Prostate最新文献

Background: The diagnostic reliability of magnetic resonance imaging (MRI)/transrectal ultrasound (TRUS) fusion-targeted re-biopsy for prostate cancer (PCa) remains limited. Therefore, additional predictive markers are needed to improve patient selection. This study aimed to identify factors predictive of clinically significant PCa (csPCa) to develop a risk stratification model. The role of systematic biopsies was also investigated.

Methods: We retrospectively analyzed 194 patients who underwent MRI/TRUS fusion-targeted re-biopsies between 2017 and 2024. Lesions were scored according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2.0 or 2.1. Univariate and multivariate logistic regression analyses were conducted to identify predictors of csPCa, defined as Gleason score ≥ 3 + 4. Detection rates for csPCa were compared between groups. The diagnostic contribution of systematic biopsies was assessed separately.

Results: Of the 194 patients, 82 (42.3%) were diagnosed with csPCa. Multivariate analysis identified prostate-specific antigen density (PSAD) ≥ 0.20 (odds ratio (OR): 6.56) and PI-RADS ≥ 4 (OR: 12.38) as independent predictors of csPCa. Based on the PI-RADS category and PSAD, patients were stratified into high-, intermediate-, and low-risk groups. These risk stratification factors led to the classification of 83 (42.8%) patients as high-risk, 77 (39.7%) as intermediate-risk, and 34 (17.5%) as low-risk, with csPCa detection rates of 74.7% (62/83), 24.7% (19/77), and 2.9% (1/34), respectively. Of the 82 patients with csPCa, 21 were diagnosed exclusively via systematic biopsies.

Conclusions: Combining PSAD with PI-RADS improved risk stratification for csPCa in men who underwent MRI/TRUS fusion re-biopsies, while systematic biopsies added diagnostic value. These findings support individualized evidence-based re-biopsy strategies.

Background: Grade Group 5 (GG5) prostate cancer carries the poorest prognosis, yet it is often undetected at biopsy. We evaluate whether Cell Cycle Progression (CCP) score identifies biopsy-undetected GG5 disease and improves risk stratification when combined with Cancer of the Prostate Risk Assessment (CAPRA) score.

Methods: A total of 430 patients with biopsy-confirmed GG1-4 underwent Prolaris® testing before immediate radical prostatectomy (RP). Logistic regression assessed the association between CCP score and pathological GG5 at RP. Predictive models using CCP, CAPRA, and clinical cell-cycle risk (CCR) score were compared using area under the curve (AUC), decision curve analysis (DCA), and net reclassification improvement (NRI).

Results: Although GG5 was not frequent (7.2%), CCP score independently predicted GG5 (p < 0.001) before and after adjusting for CAPRA and biopsy core number obtained. AUCs were 0.71 (95% CI: 0.60-0.83) for CCP, 0.67 (0.56-0.77) for CAPRA, 0.77 (0.67-0.87) for CCP + CAPRA, and 0.74 (0.64-0.84) for CCR. Both CCP + CAPRA and CCR outperformed CAPRA (DeLong's test, p = 0.008 and 0.001, respectively). DCA showed greater net benefit for CCP + CAPRA at thresholds 0.05-0.50 and for CCR at 0.05-0.40. CCR score yielded a higher overall NRI of 0.90 (95% CI: 0.55-1.20), improving classification for both events and non-events. A significant positive CCP-CAPRA interaction was identified: GG5 was observed in 5.7% (24/421) of patients with CCP ≤ 4.6 and/or CAPRA ≤ 4, versus 78% (7/9) with both > 4.6 and ≥ 5 (p = 0.039).

Conclusions: Our data suggests that CCP score adds value to initial risk assessment, particularly in CAPRA-defined low- to favorable-intermediate-risk patients. An elevated CCP score should prompt counseling on the increased risk of biopsy-undetected GG5 disease and consideration of intensified management, such as RP or radiotherapy with prolonged androgen deprivation therapy within a multimodal framework. This is especially relevant in non-surgical settings where final pathology is unavailable.

Clinical trial registration: N/A.

Background: To question the necessity of simultaneous benign prostatic obstruction (BPO) intervention with cystolitholapaxy in patients with bladder stone (BS) due to BPO and to investigate the factors predicting secondary intervention.

