Prostate International最新文献

Holmium laser enucleation of the prostate as a treatment option for patients with concurrent outlet obstruction and bladder diverticulum 钬激光前列腺摘除作为并发出口梗阻和膀胱憩室患者的治疗选择

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.07.003

Michael Frumer, Iyad Khamaisi, Guy Levenberg, Gherman Creiderman, Ron Gilad, Sagi A. Shpitzer, Tzach Aviv, Muhammad Krenawi, Shayel Bercovich, Nadav Dekel, Hadar Tamir, Tomer Hasdai, Yossi Ventura, Niv Segal, Hen Hendel, Liran Zieber, Jack Baniel, David Lifshitz, Abd E. Darawsha, Yaron Ehrlich

Background

A bladder diverticulum is a source of infections, urinary stones, and malignancy. Until recent years, patients suffering from large obstructive prostate and diverticulum were treated with open surgery, which also allowed diverticulectomy. The transition to a closed approach has led to diverticulum preservation. The clinical implications of this preservation strategy have not been sufficiently studied.

Materials and methods

A retrospective comparison was made between holmium laser enucleation of the prostate (HoLEP) patients with a diverticulum (≥2 cm) and HoLEP patients without any diverticulum. For each patient with a diverticulum, two patients without a diverticulum who were operated on around the same time were matched (1:2). Patients operated on until March 2022 were included to allow for a relatively long follow-up period.

Results

Out of 602 HoLEP patients, 32 (5%) had a diverticulum ≥2 cm, and they were matched with 64 patients without a diverticulum. The median diverticulum size was 37 mm (interquartile range: 25, 51). A comparison of preoperative data between the two groups revealed no significant differences. Two patients with a diverticulum required a temporary urinary catheter at discharge, but there were no significant differences in surgical, perioperative, or postoperative measures between the two groups, except for a clinically insignificant difference in residual urine volume. With a median follow-up of 3.3 years (interquartile range: 2.5, 4.5), no patient required or was referred for diverticulectomy.

Conclusions

HoLEP is an effective treatment method for patients with bladder outlet obstruction and concomitant bladder diverticulum. By effectively relieving the bladder outlet obstruction, HoLEP can avoid the need for more invasive surgical interventions.

膀胱憩室是感染、尿路结石和恶性肿瘤的来源。直到最近几年，患有大前列腺梗阻性和憩室的患者都采用开放手术治疗，这也允许憩室切除术。向封闭入路的过渡导致憩室保存。这种保存策略的临床意义尚未得到充分的研究。材料与方法回顾性比较有憩室（≥2 cm）的钬激光前列腺摘除（HoLEP）患者与无憩室的HoLEP患者。每个有憩室的患者，匹配两个同时手术的无憩室患者（1:2）。直到2022年3月手术的患者被包括在内，以允许相对较长的随访期。结果602例HoLEP患者中，32例（5%）憩室≥2 cm，与64例无憩室患者相匹配。憩室中位大小为37 mm（四分位数间距：25,51）。两组术前资料比较无明显差异。两例憩室患者在出院时需要临时导尿管，但两组在手术、围手术期和术后措施上没有显著差异，除了残余尿量在临床上没有显著差异。中位随访时间为3.3年（四分位数范围：2.5 - 4.5），无患者需要或转诊行憩室切除术。结论sholep是治疗膀胱出口梗阻合并膀胱憩室的有效方法。HoLEP通过有效缓解膀胱出口梗阻，可以避免更多的侵入性手术干预。

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引用次数: 0

Multimodality focal therapy for prostate cancer: outcome of the à la carte approach in clinical practice 前列腺癌的多模式局灶治疗：<s:1>点菜法在临床实践中的效果

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.03.006

Chi-Hang Yee , Peter K-F. Chiu , Alex Q. Liu , H.F. Wong , Wilson H.C. Chan , K.L. Lo , C.K. Chan , R. Chan , Carmen CM. Cho , H.Y. Hung , Jeremy Y.C. Teoh , C.F. Ng

Background

Our study reported the outcome of a multimodality focal therapy (FT) cohort for localized primary prostate cancer.

Methods

In a prospective registry all patients underwent magnetic resonance imaging and biopsy (fusion targeted or template biopsy) before FT. Modalities included focal high-intensity focused ultrasound (HIFU), focal cryotherapy, or targeted microwave ablation (TMA). Postoperatively, prostate-specific antigen and functional outcome assessment with validated questionnaires were checked 3 monthly. Magnetic resonance imaging was performed at 1 week, 6 months, and 12 months. Elective prostate biopsy was performed between 6 and 12 months.

