Prostate最新文献

Background: To investigate the utility of diffusion-weighted magnetic resonance imaging (DW-MRI) in evaluating Gleason score (GS) 7 tumors before definitive radiotherapy (RT) and to explore its association with clinicopathological factors and treatment outcomes.

Materials and methods: Clinical data of 266 prostate cancer (PCa) patients with biopsy-confirmed GS 7 who underwent RT were retrospectively analyzed. Pretreatment DW-MRI was utilized to measure apparent diffusion coefficient (ADC) values of primary tumors. Treatment outcomes, including biochemical disease-free survival (bDFS) and prostate cancer-specific survival (PCSS), were assessed. Statistical analyses were conducted to determine the correlation between tumor ADC values, clinicopathological factors, and treatment outcomes.

Results: Tumors with a GS of 3 + 4 had significantly higher ADC values than those with a GS of 4 + 3 (0.746 ± 0.150 vs. 0.702 ± 0.157 × 10^-³ mm²/s; p < 0.001). Median follow-up time was 8.6 years, and the 7-year rates for bDFS and PCSS were 89.1% and 95.3%, respectively. Lower tumor ADC values were significantly correlated with higher GS and increased risk of disease progression. A primary tumor ADC cutoff value of 0.682 × 10^-³ mm²/s was identified for predicting disease progression. Patients with higher ADC values exhibited significantly better 7-year bDFS rates (92.8% vs. 83.2%; p = 0.02). However, GS 4 + 3 tumors independently predicted poorer bDFS and PCSS outcomes. In the multivariable analysis, only GS 4 + 3 tumor was predictive for worse bDFS and PCSS.

Conclusions: Tumor ADC values are a reliable biomarker for differentiating between GS 3 + 4 and 4 + 3 tumors in the GS 7 category. Tumors exhibiting lower ADC values have been associated to higher risk factors and an increased likelihood of disease progression, particularly in GS 3 + 4 tumors where GS upgrading could happen.

Background: We compare the oncological outcomes and health-related quality of life (HRQOL) in men with high-risk prostate cancer after robot-assisted radical prostatectomy (RARP) versus that after high-dose-rate brachytherapy + external beam radiotherapy + hormone therapy (hereafter: "HDR+").

Methods: We included 233 men who underwent RARP and 179 men who underwent HDR+ for high-risk prostate cancer at our hospital. We investigated the following oncologic outcomes: time to biochemical recurrence, time to development of castration-resistant prostate cancer (CRPC), cancer-specific survival, and overall survival. HRQOL was assessed using SF-8 and Expanded Prostate Cancer Index Composite (EPIC) at baseline and at 3, 6, 12, and 24 months after treatment. Propensity score matching was performed to adjust the background of the two treatment groups.

Results: The HDR+ group had a significantly lower rate of biochemical recurrence than the RARP group (p ≤ 0.01). There were no significant differences between the two groups in the time to CRPC, in cancer-specific survival, or in overall survival. The two groups had similar HRQOL, according to SF-8. The urinary domain of EPIC was significantly worse in the RARP group at 3 and 6 months postoperatively than in the HDR+ group (p ≤ 0.01). Urinary function and urinary incontinence were significantly worse in the RARP group than in the HDR+ group at all time points postoperatively (p ≤ 0.01), while urinary irritation/obstruction was significantly worse in the HDR+ group at 12 months than in the RARP group (p ≤ 0.01). Bowel function was similar between the two groups.

Conclusions: Both RARP and HDR+ were considered to be effective treatments for patients with high-risk prostate cancer in terms of oncological outcomes. Our RARP group had more postoperative urinary incontinence than our HDR+ group, while the HDR+ group had more frequent urination as a symptom of late genitourinary toxicity than the RARP group.

Background: Benign prostatic hyperplasia (BPH) is a disease linked to the hormonal imbalance that occurs during aging and over the last decades, complementary and alternative medicines have come on the scene as a treatment option for BPH, such as herbal medicines. Coconut oil has been shown to be capable of interfering in testosterone-induced BPH. However, until now there is no study of the effect of coconut oil during aging. The present study evaluated the effect of the intake of coconut oil on the prostate of aging gerbils (Meriones unguiculatus).

Methods: Two experimental groups were assigned: Gavage control (GC-animals subjected to gavage with water for 1 year, n = 11) and coconut oil (CO-animals subjected to gavage with coconut oil for 1 year, n = 11). Testosterone, and estradiol serum levels were determined by ELISA assay and histopathological analysis employed Hematoxylin-Eosin. Cell proliferation index was determined by PHH3 immunohistochemistry and TUNEL assay and receptors of androgen (AR) and estrogen (ERα and ERβ) were evaluated on the prostate.

