Prostate最新文献

Objective: To explore the stratification differences of MRI and prostate-specific antigen (PSA) density (PSAD) in the peripheral zone (PZ) and transition zone (TZ) lesions, in order to optimize the biopsy decision for patients with PSA 4-20 ng/mL.

Methods: This retrospective study analyzed 1524 patients undergoing MRI and biopsy. Lesions were grouped by PZ and TZ and the differences of PSAD within the subgroups were explored. A zonal-specific risk matrix was constructed by integrating the Prostate Imaging Reporting and Data System (PI-RADS) categories and PSAD in overall, PZ, and TZ cohorts. Low or high-threshold pathway was constructed by 10% or 30% clinically significant prostate cancer (csPCa) probability for PZ and TZ. Six biopsy pathways were then formed and evaluated by the biopsy avoidance, csPCa detection, and positive predictive value (PPV). Finally, decision curve analysis (DCA) was employed to evaluate the net benefit associated with each pathway.

Results: PZ lesions exhibited higher PSAD than TZ counterparts in equivalent PI-RADS categories (p < 0.05). In the risk matrix, for PI-RADS 1-2 lesions, TZ required PSAD ≥ 0.15 ng/mL/cm³ while PZ ≥ 0.20 ng/mL/cm³ to achieve > 10% csPCa risk. For PI-RADS 3 lesions, thresholds were ≥ 0.15 ng/mL/cm³ (TZ) and ≥ 0.20 ng/mL/cm³ (PZ) to trigger biopsy at > 30% csPCa risk. Among six pathways, the "PZ high + TZ high" pathway (PSAD ≥ 0.20 ng/mL/cm³ for PZ and ≥ 0.15 ng/mL/cm³ for TZ in PI-RADS 3) achieved optimal balance, detecting 86.6% of csPCa while avoiding 48.0% of unnecessary biopsies, with a PPV of 69.1% (F1-score = 0.77). DCA confirmed superior net clinical benefit for this pathway at ≥ 20% risk thresholds.

Conclusion: In the risk stratification of MRI and PSAD, considering zonal specific of the lesion is helpful to improve biopsy decisions in patients with PSA 4-20 ng/mL.

Background: This study evaluates the impact of early modification of upfront androgen receptor signaling inhibitors (ARSI) on outcomes among patients with metastatic hormone-sensitive prostate cancer (mHSPC).

Methods: This retrospective, multicenter cohort study included 590 patients with mHSPC who received upfront ARSI combined with androgen deprivation therapy. All had a follow-up duration of ≥ 6 months. The impact of early modification of ARSI without progression on survival outcomes was analyzed. The inverse probability of treatment weighting (IPTW) was applied to adjust for confounding factors associated with survival outcomes, comparing patients who did and did not discontinue ARSI early.

Results: Upfront abiraterone acetate, apalutamide, and enzalutamide were used in 50.8%, 28.1%, and 21.0% of patients, respectively. The rates of withdrawal of the upfront ARSI and initial dose reduction were 21.2% and 6.1%, respectively. The highest withdrawal rate (33.1%) was with apalutamide, mainly due to adverse events (89.1%). Apalutamide use (odds ratio [OR] 2.39, 95% CI: 1.50-3.80) and a low-risk CHAARTED status (OR 1.84, 95% CI: 1.08-3.14) were identified as independent risk factors for early ARSI withdrawal. IPTW analysis revealed early ARSI withdrawal (within 6 months) significantly correlated with poor castration-resistant prostate cancer-free survival (CRPC-FS) (p = 0.004) and second progression-free survival (PFS2) (p = 0.035). However, it had no significant relationship with overall survival (p = 0.280).

Conclusions: Early withdrawal of initial upfront ARSI was associated with poor CRPC-FS and PFS2 among mHSPC patients. Maximizing the effectiveness of first-line treatment requires optimal management of ARSI therapy.

Trial registration: jRCTs021180021.