Results

A total of 102 patients underwent FT between 2019 and 2024. The cohort consisted of 44 (43.1%) patients for focal HIFU, 18 (17.6%) patients for focal cryotherapy, and 40 (39.2%) patients for TMA. D'Amico low-, intermediate-, and high-risk patients accounted for 31 (30.4%), 66 (64.7%), and 5 (4.9%) patients, respectively. Referring to tumor location, focal HIFU had 38 (86.4%) posterior tumors, focal cryotherapy had 12 (72.2%) anterior tumors, and TMA had 31 (77.5%) anterior tumors. Biopsy data were available for 63 patients (61.8%). Clinically significant recurrence (International Society of Urological Pathology grade group: ≥2) were found in 7 patients (11.1%). Subsequent salvage treatment included the following cases: robotic radical prostatectomy: 2, radiotherapy: 4, and second focal cryotherapy: 1. No deterioration in Expanded Prostate Cancer Index Composite score was observed across all domains before and after the treatment. Improvement in the Urinary Irritative/Obstructive domain was observed in focal cryotherapy (78.3 vs. 91.5, P = 0.011) and TMA (75.7 vs. 84.9, P = 0.019) at 12 months.

Conclusions

Multimodality FT with à la carte approach provides versatility in ablative strategies and offers a reasonable functional and oncological outcome for low- to intermediate-risk prostate cancer.

我们的研究报告了局部原发性前列腺癌的多模式局灶治疗（FT）队列的结果。方法在一项前瞻性登记中，所有患者在FT前都接受了磁共振成像和活检（融合靶向或模板活检）。方式包括局灶高强度聚焦超声（HIFU）、局灶冷冻治疗或靶向微波消融（TMA）。术后每3个月检查一次前列腺特异性抗原和功能结果评估。分别于1周、6个月和12个月进行磁共振成像。择期前列腺活检于6 - 12个月间进行。结果2019年至2024年，共有102例患者接受了FT。该队列包括44例（43.1%）局灶HIFU患者，18例（17.6%）局灶冷冻治疗患者和40例（39.2%）TMA患者。D'Amico低、中、高风险患者分别占31例（30.4%）、66例（64.7%）和5例（4.9%）。从肿瘤位置看，HIFU局灶性后路肿瘤38例（86.4%），冷冻局灶性前路肿瘤12例（72.2%），TMA前路肿瘤31例（77.5%）。63例（61.8%）患者获得活检数据。有临床意义的复发（国际泌尿病理学会分级组：≥2级）7例（11.1%）。随后的抢救治疗包括：机器人前列腺根治术2例，放疗4例，二次局灶冷冻治疗1例。前列腺癌扩展指数综合评分在治疗前后均未出现恶化。局部冷冻治疗12个月时尿刺激/梗阻性区改善（78.3 vs 91.5, P = 0.011）， TMA改善（75.7 vs 84.9, P = 0.019）。结论多模式FT结合单点入路为低至中危前列腺癌的消融策略提供了多样性，并提供了合理的功能和肿瘤预后。

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引用次数: 0

Utility of the prostate health index density for detecting clinically significant prostate cancer in patients with negative magnetic resonance imaging findings 前列腺健康指数密度在磁共振成像阴性患者中检测具有临床意义的前列腺癌的应用

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.08.004

Kazuhiko Oshinomi, Shota Kikuchi, Hirotaka Kishi, Anju Hayashi, Sho Okada, Masahiro Kurokawa, Toshiki Mugita, Yoshiki Tsunokawa, Tatsuki Inoue, Motoki Yamagishi, Yoshihiro Nakagami, Masakazu Nagata, Takashi Fukagai

Background

Multiparametric magnetic resonance imaging (MRI) is widely used in prostate cancer diagnosis; however, a significant proportion of clinically important cancers can be missed in patients with negative MRI findings. Although attempts have been made to analyze prostate-specific antigen (PSA)-related parameters to improve the specificity of PSA testing, no evidence-based cutoff values have been established. This study aimed to evaluate the diagnostic performance of the prostate health index (PHI) and PHI density (PHID) in detecting clinically significant prostate cancer (csPCa) in the MRI-negative population.

Methods

A retrospective analysis was conducted on 339 MRI-negative patients with PSA levels of 3–15 ng/mL who underwent PHI testing and MRI between September 2022 and July 2024. MRI-negative patients were defined as those with Prostate Imaging Reporting and Data System (PI-RADS) category 1 or 2 lesions. Biopsies were performed in 181 patients. The diagnostic accuracies of PSA, % free PSA, PHI, PSA density, and PHID were assessed using the receiver operating characteristic curves.

Results

Among the 47 patients with PI-RADS 1 or 2 who underwent biopsy, 24 (51.1%) had prostate cancer, of whom 16 (66.7%) had csPCa. The PHID showed the highest diagnostic performance (area under the curve [AUC] = 0.8832 for any cancer; AUC = 0.7843 for csPCa). Two patients with a PHI <27.2 were diagnosed with low-risk cancer (Gleason 6).

Conclusions

The PHI and PHID may serve as valuable adjuncts to MRI for the detection of csPCa and may help avoid unnecessary biopsies in patients with negative MRI findings.

