Prostate最新文献

Background: Active surveillance (AS) is the preferred management approach for patients with low-risk prostate cancer (PC); yet whether younger patients with favorable-intermediate-risk (FIR) PC experience increased mortality-risk when electing AS remains unknown. We evaluated all-cause, PC-specific, and non-PC-specific mortality (ACM, PCSM, and non-PCSM) in younger patients with FIR PC managed with either AS/watchful-waiting (WW) or immediate definitive treatment, stratified by race.

Methods: We conducted a retrospective cohort study using SEER data (2010-2020). Patients included were < 60 years-old with FIR PC. The primary outcome was ACM, secondary outcomes PCSM and non-PCSM. Multivariable Cox and Fine-Gray competing-risk regressions were used, adjusting for known prognostic factors. Interaction by race (White vs underrepresented minority [URM]) was explored. Statistical significance was set at p < 0.025 (Bonferroni-adjusted).

Results: Among 3,832 patients, 127 died (3.31%), including 18 of the 127 deaths from PC (14.17%). Initial treatment with RP/RT did not significantly reduce ACM or non-PCSM compared to AS/WW in White (ACM AHR, 0.92; 95% CI, 0.44-1.94; non-PCSM AHR, 1.36; 95% CI, 0.53-3.46) or URM patients (ACM AHR, 0.68; 95% CI, 0.33-1.43; non-PCSM AHR, 1.04; 95% CI, 0.44-2.44). However, after adjustment for multiplicity RP/RT significantly reduced PCSM-risk compared to AS/WW in URM (AHR, 0.03; 95% CI, 0.00-0.48; p = 0.01), but not in White patients (AHR, 0.21; 95% CI, 0.05-0.88; p = 0.03) although the median follow-up was 6.5-months longer in URM patients undergoing AS/WW compared to RP/RT.

Conclusions: Early mortality-risks were similar and low in patients age < 60 years with FIR PC managed with AS/WW compared to RP/RT, irrespective of race.

Background: Prostate cancer is a highly heterogeneous disease, this study assessed the association between tumor prostate-specific antigen density (TPSAD) and tumor heterogeneity in prostate cancer.

Methods: A retrospective study was performed from January 2022 to December 2024 to analyze the correlation between TPSAD and subsequent clinical features in patients with nonmetastatic prostate cancer. The tumor volume was delineated by two radiologists on multi-parametric prostate MRI images using three-dimensional (3D) Slicer software; the TPSAD was calculated by dividing the serum PSA density by the tumor volume. The clinical features between patients with low TPSAD and high TPSAD were analyzed. Immunohistochemistry (IHC) was performed to analyze RB1, TP53, PTEN, and neuroendocrine differentiation (NED) markers in tumor species, to evaluate the heterogeneity of prostate cancer.

Results: A total of 172 patients were enrolled in the study; the median tumor volume was 5.47 cm³, and the median TPSAD was 3.50 ng/mL/cm³. Differential analysis showed that patients with low TPSADs had a higher tumor volume (18.82 vs. 2.10 cm³), were in a higher ISUP group, and presented with a higher T stage compared with patients with high TPSADs (p < 0.001). Univariate and multivariate logistic regression analyses indicated that the TPSAD was an independent protective factor for ISUP 5 pathological type (aOR = 0.846, 95% CI: 0.746-0.959; p = 0.009), and low TPSAD indicated a shorter biochemical recurrence-free survival in patients received radical prostatectomy (25.5 months vs. not reached, p = 0.007). The IHC indicated that patients with a low TPSADs had reduced PSA expression and a higher positive KI67 index in tumor tissues compared with patients with a high TPSADs. Further molecular detection found higher incidences of PTEN loss and NED in patients with low TPSADs (all p < 0.05).

Conclusions: TPSAD represents a good predictor of prostate cancer heterogeneity. A low TPSAD indicates prostate cancer with high aggressiveness and poor prognosis, which is associated with low PSA expression and high heterogeneity in the tumor.

Introduction: The necessity of routinely combining bladder stone removal with surgical treatment for BPH remains debated. We compared the efficacy and safety of bladder stone removal with and without concomitant outlet surgery in patients with BPH.

