We aim to determine the prognostic significance of glutathione S-transferase Pi 1 DNA methylation (mGSTP1) in two independent prostate cancer cohorts with long-term clinical follow-up data.
We first re-examined a published, in-house whole genome bisulphite sequencing (WGBS) prostate cancer dataset, derived from radical prostatectomy (RP) tissue (n = 15) with median follow-up 19.5 years, to confirm and visualise the association between mGSTP1 and patient mortality. To validate prognostic significance, we used a quantitative methylation-specific head-loop (MS-HL) assay to measure mGSTP1 levels in a larger, independent cohort (n = 186), and performed univariable and multivariable Cox survival analysis.
Re-analysis of WGBS data showed a significant increase in mGSTP1 in RP samples from patients with lethal versus non-lethal disease. Subsequent analysis in the larger cohort using the MS-HL assay confirmed that mGSTP1 was detectable in 97% of RP samples, validating the diagnostic potential of mGSTP1. Univariable Cox survival analysis revealed a significant association between mGSTP1 levels and biochemical recurrence and metastatic relapse free survival, with a near-significant association with prostate cancer specific mortality. Notably, multivariable Cox models demonstrated that mGSTP1 did not add independent prognostic value beyond standard clinicopathological features.
Our study supports the importance of DNA methylation as a tissue-based prostate tumour biomarker. GSTP1 methylation is well established as a diagnostic marker, and in this study, we find that GSTP1 methylation levels are also associated with disease prognosis. Further research is required into the clinical utility of prognostic methylation markers and their functional role in disease progression.
The aim of this study was to assess the precision and safety of targeted microwave ablation (TMA) using organ-based tracking (OBT) fusion, in patients with intermediate risk prostate cancer.
We conducted a prospective, multicentric trial. Eligible patients had a prostate-specific antigen (PSA) < 20 ng/mL, a magnetic resonance imaging (MRI)-visible index tumour of Gleason score 3 + 4, with largest axis ≤15 mm and distant of at least 5 mm from the rectum and apex. TMA was performed with microwave needle applicator using OBT fusion, with a transperineal or a transrectal approach. In this interim analysis, we evaluated precision, safety, urinary and sexual outcomes, and PSA density kinetics.
At this point, 37 patients were treated in five centres. Median (interquartile range) age is 68 (63–72) years. Baseline median prostate volume and PSA are of 45 (34–57) mL and 8 (6.2–10.8) ng/mL, respectively. Median largest tumour axis on T2W MRI is of 11 mm (10–13). Patients were treated under general anaesthesia or conscious IV sedation in an outpatient setting. Anaesthesia had a median duration of 78 (66–90) min. A median number of 3 (2–4) 12-W ablations of 2 to 5 min were performed per patient. After a median follow-up of 6 (2.4–10) months, we observed 58 adverse events (AE) in 22 patients. These were of Common Terminology Criteria for Adverse Events (CTCAE) grade 1, 2 and 3 in 43 (74%), 13 (22%) and 2 (4%) cases. Six (15%) patients had an acute urinary retention, five of which considered as severe AE because of rehospitalisation. We did not observe any significant difference in International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire-ejaculatory dysfunction (MSHQ-EjD) and International Index of Erectile Function (IIEF5) from baseline to last follow-up. Median PSA density evolved from 0.2 (0.1–0.3) at baseline to 0.1 (0.07–0.16) at 12 months.
These preliminary results suggest that TMA using OBT fusion is precise and safe in patients with intermediate risk localised prostate cancer. Further inclusions and follow-up are needed to assess oncological outcome.
To show that robot-assisted laparoscopic cutaneous continent urinary diversion (RALCCUD) is feasible and safe; however, data on clinical outcomes in adults are lacking.
We conducted a retrospective study of all adults who underwent RALCCUD between 2017 and 2022 at a single tertiary reference centre.
Patient characteristics, clinical information and perioperative outcomes were recorded. All patients underwent pre- and postoperative urodynamic evaluations.