多参数磁共振成像（MRI）在前列腺癌诊断中应用广泛；然而，在MRI阴性的患者中，有很大一部分临床重要的癌症可能会被遗漏。虽然已经尝试分析前列腺特异性抗原（PSA）相关参数以提高PSA检测的特异性，但尚未建立循证截止值。本研究旨在评价前列腺健康指数（PHI）和PHI密度（PHID）在mri阴性人群中检测临床显著性前列腺癌（csPCa）的诊断价值。方法回顾性分析2022年9月至2024年7月期间接受PHI检测和MRI的339例PSA水平为3-15 ng/mL的MRI阴性患者。mri阴性患者定义为前列腺影像学报告和数据系统（PI-RADS） 1类或2类病变。181例患者行活组织检查。采用受者工作特征曲线评估PSA、游离PSA %、PHI、PSA密度和PHID的诊断准确性。结果47例PI-RADS 1或2型患者行活检，其中24例（51.1%）为前列腺癌，其中16例（66.7%）为csPCa。PHID表现出最高的诊断效能（曲线下面积[AUC] = 0.8832，对于任何癌症，AUC = 0.7843）。2例PHI = 27.2的患者被诊断为低危癌（Gleason 6）。结论PHI和PHI可作为MRI检测csPCa的重要辅助手段，有助于避免MRI阴性患者进行不必要的活检。

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引用次数: 0

Transurethral water vapor therapy (Rezūm) for acute urinary retention with obstructive uropathy: a prospective cohort study with one-year follow-up 经尿道水蒸气疗法（Rezūm）治疗急性尿潴留伴阻塞性尿病：一项为期一年随访的前瞻性队列研究

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.08.001

Brian W.H. Siu , Jeremy M.H. Ho , Steffi K.K. Yuen , David K.W. Leung , Alex Q. Liu , Chris H.M. Wong , Yvonne Y.Y. Chan , Ivan C.H. Ko , Chi Hang Yee , Jeremy Y.C. Teoh , Chi Fai Ng , Peter K.F. Chiu , Ka Lun Lo

Introduction

This prospective cohort study evaluates the safety and efficacy of transurethral water vapor therapy (Rezūm) in men with acute urinary retention (AUR) complicated by obstructive uropathy (acute renal impairment).

Patients and methods

Obstructive uropathy was defined per 2012 Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury (AKI) criteria. Rezūm was performed as an ambulatory procedure under local anesthesia. The primary outcome was the proportion of catheter-free patients at 3 and 12 months with stable renal function (i.e. serum creatinine not exceeding +0.3 mg/dL or 1.5 times baseline).

Results

Twenty-three consecutive patients were recruited (August 2023–February 2024). Median age was 71 years (interquartile range [IQR]: 67–80) and mean ± standard deviation of prostate size was 57.9 ± 13.8 mL. At 3- and 12-month follow-up, 96% (22/23) were catheter-free with stable renal function. Median time to successful trial without catheter (TWOC) was 36.5 days (IQR: 27.5–42.8 days). Prostate size decreased by 36.8% (P < 0.001) at 3 months. Thirty-day readmissions occurred in 13% (3/23), all Clavien–Dindo grade 1–2.

Conclusion

Rezūm shows promise as a safe and effective procedure in AUR with obstructive uropathy, providing durable catheter independence in high-risk patients. It expands minimally invasive surgical therapies (MISTs) indications, particularly as an ambulatory option under local anesthesia.

本前瞻性队列研究评估经尿道水蒸气疗法（Rezūm）对男性急性尿潴留（AUR）合并阻塞性尿病（急性肾功能损害）的安全性和有效性。患者和方法梗阻性尿病是根据2012肾脏疾病改善全球结局（KDIGO）急性肾损伤（AKI）标准定义的。Rezūm是在局部麻醉下进行的门诊手术。主要终点是3个月和12个月时无导管且肾功能稳定的患者比例（即血清肌酐不超过+0.3 mg/dL或基线的1.5倍）。结果连续招募23例患者（2023年8月~ 2024年2月）。中位年龄为71岁（四分位间距[IQR]: 67-80），前列腺大小的平均±标准差为57.9±13.8 mL。在3个月和12个月的随访中，96%（22/23）患者无置管，肾功能稳定。无导管成功试验的中位时间（TWOC）为36.5天（IQR: 27.5-42.8天）。3个月时前列腺大小下降36.8% （P < 0.001）。30天再入院率为13%(3/23)，均为Clavien-Dindo 1-2级。ConclusionRezūm有望作为一种安全有效的治疗伴有梗阻性尿路病变的AUR的方法，为高危患者提供持久的导管独立性。它扩展了微创手术治疗（mist）的适应症，特别是作为局部麻醉下的门诊选择。

