Prostate International最新文献

Comparisons of three scoring systems based on biparametric magnetic resonance imaging for prediction of clinically significant prostate cancer 基于双参数磁共振成像的三种评分系统在预测具有临床意义的前列腺癌方面的比较

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.08.002

Wei Li , Haibing Xu , Wenwen Shang, Guohui Hong

Purpose

In this study, we aimed to validate and compare three scoring systems based on biparametric magnetic resonance imaging (bpMRI) for the detection of clinically significant prostate cancer (csPCa) in biopsy-naïve patients.

Method

In this study, we included patients who underwent MRI examinations between January 2018 and December 2022, with MRI-targeted fusion biopsy (MRGB) as the reference standard. The MRI findings were categorized using three bpMRI-based scorings, in all of them the diffusion-weighted imaging (DWI) was the dominant sequence for peripheral zone (PZ) and T2-weighed imaging (T2WI) was the dominant sequence for transition zone (TZ). We also used the Prostate Imaging Reporting and Data System version (PI-RADS) v2.1 to evaluate each lesion. For each scoring, we calculated the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the receiver operating characteristic (ROC) curves (AUC).

Results

The calculated AUC for three bpMRI-based scorings were 83.2% (95% CI 78.8%–87.6%), 85.0% (95% CI 80.8%–89.3%), 82.9% (95% CI 78.4%–87.5%), and 86.0% (95% CI 81.8%–90.1%), respectively. Scoring 2 exhibited significantly superior performance than scoring 1 (P = 0.01) and scoring 3 (P < 0.001). Moreover, the accuracy of scoring 2 was not decreased significantly as compared to PI-RADS v2.1 (P = 0.05). There was no significant difference between 3 bpMRI-based scorings and with PI-RADS in TZ. However, although scoring 2 yielded the highest AUC, it was still notably inferior to PI-RADS (P = 0.02).

Conclusion

All three bpMRI-based scorings demonstrated favorite diagnostic accuracy, and scoring 2 performed significantly better than the other two bpMRI-based scorings. Notably, scoring 2 was not significantly inferior to the full-sequence PI-RADS v2.1 in terms of sensitivity and specificity.

在这项研究中，我们旨在验证和比较三种基于双参数磁共振成像（bpMRI）的评分系统，用于检测活检无效患者中具有临床意义的前列腺癌（csPCa）。在这项研究中，我们纳入了在2018年1月至2022年12月期间接受磁共振成像检查的患者，并以磁共振成像靶向融合活检（MRGB）作为参考标准。核磁共振成像结果采用基于bpMRI的三种评分方法进行分类，其中扩散加权成像（DWI）是外周区（PZ）的主要序列，T2加权成像（T2WI）是过渡区（TZ）的主要序列。我们还使用前列腺成像报告和数据系统版本（PI-RADS）v2.1 对每个病灶进行评估。我们计算了每种评分的敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）和接收者操作特征曲线（ROC）下面积（AUC）。计算得出的基于 bpMRI 的三种评分的 AUC 分别为 83.2%（95% CI 78.8%-87.6%）、85.0%（95% CI 80.8%-89.3%）、82.9%（95% CI 78.4%-87.5%）和 86.0%（95% CI 81.8%-90.1%）。评分 2 的表现明显优于评分 1 ( = 0.01) 和评分 3 ( < 0.001)。此外，与 PI-RADS v2.1 相比，评分 2 的准确性也没有明显下降（= 0.05）。基于 bpMRI 的 3 种评分与 PI-RADS 在 TZ 方面没有明显差异。不过，虽然评分 2 的 AUC 最高，但仍明显低于 PI-RADS（= 0.02）。所有三种基于 bpMRI 的评分都显示出最理想的诊断准确性，而评分 2 的表现明显优于其他两种基于 bpMRI 的评分。值得注意的是，就敏感性和特异性而言，评分 2 并不比全序列 PI-RADS v2.1 差。

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引用次数: 0

Whole gland versus partial gland ablation in patients with localized prostate cancer treated by high-intensity focused ultrasound ablation 高强度聚焦超声消融治疗局限性前列腺癌患者的全腺体与部分腺体消融比较。

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.09.001

Hae Sung Lee , Sang Hun Song , Hakmin Lee , Sung Kyu Hong

Background

Focal therapy is considered one of the treatment options for localized prostate cancer (PCa), particularly for low or very-low-risk patients. In this study, we compared the mid-term oncological outcomes in localized PCa patients treated with high-intensity focused ultrasound (HIFU).

Methods

We retrospectively analyzed 237 patients who underwent HIFU for localized PCa. Patients were divided into two groups based on ablation type: whole gland ablation (WGA) and partial gland ablation (PGA). Follow-up biopsies were performed after one year postoperatively, and the oncological outcomes were compared between the groups.