Background: The impact of preoperative bladder function on outcomes of simple prostatectomy (SP) is unknown. The goal of this study was to determine if detrusor contractility affects postoperative catheter-free status in patients undergoing SP for benign prostatic hyperplasia (BPH).

Methods: Patients who underwent SP (either open or minimally invasive) from 2017 to 2024 at our institution and had preoperative urodynamics were identified retrospectively. Bladder contractility index (BCI) was used to categorize patients as normocontractile (BCI ≥ 100) or hypocontractile (BCI < 100). Demographics, preoperative urodynamics, peri-operative characteristics, and postoperative variables were compared between the two groups with postoperative catheter status being the primary outcome.

Results: Among 101 SP patients with preoperative urodynamics, 47 had hypocontractile bladders (median BCI 69 vs. 131). Both groups had similar median age, preoperative prostate specific antigen (PSA), and rates of diabetes. The majority of procedures in both the normocontracile and hypocontractile groups were robot-assisted (83% vs. 81%, respectively). Patients in the hypocontractile group were significantly more likely to be catheter dependent pre-operatively (77% vs. 57%, p = 0.04). There was no difference in preoperative prostate size or use of BPH pharmacotherapy. Overall, 97% of hypocontractile and 100% of normocontractile patients were catheter-free following surgery. There were no differences in postoperative outcomes including pathology tissue weight and post-op PSA.

Conclusions: This is one of the first studies assessing outcomes of SP in patients with hypocontractile bladders. SP is an effective surgical option for patients with impaired detrusor function including those who are catheter dependent.

Introduction: Neoadjuvant intense androgen deprivation therapy (ADT) with androgen receptor signaling inhibitors (ARSIs) has shown pathologic complete responses (pCR) in prostate cancer (PCa), but long-term survival outcomes remain unclear. This study evaluates the durability of response following neoadjuvant ADT plus enzalutamide before robot-assisted radical prostatectomy (RARP) and lymph node dissection.

Methods: We conducted a secondary analysis of an open-label feasibility trial enrolling men with NCCN intermediate-, high-, very high-risk localized and regional PCa treated with 6 months of neoadjuvant ADT and enzalutamide. Factors associated with biochemical recurrence (BCR) and metastases were evaluated using appropriate univariable statistical tests, and BCR-, metastasis-free survival (MFS), and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method.

Results: Of 39 patients enrolled, 36 patients completed all study interventions. Eighteen (66.7%) patients had NCCN very high-risk disease or clinical regional lymph nodes on imaging. Four patients (11.1%) achieved pCR, although two (5.6%) developed BCR. One patient (2.8%) had M1 and three (8.3%) had N1 disease on final pathology, and all four developed metastases. Eleven (30.6%) patients received salvage therapy, with all but one receiving ADT with radiation. Factors associated with BCR included biopsy ISUP grade and positive surgical margins, while NCCN risk group, biopsy ISUP grade, perineural invasion, and pathological stage were associated with metastases (p < 0.05). Median follow-up was 7.3 (95% CI 6.3-8.3) years, and the 5-year BCR-free survival, MFS, and CSS were 64.1%, 84.6%, and 94.3%, respectively.

Conclusions: Neoadjuvant enzalutamide and ADT was associated with favorable long-term oncologic outcomes, supporting continued investigation in localized PCa.

Background: This study evaluated the diagnostic accuracy of the novel biomarkers α2,3-sialylated prostate-specific antigen percentage (S2,3PSA%) and S2,3PSA density (S2,3PSAD) in patients classified into Prostate Imaging Reporting and Data System (PI-RADS) categories 3-5 and examined their utility in optimizing prostate cancer (PCa) diagnosis. S2,3PSA% reflects cancer-specific N-glycan modifications of free PSA, and its volume-adjusted index S2,3PSAD may improve diagnostic precision.

