Therapeutic Advances in Urology最新文献

Background: Many metastatic prostate cancer prognostics have been suggested, but few are validated. Nodal metastasis burden and baseline biochemical characteristics are overlooked in the currently accepted stratifications for metastatic hormone-sensitive prostate cancer (mHSPC). Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is likely to increase the incidence of pelvic nodal and mHSPC undetected by conventional scans. However, there is no consensus on managing regional nodal metastasis (N1M0) and no separate guidelines for non-regional nodal (M1a) and low-volume bone (M1b) spread but collectively as a part of low-volume CHAARTED disease.

Objectives: To assess the different prognostic factors for stage IV disease classified as CHAARTED low-volume on a real-world series of patients and to examine treatment preference for each of the disease subcategories.

Methods and design: This retrospective cross-sectional study included patients diagnosed with HSPC at stage IV, with low-volume disease according to the CHAARTED criteria. Data were collected from the database of Portsmouth and St. Mary NHS Hospitals between February 2017 and August 2023. Patient characteristics were analysed, and prognostic factors were evaluated using Cox regression analysis. 5-year progression-free survival (PFS) was the primary outcome measure.

Results: Data on 126 patients were analysed. Seven patients (6%) had N1M0, 28 (22%) M1a, and 91 (72%) M1b. 5-year PFS was 80.9% for M1a and 54.9% for M1b metastases, p = 0.3. High prostate-specific antigen (PSA) value (⩾25) was identified as an independent prognostic factor for PFS with HR = 2.80 (95% CI: 1.19-6.56), p = 0.0179. Variable treatment preference for each subclass reflects the uncertainty regarding the best regimen and the importance of consolidation prostate radiotherapy (cRT) in clinical practice.

Conclusion: Early results of our data analysis underscore the significance of baseline PSA as an independent prognostic factor alongside anatomical tumour extent of spread in stage IV low-volume metastasis prostate cancer. There is no agreement on treatment for each subcategory, necessitating further real-world studies and clinical trials. Further follow-up would assess the prognostic benefit of cRT.

Background and objectives: Intermittent androgen deprivation therapy (iADT) may result in measurable improvements in quality of life over continuous ADT in patients with advanced prostate cancer (aPC). Here, we studied time to castration and testosterone recovery in real-world patients with aPC undergoing iADT with relugolix.

Methods and design: Eligibility criteria for this retrospective study were histologically confirmed through the diagnosis of aPC and initiation of iADT with relugolix. Primary endpoints were time to castrate level of testosterone after relugolix initiation and time to recovery to noncastrate levels after relugolix discontinuation.

Results: Overall, 25 patients with aPC were treated with iADT and with relugolix. Median time to serum testosterone <50 ng/dL was 1.13 months [range 0.67-2.5 months]. The median time to recovery >50 ng/dL was 1.4 months [range 0.83-6.57 months] from holding treatment with relugolix.

Conclusion: iADT with relugolix is associated with a rapid time to testosterone suppression and recovery. These results may guide patients' counseling and monitoring of serum testosterone and PSA levels in patients wishing to pursue iADT for aPC.

Background: Cystitis glandularis is a chronic inflammatory disease of the urinary system characterized by high recurrence rates, the reasons for which are still unknown.

Objectives: This study aims to identify potential factors contributing to recurrence and propose a simple and feasible prognostic model through nomogram construction.

Design: Patients with confirmed recurrence based on outpatient visits or readmissions were included in this study, which was subsequently divided into training and validation cohorts.

Methods: Machine learning techniques were utilized to screen for the most important predictors, and these were then employed to construct the nomogram. The reliability of the nomogram was assessed through receiver operating characteristic curve analysis, decision curve analysis, and calibration curves.

Results: A total of 252 patients met the screening criteria and were enrolled in this study. Over the 12-month follow-up period, the relapse rate was found to be 57.14% (n = 144). The five final predictors identified through machine learning were urinary infections, urinary calculi, eosinophil count, lymphocyte count, and serum magnesium. The area under curve values for all three time points assessing recurrence exceeded 0.75. Furthermore, both calibration curves and decision curve analyses indicated good performance of the nomogram.

Conclusion: We have developed a reliable machine learning-based nomogram for predicting recurrence in cystitis glandularis.

Background: The Penuma is a soft silicone penile implant designed for cosmetic enhancement of the flaccid penis in men who have normal erections.

Objectives: The goal of this study is to report outcomes on patient satisfaction at least 6 months after Penuma subcutaneous penile implant for cosmetic enhancement of the penis, and to determine if modifications in surgical approach resulted in reduction in postoperative complications.

Design: Penile measurements, adverse events, and patient satisfaction were compared between patients undergoing the new lateral scrotal incision versus the traditional infrapubic approach.

Methods: A retrospective chart review was performed on all patients who underwent a Penuma implant by a single surgeon from April 2019 to December 2022. A 26-item non-validated device-specific questionnaire was sent to patients at least 6 months after the date of their initial surgery.

