Prostate International最新文献

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.

Background

The aim of this study was to determine whether inflammatory bowel disease (IBD) is associated with the risk of developing prostate cancer (PCa) through a population-based study.

Materials and methods

Male patients aged ≥40 years, diagnosed with IBD from 2010 to 2013 and without IBD were identified and followed-up till 2019. A matched cohort of male patients with and without IBD in a ratio of 1:4 was created based on age, income level, and Charlson comorbidity index. Multivariate Cox regression analysis was conducted to evaluate the association of IBD with the prescence of PCa and PCa requiring definitive treatment within 1 year of diagnosis. The hazard ratio (HR) and 95% confidence interval (CI) were stratified by Crohn's disease, ulcerative colitis (UC), and subtypes.

Results

After matching, 15,751 IBD patients and 62,346 controls were analyzed. Over a median follow-up period of 96 months, the HR for PCa was significantly increased in patients with IBD (HR: 2.44; 95% CI: 2.08–2.86, P < 0.001). IBD was also associated with PCa requiring definitive treatment within 1 year (HR: 2.67; 95% CI: 2.09–3.42, P < 0.001). In subgroup analysis, UC (HR: 2.83; 95% CI: 2.18–3.69, P < 0.001) showed higher risk of PCa requiring definitive treatment than for Crohn's disease (HR: 2.21; 95% CI: 1.43–3.43, P = 0.0004). All-cause death in patient-diagnosed PCa was the highest in UC of pancolitis (HR: 2.26; 95% CI: 0.99–5.16, P = 0.054), and the lowest in ulcerative proctitis (HR: 0.35; 95% CI: 0.21–0.60, P = 0.0001).

Conclusion

IBD was associated with an increased incidence of PCa in our matched analysis.

Objective

To analyze the outcomes of transperineal template-guided mapping biopsy (TTMB) in biopsy-naïve men with multiparametric magnetic resonance imaging (mpMRI) results of Prostate Imaging-Reporting and Data System (PI-RADS) 1-2.

Patients and methods

We retrospectively reviewed TTMB outcomes in biopsy naïve patients with PI-RADS 1-2 at a single center from August 2018 to May 2023. The patients' clinicopathologic data were reviewed, clinically significant prostate cancer (csPCa) detection rates were identified. We determined significant predictive factors and determined those optimal cutoff point using receiver operating characteristic (ROC) curves.

Results

255 biopsy naïve patients with PI-RADS 1-2 underwent TTMB. 72 (28.2%) were diagnosed with prostate cancer and 30 (11.8%) were diagnosed with csPCa. ROC curves were used to identify predictive factors for diagnosing csPCa. Age (area under ROC curve [AUC]: 0.74, 95% CI: 0.65–0.83, P < 0.001) and prostate specific antigen density (PSAD) (AUC: 0.63, 95% CI: 0.53–0.72, P = 0.025) were significant predictive factors, and the optimal cutoff points determined using the Youden index were 65 years and 0.15 ng/mL/mL, respectively.

Conclusion

Of biopsy-naïve patients classified as PI-RADS 1–2, 11.8% were diagnosed with csPCa, and we identified age and PSAD as significant predictive factors. Our study will help determine the biopsy method for patients with PI-RADS 1–2 without biopsy experience.

Background

Studies on the association between hematospermia and prostate cancer are insufficient. The purpose of this study was to determine the prevalence of prostate cancer in patients with hematospermia using large United States population data.

Materials and methods

This was a retrospective observational cohort study. Administrative claims data were extracted from the IBM® MarketScan Research Database. Patients who had undergone a prostate biopsy and newly diagnosed patients with hematospermia before prostate biopsy from January 2007 to December 2014 were included using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes. Treatment methods were identified with the Current Procedural Terminology (CPT) code.