{"title":"Transurethral water vapor therapy (Rezūm) for acute urinary retention with obstructive uropathy: a prospective cohort study with one-year follow-up","authors":"Brian W.H. Siu , Jeremy M.H. Ho , Steffi K.K. Yuen , David K.W. Leung , Alex Q. Liu , Chris H.M. Wong , Yvonne Y.Y. Chan , Ivan C.H. Ko , Chi Hang Yee , Jeremy Y.C. Teoh , Chi Fai Ng , Peter K.F. Chiu , Ka Lun Lo","doi":"10.1016/j.prnil.2025.08.001","DOIUrl":"10.1016/j.prnil.2025.08.001","url":null,"abstract":"<div><h3>Introduction</h3><div>This prospective cohort study evaluates the safety and efficacy of transurethral water vapor therapy (Rezūm) in men with acute urinary retention (AUR) complicated by obstructive uropathy (acute renal impairment).</div></div><div><h3>Patients and methods</h3><div>Obstructive uropathy was defined per 2012 Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury (AKI) criteria. Rezūm was performed as an ambulatory procedure under local anesthesia. The primary outcome was the proportion of catheter-free patients at 3 and 12 months with stable renal function (i.e. serum creatinine not exceeding +0.3 mg/dL or 1.5 times baseline).</div></div><div><h3>Results</h3><div>Twenty-three consecutive patients were recruited (August 2023–February 2024). Median age was 71 years (interquartile range [IQR]: 67–80) and mean ± standard deviation of prostate size was 57.9 ± 13.8 mL. At 3- and 12-month follow-up, 96% (22/23) were catheter-free with stable renal function. Median time to successful trial without catheter (TWOC) was 36.5 days (IQR: 27.5–42.8 days). Prostate size decreased by 36.8% (P < 0.001) at 3 months. Thirty-day readmissions occurred in 13% (3/23), all Clavien–Dindo grade 1–2.</div></div><div><h3>Conclusion</h3><div>Rezūm shows promise as a safe and effective procedure in AUR with obstructive uropathy, providing durable catheter independence in high-risk patients. It expands minimally invasive surgical therapies (MISTs) indications, particularly as an ambulatory option under local anesthesia.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 4","pages":"Pages 258-263"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712435","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}

引用次数: 0

Comparison of 7-tesla ex vivo and conventional 3-tesla magnetic resonance imaging for prostate cancer staging 7特斯拉离体磁共振与常规3特斯拉磁共振诊断前列腺癌分期的比较

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.06.002

Taek Min Kim , Sang Hun Song , Sung Il Hwang , Sung Kyu Hong , Seok-Soo Byun , Gheeyoung Choe , Hye Mi Jee , Sung Woo Park , Hyungwoo Ahn

Background

Conventional 3T magnetic resonance imaging (MRI) shows limited sensitivity for predicting extraprostatic extension (EPE) and frequently underestimates prostate tumor size versus pathology. Ultrahigh-field (7T) ex vivo MRI—performed on prostatectomy specimens after surgery—may overcome these limitations through superior spatial resolution and tissue contrast.

Materials and methods

In this prospective study, 20 patients with biopsy-proven prostate cancer underwent preoperative 3T in vivo MRI followed by 7T ex vivo MRI of radical prostatectomy specimens. Two experienced uroradiologists independently assigned EPE scores (a 5-point scale modified from International Society of Urological Pathology (ISUP) guidelines) and measured tumor dimensions on both modalities; histopathology served as the reference standard. A clarity score quantified the deviation of each EPE score from an equivocal midpoint. Statistical analyses included logistic regression for EPE prediction, receiver operating characteristic curve analysis for diagnostic performance, Wilcoxon signed-rank testing for paired comparisons of clarity scores and size discrepancies, weighted kappa for inter-reader agreement, and intraclass correlation coefficients (ICCs) for MRI–pathology size concordance.

Results

The 7T MRI EPE score was the only significant predictor of pathologic EPE (odds ratio: 4.40, P = 0.02) and achieved an area under the receiver operating characteristic curve of 0.86 versus 0.61 for 3T (P = 0.06). Clarity scores improved on 7T (P < 0.01), with inter-reader agreement rising from κ = 0.32 (3T) to κ = 0.53 (7T). Both modalities underestimated tumor size, but the median discrepancy was significantly lower with 7T (2.0 mm vs. 6.0 mm; P < 0.01), and size concordance improved from ICC = 0.48 (3T) to ICC = 0.70 (7T).

Conclusions

The 7T ex vivo MRI enhances the diagnostic accuracy, clarity, and reproducibility of EPE assessment and reduces tumor size underestimation compared to 3T MRI, supporting its potential role in optimizing preoperative prostate cancer staging.

传统的3T磁共振成像（MRI）对预测前列腺外展（EPE）的敏感性有限，并且经常低估前列腺肿瘤的大小。对前列腺切除术后的标本进行超高场（7T）离体mri检查，可以通过优越的空间分辨率和组织对比来克服这些局限性。材料与方法在本前瞻性研究中，20例活检证实的前列腺癌患者术前行3T体内MRI检查，随后行根治性前列腺切除术标本7T体外MRI检查。两名经验丰富的泌尿科医生独立分配EPE评分（根据国际泌尿病理学会（ISUP）指南修改的5分制）并测量两种方式的肿瘤尺寸；以组织病理学为参考标准。清晰度评分量化了每个EPE评分与模糊中点的偏差。统计分析包括用于EPE预测的逻辑回归，用于诊断性能的受试者工作特征曲线分析，用于清晰度评分和大小差异配对比较的Wilcoxon签名秩检验，用于读者间一致性的加权kappa，以及用于mri病理大小一致性的类内相关系数（ICCs）。结果7T MRI EPE评分是病理性EPE的唯一显著预测因子（优势比：4.40,P = 0.02），受试者工作特征曲线下面积为0.86,3T为0.61 （P = 0.06）。清晰度评分在7T时有所提高（P < 0.01），读者间一致性从κ = 0.32 （3T）上升到κ = 0.53 （7T）。两种方式都低估了肿瘤大小，但中位差异在7T时显著降低（2.0 mm vs. 6.0 mm; P < 0.01），尺寸一致性从ICC = 0.48 （3T）改善到ICC = 0.70 （7T）。结论与3T MRI相比，7T离体MRI提高了EPE诊断的准确性、清晰度和重复性，减少了对肿瘤大小的低估，支持了其在优化前列腺癌术前分期中的潜在作用。

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引用次数: 0

Burden of prostate cancer in China during 1990–2021 and the projections through 2050 1990-2021年中国前列腺癌负担及2050年预测

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.06.001

Lei Hua , Qiulin Huang , Jinlei Zhang , Ruijiao Lei , Xukai Chen , Xiaohua Tan , Tianhua Chen , Tianhui Chen

Background

To provide the most up-to-date data on the burden of prostate cancer (PC) in China and the projections through 2050.