Results: A total of 92 cases were performed by a single surgeon. The average increase in flaccid length was 2.5 cm (±2.2), representing a 44% increase (p < 0.01). The average increase in girth was 3.1 cm (±1.8 cm), a 32% change (p < 0.01). Seroma requiring drainage occurred in 12%. 7% of patients required operative revision of the implant. When assessed by surgical approach, the revision rate was significantly higher in infrapubic patients (13% vs 2%, p < 0.05). The implant removal rate was also significantly higher when the infrapubic approach was used (21% vs 6%, p < 0.05). 82% of patients reported being satisfied or very satisfied with their postoperative penile appearance. 75% of patients would undergo surgery again.

Conclusion: The subcutaneous Penuma penile implant appears to improve satisfaction with regard to the appearance of the penis and is a viable option for men who desire to enhance flaccid penile length and girth. Furthermore, the lateral scrotal surgical approach appears to have a lower postoperative complication rate.

Background: Artificial urinary sphincter (AUS) placement remains the gold-standard treatment for post-prostatectomy urinary incontinence (PPUI), despite their need for periodic surgical revision.

Objective: To understand the experiences of patients who undergo repeat AUS revisions.

Design: Mixed design including quantitative surveys and qualitative interviews for thematic analysis.

Methods: Men with ⩾2 revisions were collected from a single-institution, retrospective database of AUS patients. Participants were interviewed about their prostatectomy, incontinence, AUS placement, and revisions. A survey was administered utilizing validated tools (e.g., Decision Regret Scale (DRS), Incontinence Impact Questionnaire-7) for quantitative analysis. Interview transcripts were used for qualitative thematic analysis.

Results: Of 26 respondents, 20 completed the interview. Twenty-three men completed the survey. The mean DRS score for prostatectomy was 24 (standard deviation (SD) = 27), indicating low regret. Median Incontinence Impact Questionnaire score was 54 (SD = 27), with 70% of participants describing their PPUI as "severe." Participants experienced a significant decrease in daily pad usage with AUS placement (5.5 pre-AUS vs 1.4 post-AUS, p < 0.0001). Qualitative analysis revealed themes involving prostatectomy urgency, physician-patient relationships, expectation setting, and quality of follow-up. Most participants (96%) were satisfied with their initial AUS placement and endorsed a positive relationship with their urologist. However, 22% of participants were unaware of device limitations, including the need for revision. Some participants (26%) were uncertain of the status of their AUS, while some participants (35%) desired improved follow-up.

Conclusions: Initial improvement and positive experiences with urologists motivate patients to undergo AUS repeat revision. Urologists should emphasize the limitations of the AUS before placement and follow up with patients to evaluate their needs for future care.

Objective: To systematically identify and quantify the incidence and risk factors of postoperative urinary incontinence (UI) in holmium laser enucleation of the prostate (HoLEP), aiming to provide a basis for intervention strategies.

Methods: Relevant studies on postoperative UI in HoLEP were searched in databases including PubMed, Web of Science, EMBase, CNKI, Wanfang Data Knowledge Service Platform, VIP and CBMdisc, with the search period up to April 2024. Titles, abstracts and full texts were screened using the Endnote application. Studies meeting the inclusion and exclusion criteria underwent quality assessment and data extraction. The incidence of postoperative UI and/or adjusted or unadjusted odds ratios (OR), relative risks or ratios were recorded, and analysis was conducted using Stata 15.0 software.

Results: A total of 17 studies encompassing 7939 patients were included. The pooled incidence of UI after HoLEP was 1.12, 95% CI (1.11-1.13); the 3-month postoperative incidence was 1.06, 95% CI (1.05-1.06); the 6-month postoperative incidence was 1.04, 95% CI (1.03-1.05); the 12-month postoperative incidence was 1.05, 95% CI (1.03-1.06); and the incidence of permanent UI after HoLEP was 1.01, 95% CI (1.00-1.01). The occurrence of UI after HoLEP exhibited a time-dependent variation. The risk factors for UI after HoLEP included the following: age (OR = 1.03, 95% CI: 1.01-1.06); body mass index (BMI; OR = 1.10, 95% CI: 1.01-1.20); prostate volume (OR = 1.77, 95% CI: 1.39-2.27); prostate-specific antigen (PSA) (OR = 0.98, 95% CI: 0.87-0.92); International Prostate Symptom Score (IPSS) (OR = 0.94, 95% CI: 0.83-1.07).

Conclusion: The results of this study indicate a decreasing trend in the incidence of postoperative UI after HoLEP over time, with a time-dependent change. Age, BMI, prostate volume, PSA and IPSS are risk factors for postoperative UI after HoLEP. Age and prostate volume have a significant impact on UI. Therefore, preoperative assessment and intervention for these factors are crucial in reducing the occurrence of postoperative UI in HoLEP.

DNA repair genomic aberrations in the Homologous Recombination pathway are identifiable in up to 25% of patients with advanced prostate cancer, making them more likely to benefit from treatment with poly (ADP-ribose) polymerase inhibitors (PARPi) alone or in combination with other therapies, particularly when BRCA driver genomic aberrations are documented. Although several clinical trials have demonstrated the efficacy of this approach, the validation of reliable biomarkers predictive of response still needs further improvement to refine patient selection. In this setting, the characterization of resistance mechanisms and the validation of novel biomarkers are critical to maximize clinical benefit and to develop novel treatment combinations to improve outcomes. In this review, we summarize the development of PARPi in prostate cancer as single agent as well as the efficacy of their combination with other drugs, and the future directions for their implementation in the management of advanced prostate cancer.