Results

Among the total of 237 patients, 54 subjects were treated by WGA and 183 subjects by PGA. After one year postoperatively, follow-up biopsies were conducted on 199 patients, revealing residual cancer in 21.4% of WGA group and 15.3% of PGA group. Additionally, clinically significant (CS) cancer was observed in 14.3% of WGA group and 8.3% of PGA group. Survival analyses revealed significantly longer failure-free (P < 0.001) and salvage-free survival (P < 0.001) in WGA group than in PGA group. Similarly, in the intermediate—high risk group, WGA group exhibited longer failure-free (P = 0.005) and salvage-free survival (P < 0.001).

Conclusion

HIFU was performed with acceptable oncological outcomes in localized PCa. Despite higher proportion of high-risk patients in WGA group, WGA was associated with significantly better failure-free survival and salvage-free survival. Further prospective and multi-center studies are warranted.

背景：局灶性治疗被认为是局部前列腺癌（PCa）的治疗选择之一，特别是对于低或极低风险的患者。在这项研究中，我们比较了局部PCa患者接受高强度聚焦超声（HIFU）治疗的中期肿瘤学结果。方法：回顾性分析237例行HIFU治疗局限性PCa的患者。根据消融类型将患者分为全腺体消融（WGA）和部分腺体消融（PGA）两组。术后1年随访活检，比较两组肿瘤预后。结果：237例患者中，WGA治疗54例，PGA治疗183例。术后1年随访活检199例，WGA组残留癌21.4%，PGA组残留癌15.3%。此外，14.3%的WGA组和8.3%的PGA组出现临床显著性（CS）癌。生存分析显示无故障生存期明显延长（P P P = 0.005），无抢救生存期明显延长(P结论：HIFU治疗局部前列腺癌具有可接受的肿瘤预后。尽管WGA组高危患者比例较高，但WGA组的无衰竭生存期和无抢救生存期明显较好。进一步的前瞻性和多中心研究是必要的。

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引用次数: 0

Comparing the efficacy of tadalafil and tamsulosin for managing erectile dysfunction and lower urinary tract symptoms in prostate brachytherapy patients: a prospective study 比较他达拉非和坦索罗辛对前列腺近距离放射治疗患者勃起功能障碍和下尿路症状的疗效：一项前瞻性研究

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.09.004

Nozomi Hayakawa , Ryuichi Mizuno , Tomoki Tanaka , Yutaka Shiraishi , Kazuhiro Matsumoto , Takeo Kosaka , Eiji Kikuchi , Mototsugu Oya

Introduction

Adverse events, such as erectile dysfunction (ED) and lower urinary tract symptoms (LUTS), are significant concerns in prostate cancer (PCa) patients treated with Iodine 125 (I-125) low-dose rate (LDR) prostate brachytherapy (PB). Alpha antagonists and phosphodiesterase-5 inhibitors are used to manage these events. The present study compared the efficacy of low-dose tadalafil with that of tamsulosin for concomitant ED and LUTS in PCa patients treated with I-125 LDR PB.

Materials and methods

One hundred and seventeen patients who received PB for low- or intermediate-risk localized PCa were analyzed. They were randomized into two groups, one receiving tamsulosin (N = 58) and the other receiving low-dose tadalafil (N = 59) immediately after PB. Sexual and urinary functions were assessed at various time points post-PB using questionnaires and objective measurements. The primary endpoint was sexual function measured by the International Index of Erectile Function-15 (IIEF-15) EF domain scores 6 months after PB. Secondary endpoints were sexual function measured by total IIEF-15 scores and Erection Hardness Scores 6 months after PB. The exploratory endpoint was the LUTS status 6 months after PB.

Results

No significant differences were observed in baseline characteristics between the two groups. Tadalafil exerted stronger effects on sexual function, particularly erection hardness, than tamsulosin. No significant differences were observed in the management of LUTS between both treatments.

Conclusion

Low-dose tadalafil and tamsulosin may manage LUTS equally after PB. Low-dose tadalafil may contribute to the maintenance of erectile function, particularly erection hardness, after PB; therefore, it is a viable option for patients with baseline erectile function.

不良事件，如勃起功能障碍（ED）和下尿路症状（LUTS），是前列腺癌（PCa）患者接受碘125 （I-125）低剂量率（LDR）前列腺近距离放射治疗（PB）的重要关注点。α拮抗剂和磷酸二酯酶-5抑制剂用于控制这些事件。本研究比较了低剂量他达拉非与坦索罗辛对I-125 LDR PB治疗PCa患者伴发ED和LUTS的疗效。材料与方法：对117例低危或中危局限性PCa患者行PB治疗的资料进行分析。随机分为两组，一组在术后立即给予坦索罗辛治疗（N = 58），另一组给予低剂量他达拉非治疗（N = 59）。通过问卷调查和客观测量在pb后的不同时间点评估性功能和泌尿功能。主要终点是通过国际勃起功能指数-15 (IIEF-15) EF域评分在PB后6个月测量性功能。次要终点是在PB后6个月通过IIEF-15总分和勃起硬度评分测量性功能。探索性终点是PB后6个月的LUTS状态。结果：两组患者的基线特征无显著差异。他达拉非对性功能，尤其是勃起硬度的影响比坦索罗辛更强。两种治疗方法对LUTS的处理无显著差异。结论：小剂量他达拉非与坦索罗辛对PB后LUTS的治疗效果相同。低剂量他达拉非可能有助于PB后勃起功能的维持，特别是勃起硬度；因此，对于有基线勃起功能的患者，它是一个可行的选择。