Methods

Using the Global Burden of Disease (GBD) database 2021, we investigated the characteristics of PC burden in China, including temporal trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Age-period-cohort models, frontier analysis, decomposition analysis and prediction models were used for data analyze.

Results

In 2021, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) reached 9.34, 59.86, 4.89, and 76.97 (per 100 000), respectively. The ASIR and ASPR in 2021 increased by 87.17 % and 209.03 %, respectively, compared with 1990, while the ASMR and ASDR remained stable. The relative risk (RR) of PC increases with age, with the highest risk of incidence at 85–89 years. By 2050, the projected age-standardized rate for incidence and mortality are expected to reach 20.85 and 5.11 per 100,000, respectively. Decomposition analysis indicated that population aging and epidemiological shifts primarily drove the increasing PC burden in China.

Conclusions

We found that the burden of PC in China is rapidly rising, with an increasing proportion of young patients, posing a serious threat to men’s health in China currently and also in 2050. Our findings suggest strengthening early screening programs and prevention strategies for high-risk groups of PC in China.

提供中国前列腺癌（PC）负担的最新数据以及到2050年的预测。方法利用全球疾病负担（GBD）数据库2021，研究中国PC负担的特征，包括发病率、患病率、死亡率和残疾调整生命年（DALYs）的时间趋势。采用年龄-时期-队列模型、前沿分析、分解分析和预测模型进行数据分析。结果2021年，年龄标准化发病率（ASIR）、年龄标准化患病率（ASPR）、年龄标准化死亡率（ASMR）和年龄标准化DALYs率（ASDR）分别为9.34、59.86、4.89和76.97（每10万人）。与1990年相比，2021年的ASIR和ASPR分别增长了87.17%和209.03%，而ASMR和ASDR保持稳定。PC的相对危险度（RR）随着年龄的增长而增加，85 ~ 89岁时发病率最高。到2050年，预计年龄标准化发病率和死亡率将分别达到20.85‰和5.11‰。分解分析表明，人口老龄化和流行病学变化是导致中国PC负担增加的主要原因。结论我们发现，中国的前列腺癌负担正在迅速上升，年轻患者的比例越来越高，这对中国目前和2050年的男性健康构成了严重威胁。我们的研究结果建议加强中国PC高危人群的早期筛查和预防策略。

{"title":"Burden of prostate cancer in China during 1990–2021 and the projections through 2050","authors":"Lei Hua , Qiulin Huang , Jinlei Zhang , Ruijiao Lei , Xukai Chen , Xiaohua Tan , Tianhua Chen , Tianhui Chen","doi":"10.1016/j.prnil.2025.06.001","DOIUrl":"10.1016/j.prnil.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>To provide the most up-to-date data on the burden of prostate cancer (PC) in China and the projections through 2050.</div></div><div><h3>Methods</h3><div>Using the Global Burden of Disease (GBD) database 2021, we investigated the characteristics of PC burden in China, including temporal trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Age-period-cohort models, frontier analysis, decomposition analysis and prediction models were used for data analyze.</div></div><div><h3>Results</h3><div>In 2021, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) reached 9.34, 59.86, 4.89, and 76.97 (per 100 000), respectively. The ASIR and ASPR in 2021 increased by 87.17 % and 209.03 %, respectively, compared with 1990, while the ASMR and ASDR remained stable. The relative risk (RR) of PC increases with age, with the highest risk of incidence at 85–89 years. By 2050, the projected age-standardized rate for incidence and mortality are expected to reach 20.85 and 5.11 per 100,000, respectively. Decomposition analysis indicated that population aging and epidemiological shifts primarily drove the increasing PC burden in China.</div></div><div><h3>Conclusions</h3><div>We found that the burden of PC in China is rapidly rising, with an increasing proportion of young patients, posing a serious threat to men’s health in China currently and also in 2050. Our findings suggest strengthening early screening programs and prevention strategies for high-risk groups of PC in China.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 4","pages":"Pages 219-226"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712436","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}

引用次数: 0

Temporal trends of prostate cancer diagnostics in Australia: Has the introduction of a magnetic resonance imaging prostate subsidy fulfilled its cost-saving promises? 澳大利亚前列腺癌诊断的时间趋势：引入磁共振成像前列腺补贴是否实现了其节省成本的承诺？

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.05.003

Matthew Qiu , Adib Rahman , Lu Yu Kuo , Kreyen Ponen , Michael Chen

Background

This study aims to assess whether magnetic resonance imaging of the prostate (MRIp) had a statistically significant effect on prostate biopsies in Australia and decreased biopsies performed in Australia. Temporal trends and cost-effectiveness of this policy were also analysed.

