Prostate最新文献

Objective: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects 2%-10% of men worldwide, yet lacks standardized treatment algorithms. This study aimed to establish a definitive treatment hierarchy by comparing four therapeutic modalities: alpha-blocker monotherapy, alpha-blocker plus antibiotic combination, alpha-blocker plus saw palmetto combination, and transurethral resection of prostate (TUR) surgery.

Materials and methods: This retrospective comparative cohort study analyzed 200 adult males with CP/CPPS (50 patients per group) treated at a single academic center between October 2023 and August 2025. Inclusion criteria comprised NIH Chronic Prostatitis Symptom Index (NIH-CPSI) total score ≥ 10 and pain score ≥ 4, with excluded bacterial infection. Primary endpoint was NIH-CPSI score improvement at 12 weeks; clinical response was defined as ≥ 6-point improvement. Secondary endpoints included safety profiles and histopathological findings.

Results: Significant therapeutic efficacy differences emerged between groups (p < 0.001). TUR surgery achieved highest efficacy with 88% clinical response rate and mean 15.7-point NIH-CPSI improvement. Alpha-blocker plus saw palmetto combination demonstrated superior medical therapy effectiveness (80% clinical response, 10.7-point improvement), exceeding monotherapy by 4.2 points (p < 0.001). Critically, alpha-blocker plus antibiotic combination showed no advantage over monotherapy (6.7 vs 6.5 points, p = 1.000). Chronic prostatitis was histologically confirmed in 100% of TUR specimens, with prostatic stones identified in 76% of cases. All treatments were well-tolerated with adverse event rates of 18%-30% (p = 0.234).

Conclusions: This study establishes an evidence-based treatment hierarchy for CP/CPPS: TUR surgery represents the most effective approach for refractory cases, while alpha-blocker plus saw palmetto combination constitutes optimal medical therapy. Antibiotic addition provides no benefit in non-bacterial prostatitis. These findings provide robust evidence for clinical decision-making and support guideline updates emphasizing antibiotic stewardship and phytotherapeutic agent validation.

Clinical trial registration: This study was not registered as a clinical trial.

Background: Prostate biopsy is currently the most common method of diagnosing prostate cancer (PCa). However, excessive biopsies not only cause physical and psychological pain to patients, but also increase the healthcare burden. We aimed to provide a biopsy strategy for patients with PI-RADS score 2 to improve the detection rate of clinically significant PCa (csPCa) while minimizing unnecessary prostate biopsies.

Methods: This study retrospectively collected clinical data from patients undergoing prostate biopsy from three medical centers in China. The KD cohort was used as the primary analysis cohort, and the ZD and YJS cohorts were used as external validation cohorts. Diagnostic capacity of clinical variables was assessed using the receiver operating characteristic (ROC) curves and area under the curve (AUC) and compared with DeLong test. By plotting the relationship between csPCa risk and prostate-specific antigen density (PSAD) values using a locally estimated scatterplot smoothing(loess) function, the PSAD cutoff value corresponding to a clinically reasonable csPCa risk is determined. Prostate biopsy strategies are represented as simple decision tree diagrams. This study used csPCa as the only study endpoint.

Results: By grouping patients with a cut-off value of PSAD ≥ 0.46 ng/ml, the detection rate of csPCa in the KD cohort of patients with a PI-RADS score of 2 increased from an initial 3.7-18.7%. And according to our proposed strategy would reduce unnecessary prostate biopsy by 86.5%, and at the same time could reduce the detection of clinically insignificant PCa (cisPCa) by 96.7%, at the cost of missing 1.3% of csPCa. The similar diagnostic performance was also shown in the ZD and YJS cohorts.

Conclusions: The individualized precision prostate biopsy strategy is developed in this study, which can be used to make optimal decisions when faced with low-risk PCa (PI-RADS score 2) patients.

Background: Grade Group 5 (GG5) prostate cancer carries the poorest prognosis, yet it is often undetected at biopsy. We evaluate whether Cell Cycle Progression (CCP) score identifies biopsy-undetected GG5 disease and improves risk stratification when combined with Cancer of the Prostate Risk Assessment (CAPRA) score.