Methods: We enrolled patients who underwent prostate biopsy at our institution between October 2023 and May 2025, all with measurable S2,3PSA%, S2,3PSAD, and PI-RADS 3-5 lesions on magnetic resonance imaging (MRI) scans. S2,3PSA% was measured using the μTASWako i50 system, and S2,3PSAD was calculated by dividing S2,3PSA% by prostate volume. The diagnostic performance (area under the curve [AUC], sensitivity, and specificity) of S2,3PSA% and S2,3PSAD was compared with that of conventional markers (prostate-specific antigen [PSA] and prostate-specific antigen density [PSAD]). Avoided biopsies and missed clinically significant PCa (csPCa, ISUP Grade Group ≥ 2) were also evaluated.

Results: Among 150 patients (median PSA, 7.18 ng/mL; prostate volume, 33.0 mL; PSAD, 0.20; S2,3PSA%, 43.2%; S2,3PSAD, 1.21), PCa and csPCa were detected in 95 (63%) and 84 (56%) patients, respectively. PSA and PSAD showed AUCs of 0.607/0.736 and specificities of 23.6%/40.0%, at 85.3% sensitivity. By contrast, S2,3PSA% and S2,3PSAD achieved higher AUCs of 0.737/0.757 and specificities of 45.5%/49.1%. In MRI-targeted biopsy (MRI-TBx) cases (n = 85), PSA and PSAD had AUCs of 0.615/0.758 and specificities of 18.8%/43.8% at 88.7% sensitivity, whereas S2,3PSA% and S2,3PSAD reached 0.799/0.810 with specificities of 53.1%/56.3%. In PI-RADS 3/4, S2,3PSAD exhibited the highest AUC (0.773). At < 0.85, avoided biopsy and csPCa miss rates were 26.4%/8.8% (MRI-TBx: 29.2%/7.5%). No csPCa was missed in PI-RADS 4 MRI-TBx group, while PI-RADS 5 showed higher miss rates.

Conclusion: S2,3PSA% and S2,3PSAD offer superior diagnostic accuracy compared to conventional markers, especially in MRI-TBx and PI-RADS 3/4, reducing unnecessary biopsies and minimizing missed csPCa. A biopsy remains warranted for PI-RADS 5.

Background: Curative surgery for prostate cancer is uncommonly offered to patients aged ≥ 75, balancing functional outcomes against survival benefit. The increased adoption of robotic-assisted radical prostatectomy (RARP) and improved overall life expectancy challenges this paradigm. The objective of this study was to compare functional outcomes between elderly and younger patients following RARP.

Methods: Retrospective review of a prospective multicentre database including all RARP patients between October 2016 and December 2023. Patients were divided into cohorts based on age; elderly (≥ 75 years) and younger (< 75 years). Variables included baseline demographics (body mass index [BMI], American Society of Anaesthesiologists [ASA] classification, prostate specific antigen [PSA], and Gleason score), surgical (technique, complications, and length of stay), pathological (histopathology, margins, and PSA) and functional (incontinence, International Prostate Symptom Score [IPSS], International Index of Erectile Function [IIEF-5], and Expanded Prostate Index Composite [EPIC]) outcomes. Univariate (chi-square and t-tests) and multivariate analysis were performed to compare cohorts against the primary outcome of continence at 1-year (number of pads/day), with p-values < 0.05 considered statistically significant.

Results: A total of 397 patients were included (< 75; n = 332, ≥ 75; n = 65). No statistically significant differences were detected in continence at 1-year in ≥ 75 (< 75; 0.73 [0.59-0.87], ≥ 75; 0.66 [0.37-0.95] mean pads/24 h, p = 0.8), despite significantly lower nerve preservation and bladder-neck spare rates (< 75; 37.3%, ≥ 75; 21.5%). IIEF-5 scores were worse in the ≥ 75 group (1.60 ± 1.17 vs. 5.73 ± 6.93 p < 0.001), however there were no significant differences in IPSS. Patient in the elderly cohort had more severe disease (67.7% T3, ≥ 75 vs. 47.3%, < 75, p < 0.05). Rates of positive surgical margins (28.3% vs. 30.8% [≥ 75]) and PSA recurrence (25% vs. 23% [≥ 75]) were similar. Complication rates were low in both groups with no significant differences (3% vs. 6.6% [≥ 75]) and were of lower severity in the ≥ 75 group.