Methods

National and state-level data were obtained from the Australian Medicare Benefits Schedule from 1 January 2006 to 1 January 2024 on MRIp and prostate biopsies. A regression model was used to calculate the impact of MRIp use on the number of biopsies. Paired t-test was used to determine statistical significance between population-adjusted pre- and post-subsidy rates. Cost-effectiveness of the subsidy was calculated.

Results

MRIp had a statistically significant impact on biopsies, with an OR of 1.42 MRIps to biopsies (95% CI: 1.358, 1.473; P < 0.0002) at a national level. State-level data suggested it impacted most, but not all, states. Population-adjusted prostate biopsy rates decreased from 215 per 100,000 men per year to 182 per 100,000 men following the introduction of MRIp subsidy (P = 0.02). Cost analysis suggests that MRIp subsidy has led to approximately $10 million in cost savings since 2018, although projected savings during policy proposal were vastly overestimated.

Conclusion

Government subsidised MRIp in Australia has a statistically significant effect on prostate biopsies. There has been a reduction in prostate biopsies, but this is likely more reflective of the rapid development and increasing complexity within prostate cancer diagnostics. Subsidy of MRI is questionable in its cost effectiveness.

本研究旨在评估前列腺磁共振成像（MRIp）是否对澳大利亚的前列腺活检有统计学意义的影响，并减少澳大利亚的活检。还分析了这一政策的时间趋势和成本效益。方法从2006年1月1日至2024年1月1日的澳大利亚医疗保险福利计划中获取国家和州一级的MRIp和前列腺活检数据。采用回归模型计算mri使用对活检次数的影响。配对t检验用于确定人口调整前后补贴率之间的统计学显著性。计算了补贴的成本效益。结果smrip对活检的影响具有统计学意义，在全国范围内，mrip对活检的OR为1.42 （95% CI: 1.358, 1.473; P < 0.0002）。州级数据显示，它影响了大部分州，但不是所有州。引入MRIp补贴后，人口调整前列腺活检率从每年每10万男性215例下降到182例（P = 0.02）。成本分析表明，自2018年以来，MRIp补贴已经节省了大约1000万美元的成本，尽管政策提案期间的预计节省被大大高估了。结论澳大利亚政府资助的mri对前列腺活检有显著的统计学意义。前列腺活组织检查有所减少，但这可能更多地反映了前列腺癌诊断的快速发展和日益复杂。MRI补贴的成本效益值得怀疑。

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引用次数: 0

Oncologic outcomes of salvage radiotherapy and lymphadenectomy for positron emission tomography–positive lymph nodes in biochemical recurrence: A systematic review to inform treatment decisions 对生化复发的正电子发射断层扫描阳性淋巴结进行补救性放疗和淋巴结切除术的肿瘤学结果：一项为治疗决策提供信息的系统综述

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.05.002

Yun-Jung Yang , Kyungchan Min , Jong Hyun Tae , Chung Un Lee , Joongwon Choi , Jung Hoon Kim , Eun-Jung Yang , Tuan Thanh Nguyen , Se Young Choi

Introduction

Positron emission tomography (PET) scans are widely used for detecting biochemical recurrence (BCR) in prostate cancer, yet evidence for salvage treatments of PET-positive lymph nodes remains limited. This study aimed to analyze the oncologic outcomes of salvage treatments, specifically lymph node dissection (LND) and radiotherapy (RT), in patients with BCR and PET-positive lymph node recurrence.

Methods

Systematic reviews and meta-analyses were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, Cochrane, and Web of Science databases up to June 2023 was conducted. Inclusion criteria encompassed patients with BCR and PET-positive lymph node recurrence following definitive prostate cancer treatment, who underwent salvage LND or RT.

Results

A total of 38 publications involving 3,559 patients (1391 LND, 2168 RT) were included. Pooled incidence rates after LND and RT were as follows: prostate-specific antigen (PSA) response (56.4% vs. 78.9%), PSA progression (61.3% vs. 36.0%), image progression (44.9% vs. 34.9%), systemic progression (41.3% vs. 35.0%), overall mortality (3.0% vs. 4.8%), and cancer-specific mortality (8.4% vs. 4.1%). Subgroup analyses by prostate-specific membrane antigen (PSMA) PET scan, PSA level ≤2 ng/ml at PET scan, and androgen deprivation therapy usage with salvage therapy revealed varied outcomes.

Conclusions

Despite salvage LND or RT, about half of BCR patients with PET-positive nodal recurrence showed disease progression, suggesting limited effectiveness of focal therapies alone. RT appeared to provide better short-term disease control than LND, highlighting the importance of treatment selection. The study underscores the necessity for further investigation into optimal salvage management strategies for BCR using PET in prospective clinical studies.

