Prostate最新文献

Background: Prostatic tissue is richly vascularized by large venous sinuses that may rupture during transurethral resection of the prostate (TURP), which may lead to unwanted functional outcomes and intraoperative bleeding. However, tranexamic acid (TXA) may be a valid strategy to reduce bleeding complications. Thus, we aimed to analyze the efficacy and safety of TXA administration in patients undergoing TURP.

Methods: We systematically reviewed the Medline, Embase, CENTRAL, and clinical trials registry platforms from their inceptions through April 2025 for randomized and quasi-randomized controlled trials with patients undergoing TURP that compared TXA versus placebo or no treatment. A pairwise meta-analysis with random-effects was performed to estimate risk ratios (RR), mean differences (MD) and their 95% confidence intervals (CI).

Results: A total of 13 studies (N = 1140) were included in our synthesis. We found that patients using TXA (mean: 1.20 g/dL) compared to control (mean: 1.79 g/dL) had less reduction in postoperative hemoglobin concentration (MD: -0.58 g/dL, CI -0.95-[-0.22]). Additionally, patients using TXA (mean: 162.3 mL) compared to control (mean: 231.1 mL) had fewer intraoperative blood loss (MD: -68.7 mL, CI -128.73-[-8.67]). We did not find differences between TXA and control when analyzing risk of blood transfusion (RR: 0.71, CI 0.46-1.10), length of stay (MD: -1.50, CI -6.91-3.92), operative time (MD: -9.34, CI -19.40-0.72), or risk of thromboembolic events (RR: 1.15, CI 0.89-1.49). There were, however, differences in intervention protocols and the number of participants in each study, in addition to high heterogeneity in some endpoints.

Conclusion: TXA is associated with lower intraoperative blood loss and higher postoperative hemoglobin concentrations without increasing the risk of thromboembolic events, indicating a valid prophylaxis before TURP. However, further studies should better address the blood transfusion risk and be adequately powered for that purpose.

Background: Cabazitaxel is a taxane agent associated with fewer symptomatic adverse events than docetaxel in treating castration-resistant prostate cancer (CRPC), yet it is typically reserved for post-docetaxel failure. This study assessed whether early switching from docetaxel to cabazitaxel could improve clinical outcomes.

Methods: Beginning in 2019, a treatment approach was adopted wherein patients with CRPC were switched to cabazitaxel after three cycles of docetaxel, regardless of response. Patients who initiated docetaxel between February 2019 and March 2022 were classified as the switch group, while those who started between September 2014 and February 2019 were designated as the historical non-switch group. Chemotherapy duration, number of chemotherapy cycles, and adverse events were compared. Progression-free survival (PFS), time to failure of both taxanes, and overall survival (OS) were analyzed using propensity score matching.

Results: The switch and non-switch groups included 36 and 37 patients, respectively. The switch group received significantly more chemotherapy cycles (p = 0.043) and had a longer cumulative chemotherapy duration (p = 0.035), even when including chemotherapy administered in subsequent lines. The cumulative incidence of peripheral neuropathy was significantly lower in the switch group (p = 0.037). Within the switch group, symptomatic adverse events, including fatigue, anorexia, and alopecia, were significantly reduced after switching to cabazitaxel. PFS was significantly prolonged in the switch group (p = 0.002), although time to failure of both taxanes and OS did not differ significantly between groups.

Conclusions: Early switching to cabazitaxel after three cycles of docetaxel may reduce symptomatic adverse events, including peripheral neuropathy, while enabling longer chemotherapy exposure and improved PFS in patients with CRPC.

Background: To investigate the role of HSD3B1 germline variant (1245C) in hormone therapy outcomes in Chinese prostate cancer (PCa) patients.

Methods: A multi-center observational study was conducted enrolling 785 PCa patients who received primary androgen deprivation therapy (ADT) in China. Genotyping of germline variant and survival data were obtained, and clinical outcomes were analysed using Cox regression models.