Conclusion: RARP in carefully selected elderly patients does not increase risk of urinary incontinence and should not be disregarded in an aging population with higher overall life expectancy.

Objective: We aimed to determine whether TL-PSMA, PSMA-TV, and SUVpeak values measured in prostate adenocarcinoma patients who underwent imaging with Ga-68 PSMA PET/CT for primary staging have a role in predicting treatment response.

Materials and methods: Images of 68 patients who underwent Ga-68 PSMA PET/CT for primary staging between March 25, 2019, and December 3, 2021, were analyzed retrospectively. Volumetric parameter data were obtained through manual delineation using a 40% threshold for the prostate gland, lymph nodes, bone, and visceral organ metastases.

Results: TL-PSMA(Bone) measurement differed statistically significantly between the treatment-responsive and unresponsive groups (p = 0.049). In addition, TL-PSMA and PSMA-TV parameters showed statistically significant differences between the treatment-responsive and unresponsive groups (p = 0.02 and p = 0.016). We could not find a significant relationship between other volumetric parameters and treatment response.

Conclusion: It has been established that the volumetric parameters derived from Ga-68 PSMA PET/CT imaging conducted for primary staging may play a role in predicting treatment response in patients with prostate adenocarcinoma. However, further studies involving larger patient populations are necessary to clarify this issue.

Background: In recent years, the incidence and mortality of prostate cancer (PCa) have risen significantly, rendering it a serious health concern for middle-aged and elderly men. Interleukin-18 (IL-18), an important pro-inflammatory cytokine within the interleukin-1 superfamily, has been implicated in various malignancies, yet there is a notable scarcity of comprehensive studies exploring the regulatory role of IL-18 in the onset and progression of PCa.

Methods: This study employed integrated bioinformatics and immunohistochemical analyses to investigate the expression patterns and potential mechanistic roles of IL-18 and its receptors in PCa. Differential expression analyses were performed on IL-18 mRNA and protein levels in normal prostate (NP), benign prostatic hyperplasia (BPH), and PCa tissues. Correlations between IL-18 expression and clinical features were also assessed. Additionally, immune cell infiltration was analyzed to explore the immunological landscape associated with IL-18 expression.

Results: A comparative analysis of IL-18 mRNA and protein expression levels between paracancerous and PCa tissues revealed an obvious decrease in IL-18 expression in both benign prostatic hyperplasia (BPH) and PCa tissues compared to normal prostate (NP) tissue (p < 0.05). The expression of IL-18 was found to be significantly elevated in correlation with the progression of pathological T-stage and an increase in the Gleason score among patients with PCa. Immune infiltration analysis, which examined 24 immune cell types, showed that IL-18 was correlated with the infiltration of Th17 cells negatively, while exhibiting positive correlations with other immune cell types. Congo red staining revealed that eosinophils were predominantly localized in the entravascular and perivascular regions of prostate tissues. Notably, Eosinophil infiltration was significantly increased PCa tissues when compared to NP tissues (p < 0.05). Immunohistochemical staining also showed that CD20⁺ B cells were mainly present in perivascular areas, with significantly higher infiltration levels observed in PCa compared to NP and BPH (p < 0.05). Similarly, CD4⁺ T cell infiltration was significantly increased in PCa compared to NP and BPH (p < 0.05). Additionally, the number of mast cell infiltration increased significantly in PCa tissues relative to NP and BPH through Toluidine blue staining (p < 0.05).

Conclusions: IL-18 may play a dual regulatory role in PCa development. In the early stages of the disease, IL-18 may act to inhibit tumorigenesis, whereas, in later stages, it may promote tumor progression in a pro-carcinogenic manner.