Methods: A total of 235 male patients over 40 years of age who underwent cystolitholapaxy, had a follow-up period longer than 12 months, and were thought to have BS secondary to BPO were included in the study.

Results: A total of 190 patients who did not require additional intervention were defined as Group 1, and 45 patients who required secondary intervention were defined as Group 2. Secondary surgical intervention was required at a rate of 19.5% with an average follow-up of 49 months. Mean peak urine flow rate (Q_max) was 11 m/s in Group 1 and 8.6 m/s in Group 2 (p < 0.001), postvoid residual urine volume (PVR) was 85.5 mL in Group 1 and 115.3 mL in Group 2 (p < 0.001), International Prostate Symptoms Score (IPSS) was 16.7 in Group 1 and 21.7 in Group 2 (p < 0.001). Total prostate volume (TPV) (p = 0.015) and serum prostate-specific antigen (PSA) (p = 0.005) were also significantly higher in Group 2. In the multivariable Cox proportional hazards regression analysis of factors predicting secondary intervention in patients undergoing cystolitholapaxy, low Q_max (hazard ratio (HR) = 0.905, 95% confidence interval (CI): 0.821-0.997, p = 0.043), high PVR (HR = 1.014, 95% CI: 1.007-1.022, p < 0.001), high IPSS (HR = 1.178, 95% CI: 1.106-1.255, p < 0.001) and high PSA (HR = 1.086, 95% CI: 1.000-1.178, p = 0.05) were found to be predictors.

Conclusions: In patients with BS secondary to BPO, performing cystolitholapaxy offers a high likelihood of avoiding secondary intervention. Low Q_max, high PVR, high IPSS, and high PSA are indicators of a higher risk of secondary intervention in the preoperative period. Therefore, in a patient-centered approach, these predictors should be taken into account when deciding whether BPO surgery is necessary in addition to cystolitholapaxy.

Background: Benign prostatic hyperplasia (BPH) is the most common urological disorder of the prostate in aged men. Oxidative stress and environmental factors have been associated with BPH. However, information on infectious agents association with BPH remains scarce. This study aims to determine Escherichia coli (E. coli) infection and virulence gene association with BPH in patients.

Methods: A case-control study was conducted with 61 BPH patients and 52 controls. Prostate volume (PV) was estimated for diagnosis of BPH using abdominal ultrasound. Serum malondialdehyde (MDA) levels were measured, and data on alcohol intake and physical exercise were obtained with questionnaire. E. coli DNA was extracted from urine samples, and targeted 16S rRNA and fimH gene primers were used for PCR amplifications.

Results: Mean difference of PV between patients (55.10 ± 27.37) and controls (26.33 ± 6.37) was statistically significant (p < 0.01). Serum MDA was significantly and positively correlated with PV (p < 0.001). Exercise correlate inversely with prostate volume. Intriguingly, alcohol intake significantly and inversely correlated with PV (p < 0.05). E. coli infection, but not virulence, was associated with an almost 12-fold increased risk of PV (p < 0.01). No fimH gene sequence variation was observed in isolates from patients and controls. However, Ghanaian isolates displayed sequence diversity when compared with isolates from other countries.

Conclusion: Escherichia coli infection, particularly variant carrying the fimH virulence gene, was more frequent among the BPH patients. These findings suggest that E. coli infection should be considered as a key factor in the management of BPH.

Introduction: In real-world practice in Japan, standard treatment for metastatic hormone-naïve prostate cancer (mHNPC) is androgen deprivation therapy (ADT), administered as monotherapy, combined androgen blockade (CAB), ADT plus androgen receptor pathway inhibitors (ARPIs), or ADT plus docetaxel. In a previous interim analysis of the large-scale, longitudinal, multicentre, J-ROCK registry study of real-world clinical and patient-reported outcomes, ADT plus ARPI or ADT plus docetaxel was used more frequently than ADT/CAB in patients (aged ≥ 20 years) with newly diagnosed LATITUDE-criteria high-risk mHNPC.