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引用次数: 0

Safety and efficacy of extracorporeal shockwave therapy on chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized, double-blind, placebo-controlled study 体外冲击波疗法对慢性前列腺炎/慢性盆腔疼痛综合征的安全性和有效性：前瞻性、随机、双盲、安慰剂对照研究

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.06.003

Kyung Jae Hur , Woong Jin Bae , U-Syn Ha , Soomin Kim , JunJie Piao , Kyung-Hwa Jeon , Cheong Woon Cheon , Dae Up Kang , Jong Woong Lee , Dongho Shin , Sae Woong Kim

Purpose

This study aimed to investigate the efficacy and safety of extracorporeal shock wave therapy (ESWT) over an 8-week period in individuals diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) compared to a control group.

Materials and methods

This prospective, double-blind, placebo-controlled study enrolled 46 participants diagnosed with CP/CPPS, who were randomly assigned to either the treatment group or the control group in a 2:1 ratio. In the treatment group, ESWT was administered at the perineum once a week for 8 weeks. CP/CPPS-related symptoms were assessed using the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH–CPSI). Pain and erectile function were measured using the Visual Analogue Scale (VAS) and the International Index of Erectile Function-Erectile Function (IIEF-EF).

Results

The primary efficacy assessment variable, the change in NIH–CPSI total score at 4 weeks after the end of the 8-week treatment compared to baseline, was significantly improved (P = 0.0225) in the treatment group (−11.27 ± 8.39) compared to the control group (−5.44 ± 5.73). Regarding the secondary efficacy assessment variables, the treatment group showed significant decreases compared to the control group in change in NIH–CPSI total score (P = 0.0055) at the end of the 8-week treatment compared to baseline, along with significant decreases in pain and quality of life scores, as well as VAS assessments at the end of the 8-week treatment and 4 weeks after the end of treatment (P < 0.05). Moreover, in the evaluation conducted to assess improvement in sexual function, the treatment group showed a significant increase compared to baseline than the control group in the IIEF total score at 4 weeks after the end of the treatment (P = 0.0364). No patients experienced severe side effects related to ESWT during the therapeutic period or the follow-up duration.

Conclusions

The efficacy assessment in this clinical trial indicates that extracorporeal shock wave therapy is expected to have a symptomic improvement effect on CP/CPPS.

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引用次数: 0

Cardiovascular risks of Asian patients on androgen-receptor-targeted agents for prostate cancer: a systematic review and meta-analysis 使用雄激素受体靶向药物治疗前列腺癌的亚洲患者的心血管风险：系统回顾和荟萃分析

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.07.004

Lin Kyaw , Qi Y. Lim , Yu X.T. Law , Chloe S.H. Ong , Wei T. Loke , Edmund Chiong , Ho Y. Tiong

Background

Prostate cancer is now one of the most prevalent cancers in men in Asia. As the average life expectancy of Asian males with prostate cancer increases with the availability of treatment options, the possible risk of cardiac-related adverse effects arising from androgen-receptor-targeted agents (ARTAs) may be increased due to the greater exposure. We aim to perform a meta-analysis on the incidence of cardiac-related adverse events in Asian patients with prostate cancer treated with ARTAs.

Materials and methods

Databases were thoroughly searched for relevant articles. The Patient Intervention Comparison Outcome Study type model was used to frame our clinical question, and 2 independent authors went through several rounds of screening to select the final included studies. A meta-analysis was conducted using the Cochran–Mantel–Haenszel method. Quality assessment was carried out with the Cochrane risk-of-bias tool RoB 2.

Results

Seven randomized controlled trials were included for the final meta-analysis. Use of ARTA in Asian men did not show any significant increase in the total number of cardiac-related adverse events (risk ratio [RR]: 1.66 [0.84–3.26], p = 0.14). However, there was increase in incidence of hypertension (RR: 2.30 [1.41–3.73], p = 0.0008) and hypertension crises (RR: 16.87 [2.13–133.34], p = 0.007). A subgroup analysis of the type of ARTA used showed enzalutamide having the highest risk of hypertension (RR: 5.86 [2.10–16.38], p = 0.0008).

Conclusion

:Although ARTAs did not show any significant increase in incidence of cardiac-related adverse events, there is an increased risk of hypertension especially with the use of enzalutamide. With this knowledge, closer blood pressure monitoring is needed for patients started on ARTA, especially enzalutamide.