Results: The median follow-up time was 31 months. In the entire study cohort, the HSD3B1 variant (1245C) was significantly associated with a shorter time to castration resistance after adjusting for Gleason grade group (dominant model: hazard ratio, HR = 1.62, 95% confidence interval, 95% CI: 1.10-2.40, p = 0.015; additive model: HR = 1.55, 95% CI: 1.12-2.13, p = 0.008). Subgroup analysis (n = 438) with patients receiving only ADT for HSPC revealed a more significant association between the C allele and ADT failure (dominant model: HR = 2.37, 95% CI: 1.49-3.77, p < 0.001; additive model: HR = 1.93, 95% CI: 1.34-2.79, p < 0.001). Among patients who received next-generation hormone therapy after ADT failure, the C allele was associated with poorer abiraterone response (HR = 3.02, 95% CI: 1.07-8.50, p = 0.037); however, no significant change of response from enzalutamide was observed (HR = 0.98, 95% CI: 0.27-3.51, p = 0.972).

Conclusions: The HSD3B1 germline variant (1245C) is linked to earlier ADT failure and diminished efficacy of abiraterone but does not affect enzalutamide in the treatment of PCa patients. These findings underscore its potential as a biomarker to guide personalized treatment in PCa.

Background: Intraductal carcinoma of the prostate (IDC-P) is most often considered a retrograde spread of invasive prostate cancer (PCa) into prostatic ducts, and its presence is associated with a poor prognosis. The aim of our study was to evaluate the differential expression between IDC-P and the associated invasive component and the heterogeneity of expression within IDC-P foci.

Methods: We studied 79 cases of PCa with an intraductal component treated by prostatectomy. TMA blocks were constructed with the intraductal and invasive components and used for immunohistochemical analysis of markers involved in the cell cycle, androgen signaling, hypoxia, DNA repair, and immune checkpoints.

Results: We found a good concordance of expression between both components for ERG, PTEN, p53, and MMR genes, which nevertheless show in some cases a loss restricted to the intraductal component. The expression of Ki67, PD-L1, and GLUT1 was increased in IDP-C compared to the invasive component. Furthermore, spatial heterogeneity was observed in the intraductal component: Ki67, ERG, androgen receptor and p53 were more expressed in the periphery of the lesion, while the expression of PD-L1 and GLUT1 was restricted to the center.

Conclusions: Our results support a relatedness between invasive PCa and IDC-P, and show increased expression of markers related to PCa aggressiveness in the intraductal component. The spatial heterogeneity within IDC-P suggests a higher degree of hypoxia in the center of the lesion. Increased PD-L1 expression and loss of expression of some MMR genes in IDC-P could lead to increased sensitivity to immunomodulatory treatments.

Background: Rezūm therapy is a minimally invasive treatment for male lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO), validated in selected patients through randomized trials. However, its effectiveness in broader real-world populations remains underreported.

Methods: This single-center retrospective study included 110 patients treated with Rezūm between 2020 and 2022. Patients were stratified according to their conformity to the original trial criteria ("pilot" vs. "nonpilot" groups). Functional outcomes, retreatment rates, sexual function and adverse events were analyzed at 24 months.

Results: At 24 months, both groups experienced a significant and sustained reduction in IPSS from baseline, with a median decrease of 18 points (IQR: 15-20) in the pilot group and 19 points (IQR: 16-22) in the non-pilot group (p = 0.2). Improvements in IPSS-QoL, Q_max, and PVR were also significant and comparable between groups. Overall, 23% of patients required retreatment: 24% in the pilot group and 24% in the non-pilot group (p = 0.9), including medical retreatment in 15% and 5%, and surgical retreatment in 8% and 16%, respectively (p = 0.2). No independent predictor of retreatment was identified. Ejaculatory function was preserved in over 90% of patients at 24 months in both groups, and erectile function remained stable throughout follow-up.

Conclusions: Rezūm therapy provides effective, durable symptom relief and preserves sexual function at 2 years, even in patients with larger prostates, prior surgery, or indwelling catheters.

Background and objective: Metastatic castration-resistant prostate cancer (mCRPC) is an aggressive, lethal state of prostate cancer, for which early progression is an indicator of poor prognosis. The ability to predict this progression is of paramount clinical importance for guiding personalized treatment strategies. We aimed to develop and validate a novel machine learning (ML) model to predict early progression (≤ 12 months) to mCRPC and compare its performance against standard ML algorithms.

Methods: This was a retrospective analysis of 172 patients with mHSPC from the publicly available MSK-IMPACT cohort. Inclusion criteria specified patients with mHSPC who had undergone genomic profiling and progressed to mCRPC during follow-up. Patients with incomplete data were excluded. We collected 11 clinical, pathological, and genomic variables. The primary outcome was early progression (≤ 12 months) to mCRPC. Model performance was evaluated using a stratified fivefold cross-validation, with AUC as the primary metric.