Methods: We conducted a multicenter ambispective cohort study comparing bladder stone removal alone vs. removal with concomitant holmium laser enucleation of the prostate (HoLEP). BPH patients with bladder stones > 1 cm were included. Exclusion criteria ruled out alternative causes of bladder stones. The "stone removal-only" group (n = 63) underwent endoscopic removal at Mount Sinai, while the "HoLEP" group (n = 42) underwent a combined procedure at Sourasky Medical Center. Outcomes included 90-day complications, stone recurrence, IPSS scores, and decisional regret.

Results: At baseline, HoLEP patients had higher PVR, greater use of 5-ARI, and more frequent preoperative catheterization, while the stone removal-only group had greater stone burden. Compared to HoLEP, stone removal alone was associated with higher bladder stone recurrence (14% vs. 0%) and a slightly higher symptom burden (median IPSS: 8 vs. 4), but lower overall (13% vs. 31%) and major complication rates (0% vs. 5%). Despite these differences, 77% of patients managed by stone removal alone remained free of BPH surgery at 3 years and reported higher long-term satisfaction. Based on the results, we developed a shared decision-making tool and user-friendly app for clinical use (PreOp Decision).

Conclusion: Bladder stone removal alone is a viable option for selected patients, and BPH surgery should be guided by obstruction severity, not stone presence. Shared decision-making is essential, and our proposed questionnaire may help guide treatment selection pending future validation.

Background: This study aimed to identify patients who would benefit from androgen receptor signaling inhibitor (ARSI) therapy in metastatic hormone-sensitive prostate cancer (mHSPC) with bone metastasis (BM). Therefore, we developed a risk stratification model based on the prognostic impact of BM number.

Methods: We retrospectively analyzed 244 patients with mHSPC and BM treated with ARSI plus androgen deprivation therapy between March 2018 and November 2024. Prognostic thresholds for BM number were assessed using four cutoffs (≥ 4, ≥ 6, ≥ 11, and ≥ 21). The cutoff with the highest hazard ratio (HR) for castration resistance-free survival (CRFS) was incorporated into a multivariable Cox model along with other clinical variables. Independent prognostic factors were used to construct a risk stratification model, and CRFS and overall survival (OS) were compared with the CHAARTED criteria.

Results: At a median follow-up of 31.3 months, ≥ 11 BM showed the strongest prognostic effect for CRFS (HR: 2.62) and OS (HR: 3.01). Multivariable analysis identified ≥ 11 BM (HR: 2.47, 95% CI: 1.45-4.21, p = 0.001), ≥ Gleason score (GS) 9 (HR: 2.07, 95% CI: 1.12-3.45, p = 0.005), and ≥ cT3b (HR: 2.16, 95% CI: 1.14-4.07, p = 0.018) as independent adverse factors. Patients were classified into favorable-risk (no risk factors), intermediate-risk (one risk factor), and poor-risk (two risk factors) groups, which demonstrated significantly different CRFS and OS outcomes (both p < 0.001). Compared with the low-volume disease, as defined by the CHAARTED criteria, the favorable-risk group represented a significantly larger proportion of patients (39.3% vs. 26.6%, p < 0.001) with comparable CRFS (HR: 0.66, p = 0.33) and OS (HR: 0.51, p = 0.18).

Conclusions: This risk model suggests that patients without ≥ 11 BM, ≥ GS9, and ≥ cT3b may benefit from ARSI plus androgen deprivation therapy for mHSPC. Moreover, it identifies a significantly larger favorable-risk subgroup than the CHAARTED criteria, potentially enhancing clinical precision in treatment selection.

Background: To compare choline PET-CT and PSMA PET-CT in a cohort of patients with high-risk localized prostate cancer, assessing the diagnostic capacity of both tests. whose therapeutic approach could be modified based on the results.

Methods: An observational study was conducted in 116 patients with high-risk prostate cancer between January 2021 and January 2024. All patients underwent sequential choline and PSMA PET-CT scans. Clinical and pathological data were collected, and extraprostatic disease and SUVmax values in these locations were evaluated.

Results: The mean age was 68.9 years (SD 7.8) and the median PSA at diagnosis was 14.6 ng/mL. The most frequent ISUP grade was 2 (28.5%). The mean interval between the two tests was 19 days. All patients had detectable intraprostatic tumor activity with both techniques. In 28.6% of patients with negative choline PET-CT, PSMA PET-CT detected extraprostatic disease. In the subgroup undergoing radical prostatectomy, PSMA PET-CT positivity was significantly associated with the presence of positive surgical margins (p < 0.05). PSMA PET-CT showed a significant association with ISUP ≥ 3 (OR 2.42; p < 0.05). SUVmax in extraprostatic lesions was higher in patients with ISUP ≥ 3 in both choline and PSMA PET-CT, being stronger with PSMA PET-CT (OR 22.67 vs. 3.26).