前列腺癌是目前亚洲男性发病率最高的癌症之一。随着亚洲男性前列腺癌患者平均寿命的延长，治疗方法的增多，雄激素受体靶向药物（ARTAs）可能引起心脏相关不良反应的风险也会随之增加。我们旨在对接受 ARTAs 治疗的亚洲前列腺癌患者心脏相关不良事件的发生率进行荟萃分析。我们在数据库中彻底搜索了相关文章。两位独立作者经过多轮筛选，选出了最终纳入的研究。采用 Cochran-Mantel-Haenszel 方法进行了荟萃分析。最终的荟萃分析纳入了 7 项随机对照试验。在亚洲男性中使用 ARTA 并未显示心脏相关不良事件的总数有任何显著增加（风险比 [RR]：1.66 [0.84-3.26]，P = 0.14）。然而，高血压（RR：2.30 [1.41-3.73]，P = 0.0008）和高血压危象（RR：16.87 [2.13-133.34]，P = 0.007）的发生率有所增加。对所用 ARTA 类型进行的亚组分析显示，恩杂鲁胺的高血压风险最高（RR：5.86 [2.10-16.38]，p = 0.0008）。虽然ARTA在心脏相关不良事件的发生率方面没有明显增加，但高血压的风险会增加，尤其是使用恩杂鲁胺时。有鉴于此，开始使用ARTA（尤其是恩扎鲁胺）的患者需要更密切地监测血压。

{"title":"Cardiovascular risks of Asian patients on androgen-receptor-targeted agents for prostate cancer: a systematic review and meta-analysis","authors":"Lin Kyaw , Qi Y. Lim , Yu X.T. Law , Chloe S.H. Ong , Wei T. Loke , Edmund Chiong , Ho Y. Tiong","doi":"10.1016/j.prnil.2024.07.004","DOIUrl":"10.1016/j.prnil.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Prostate cancer is now one of the most prevalent cancers in men in Asia. As the average life expectancy of Asian males with prostate cancer increases with the availability of treatment options, the possible risk of cardiac-related adverse effects arising from androgen-receptor-targeted agents (ARTAs) may be increased due to the greater exposure. We aim to perform a meta-analysis on the incidence of cardiac-related adverse events in Asian patients with prostate cancer treated with ARTAs.</div></div><div><h3>Materials and methods</h3><div>Databases were thoroughly searched for relevant articles. The Patient Intervention Comparison Outcome Study type model was used to frame our clinical question, and 2 independent authors went through several rounds of screening to select the final included studies. A meta-analysis was conducted using the Cochran–Mantel–Haenszel method. Quality assessment was carried out with the Cochrane risk-of-bias tool RoB 2.</div></div><div><h3>Results</h3><div>Seven randomized controlled trials were included for the final meta-analysis. Use of ARTA in Asian men did not show any significant increase in the total number of cardiac-related adverse events (risk ratio [RR]: 1.66 [0.84–3.26], p = 0.14). However, there was increase in incidence of hypertension (RR: 2.30 [1.41–3.73], p = 0.0008) and hypertension crises (RR: 16.87 [2.13–133.34], p = 0.007). A subgroup analysis of the type of ARTA used showed enzalutamide having the highest risk of hypertension (RR: 5.86 [2.10–16.38], p = 0.0008).</div></div><div><h3>Conclusion</h3><div>:Although ARTAs did not show any significant increase in incidence of cardiac-related adverse events, there is an increased risk of hypertension especially with the use of enzalutamide. With this knowledge, closer blood pressure monitoring is needed for patients started on ARTA, especially enzalutamide.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 4","pages":"Pages 186-194"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189099","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}

引用次数: 0

The association between behavioral habits and physical health status in prostate cancer patients: a large US national health-related survey 前列腺癌患者的行为习惯与身体健康状况之间的关系：一项大型美国全国健康相关调查

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.08.001

Chang-Rong Chen , Logan Briggs , Mara Koelker , Benjamin V. Stone , Khalid Alkhatib , Muhieddine Labban , Alberto Briganti , Francesco Montorsi , Giorgio Gandaglia , Quoc-Dien Trinh

Background

The impact of behavioral habits such as exercise on the physical health of prostate cancer (PCa) patients is poorly understood. We aimed to investigate PCa patients' exercise habits and the association between exercise and self-reported physical health status.

Methods

The 2016–2020 Behavioral Risk Factor Surveillance System (BRFSS) databases were used to identify men with a history of PCa. We identified patients with self-reported PCa diagnosis and excluded the non-male gender respondents in the self-reported PCa patients. We performed descriptive statistics and multivariable logistic regression analysis examining the association between exercise and poor physical health status. Our exposure of interest was the amount of physical exercise, and primary outcome was poor physical health status, defined as >14 self-reported days per month when patients felt “physical health is not good.” Covariates included age, body mass index (BMI), income, treatment, smoking, and exercise frequency.