Methods: A total of 430 patients with biopsy-confirmed GG1-4 underwent Prolaris® testing before immediate radical prostatectomy (RP). Logistic regression assessed the association between CCP score and pathological GG5 at RP. Predictive models using CCP, CAPRA, and clinical cell-cycle risk (CCR) score were compared using area under the curve (AUC), decision curve analysis (DCA), and net reclassification improvement (NRI).

Results: Although GG5 was not frequent (7.2%), CCP score independently predicted GG5 (p < 0.001) before and after adjusting for CAPRA and biopsy core number obtained. AUCs were 0.71 (95% CI: 0.60-0.83) for CCP, 0.67 (0.56-0.77) for CAPRA, 0.77 (0.67-0.87) for CCP + CAPRA, and 0.74 (0.64-0.84) for CCR. Both CCP + CAPRA and CCR outperformed CAPRA (DeLong's test, p = 0.008 and 0.001, respectively). DCA showed greater net benefit for CCP + CAPRA at thresholds 0.05-0.50 and for CCR at 0.05-0.40. CCR score yielded a higher overall NRI of 0.90 (95% CI: 0.55-1.20), improving classification for both events and non-events. A significant positive CCP-CAPRA interaction was identified: GG5 was observed in 5.7% (24/421) of patients with CCP ≤ 4.6 and/or CAPRA ≤ 4, versus 78% (7/9) with both > 4.6 and ≥ 5 (p = 0.039).

Conclusions: Our data suggests that CCP score adds value to initial risk assessment, particularly in CAPRA-defined low- to favorable-intermediate-risk patients. An elevated CCP score should prompt counseling on the increased risk of biopsy-undetected GG5 disease and consideration of intensified management, such as RP or radiotherapy with prolonged androgen deprivation therapy within a multimodal framework. This is especially relevant in non-surgical settings where final pathology is unavailable.

Clinical trial registration: N/A.

Background: The aim of this study is to investigate the relationship between the gut microbial profiles, occurrence of side effects, total testosterone (TS) levels, and pretreatment dietary habits among patients with high-risk localized prostate cancer who were subjected to androgen-deprivation therapy (ADT).

Methods: This prospective study included patients diagnosed with high-risk localized prostate cancer who underwent ADT between March 2021 and August 2022. The correlation between the pre- and post (after 3 months)-ADT gut microbial profiles, laboratory tests, body consumption data, and pretreatment dietary habits was analyzed.

Results: No significant differences were observed in the alpha- and beta-diversities of the gut microbiota during pre- and post-ADT. The relative abundance of genus Ruminococcus 2 (p = 0.013) and genus [Eubacterium] ruminantium group (p = 0.043) were significantly higher during post-ADT compared with those during pre-ADT. Twenty percent of the patients with a post-ADT TS level of < 20 ng/dL had a significantly high proportion of genus Ruminococccus 2, whereas no significant proportion was observed in patients with a TS level of ≥ 20 ng/dL. In terms of the impact of the pretreatment dietary habits on the changes of the gut microbiota, genus Romboutsia and genus Fusicatenibacter showed a positive correlation with n-6 polyunsaturated fatty acid intake, whereas the amounts of genus Ruminococcus 2 and genus Veillonella showed a negative correlation with n-3 polyunsaturated fatty acids.

Conclusions: Short-term ADT was found to increase the proportion of gut genus Ruminococcus 2 in patients with advanced prostate cancer, which was associated with low TS levels and showed a negative correlation with n-3 polyunsaturated fatty acid intake. Further validation is important to identify specific changes in the gut microbiota during ADT in patients with prostate cancer.

Salvage stereotactic body radiation therapy (SBRT) for localised prostate cancer recurrence following radiation therapy remains controversial. Salvage SBRT may cure disease recurrence however receives criticism as it carries with it risks of severe genitourinary and gastrointestinal toxicity. We performed a systematic review to assess the efficacy and side effects profile of salvage SBRT for locally recurrent prostate cancer to assess the role of salvage SBRT in clinical practice. A systematic review was carried out using Pubmed (MEDLINE) and Scopus databases. Inclusion and exclusion criteria were satisfied, and those studies included were quality assessed using the ROBINS-I checklist. Five studies in total met criteria for inclusion. Median doses for SBRT ranged from 30Gy to 36Gy delivered over 5 to 6 fractions. Recurrence free survival ranged from 40% to 76% at 2 years. Genitourinary toxicity was more prevalent than gastrointestinal toxicities. Grade 2 and 3 genitourinary complication rates ranged from 5 - 22% and 0 to 9% respectively. Gastrointestinal grade 2 complication rates ranged from 0 to 11% and no grade 3 complications were recorded. Lower dose SBRT generally was associated with less gastrointestinal and genitourinary side effects however had inferior recurrence free survival rates. Compared to other forms of salvage therapies, SBRT appears to be superior. This systematic review serves as one of the first to characterise SBRT as a salvage option for locally recurrent prostate cancer. Further large-scale prospective studies are required to guide whether the benefits outweigh the risk profile. This article is protected by copyright. All rights reserved.