Results: The CO group exhibited a lower prostate weight (↓16.62%), decreased thickness of the prostate muscle stroma (↓18.27%), reduced expression of both AR (↓51.32) and ERα (↓14.26%) and reduced the percentage of BPH (↓1.53%) and intraepithelial neoplasms in the prostate (↓14.24%). Coconut oil intake mitigated age-related changes and increased the rate of apoptosis in prostatic cells (↑54.32).

Conclusions: Coconut oil treatment throughout aging helped counteract the negative effects of aging on prostate health.

Introduction: The introduction of multiparametric prostate magnetic resonance imaging (mpMRI) has revolutionized prostate cancer (PCa) diagnosis, enhancing the localization of clinically significant prostate cancer (csPCa) and guiding targeted biopsies. However, significant disparities in the execution, interpretation, and reporting of prostate MRI examinations across centers necessitate greater standardization and accuracy. This study compares the diagnostic efficacy of mpMRI from academic and nonacademic centers in detecting csPCa and identifies factors associated with csPCa detection.

Materials and methods: Between July 2018 and October 2023, we prospectively followed 810 men at SS. Annunziata Hospital of Chieti who underwent MRI/US fusion biopsies due to elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE). Patients with mpMRI-documented suspicious lesions classified as PI-RADS ≥ 3 were included. Patients were divided into two groups based on the source of their mpMRI (academic or nonacademic centers). All biopsies were conducted using the MRI/US fusion technique. Clinical, mpMRI, and pathological data were collected and analyzed. Statistical analyses were performed using R software.

Results: The cohort included 354 patients from academic centers and 456 from nonacademic centers. There were no significant differences in patient demographics, such as age and PSA levels, between the groups. Patients at academic centers were more likely to receive a higher number of elevated PI-RADS scores compared to those at nonacademic centers (PI-RADS > 3: 72.6% vs. 62.3%, p = 0.003). Histopathological analysis revealed no significant differences in the ISUP grade distribution between groups. Increased age, PSA levels, and positive DRE were significantly associated with higher odds of detecting csPCa. Median PSA density was significantly higher in patients with csPCa compared to those without csPCa (0.14 vs. 0.11 ng/mL/cm³, p < 0.001). Academic centers exhibited a higher odds ratio for csPCa detection in patients with PI-RADS scores > 3 compared to nonacademic centers.

Conclusion: Our study highlights significant variability in PI-RADS score assignments between academic and nonacademic centers, affecting csPCa detection rates. This variability underscores the need for greater standardization in PI-RADS scoring to reduce disparities and improve diagnostic uniformity across centers.

Background: Our study aimed to correlate ERG and PTEN expressions in prostate biopsy with multiparametric magnetic resonance imaging PI-RADS score, clinical reclassification, and prognosis of very low-risk prostate cancer (PCa) patients under active surveillance (AS).

Methods: We evaluated 101 very low-risk PCa patients under AS between 2013 and 2018. They were followed with DRE, PSA, MRI, and re-biopsies every 1-2 years. Per cause biopsy was recommended if PSA > 10 ng/mL, suspicious DRE, or PI-RADS ≥ 4 was present. ERG and PTEN expressions were assessed by immunohistochemistry at biopsy. Reclassification was defined by PSA > 10 ng/mL, re-biopsy with > 3 positive cores, > 50% positive core, Gleason Score (GS) upgrading ≥ 3 + 4 or extreme GS upgrading ≥ 4 + 3. We correlated ERG and PTEN with reclassification, PI-RADS, pathologic outcomes, and biochemical recurrence in patients surgically treated after reclassification.

Results: After a 49.2-month follow-up, 80% of patients showed reclassification, and GS upgrading was the most common criterion. Seventy-four out of 81 patients with reclassification underwent local treatment and seven had biochemical recurrence during a mean 39.7-month follow-up. At biopsy, positive ERG expression was found in 39.6% of patients and PTEN loss in 12.6%. PTEN loss was associated with GS upgrading (OR = 9.7, p = 0.011) in univariate analysis. PTEN loss was correlated with GS upgrading; these patients had a 9.7-fold greater chance of upgrading when compared to PTEN-positive patients. ERG-positive was associated with PI-RADS ≥ 4 (OR = 2.8, p = 0.026). At multivariate analysis, PI-RADS ≥ 4 was predictor of GS upgrading (OR = 25.2, p < 0.001); MRI PI-RADS score remained an independent factor for extreme GS upgrading, together with PSAd > 0.15 (OR = 15.1, p = 0.012 and OR = 5.76, p = 0.012, respectively).