Results

From 2,193,981 weighted survey participants, we identified 3,952 men with a history of PCa. Of these, 75% of participants reported exercise within the last month. In adjusted analyses among men with a history of PCa, exercise (OR 0.50, 95% CI 0.40–0.64, P < 0.001) was associated with lower odds of poor physical health status. Other independent predictors of poor physical health included income (High: OR 0.27, 95% CI 0.18–0.41, P < 0.01), BMI (underweight: OR 3.78, 95% CI 1.38–10.37, P = 0.01), treatment status (Active: OR 1.76, 95% CI 1.05–2.94, P = 0.03), smoking status (Active: OR 1.64, 95% CI 1.13–2.38, P = 0.01).

Conclusion

Our BRFSS cross-sectional study concluded that exercise among men with a history of PCa, even once per month, is associated with decreased odds of self-reported poor physical health; therefore, exercise programs should be considered for sedentary PCa patients.

人们对锻炼等行为习惯对前列腺癌（PCa）患者身体健康的影响知之甚少。我们旨在调查 PCa 患者的运动习惯以及运动与自我报告的身体健康状况之间的关联。我们使用 2016-2020 年行为危险因素监测系统（BRFSS）数据库来识别有 PCa 病史的男性。我们确定了自我报告的 PCa 诊断患者，并排除了自我报告的 PCa 患者中的非男性性别受访者。我们对运动与不良身体健康状况之间的关系进行了描述性统计和多变量逻辑回归分析。我们所关注的暴露因素是运动量，主要结果是身体健康状况差，即患者自述每月感觉 "身体健康状况不佳 "的天数大于 14 天。协变量包括年龄、体重指数（BMI）、收入、治疗、吸烟和运动频率。从 2,193,981 名加权调查参与者中，我们发现了 3,952 名有 PCa 病史的男性。其中，75% 的参与者表示在最近一个月内进行过锻炼。在对有 PCa 病史的男性进行的调整分析中，运动（OR 0.50，95% CI 0.40-0.64，< 0.001）与身体健康状况较差的几率较低有关。身体健康状况差的其他独立预测因素包括收入（高：OR 0.27，95% CI 0.18-0.41，<0.01）、体重指数（体重不足：OR 3.78，95% CI 1.38-10.37，=0.01）、治疗状态（活跃：OR 1.76，95% CI 1.05-2.94，=0.03）、吸烟状态（活跃：OR 1.64，95% CI 1.13-2.38，=0.01）。我们的BRFSS横断面研究得出结论：有PCa病史的男性即使每月锻炼一次，也会降低自我报告的身体健康状况不良的几率；因此，久坐不动的PCa患者应考虑参加锻炼计划。

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引用次数: 0

Effects of bladder neck sparing on continence outcomes of robotic-assisted radical prostatectomy: a systemic review and metaanalysis 保留膀胱颈对机器人辅助根治性前列腺切除术尿失禁疗效的影响：系统回顾与荟萃分析

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.04.004

Joongwon Choi , Yun-Jung Yang , Chung Un Lee , Jung Hoon Kim , Jin Wook Kim , Jong Hyun Tae , Se Young Choi , In Ho Chang , Eun-Jung Yang , Yong Seong Lee

Restoration of postoperative urinary continence after robot-assisted radical prostatectomy (RARP) is affected by diverse factors. We compared the pad-free and positive margin rates of patients who underwent RARP with or without bladder neck sparing (BNS) for prostate cancer. During this systematic review and metaanalysis, we performed an electronic search of the Web of Science, Embase, Cochrane Central Register of Controlled Trials, and PubMed to find original articles comparing RARP with and without BNS for prostate cancer. We identified six studies (2,351 patients in total) who underwent RARP with or without BNS. A metaanalysis of the pad-free rate at 3 months was performed. The overall pad-free rate at 3 months for patients who underwent RARP with BNS was significantly higher than that of patients who underwent RARP alone (control group) (odds ratio, 1.86; 95% confidence interval [CI], 1.22–2.82), with high heterogeneity (P = 0.005; I² = 67.45%). The pad-free rates at 7 days, 6 months, and 1 year and positive surgical margin rates of patients who underwent BNS were not significantly different than those in the control group. Although no statistical difference was observed, the catheterization period of the BNS group was shorter than that of the control group (standardized mean difference = −0.08; 95% CI, −0.16 to 0.01). Although RARP with BNS did not affect the long-term outcome of continence, it had a significant effect on the early recovery of continence.