正电子发射断层扫描（PET）广泛用于检测前列腺癌的生化复发（BCR），但PET阳性淋巴结的补救性治疗的证据仍然有限。本研究旨在分析BCR和pet阳性淋巴结复发患者的挽救性治疗，特别是淋巴结清扫（LND）和放疗（RT）的肿瘤学结果。方法根据系统评价和荟萃分析指南的首选报告项目进行系统评价和荟萃分析。对PubMed、Cochrane和Web of Science数据库进行了截至2023年6月的全面检索。纳入标准包括BCR和pet阳性淋巴结复发的确诊前列腺癌治疗后接受补救性LND或RT的患者。结果共纳入38篇文献，涉及3,559例患者（1391例LND， 2168例RT）。LND和RT后的合并发病率如下：前列腺特异性抗原（PSA）应答（56.4%对78.9%）、PSA进展（61.3%对36.0%）、影像学进展（44.9%对34.9%）、全身进展（41.3%对35.0%）、总死亡率（3.0%对4.8%）和癌症特异性死亡率（8.4%对4.1%）。前列腺特异性膜抗原（PSMA） PET扫描亚组分析，PET扫描PSA水平≤2 ng/ml，雄激素剥夺治疗与挽救治疗的使用显示出不同的结果。结论尽管进行了补救性LND或RT治疗，但约有一半的pet阳性淋巴结复发的BCR患者出现疾病进展，表明单纯局灶治疗的效果有限。RT似乎比LND提供更好的短期疾病控制，突出了治疗选择的重要性。该研究强调了在前瞻性临床研究中进一步研究BCR最佳抢救管理策略的必要性。

{"title":"Oncologic outcomes of salvage radiotherapy and lymphadenectomy for positron emission tomography–positive lymph nodes in biochemical recurrence: A systematic review to inform treatment decisions","authors":"Yun-Jung Yang , Kyungchan Min , Jong Hyun Tae , Chung Un Lee , Joongwon Choi , Jung Hoon Kim , Eun-Jung Yang , Tuan Thanh Nguyen , Se Young Choi","doi":"10.1016/j.prnil.2025.05.002","DOIUrl":"10.1016/j.prnil.2025.05.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Positron emission tomography (PET) scans are widely used for detecting biochemical recurrence (BCR) in prostate cancer, yet evidence for salvage treatments of PET-positive lymph nodes remains limited. This study aimed to analyze the oncologic outcomes of salvage treatments, specifically lymph node dissection (LND) and radiotherapy (RT), in patients with BCR and PET-positive lymph node recurrence.</div></div><div><h3>Methods</h3><div>Systematic reviews and meta-analyses were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, Cochrane, and Web of Science databases up to June 2023 was conducted. Inclusion criteria encompassed patients with BCR and PET-positive lymph node recurrence following definitive prostate cancer treatment, who underwent salvage LND or RT.</div></div><div><h3>Results</h3><div>A total of 38 publications involving 3,559 patients (1391 LND, 2168 RT) were included. Pooled incidence rates after LND and RT were as follows: prostate-specific antigen (PSA) response (56.4% vs. 78.9%), PSA progression (61.3% vs. 36.0%), image progression (44.9% vs. 34.9%), systemic progression (41.3% vs. 35.0%), overall mortality (3.0% vs. 4.8%), and cancer-specific mortality (8.4% vs. 4.1%). Subgroup analyses by prostate-specific membrane antigen (PSMA) PET scan, PSA level ≤2 ng/ml at PET scan, and androgen deprivation therapy usage with salvage therapy revealed varied outcomes.</div></div><div><h3>Conclusions</h3><div>Despite salvage LND or RT, about half of BCR patients with PET-positive nodal recurrence showed disease progression, suggesting limited effectiveness of focal therapies alone. RT appeared to provide better short-term disease control than LND, highlighting the importance of treatment selection. The study underscores the necessity for further investigation into optimal salvage management strategies for BCR using PET in prospective clinical studies.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"13 4","pages":"Pages 191-200"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712405","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}

引用次数: 0

Clinical implication of peri-seminal vesicle soft-tissue invasion in patients with pT3b prostate cancer pT3b前列腺癌患者精囊周围软组织侵犯的临床意义

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.06.005

Sungun Bang , Su-Jin Shin , Do Kyung Kim , Jong Kyou Kwon , Jinhyung Jeon , Kang Su Cho

Background

Prognosis of patients with prostate cancer seminal vesicle invasion (SVI) varies considerably, suggesting that SVI may be a heterogeneous pathological entity. This study aimed to perform a detailed histopathological analysis of seminal vesicle (SV) specimens in prostate cancer to better characterize SVI and evaluate its clinical significance.

Materials and methods

We retrospectively reviewed a database of robotic prostatectomies performed between July 2020 and December 2024. Since July 2020, a refined histopathological protocol has been employed in which the prostate and SVs are axially sectioned and separated, and the SVs and vas deferens are sectioned along their natural anatomical axis. This approach allowed a detailed assessment of SV stromal invasion, peri-SV soft-tissue involvement, and surgical margin status.