Key findings and limitations: A novel Rivality Index (RINH)-based model, adapted from chemoinformatics, demonstrated significantly superior predictive performance (AUC: 0.86) compared to a panel of standard ML algorithms, none of which exceeded an AUC of 0.67. The model achieved an accuracy of 0.74, a sensitivity of 0.70, and a specificity of 0.77. Key limitations include the retrospective design and use of a single-institution data set.

Conclusions and clinical implications: This novel RINH model offers a robust tool for risk stratification in mHSPC patients, capable of personalizing therapeutic strategies. However, external validation in multi-center, prospective cohorts is an essential next step before its consideration as a clinical decision support tool.

Objective: To evaluate the value of circulating free DNA (cfDNA) in prostate cancer (PCa) by cfDNA assay and analysis of plasma and urinary cfDNA fragmentation to determine the usefulness of this parameter for risk staging and tumor progression monitoring.

Materials and methods: A prospective, longitudinal study was conducted with 143 individuals, including a control group and a cohort of patients with PCa at different stages: localized, metastatic hormone-sensitive (mHSPC), and metastatic castration-resistant (mCRPC). Plasma and urine samples were collected to measure the concentration, fluorescence units (FU), and cfDNA fragmentation, correlating them with clinical and pathological variables.

Results: Plasma cfDNA levels were higher in patients with PCa than in control subjects (14.3 ng/mL vs. 4.2 ng/mL, p = 0.04) and even higher in metastatic disease than in localized (20.8 ng/mL vs. 3.6 ng/mL, p < 0.001). The fragmentation size of plasma cfDNA was smaller in metastatic PCa (168.7 base pairs) than in localized PCa (172.8 base pairs, p < 0.001), suggesting that shorter fragments are associated with more aggressive disease. Following systemic treatment, the patients decreased cfDNA levels (8.3 ng/mL vs. 4.9 ng/mL, p = 0.027) and plasma FU (35.2 vs. 12.9, p < 0.001). In urine, differences were only observed in patients who progressed to CRPC than in those who remained HSPC (261.8 ng/mL vs. 43.5 ng/mL, p = 0.046).

Conclusions: The assay and analysis of plasma and urinary cfDNA fragmentation may provide useful biomarkers for PCa diagnosis and follow-up, particularly when differentiating between localized and metastatic disease. These findings are promising, but further research is required to determine their potential utility in clinical risk stratification and treatment monitoring.

Background: While male breast cancer incidence is rare, veteran status is found to be associated with increased risk, for incidence, a higher prevalence of male breast cancer patients was observed among male veteran prostate cancer survivors. This study leveraged the existing large-scale Veterans Affairs (VA) Prostate Cancer Data Core and examined factors associated with increased risk of male breast cancer incidence in veterans with prior prostate cancer diagnoses.

Methods: A retrospective cohort study of 1.3 million male veterans treated for prostate cancer at VA hospitals was conducted using the VA Prostate Cancer Data Core. Of these, 11,327 (0.86%) were newly diagnosed with male breast cancer on average 5.4 years post prostate cancer diagnosis.

Results: Multivariate Cox and competing risk model results found that younger onset age of prostate cancer (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.97-0.98), metastasized prostate cancer (HR 2.03, 95% CI 1.90-2.17), being Non-Hispanic (N-H) Black (HR 1.10, 95% CI: 1.05-1.15), radiation (HR 1.06, 95% CI: 1.02-1.11) and androgen deprivation therapy (ADT; HR 1.24, 95% CI 1.17-1.32) were associated with significantly increased risk of male breast cancer diagnosis. Prolonged use of cardiovascular disease (CVD) medications, furosemide (HR 1.51, 95% CI 1.39-1.63), spironolactone (HR 1.36; 95% CI 1.15-1.61), and digoxin (HR 1.50, 95% CI: 1.29-1.72), significantly increased risk for male breast cancer incidence.

Conclusions: Younger age onset of prostate cancer, metastasized prostate cancer, prolonged use of CVD medications, radiation, and ADT cancer treatment were factors significantly associated with increased risk of being diagnosed with male breast cancer among male veteran prostate cancer survivors. The study findings may shed insights in cardio-oncology specific risk factors for male breast cancer among prostate cancer survivors.