Results

A total of 369,170 adult men had a prostate biopsy. The mean age of patients was 62 years (range, 18 to 100 years). Among the TRUS bx patients, the number of patients with hematospermia was 1,357 (0.4%). The prostate cancer detection rate was significantly lower in patients with hematospermia than in patients without hematospermia (30.4% vs. 48.0%, P < 0.01). During the study period, 83,712 patients had hematospermia, of whom only 1.6% underwent a prostate biopsy.

Conclusions

Only 1.6% of hematospermia patients underwent a prostate biopsy. Prostate cancer was detected at a lower rate in those with hematospermia than in those without hematospermia. This study suggests that the presence of hematospermia prior to biopsy does not increase the risk of prostate cancer detection.

Aim

To investigate the predictive value of lesion length in multiparametric prostate magnetic resonance imaging with respect to prostate volume for clinically significant prostate cancer diagnosis in targeted biopsies.

Materials and methods

The data of biopsy-naïve patients in the Turkish Urooncology Association Prostate Cancer Database who underwent targeted prostate biopsies were included in this study. Lesion density is calculated as the ratio of lesion length (mm) in MR to prostate volume (cc). The biopsy results were divided into either clinically significant or insignificant cancer and benign groups. The difference in parameters between groups is evaluated by multivariable analysis to determine independent risk factors for clinically significant prostate cancer diagnosis.

Results

A total of 590 lesion biopsies were included in the study. In univariable analysis, prostate-specific antigen (PSA), PSA density, number of cores taken, lesion length, lesion density, patient age, and digital rectal examination findings were found to be different at a statistically significant level between groups (P values, respectively: 0.001, <0.001, <0.001, <0.001, <0.001, 0.012, 0.001). Subgroup analysis demonstrated that the lesion density was still significantly different between groups for all Prostate Imaging - Reporting and Data System (PI-RADS) 3, 4, and 5 subgroups (P values, respectively: 0.001, <0.001, <0.001). The multivariable analysis demonstrated that lesion density, along with the number of cores taken and the PI-RADS score of the lesion is an independent risk factor for predicting clinically significant prostate cancer, with the highest odds ratio among all parameters (OR: 27.31 [CI: 7.9–94.0]).

Conclusion

This study demonstrated that lesion size with respect to prostate volume is an important independent risk factor for the prediction of clinically significant prostate cancer in the lesion-targeted biopsy. Combined with the PI-RADS score and parameters like digital rectal examination (DRE) findings and PSA density may further increase predictive power and help clinicians decide whether to perform a biopsy in low-risk patients or perform a re-biopsy for high-risk patients subsequent to an initial negative biopsy.

Background

It has been more than a decade since fusion prostate biopsy (FPB) has been used in the diagnosis of prostate cancer (PCa). Therefore, patients with a previous history of negative FPB and ongoing suspicion of PCa are beginning to emerge. This study investigated whether the first biopsy type (standard or fusion) should be effective in deciding on a second biopsy.

Methods

Male patients aged 40–75, with a serum prostate-specific antigen (PSA) value of less than 10 ng/mL and a negative biopsy history within the last 24 months, who underwent FPB in our clinic due to persistent PSA elevation and/or suspicious multiparametric prostate magnetic resonance imaging (MpMRI) findings were included to the study. Patients were divided into groups according to the type of first biopsy (Group 1; those whose first biopsy was FPB, Group 2; those whose first biopsy was standard prostate biopsy). Some demographic and clinical data of the groups, as well as PCa detection rates, were compared. A p value of less than 0.05 was considered statistically significant.

Results

A total of 275 patients (Group 1: 84, Group 2: 191) were included in this study. The groups were similar in terms of age, PSA values before the first biopsy, PSA values before the second biopsy, family history of PCa, and prostate volume. PCa was detected at a higher rate in Group 2 than Group 1 (23% vs 15.5%, p = 0.044).

Concluison

The data obtained from this study indicate that the type of initial biopsy should be taken into account when deciding on FPB in secondary patients with a previous negative biopsy history.

