanayama, Emeline Colomba, Yusra Shao, Sarah M Nielsen, Edward D Esplin, Changxue Lu, William B Isaacs, John C Henegan, Elisabeth I Heath, Jun Luo, Régine Marlin, Emmanuel S Antonarakis","doi":"10.1038/s41391-025-00994-5","DOIUrl":"10.1038/s41391-025-00994-5","url":null,"abstract":"<p><strong>Background: </strong>Recently, a germline HOXB13 variant, X285K was identified as a risk factor for prostate cancer in men of African ancestry. While this variant is likely associated with more aggressive prostate cancer, there has not yet been an in-depth clinical description of individual patients carrying this variant and their response to systemic therapies.</p><p><strong>Methods: </strong>We studied six cases of germline X285K carriers with metastatic hormone-sensitive prostate cancer to characterize their hormonal sensitivity or resistance.</p><p><strong>Conclusions: </strong>Longitudinal outcome analysis indicates that patients carrying X285K generally show favorable responses to therapies targeting the androgen receptor (AR), a finding that requires confirmation.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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