Objective: For centuries, humans have used directed evolution to promote desired traits in domesticated animals. We hypothesized similar strategies may be employed to steer castrate resistant prostate cancer cells to a castrate sensitive phenotype allowing resumption of Androgen Deprivation therapy (ADT) and prolonging survival.

Methods: Our interdisciplinary team investigated directed evolution to restore castrate sensitivity in a patient with metastatic castrate resistant prostate cancer who could not tolerate available therapeutic agents for castrate resistant disease. Guided by an evolutionary mathematical model and using the PSA/testosterone ratio as a biomarker for intra-tumoral population dynamics, we applied a sequence of testosterone injections as evolutionary selection forces to suppress resistant androgen receptor-upregulated clones and promote proliferation of ADT-responsive clones.

Results: When the PSA/testosterone ratio indicated successful transition to dominant castrate sensitive population, reinstitution of adaptive dosing of ADT has resulted in three stable cycles.

Conclusion: This case suggests that evolution-informed strategies using population-based biomarkers to manipulate intra-tumoral evolution can restore castrate sensitivity in select patients.

Background: PSA response to apalutamide combined with androgen deprivation therapy (ADT) in metastatic hormone-sensitive prostate cancer (mHSPC) has been linked to prognosis. Post hoc analyses from clinical trials suggest that PSA levels at 6 months are critical for predicting radiographic progression-free survival (rPFS) and overall survival (OS). Real-world evidence (RWE) is needed to confirm these findings.

Materials and methods: This multicentre, retrospective study included patients with mHSPC treated with apalutamide plus ADT from May 2018 to January 2025 across 18 Spanish centers. Patients were stratified according to PSA level at 6 months: Complete response (CR; ≤ 0.2 ng/mL) or incomplete response (IR; > 0.2 ng/mL). The primary objective was to evaluate the association between PSA response and rPFS at 24 and 36 months. Univariate and multivariate Cox regression analyses were used to identify predictors of progression.

Results: Among 812 patients, 65% achieved a CR at 6 months, associated with higher rPFS at 24 (94%) and 36 (81%) months compared to the IR group (73% and 60%, respectively; p < 0.0001). CR (hazard ratio: 0.38; p < 0.001) and low-volume disease (hazard ratio: 0.41; p < 0.001) were independent predictors of rPFS. Baseline PSA, disease volume, and positron emission tomography imaging predicted achieving a CR.

Conclusions: In this large real-world cohort, PSA response at 6 months was a strong predictor of disease progression, supporting its use as a dynamic prognostic biomarker.

Introduction: Effective management of post-prostate cancer is hindered by the limitations of current prognostic tools in accurately assessing disease aggressiveness. Radical prostatectomy remains a standard treatment, but some patients develop biochemical recurrence and metastasis, underscoring the need for improved postsurgical prognostic tools.

Methods: This investigation involved sequencing data derived from 38 matched prostate cancer patients who had undergone RP. Initial statistical analysis helped identify the most significant miRNAs, which were further subjected to unsupervised clustering and stepwise selection. A linear discriminant analysis (LDA) model was then trained and tested using a miRNA combination method to pinpoint biomarkers predictive of metastasis.

Results: Out of 1123 miRNAs initially identified, 519 were selected as high-confidence candidates. Parametric analysis of these miRNAs discerned 41 that effectively distinguished between patients who developed metastasis postoperatively and those who did not. Utilizing LDA, this study harnessed 41 miRNAs in a combinatorial approach, identifying eight key miRNAs (hsa-miR-106b-3p, hsa-miR-769-5p, hsa-miR-182-5p, hsa-miR-194-5p, hsa-miR-345-5p, hsa-miR-183-3p, hsa-miR-200a-3p, hsa-miR-301a-3p) that collectively stratified the metastatic group from control with up to 91% accuracy. This model's effectiveness was supported by a receiver operating characteristic analysis, demonstrating an area under the curve of 80% or higher for the best miRNA combinations. Notably, the performance of this eight-miRNA panel was consistent with CAPRA-based risk stratification.

