Prostate最新文献

Introduction: To assess adverse pathology (AP) rates in patients with grade group (GG) 2 prostate cancer (PCa) based on biopsy characteristics and treated with radical prostatectomy (RP). Performance of active surveillance (AS) guidelines in distinguishing patients with AP has also been investigated.

Methods: Records of 345 patients who underwent RP for GG 2 disease detected in prostate biopsy were retrospectively reviewed. Patients with suspicion of extracapsular disease on imaging, PSA ≥ 20 ng/dL, unavailable biopsy data, and in-bore biopsy were excluded from the study. AP was defined as the presence of ISUP GG ≥ 3 or extracapsular disease. AP rates in patients meeting the AS criteria of NCCN and EAU guidelines were recorded. A novel model was developed to determine AP predictors by using a multivariable logistic regression analysis and a backward stepwise method.

Results: Among 231 patients, median age was 64 (45-79), median PSA was 6.1 (1.2-19) ng/dL. According to biopsy and clinical characteristics, 124 patients (53.7%) met the NCCN, 31 patients (13.4%) met the EAU AS criteria. Pathological examination after RP revealed AP in 105 patients (45.5%); GG ≥ 3 disease in 31 (13.4%), pT3a disease in 78 (33.7%), pT3b disease in 18 (7.8%), and pN1 disease in four patients (1.7%). AP rates in patients meeting NCCN and EAU criteria were 37.9% and 22.6%, respectively. Age ( > 63.5), PSA level ( > 5.04 ng/dL), GG2 PCa-bearing index lesion size on mpMRI ( > 11.5 mm), maximum tumor length/core length ( > 51.5%) and Gleason Pattern 4 percentage (>%17.5) were independent predictors of AP in our new model.

Conclusions: NCCN AS criteria were associated with nearly a twofold higher rate of AP compared with patients meeting EAU criteria. Our new model, including parameters derived from age, PSA, mpMRI and biopsy characteristics, demonstrated superior performance relative to both NCCN and EAU criteria regarding AP prediction among patients with GG 2 PCa.

Background: The impact of 5-alpha reductase inhibitors (5-ARIs) on Prostate Imaging Reporting and Data System (PI-RADS) tumor classifications and prostate cancer (PCa) detection were reviewed and analyzed.

Method: A comprehensive systematic review and meta-analysis were conducted by evaluating published studies examining the influence of 5-ARIs on PI-RADS lesions and PCa detection. The Web of Science, PubMed, and Embase databases were accessed for relevant study retrieval. Statistical analyses were performed through the use of STATA v.16.0.

Results: Seven studies, comprising 12,132 participants, were included. Compared to men who had not received 5-ARIs, those exposed to 5-ARIs exhibited no significant differences in PCa diagnosis (OR 0.97, 95% CI 0.86-1.08; p = 0.55) or clinically significant PCa (csPCa) diagnosis (OR 1.01, 95% CI 0.89-1.16; p = 0.85). Further subgroup analyses demonstrated that 5-ARI-exposed men had comparable PCa diagnosis in PI-RADS 3 (OR 0.85, 95% CI 0.65-1.12; p = 0.25), PI-RADS 4 (OR 1.01, 95% CI 0.85-1.21; p = 0.84), and PI-RADS 5 (OR 1.01, 95% CI 0.81-1.26; p = 0.87) groups relative to 5-ARI-naïve men.

Conclusions: These findings suggest that 5-ARIs do not significantly alter PI-RADS lesion distribution or impact PCa and csPCa diagnosis. Consequently, exposure to 5-ARIs should not influence MRI-based diagnostic approaches in patients with suspected PCa.

Background: The history of the long-unlabeled prostate refers to an aging story of the confrontation of Galen/Herophilos with early modern human anatomy. Attributions of discovery have been made ever since, with a supposedly pivotal role for Niccolò Massa's 1536 description of the organ. However, Massa did not credit anyone and also did not claim to be seeing something new, indeed few did for centuries after.

Methods: The historical event of Massa's nomination is revisited in light of the transmission and reception of Galen, especially via Avicenna.

Results: Massa seemingly only reconfirmed Avicenna, who assimilated wisdom by Galen, whose transmission was otherwise imperfect. The subsequent discovery of the seminal vesicles was disputed and missed by Vesalius, but Guillaume Rondelet's work and piloting of this expression (vesiculae) was eventful, not least because it was nominated early on as a novum, and for the first time introduced a physiological as well as an anatomical distinction. Giovanni Filippo Ingrassia is among the first to have moved from anatomy in the direction of anatomical history at this point.

Conclusions: Notables in the modern history of the prostate were all historians: interpreters of past writings and authors of stories of discovery. Writing the prostate's biography requires recalling how such writing got underway in early modern medicine and has been ongoing ever since.

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.