Pelvic lymph node dissection (PLND) is important for accurate staging and prognosis of prostate cancer. Several guidelines recommend extended pelvic lymph node dissection (ePLND) for patients with non-low-risk prostate cancer. However, the therapeutic benefits of ePLND are unclear. Therefore, we reviewed the literature regarding the therapeutic value of PLND for prostate cancer. Although some reports showed that ePLND improves postoperative biochemical recurrence and postoperative overall survival compared with limited lymph node dissection, other reports show no benefits. Overall, the current evidence supporting ePLND is poor. The extent of PLND varied among studies concerning the therapeutic value of ePLND, and study design issues such as patient background and length of follow-up period were different. Some reports demonstrated potential therapeutic value for ePLND when adjusting for patient background. Focusing on patients with high-grade prostate cancer may be important in demonstrating the therapeutic benefits of ePLND. Although the incidence of major adverse events related to ePLND was low, the possibility of adverse events such as lymphedema and lymphocele formation should be considered. In the future, we hope that evidence for optimal selection criteria for ePLND and the extent of ePLND will become more definitive and evidence for the therapeutic value of ePLND will be developed.

Background

The causal associations and potential mechanisms between prostatic diseases, the predominant male urological disorders, and the course of COVID-19 remain unclear.

Methods

A two-sample Mendelian randomization (MR) analysis was performed to evaluate causal associations between prostate cancer, benign prostatic hyperplasia, and prostatitis and different COVID-19 outcomes (SARS-CoV-2 infection, hospitalized COVID-19, and severe COVID-19). Reverse MR, linkage disequilibrium score regression, and Bayesian colocalization analyses were subsequently performed to strengthen the identified causal relationships. Furthermore, immunome- and metabolome-wide MR analysis was conducted to prioritize COVID-19-associated immune characteristics and metabolites. Two-step MR analysis was performed to evaluate the mediating effects of the immunome and metabolome on the associations between prostatic diseases and COVID-19.

Results

Genetically predicted prostatic diseases were not causally associated with severe COVID-19, while prostatitis was suggested to be an independent risk factor for SARS-CoV-2 infection (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.01 to 1.23; P = 0.03). Multiple sensitivity tests verified the reliability of the established causal relationships. Dozens of blood immune and metabolic features were identified to reveal the immune and metabolic profiles of different COVID-19 courses. Moreover, PDL-1 on monocyte was found to mediate the interaction between prostatitis and SARS-CoV-2 infection, with a mediation proportion of 9.2%.

Conclusion

Our study identified the causal relationships of prostatic diseases with COVID-19 and suggested pathways explaining these associations through alterations in the blood immunome and metabolome.

Background

Despite providing valuable staging and prognostic information, the therapeutic benefit of pelvic lymph node dissection (PLND) remains uncertain. We sought to assess the effect of extended PLND (ePLND) on the biochemical recurrence (BCR) of patients with National Comprehensive Cancer Net (NCCN) high- or very high-risk prostate cancer treated via robot-assisted radical prostatectomy (RARP).

Methods

We used a multi-institutional database (six centers) to assess 989 patients who underwent RARP from 2014 to 2022 with or without ePLND, among which 699 patients underwent BCR analysis. We performed 1:1 propensity score matching to account for potential differences between the two groups and compared them in terms of BCR-free survival. Cox's regression models were used to test the effect of ePLND on BCR.

Results

A total of 585 patients underwent ePLND and 404 did not. A median of 19 lymph nodes was removed in the ePLND cohort. After propensity score matching, no significant differences in BCR-free survival were observed between the two cohorts (HR 1.108, 95% CI 0.776–1.582, p = 0.556). Multivariable Cox's regression models adjusted for the preoperative and postoperative tumor characteristics revealed that PLND was not an independent predictor of BCR.

Conclusion

No significant differences in BCR-free survival were observed between NCCN high- or very high-risk prostate cancer patients who underwent PLND during RARP and those who did not. The therapeutic utility of PLND thus remains unclear.