机器人辅助前列腺癌根治术（RARP）术后恢复排尿受多种因素影响。我们比较了接受或未接受膀胱颈疏通术（BNS）的前列腺癌根治术患者的无尿垫率和阳性边缘率。在这项系统回顾和荟萃分析中，我们对 Web of Science、Embase、Cochrane Central Register of Controlled Trials 和 PubMed 进行了电子检索，以找到比较前列腺癌 RARP 有无 BNS 的原始文章。我们找到了六项研究（共 2351 名患者），这些患者接受了有无 BNS 的 RARP 治疗。我们对 3 个月的无衬垫率进行了荟萃分析。接受 RARP 和 BNS 治疗的患者 3 个月后的总无垫率明显高于单纯接受 RARP 治疗的患者（对照组）（几率比 1.86；95% 置信区间 [CI]，1.22-2.82），异质性较高（= 0.005；I = 67.45%）。接受 BNS 治疗的患者在 7 天、6 个月和 1 年后的无衬垫率以及手术切缘阳性率与对照组相比没有显著差异。虽然没有观察到统计学差异，但 BNS 组的导管插入时间比对照组短（标准化平均差异 = -0.08；95% CI，-0.16 至 0.01）。虽然使用 BNS 的 RARP 并不影响排尿的长期效果，但对排尿的早期恢复有显著影响。

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引用次数: 0

Weekly versus 2-weekly versus 3-weekly docetaxel to treat metastatic castration-resistant prostate cancer 每周、2周、3周多西他赛治疗转移性去势抵抗性前列腺癌。

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.09.002

Hyeong Dong Yuk , Miso Kim , Bhumsuk Keam , Ja Hyeon Ku , Cheol Kwak , Chang Wook Jeong

Background

To compare the efficacy and toxicity of docetaxel treatment regimens in metastatic castration-resistant prostate cancer (mCRPC).

Methods

We retrospectively analyzed 162 patients diagnosed with mCRPC who underwent docetaxel chemotherapy between 2009 and 2020. The patients were divided into three groups according to the dosage and interval of docetaxel (DCT) chemotherapy regimen: 30 mL/m² weekly, 50 mL/m² biweekly (every 2 weeks), and 75 mL/m² triweekly (every 3 weeks).

Results

There were no significant differences in the prostate-specific antigen (PSA) response rates (P = 0.709). The median time to progression was 3.0 [interquartile range (IQR 2.0–5.3)] months, 5.0 (IQR 2.0–13.0) months, and 5.0 (IQR 3.0–12.0) months in the weekly, biweekly, and triweekly groups, respectively (P = 0.062). The median overall survival (OS) was 12.5 (IQR 6.0–14.0) months, 18.8 (IQR 5.5–23.5) months, and 22.9 (IQR 11.0–33.0) months in the weekly, biweekly, and triweekly groups, respectively (P < 0.001). There were no differences in all toxicity and Grade 3 or higher toxicity. In Cox multivariate regression analysis, the Eastern Cooperative Oncology Group performance status (ECOG-PS), response to chemotherapy, and chemotherapy cycle also affected the PFS. Age, ECOG-PS, and chemotherapy cycle affected the OS.

Conclusions

The various options for optimal chemotherapy are indicated depending on the patient’s conditions during the diagnosis of mCRPC. Treatment with DCT at 2-week or even 1-week intervals appears to be well tolerated in men diagnosed with mCRPC and represents a useful option when the conventional triweekly regimen is not tolerated due to poor patient condition.

背景：比较多西紫杉醇治疗转移性去势抵抗性前列腺癌（mCRPC）的疗效和毒性。方法：回顾性分析2009年至2020年期间接受多西紫杉醇化疗的162例mCRPC患者。根据多西他赛（DCT）化疗方案的剂量和间隔时间将患者分为三组：每周30 mL/m2、每两周50 mL/m2（每2周）、每三周75 mL/m2（每3周）。结果：两组前列腺特异性抗原（PSA）应答率差异无统计学意义（P = 0.709）。两周治疗组、两周治疗组和三周治疗组的中位进展时间分别为3.0个月、5.0个月和5.0个月（IQR 3.0-12.0），差异有统计学意义（P = 0.062）。单周、双周和三周治疗组的中位总生存期（OS）分别为12.5 （IQR 6.0-14.0）个月、18.8 （IQR 5.5-23.5）个月和22.9 （IQR 11.0-33.0）个月。(P)结论：根据mCRPC诊断时患者的情况，有不同的最佳化疗方案。在诊断为mCRPC的男性中，间隔2周甚至1周的DCT治疗似乎耐受性良好，当常规的三周治疗方案因患者病情不佳而不能耐受时，DCT治疗是一种有用的选择。