Conclusion: Our study presents a miRNA-based machine learning model that distinguishes metastatic from non-metastatic prostate cancer patients following surgery. The panel's alignment with CAPRA underscores its clinical relevance and highlights its potential for integration into future clinical frameworks.

Background: Prostate-specific antigen (PSA) density is an easily available predictor for clinically significant PCa. While transrectal ultrasound (TRUS) is utilized for PSA density (PSAD) estimation, transabdominal ultrasound (TAUS) is a more accessible, noninvasive alternative that can be used to decide if follow-up diagnostics are necessary. This study aims to compare prostate volume (PV) and PSAD across TAUS, TRUS and MRI, comparing the clinical utility of TAUS and TRUS for PSAD-based risk stratification.

Methods: Hundred and eighty men undergoing PCa diagnostics were included by collecting serum PSA, TRUS, MRI, and TAUS PV examinations. PV was calculated blindly by all operators and image quality was assessed. Agreement in PV measurements of all imaging modalities was analyzed in Bland-Altman diagrams. PCa risk derived from PSAD_TAUS and PSAD_TRUS was compared against MRI outcomes in Sankey diagrams and the percentage of misclassified PCa risk was reported.

Results: After excluding 33 inadequate TAUS acquisitions, 147 patients were included. The average volume difference between TAUS and MRI was 2.5 mL (standard deviation (SD): 16.4), between TAUS and TRUS 11.5 mL (SD: 20.4), and between TRUS and MRI -9.0 mL (SD: 21.1). TAUS and TRUS underestimate PCa risk in 3%-4%, while the percentage of men with overestimated risk decreased when TAUS was used (7% vs. 13%).

Conclusions: PVs obtained with TAUS are equivalent to MRI. Still, image quality varies with experience and interobserver variability needs further exploration, ensuring generalizable outcomes. Nevertheless, TAUS represents a valid alternative for PV and PSAD estimation, enabling a patient-friendly alternative for PCa risk assessment.

Background: Prostate cancer (PCa) is the only cancer in men to exhibit androgen sensitivity at diagnosis, which has allowed for the development of androgen deprivation therapy (ADT). However, outcomes in high-risk PCa (HRPCa) remain significantly worse than low risk disease and the use of ADT varies among treatment algorithms and medical specialties. In men treated with radiation, testosterone recovery after completing ADT has been associated with oncologic outcomes. However, the relationship between testosterone recovery and oncologic outcomes following ADT in surgically managed HRPCa remains unexplored.

Methods: Using pooled data from two large, phase III clinical trials (CALGB 90203 and SWOG S9921), we performed a retrospective analysis of men with HRPCa treated with ADT and RP. Subjects were classified as recovered or non-recovered based on study protocol-defined testosterone recovery thresholds. Primary and secondary outcomes were overall survival (OS) and modified event-free survival (mEFS), analysed utilizing time-to-event Kaplan-Meier estimates and Cox proportional hazards models. Additional secondary analyses repeated this on an unpooled, per trial basis and also looked at speed of testosterone recovery using early ( ≤ 6 months) and late ( ≤ 12 months, including early recoverees) recovery subgroups.

Results: Among 445 eligible patients meeting our inclusion criteria, 87.2% achieved testosterone recovery. No significant differences in OS (HR = 0.72, p = 0.400) or mEFS (HR = 1.24, p = 0.360) were observed between the recovered and non-recovered groups. Similarly, no significant differences were present when OS and mEFS were analysed separately in each individual trial's cohort. Finally, we also saw no differences in oncologic outcomes between the early and late testosterone recovery subgroups.

Conclusions: Testosterone recovery status and speed were not significantly associated with oncologic outcomes in HRPCa patients treated with RP and ADT. These findings, the first to assess this question in a surgical cohort, provide a foundation for further research into treatment strategies, including intermittent ADT, and optimization of patient quality of life while maintaining oncologic efficacy.