Results

We identified 73 patients with pT3b prostate cancer. Unilateral SVI was present in 40 patients (54.8%) and bilateral SVI in 33 patients (45.2%). Notably, peri-SV soft-tissue invasion was observed in 54 patients (74.0%), with it being unilateral in 28 (38.4%) and bilateral in 26 (35.6%). Positive surgical margins in the peri-SV soft-tissue were found in five patients (9.3%). Among 58 patients who underwent pelvic lymph node dissection without preoperative androgen deprivation therapy, 25 (43.1%) had lymph node metastases. On multivariate analysis, lymph node metastasis was significantly associated with lymphovascular invasion only, but not with peri-SV soft-tissue invasion.

Conclusion

In pT3b patients, peri-SV soft-tissue invasion and lymph node metastasis are common. These findings suggest that a more radical surgical approach is warranted in patients with suspected SVI.

前列腺癌精囊浸润（SVI）患者的预后差异很大，提示SVI可能是一种异质性的病理实体。本研究旨在对前列腺癌精囊（SV）标本进行详细的组织病理学分析，以更好地表征SVI并评估其临床意义。材料和方法我们回顾性地回顾了2020年7月至2024年12月期间进行的机器人前列腺切除术的数据库。自2020年7月以来，采用了一种改进的组织病理学方案，其中前列腺和上腔静脉轴向切片并分离，上腔静脉和输精管沿其自然解剖轴切片。这种方法可以详细评估SV间质侵犯、SV周围软组织受损伤和手术边缘状态。结果我们发现73例pT3b前列腺癌患者。单侧SVI 40例（54.8%），双侧SVI 33例（45.2%）。值得注意的是，54例患者（74.0%）观察到sv周围软组织侵犯，其中单侧28例（38.4%），双侧26例（35.6%）。5例患者（9.3%）发现sv周围软组织手术切缘阳性。在58例术前未进行雄激素剥夺治疗的盆腔淋巴结清扫患者中，有25例（43.1%）发生淋巴结转移。在多变量分析中，淋巴结转移仅与淋巴血管侵袭显著相关，而与sv周围软组织侵袭无关。结论pT3b患者常发生sv周围软组织侵犯及淋巴结转移。这些发现表明，对于疑似SVI的患者，更根治性的手术方法是必要的。

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引用次数: 0

Postoperative tadalafil for recovery of continence and voiding function after radical prostatectomy for prostate cancer: a single-center experience 他达拉非用于前列腺癌根治性前列腺切除术后尿失禁和排尿功能的恢复：单中心研究

IF 2.6 2区医学 Q2 UROLOGY & NEPHROLOGY

Prostate International

Pub Date : 2025-12-01 DOI: 10.1016/j.prnil.2025.06.004

Sang Hun Song , Hae Sung Lee , Younsoo Chung , Hyung Joon Kim , Hakmin Lee , Jong Jin Oh , Sangchul Lee , Seok-Soo Byun , Sung Kyu Hong

Purpose

To evaluate the impact of postoperative tadalafil on the recovery of erectile function, voiding function, and urinary continence in patients undergoing radical prostatectomy (RP) for prostate cancer.

Materials and methods

A retrospective analysis was conducted on 4,173 patients who underwent RP. Patients were categorized based on postoperative use of tadalafil. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS), along with continence status and oncologic parameters. Statistical analyses included chi-square and t-tests.

Results

In the final cohort, 916 patients received postoperative tadalafil and were compared to 3,257 patients without any phosphodiesterase type 5 (PDE5) inhibitor therapy. While early postoperative erectile function was lower in the tadalafil cohort at 1 month, recovery was superior by 12 months (IIEF-5: 5.9 ± 5.5 vs. 4.8 ± 5.6, p = 0.002). Voiding function also declined less markedly postoperatively (IPSS increase: 1.4 vs. 2.4 points), with significant improvement maintained through 12 months. Social continence rates were higher in the tadalafil group (95.1% vs. 92.6 %, p = 0.009), and biochemical recurrence was lower (11.7% vs. 25.7%, p < 0.001).

Conclusions

Postoperative tadalafil is associated with improved recovery of erectile and voiding function, as well as higher continence rates, without compromising oncologic outcomes. These findings support its consideration as part of routine postoperative management in selected RP patients.

目的评价他达拉非对前列腺癌根治性前列腺切除术（RP）患者勃起功能、排尿功能和尿失禁恢复的影响。材料与方法对4173例RP患者进行回顾性分析。根据术后他达拉非的使用情况对患者进行分类。使用国际勃起功能指数（IIEF-5）和国际前列腺症状评分（IPSS）以及失禁状态和肿瘤参数评估功能结局。统计分析包括卡方检验和t检验。结果在最后的队列中，916例患者术后接受了他达拉非治疗，3257例患者未接受任何5型磷酸二酯酶（PDE5）抑制剂治疗。他达拉非组术后1个月早期勃起功能较低，12个月恢复较好（IIEF-5: 5.9±5.5比4.8±5.6,p = 0.002）。术后排尿功能的下降也不那么明显（IPSS增加：1.4分对2.4分），并在12个月内保持显著改善。他达拉非组患者社交失禁率较高（95.1%比92.6%,p = 0.009），生化复发率较低（11.7%比25.7%,p < 0.001）。结论术后他达拉非可改善勃起和排尿功能的恢复，以及更高的尿失禁率，且不影响肿瘤预后。这些发现支持将其作为RP患者常规术后管理的一部分。

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引用次数: 0