{"title":"Weekly versus 2-weekly versus 3-weekly docetaxel to treat metastatic castration-resistant prostate cancer","authors":"Hyeong Dong Yuk , Miso Kim , Bhumsuk Keam , Ja Hyeon Ku , Cheol Kwak , Chang Wook Jeong","doi":"10.1016/j.prnil.2024.09.002","DOIUrl":"10.1016/j.prnil.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>To compare the efficacy and toxicity of docetaxel treatment regimens in metastatic castration-resistant prostate cancer (mCRPC).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 162 patients diagnosed with mCRPC who underwent docetaxel chemotherapy between 2009 and 2020. The patients were divided into three groups according to the dosage and interval of docetaxel (DCT) chemotherapy regimen: 30 mL/m<sup>2</sup> weekly, 50 mL/m<sup>2</sup> biweekly (every 2 weeks), and 75 mL/m<sup>2</sup> triweekly (every 3 weeks).</div></div><div><h3>Results</h3><div>There were no significant differences in the prostate-specific antigen (PSA) response rates (<em>P</em> = 0.709). The median time to progression was 3.0 [interquartile range (IQR 2.0–5.3)] months, 5.0 (IQR 2.0–13.0) months, and 5.0 (IQR 3.0–12.0) months in the weekly, biweekly, and triweekly groups, respectively (<em>P</em> = 0.062). The median overall survival (OS) was 12.5 (IQR 6.0–14.0) months, 18.8 (IQR 5.5–23.5) months, and 22.9 (IQR 11.0–33.0) months in the weekly, biweekly, and triweekly groups, respectively (<em>P</em> < 0.001). There were no differences in all toxicity and Grade 3 or higher toxicity. In Cox multivariate regression analysis, the Eastern Cooperative Oncology Group performance status (ECOG-PS), response to chemotherapy, and chemotherapy cycle also affected the PFS. Age, ECOG-PS, and chemotherapy cycle affected the OS.</div></div><div><h3>Conclusions</h3><div>The various options for optimal chemotherapy are indicated depending on the patient’s conditions during the diagnosis of mCRPC. Treatment with DCT at 2-week or even 1-week intervals appears to be well tolerated in men diagnosed with mCRPC and represents a useful option when the conventional triweekly regimen is not tolerated due to poor patient condition.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 4","pages":"Pages 219-223"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903059","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}

引用次数: 0

Oncological outcomes after radical prostatectomy of localized prostate cancer: stratified by magnetic resonance imaging and risk classification 局部前列腺癌根治性前列腺切除术后的肿瘤预后：磁共振成像分层和风险分类。

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-12-01 DOI: 10.1016/j.prnil.2024.09.003

Gyoohwan Jung , Byeongdo Song , Hyungwoo Ahn , Sung Il Hwang , Hak Jong Lee , Ki Young Huh , Sang Hun Song , Sangchul Lee , Seok-Soo Byun , Sung Kyu Hong

Background

We investigated whether combining T2-weighted magnetic resonance imaging (MRI) findings and clinical risk categories improves upon established prognostic indicators of oncological outcomes in prostate cancer.

Methods

Patients who underwent radical prostatectomy, but not preoperative hormone therapy, radiotherapy, or chemotherapy, for localized prostate cancer at Seoul National University Bundang Hospital from October 2007 to April 2016 were included. MRIs were classified according to the Prostate Imaging-Reporting and Data System (PI-RADS). Patients were divided into the following five groups: 1, no focal suspicious lesion; 2, organ-confined suspicious lesion PI-RADS ≤3; 3, organ-confined suspicious lesion PI-RADS 4 or 5; 4, suspicious lesion with extraprostatic extension (EPE), no seminal vesicle invasion (SVI); 5, suspicious lesion with EPE and SVI. Risk classified according to the National Comprehensive Cancer Network (NCCN) and MRI findings were combined to analyze survival curves for biochemical recurrence (BCR)-free and metastasis-free survival. The area under a time-dependent receiver operating characteristic was analyzed for event prediction after 5 years.

Results

We analyzed 1,290 patients. In multivariate Cox regression models, PI-RADS ≥4 (hazard ratio [HR] 2.33, P < 0.001), EPE (HR 1.46, P = 0.027), SVI (HR 5.03, P < 0.001) and NCCN high-risk (HR 2.33, 95% CI 1.66-3.26, P < 0.001) were associated with BCR. For metastasis, EPE (HR 2.33, P = 0.047), SVI (HR 13.08, P < 0.001) and NCCN high-risk (HR 2.78, P = 0.026) were independent risk factors. Depending on MRI group, BCR-free survival significantly decreased in NCCN intermediate-risk (P = 0.001) and high-risk (P < 0.001) groups, and metastasis-free survival decreased in the intermediate-risk group (P = 0.39) and significantly decreased in the high-risk (P < 0.001) group. Adding MRI group to NCCN risk classification significantly improved the predictive accuracy for BCR in comparison with NCCN risk classification alone (P = 0.042), but not for metastasis (P = 0.012).

Conclusion

Combining prostate MRI with NCCN risk classification improves the prediction value of BCR following radical prostatectomy for localized prostate cancer.