Methods: This post hoc analysis of the J-ROCK study evaluated prostate-specific antigen (PSA) response, progression-free survival (PFS), time to castration-resistant prostate cancer (CRPC), overall survival (OS) and safety in patients with high-risk mHNPC who received ADT/CAB (cohort 1) or ADT plus ARPI (cohort 2B) in subgroups were defined according to the following known prognostic factors at baseline: age, Gleason Grade Group (GGG), alkaline phosphatase (ALP), hemoglobin (Hb) and lactate dehydrogenase (LDH).

Results: This analysis included 947 evaluable patients (371 in cohort 1 and 576 in cohort 2B). PSA response rates remained similar among age and GGG subgroups in both cohorts, but were reduced in cohort 2B patients with elevated ALP, low Hb, and elevated LDH. Time to CRPC and OS were longer in cohort 2B than in cohort 1, regardless of prognostic factors. Among patients with poor prognosis (older, high GGG, low Hb, elevated LDH), OS decline occurred earlier in cohort 1 versus cohort 2B. A trend towards a plateau in the time to CRPC curve was observed in both cohorts, even in patients with poor prognosis. Safety data were not affected by prognostic factors or treatment.

Conclusions: These findings suggest that novel ADT plus ARPI regimens for LATITUDE-criteria high-risk mHNPC may improve real-world outcomes compared with ADT monotherapy or CAB, particularly among patients with poor prognosis.

Objective: To investigate the application value of Rapid On-Site Evaluation (ROSE) in prostate biopsy.

Methods: All consecutive subjects who attended our clinic to underwent magnetic resonance imaging (MRI)-ultrasound fusion biopsy due to highly suspicious findings on MRI for prostate cancer (PCa) and met the inclusion criteria were enrolled into our prospective study between October 2020 and January 2025. ROSE was performed concurrently in the same operating room with MRI-ultrasound fusion biopsy. For each lesion with Prostate Imaging-Reporting and Data System (PI-RADS) 4-5, one to two additional needle passes were taken for ROSE, in addition to the standard biopsy. The results of ROSE during the biopsy were recorded. The sensitivity, specificity, positive predictive value, and negative predictive value of ROSE were assessed using paraffin-embedded histopathology of the biopsy specimens as the gold standard.

Results: A total of 313 lesions with PI-RADS 4-5 from 147 patients were ultimately included in this study. All biopsies were performed smoothly, with no severe complications occurring postoperatively. 192 lesions were pathologically diagnosed with PCa, yielding a positive detection rate of 61.3% (192/313). With paraffin-embedded histopathology of the biopsy specimens serving as the gold standard, the sensitivity of ROSE for detecting PCa was 71.9% (138/192), specificity was 100% (121/121), accuracy was 82.7% (259/313), positive predictive value was 100% (138/138), and negative predictive value was 69.1% (121/175).

Conclusions: The application of ROSE technology in the diagnosis during prostate biopsy is accurate and reliable, with specificity and positive predictive value both reaching 100%.

Background: Prostate biopsy is currently the most common method of diagnosing prostate cancer (PCa). However, excessive biopsies not only cause physical and psychological pain to patients, but also increase the healthcare burden. We aimed to provide a biopsy strategy for patients with PI-RADS score 2 to improve the detection rate of clinically significant PCa (csPCa) while minimizing unnecessary prostate biopsies.

Methods: This study retrospectively collected clinical data from patients undergoing prostate biopsy from three medical centers in China. The KD cohort was used as the primary analysis cohort, and the ZD and YJS cohorts were used as external validation cohorts. Diagnostic capacity of clinical variables was assessed using the receiver operating characteristic (ROC) curves and area under the curve (AUC) and compared with DeLong test. By plotting the relationship between csPCa risk and prostate-specific antigen density (PSAD) values using a locally estimated scatterplot smoothing(loess) function, the PSAD cutoff value corresponding to a clinically reasonable csPCa risk is determined. Prostate biopsy strategies are represented as simple decision tree diagrams. This study used csPCa as the only study endpoint.

Results: By grouping patients with a cut-off value of PSAD ≥ 0.46 ng/ml, the detection rate of csPCa in the KD cohort of patients with a PI-RADS score of 2 increased from an initial 3.7-18.7%. And according to our proposed strategy would reduce unnecessary prostate biopsy by 86.5%, and at the same time could reduce the detection of clinically insignificant PCa (cisPCa) by 96.7%, at the cost of missing 1.3% of csPCa. The similar diagnostic performance was also shown in the ZD and YJS cohorts.

