Prostate最新文献

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.

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: 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.

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: 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.

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.