Conclusion: PSMA PET-CT offers superior diagnostic performance to choline PET-CT in patients with high-risk prostate cancer which has a clinical impact on therapeutic decision-making.

Background: With the increasing integration of multiparametric MRI (mpMRI) and 68Ga-PSMA PET/CT into the diagnostic and staging algorithms of prostate cancer (PCa), digital rectal examination (DRE)-a once foundational and cost-effective physical examination-has gradually become marginalized in daily clinical practice. However, the continued relevance of DRE in the modern imaging era remains uncertain. This study aimed to reassess the diagnostic value of DRE in the context of contemporary imaging tools, particularly mpMRI and PSMA PET/CT.

Methods: This retrospective analysis included 164 patients diagnosed with prostate adenocarcinoma via transrectal ultrasound-guided biopsy. All patients underwent DRE before biopsy, and 151 received mpMRI while 62 underwent PSMA PET/CT. mpMRI findings were reported using PI-RADS v2.1, and SUVmax values were recorded from PET/CT reports. Radical prostatectomy was performed in 156 patients. The relationship between DRE findings and imaging parameters, biopsy results, and pathological staging was analyzed using multivariate statistics and ROC curve analyses.

Results: DRE findings were benign in 100 patients and suspicious for malignancy in 64. Suspicious DRE was significantly associated with higher PI-RADS scores, greater lesion size, elevated SUVmax, and clinically significant PCa (p  <  0.001 for all). Each one-point increase in PI-RADS was associated with a twofold rise in the likelihood of a positive DRE. ROC analyses identified a 13.5 mm lesion size and an SUVmax of 15.1 as predictive thresholds for DRE positivity. Suspicious DRE also correlated with advanced pathological stage (≥ pT3) (p < 0.001).

Conclusion: Despite the rise of advanced imaging techniques, DRE remains a valuable adjunctive tool in identifying high-risk and advanced PCa. When interpreted alongside mpMRI and PSMA PET/CT findings, DRE provides additional clinical insight, supporting its continued role in risk stratification rather than screening in the modern diagnostic workflow.

Background: Prostate Cancer (PCa) is the second most common malignancy among men worldwide, with significant heterogeneity in disease burden across countries. The United States (US) and China, representing high socio-demographic index (SDI) countries and rapidly developing economies respectively, have distinct healthcare systems that lead to contrasting trends in PCa epidemiology. A systematic comparison of the PCa burden between the two nations from 1990 to 2021, based on the latest Global Burden of Disease (GBD) database 2021, remains limited.

Methods: Data on age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years (ASDR) of PCa were extracted from the GBD 2021 database. Joinpoint regression and estimated annual percent change (EAPC) analyses were performed to evaluate time trends. Das Gupta's decomposition method was used to quantify the relative contributions of population growth, aging and epidemiological changes on the PCa burden. Comparative analyses focused on age-specific differences between the US and China.

Results: From 1990 to 2021, Global ASIR increased from 13.69 (12.96-14.19) to 15.37 (14.13-16.25) per 100,000; the US ASMR fell from 10.85 to 6.91 (EAPC - 1.83) while China's ASIR rose from 2.04 to 4.22 (EAPC + 2.20). The aging population accounts for 74.49% of new cases and 214.72% of cancer deaths in the US, compared to 46.62% of new cases and 79.02% of deaths in China. In the US, age-specific incidence rates offset 32.44% of new cases, while in China, 31,610 new cases-representing 42.23%-were attributed to age-specific rates. The divergent magnitude, age distribution, and trajectory of PCa burden between the two countries underscore the urgent need for country-specific strategies.

Conclusion: The PCa burden in the US and China has evolved in markedly different directions over the past three decades, reflecting profound impact in screening strategies and population aging. High SDI countries should refine risk-based screening protocols and management strategies. Meanwhile, China and other low and middle SDI countries must expand early, targeted screening for high-risk populations and strengthen primary healthcare to mitigate the growing burden.