Conclusions: The individualized precision prostate biopsy strategy is developed in this study, which can be used to make optimal decisions when faced with low-risk PCa (PI-RADS score 2) patients.

Objective: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects 2%-10% of men worldwide, yet lacks standardized treatment algorithms. This study aimed to establish a definitive treatment hierarchy by comparing four therapeutic modalities: alpha-blocker monotherapy, alpha-blocker plus antibiotic combination, alpha-blocker plus saw palmetto combination, and transurethral resection of prostate (TUR) surgery.

Materials and methods: This retrospective comparative cohort study analyzed 200 adult males with CP/CPPS (50 patients per group) treated at a single academic center between October 2023 and August 2025. Inclusion criteria comprised NIH Chronic Prostatitis Symptom Index (NIH-CPSI) total score ≥ 10 and pain score ≥ 4, with excluded bacterial infection. Primary endpoint was NIH-CPSI score improvement at 12 weeks; clinical response was defined as ≥ 6-point improvement. Secondary endpoints included safety profiles and histopathological findings.

Results: Significant therapeutic efficacy differences emerged between groups (p < 0.001). TUR surgery achieved highest efficacy with 88% clinical response rate and mean 15.7-point NIH-CPSI improvement. Alpha-blocker plus saw palmetto combination demonstrated superior medical therapy effectiveness (80% clinical response, 10.7-point improvement), exceeding monotherapy by 4.2 points (p < 0.001). Critically, alpha-blocker plus antibiotic combination showed no advantage over monotherapy (6.7 vs 6.5 points, p = 1.000). Chronic prostatitis was histologically confirmed in 100% of TUR specimens, with prostatic stones identified in 76% of cases. All treatments were well-tolerated with adverse event rates of 18%-30% (p = 0.234).

Conclusions: This study establishes an evidence-based treatment hierarchy for CP/CPPS: TUR surgery represents the most effective approach for refractory cases, while alpha-blocker plus saw palmetto combination constitutes optimal medical therapy. Antibiotic addition provides no benefit in non-bacterial prostatitis. These findings provide robust evidence for clinical decision-making and support guideline updates emphasizing antibiotic stewardship and phytotherapeutic agent validation.

Clinical trial registration: This study was not registered as a clinical trial.

Background: As no randomized study has compared abiraterone acetate (ABI) doublet and triplet therapy, the optimal target for the add-on of docetaxel (DTX) to ABI doublet therapy remains unclear. The present study explored patients who may benefit from add-on DTX using initial prostate-specific antigen (PSA) reduction after ABI doublet therapy.

Methods: We retrospectively reviewed 233 patients with CHAATED high-volume metastatic castration-sensitive prostate cancer (mCSPC) treated with ABI doublet therapy. Using the initial PSA half-life calculated by PSA reduction within 6 weeks of treatment (initial PSA^T1/2), a subgroup of patients with a poor overall survival (OS) was explored. The optimal cutoff value of PSA^T1/2 predicting a PSA decline < 90% after 12 weeks of ABI treatment was investigated using a receiver operating characteristic (ROC) analysis.

Results: A PSA^T1/2 of 0.33 months was an ideal cutoff value for predicting a PSA decline < 90% after 12 weeks of ABI treatment. In addition to Grade Group 5 (hazard ratio [HR]: 3.06, p = 0.002) and an LDH ≥ 250 U/L (HR: 2.30, p = 0.017), an initial PSA^T1/2 ≥ 0.33 months (HR: 3.39, p < 0.001) were identified as significant predictors of a poor OS in mCSPC treated with ABI doublet therapy. Only liver metastasis was significantly associated with an initial PSA^T1/2 of ≥ 0.33 months.

Conclusion: We showed that the initial PSA^T1/2 of treatment was significantly prognostic in high-volume mCSPC patients treated with ABI doublet therapy. Our findings suggest that initial PSA reduction may help identify patients who will benefit from the addition of DTX. A prospective study is required to verify our hypotheses.