Introduction: Prostate-specific antigen bounce (PSAb), characterized by a transient elevation in PSA levels followed by a spontaneous decline, is a well-documented phenomenon in prostate cancer (PC) patients undergoing radiotherapy. While PSAb can cause diagnostic uncertainty, mimicking biochemical recurrence, its etiology and clinical implications remain poorly understood. This study aims to analyze the incidence, characteristics, and prognostic significance of PSAb in a cohort of PC patients treated with stereotactic body radiotherapy (SBRT) using a 1.5 T MR-Linac platform.

Methods: A total of 305 patients with low-to-intermediate risk PC (stage T1-T2, Gleason score ≤ 4 + 3) were treated with SBRT in five fractions (35-36.25 Gy) using an adaptive workflow guided by pretreatment MRI and real-time cine-MRI monitoring. PSAb was defined as a temporary increase in PSA levels ≥ 0.2 ng/mL above the nadir, followed by a return to or below the nadir. Statistical analyses evaluated correlations between PSAb and clinical/dosimetric variables, including tumor volume, treatment scheduling, and toxicity. The Chi-square test was used for categorical variables, while Spearman's correlation and linear regression assessed continuous variables.

Results: PSAb occurred in 25% of patients, with a median time to bounce of 11 months posttreatment. The incidence of PSAb within the first 6 months was 86.4%. The median time to post-bounce nadir (PSAn) was 25 months, with a mean PSAn of 0.90 ng/mL (range: 0.05-5.02 ng/mL). Biochemical relapse was observed in only 2,95% of patients. No significant associations were found between PSAb and tumor volume metrics or treatment scheduling. Toxicity analysis revealed predominantly mild-to-moderate acute events, including cystitis (28.2%) and proctitis (4.6%), with minimal late toxicity (cystitis: 9.2%; proctitis: 2.9%; sexual impotence: 4.3%). Univariate analysis demonstrates a significant correlation between PSAb and improved biochemical relapse-free survival (p = 0.016).

Conclusions: PSAb is a common and benign phenomenon in PC patients treated with SBRT, associated with favorable oncological outcomes. The absence of significant correlations with tumor volume or treatment scheduling suggests that PSAb may be influenced by individual biological factors rather than dosimetric or procedural variables. These findings underscore the importance of distinguishing PSAb from true biochemical recurrence.

Background: Multiparametric MRI (mpMRI) is the standard imaging for detecting clinically significant prostate cancer (csPCa), but its limitations in MRI-invisible lesions demand complementary strategies. We aimed to evaluate the diagnostic utility of 18F-DCFPyL PSMA PET/CT-ultrasound fusion-guided biopsies in patients by determining the optimal cut-off for the lesion's standardized uptake value (SUV).

Methods: This was a single-center cohort study of 89 men with suspected PCa or low-risk PCa on active surveillance; all underwent PSMA PET/CT before biopsy. Transperineal PSMA PET/US fusion-guided biopsy was performed using the KOELIS Trinity platform. Biopsy outcomes, SUVmax values, and Gleason Grade Group (GGG) were analyzed. Outcomes were compared between MRI-visible and MRI-invisible lesions and among patients with and without prior biopsy. ROC curves and Youden's index were used to assess predictive accuracy and determine optimal SUVmax cut-offs. Decision curve analysis (DCA) was used to evaluate net clinical benefit.

Results: Eighty seven patients had an MRI, of which 34 lesions were MRI invisible. MRI-visible lesions had higher detection rates of PCa (83.3%) compared to MRI-invisible lesions (45.7%, p < 0.001). PET-only identified csPCa in 28% of MRI-invisible lesions (SUVmax mean 9.2 ± 1.8), with 32.4% of these patients proceeding to definitive treatment. Among patients with prior biopsies (60), 35.3% were upgraded, including 18.3% with reassuring/equivocal MRI (PI-RADS ≤ 3) findings. Overall, PET-guided biopsy detected PCa in 47.2% of all patients and csPCa in 24.7%. For the entire cohort, SUVmax ≥ 7.6 provided optimal discrimination between benign and csPCa (AUC = 0.73, 95% CI 0.64-0.82) with a clinical net benefit.

Conclusion: PSMA PET-fusion targeting can improve accuracy for PCa detection at SUV ≥ 7.7. PET-targeted biopsy can complement standard biopsy methods, especially in those with MRI-invisible lesions or patients with prior negative biopsies.