背景：我们研究了t2加权磁共振成像（MRI）结果和临床风险分类是否能改善前列腺癌肿瘤预后的既定预后指标。方法：纳入2007年10月至2016年4月在首尔国立大学盆唐医院接受根治性前列腺切除术，但术前未接受激素治疗、放疗或化疗的局限性前列腺癌患者。根据前列腺成像报告和数据系统（PI-RADS）对mri进行分类。患者分为以下5组：1、无局灶性可疑病变；2、器官局限性可疑病变PI-RADS≤3；3、器官局限性可疑病变PI-RADS为4或5；4、可疑病变伴前列腺外展（EPE），无精囊侵犯（SVI）；5、可疑病灶伴EPE、SVI。根据国家综合癌症网络（NCCN）和MRI结果进行风险分类，分析无生化复发（BCR）和无转移生存的生存曲线。分析了时变接收机工作特征下的5年后事件预测面积。结果：我们分析了1290例患者。在多因素Cox回归模型中，PI-RADS≥4（危险比[HR] 2.33, P P = 0.027）、SVI （HR 5.03, P P = 0.047）、SVI （HR 13.08, P P = 0.026）为独立危险因素。不同MRI组，NCCN中危（P = 0.001）和高危（P = 0.39）患者无bcr生存率显著降低，高危（P = 0.042）患者无bcr生存率显著降低，而转移患者无bcr生存率显著降低（P = 0.012）。结论：前列腺MRI结合NCCN风险分级提高了前列腺根治术后BCR对局限性前列腺癌的预测价值。

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引用次数: 0

Negative magnetic resonance imaging cannot be used to omit an initial prostate biopsy - An ambispective study 核磁共振成像阴性不能用于省略首次前列腺活检--一项前瞻性研究

IF 2.7 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2024-09-01 DOI: 10.1016/j.prnil.2024.03.005

Introduction

Up to 40% of patients with suspected prostate cancer (PCa) have a negative prebiopsy magnetic resonance imaging (nMRI), and up to 15% of them may have clinically significant PCa (csPCa). The ability to predict the presence of csPCa despite nMRI may help avoid unnecessary biopsies. We aimed to determine the negative predictive value (NPV) of mpMRI, the influence of MRI reporting patterns in clinical practice, and the factors that might predict csPCa among men with an nMRI.

Methodology

In an IRB-approved, ambispective study, men who underwent prostate biopsy from 2016 to 2023 and had a prebiopsy MRI, were included to determine the presence of csPCa. The reporting patterns of institutional and noninstitutional MRI were evaluated. Age, digital rectal examination (DRE) findings, prostate specific antigen (PSA), PSA density (PSAD), and MRI reports were evaluated for their ability to predict csPCa in men with nMRI.

Results

1660 patients who underwent prostate biopsy were assessed for eligibility, and 685 patients were enrolled in the study. The median age, PSA and PSAD were 60 years, 11.63 ng/ml and 0.23 ng/ml/cm³, respectively. 62 (9%) men had an nMRI, among which csPCa, non-csPCa, and negative biopsy were found in 34%, 5%, and 61% of men, respectively. 61% had an institutional MRI, while 39% had a noninstitutional MRI. The sensitivity and NPV of any MRI for csPCa were 93% and 66%, respectively, which improved to 96% and 81% for institutional MRI. Univariate and multivariate analyses showed abnormal DRE and PSAD ≥0.25 ng/ml/cc as predictive factors for csPCa in men with an nMRI.

Conclusion

34% of men with negative MRIs were found to harbor csPCa on prostate biopsy. The NPV of institutional MRI was higher than for noninstitutional MRI. Men with an abnormal DRE or PSAD ≥0.25 ng/ml/cc had a higher incidence of csPCa despite an nMRI.

导言：多达 40% 的疑似前列腺癌（PCa）患者活检前磁共振成像（nMRI）呈阴性，其中多达 15% 的患者可能患有具有临床意义的 PCa（csPCa）。通过 nMRI 预测 csPCa 的存在有助于避免不必要的活检。我们旨在确定 mpMRI 的阴性预测值 (NPV)、MRI 在临床实践中的报告模式的影响，以及在接受过 nMRI 的男性中预测 csPCa 的因素。方法在一项经 IRB 批准的前瞻性研究中，纳入了 2016 年至 2023 年期间接受前列腺活检并在活检前接受 MRI 检查的男性，以确定是否存在 csPCa。对机构和非机构 MRI 的报告模式进行了评估。评估了年龄、数字直肠检查（DRE）结果、前列腺特异性抗原（PSA）、PSA 密度（PSAD）和 MRI 报告预测男性 csPCa 的能力。中位年龄、PSA 和 PSAD 分别为 60 岁、11.63 纳克/毫升和 0.23 纳克/毫升/立方厘米。62（9%）名男性进行了 nMRI 检查，其中分别有 34%、5% 和 61% 的男性发现了 csPCa、非 csPCa 和阴性活检。61%的男性进行了机构磁共振成像，39%的男性进行了非机构磁共振成像。任何磁共振成像对 csPCa 的灵敏度和 NPV 分别为 93% 和 66%，机构磁共振成像的灵敏度和 NPV 分别提高到 96% 和 81%。单变量和多变量分析显示，DRE异常和PSAD≥0.25 ng/ml/cc是nMRI男性中csPCa的预测因素。机构 MRI 的 NPV 值高于非机构 MRI。DRE 异常或 PSAD ≥0.25 ng/ml/cc 的男性尽管接受了 nMRI，但 csPCa 的发生率更高。

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引用次数: 0