Conclusions: Neither ERG-positive nor PTEN loss were associated with upgrading during AS. ERG and PTEN biomarkers, despite commonly studied in advanced PCa, have yet no defined role in very low-risk PCa under AS. PI-RADS score was an independent predictor of GS upgrading and extreme upgrading during AS.

Background: Previous studies found that Midlife Baseline PSA (MB PSA) predicts the risk of developing lethal prostate cancer (PCa), although the cohorts were homogenous in terms of racial compositions. We aimed to investigate racial disparities in the predictive value of MB PSA for lethal PCa in a diverse, contemporary, North American population.

Methods: Our cohort included White and Black men aged 40-59 years, who underwent MB PSA through our health system. Cumulative incidence curves depicted lethal PCa stratified by race and MB PSA above/below the median. We utilized time-dependent Receiver Operating Characteristic (ROC) curves and Area Under the ROC Curve (AUC) to compare the performance of MB PSA in predicting lethal PCa based on race. Multivariable regression (MVA) was used to examine the impact of the MB PSA in predicting lethal PCa by race.

Results: We included 112,967 men, of whom 27% were Black. The cumulative incidence estimate with MB PSA values equal to the median at 15 years of follow-up was 0.13 (0.04, 0.32) for White men and 0.55 (0.24, 1.11) for Black men. AUCs comparison showed no statistically significant differences in the predictive role of MB PSA for lethal PCa between White and Black men. At MVA, using White patients with PSA ≤ median as the reference group, the HR of lethal PCa for White men with PSA > median aged 40-44, 45-49, 50-54, and 55-59 was respectively 2.98 (1.59-5.57), 3.01 (1.89-4.81), 5.10 (3.38-7.70), and 3.38 (2.32-4.92). While for Black men was respectively 5.50 (2.94-10.27), 4.19 (2.59-6.78), 9.79 (6.37-15.04), and 7.53 (5.03-11.26) (all p < 0.001).

Conclusion: Our findings indicate that for the same MB PSA and within the same age category, Black men have a greater risk of developing lethal PCa than White men. A separate cut-off should be created for MB PSA, if this is to be used to guide PSA screening in clinical practice.

Introduction: Non-castrating therapies are an unmet clinical need for patients with advanced prostate cancer. To maximize quality of life and prioritize cardiovascular health, we investigated SGLT2 inhibitors as a non-castrating therapy in patients with prostate cancer.

Materials and methods: We conducted a retrospective analysis of patients with either local or biochemically recurrent prostate cancer who initiated therapy with an SGLT2 inhibitor without concurrent androgen deprivation therapy. The primary endpoint was an estimated PSA₅₀ response rate. A secondary endpoint was PSA any response rate.

Results: A total of nine patients (median age 63 years old; 44.4% Black; median PSA 3.7; 33.3% localized, 66.7% biochemically recurrent) were included. The PSA₅₀ and PSA_any response rate were 22.2% (N = 2/9) and 44.4% (N = 4/9), respectively.

Conclusions: Patients with localized or biochemically recurrent prostate cancer achieved PSA responses to SGLT2 inhibitors. These findings justify prospective studies in patients with prostate cancer.

Background: Multiparametric magnetic resonance imaging (mpMRI) is pivotal in prostate cancer (PCa) diagnosis, but some clinically significant (cs) PCa remain undetected. This study aims to understand the pathological and molecular basis for csPCa visibility at mpMRI.

Methods: We performed a retrospective matched-pair cohort study, including patients undergoing radical prostatectomy (RP) for csPCa (i.e., ISUP grade group ≥ 2) from 2015 to 2020, in our tertiary-referral center. We screened for inclusion in the "mpMRI-invisible" cohort all consecutive men (N = 45) having a negative preoperative mpMRI. The "mpMRI-visible" cohort was matched based on age, PSA, prostate volume, ISUP grade group. Included patients underwent radiological and pathological open-label revisions and characterization of the tumor mRNA expression profile (analyzing 780 gene transcripts, signaling pathways, and cell-type profiling). We compared the clinical-pathological variables and the gene expression profile between matched pairs. The analysis was stratified according to histological characteristics and lesion diameter.

Results: We included 34 patients (17 per cohort); mean age at RP and PSA were 70.5 years (standard deviation [SD] = 7.7), 7.1 ng/mL (SD = 3.3), respectively; 65% of men were ISUP 2. Overall, no significant differences in histopathological features, tumor diameter and location, mRNA profile, pathways, and cell-type scores emerged between cohorts. In the stratified analysis, an upregulation of cell adhesion and motility, of extracellular matrix remodeling and of metastatic process pathways was present in specific subgroups of mpMRI-invisible cancers.

Conclusions: No PCa pathological or gene-expression hallmarks explaining mp-MRI invisibility were identified. Aggressive features can be present both in mpMRI-invisible and -visible tumors.