Expression of concern: C. Liu, Y. Zhu, W. Lou, N. Nadiminty, X. Chen, Q. Zhou, X. B. Shi, R. W. deVere White, and A. C. Gao, "Functional p53 Determines Docetaxel Sensitivity in Prostate Cancer Cells," The Prostate 73, no. 4 (2013): 418-427, https://doi.org/10.1002/pros.22583. This Expression of Concern is for the above article, published online on 19 September 2012 in Wiley Online Library (wileyonlinelibrary.com), and has been issued by agreement between the journal Editor-in-Chief, Dr. Samuel Denmeade; and Wiley Periodicals LLC. A third party reported that the GAPDH band had been duplicated between Figures 4 A and 5B. This duplication was confirmed by the publisher. The authors responded to an inquiry by the publisher and stated that the GAPDH band in Figure 5B was inadvertently misplaced and duplicated from Figure 4 A. The authors also supplied images and data related to Figures 4 and 5. An evaluation of this data could not confirm that the corrected image for the GAPDH band in Figure 5B corresponded to data collected from the original experiments. This Expression of Concern has been agreed to because the journal is not able to validate some experimental data for Figures 4 and 5. The authors disagree with the Expression of Concern.

Introduction and objectives: Post-surgical urinary incontinence (PSI) can occur after benign prostatic hyperplasia (BPH) surgery. Estimating incontinence risks across modalities largely relies upon reports from single surgeons or expert groups. Real-world data (RWD) provides a broader view of practice settings and surgeon experience. We used RWD to assess the incidence, duration, and risk factors of PSI.

Methods: We conducted a retrospective cohort study using U.S. healthcare system electronic health records data compiled by Truveta of 97,970 men who underwent transurethral resection of the prostate, endoscopic enucleation, photoselective vaporization, prostatic urethral lift, water vapor thermal therapy, or robotic waterjet therapy from 2017 to 2024. Continence was defined by absence of incontinence codes or supplies for ≥ 2 consecutive encounters, or a continence restoring procedure. Incontinence rates were estimated using Kaplan-Meier methods.

Results: PSI occurred in 6.9% of patients across all procedures within 1 month of surgery, decreasing to 3.8% at 18 months and 2.3% at 3 years. Adjusted for age and BPH procedure, rates of persistent PSI (18 months to 3 years) were independently highest with polyuria (p < 0.0001), neurological disorders (p < 0.0001), and sleep apnea (p < 0.0001). Those with baseline pre-surgical urinary retention (p < 0.0001), essential hypertension (p = 0.003), chronic kidney disease (p < 0.0001), and anticholinergic medications (p = 0.00016) were less likely to experience persistent incontinence.

Conclusions: While PSI decreased over time, 3.8% had persistent incontinence at 18 months. Certain co-morbidities were associated with higher PSI rates. RWD can provide a comprehensive view of incontinence risk in real-world practice, however, utilizing RWD to determine resolution of incontinence is challenging.

Background: Post-prostatectomy urinary incontinence significantly impacts quality of life. Techniques that preserve periprostatic structures have shown promise in promoting earlier continence recovery, particularly with robotic-assisted surgery. The study aimed to evaluate the effect of pubovesical complex (PVC) preservation on urinary continence recovery in patients undergoing laparoscopic radical prostatectomy (LRP).

Methods: In this randomized, blinded, prospective clinical trial, 72 patients with localized prostate cancer were assigned to standard LRP or LRP with PVC preservation. The primary endpoint was urinary continence recovery, defined as complete absence of leakage or pad use, assessed at 24 h, 15 days, 1, 3, and 6 months post-catheter removal. Secondary endpoints included operative time, blood loss, complications, and oncologic outcomes.

Results: At 6 months, continence was significantly higher in the PVC group (82.4% vs. 57.6%; p = 0.027). Earlier timepoints showed improved, though not statistically significant, continence rates in the PVC group. Operative time (109 vs. 75 min; p < 0.001) and blood loss (365 vs. 247 ml; p = 0.010) were greater with PVC preservation. Complication and margin positivity rates were similar between groups.

Conclusion: PVC preservation during LRP significantly improves urinary continence recovery without compromising oncologic safety. This accessible technique can be adopted in centers lacking robotic platforms, offering equitable benefits for patients in resource-limited settings.

Trial registration: Brazilian Clinical Trials Registry (ReBEC), RBR-7f25wsz.