Functional outcomes were evaluated at 3 months, then yearly. Continence was defined as no stomal or urethral leakage.
Twelve patients, mostly women (n = 11), median (IQR) age 47.4 (19–57) years underwent RALCCUD (four Mitrofanoff, four Yang-Monti and four Casale). The main indication for surgery was inability to perform intermittent self-catheterization through the native urethra.
Eleven patients (92%) had neurogenic lower urinary tract disease caused by spinal cord injury or spinal dysraphism.
Median (IQR) operative time was 313 (285–367) min. Four patients (33%) underwent concomitant procedures: three supratrigonal cystectomy (SC) with augmentation cystoplasty (AC) and one artificial urinary sphincter (AUS). No conversions to an open approach were required. Median (IQR) follow-up was 51 (40–61) months. One early postoperative complication occurred (Clavien grade III). The late postoperative complication rate was 17%, with three complications occurring in three patients.
At the last follow-up, all patients could self-catheterize through the tube, and the stomal and urethral continence rate was 100%.
RALCCUD is feasible and safe in adults, with a high rate of stomal and urethral continence and a low complication rate.
The objectives of this study are to compare the accuracy of warm ischemia times (WITs) derived by a surgical artificial intelligence (AI) software to those documented in surgeon operative reports during partial nephrectomy procedures and to assess the potential of this technology in evaluating postoperative renal function.
A surgical AI software (Theator Inc., Palo Alto, CA) was used to capture and analyse videos of partial nephrectomies performed between October 2023 and April 2024. The platform utilized computer vision algorithms to detect clamp placement and removal, enabling precise WIT measurement. Expert-reviewed surgical videos served as the ground truth. Platform-derived WITs were compared to those in surgeon operative reports using paired-sample t-tests. Additionally, we analysed the correlation between platform-derived WITs and postoperative creatinine levels extracted from electronic health records (EHRs) integrated via health level seven (HL7) messaging protocols.
Of 64 eligible cases, 61 were included in the final analysis. Platform-derived WITs were within 1 min of the ground truth in all procedures, within 30 s in 97%, and within 10 s in over 80%. The mean difference between platform-derived WITs and ground truth was 8.3 s, significantly lower than the 2.45 min difference for operative reports (p < 0.001). No significant correlation was found between platform-derived WIT and postoperative creatinine changes, aligning with the view that WIT may not independently determine postoperative renal function. Although not the primary goal of this study, significant correlations were observed between WIT, tumour size and RENAL score.
This study demonstrates the high accuracy of a surgical intelligence platform in measuring WIT during partial nephrectomies. The findings support the use of AI-based surgical time measurement for precise intraoperative documentation and highlight the potential of integrating these data with EHRs to advance research on surgical outcomes.
To assess the carbon footprint, accessibility, and diagnostic performance of an expedited ‘One-Stop’ prostate cancer (PCa) diagnostic pathway.
A total of 1083 consecutive patients undergoing magnetic resonance imaging (MRI) followed by transrectal ultrasound fusion-guided prostate biopsy (PBx) were identified from a prospective database. The patients were divided according to the diagnostic pathway: One-Stop, with MRI and same-day PBx (3 hours apart), or Standard, with MRI followed by a second visit for PBx. Socioeconomic status was evaluated by the Distressed Communities Index (DCI) and the carbon footprint by the United States (U.S.) Environmental Protection Agency Greenhouse Gases Equivalencies Calculator.
Overall, 260 patients underwent the One-Stop and 823 the Standard pathway. The One-Stop patients lived farther from the hospital (163 vs. 23 km; p < 0.001), had lower socioeconomic status with DCI scores of 49 versus 30 (p < 0.001), and were more likely to be Latinos (21% vs. 13%, p < 0.001) compared to the Standard patients, respectively. The One-Stop saved 69 575 km in round trips, over 16 tons of travel-related CO2 emissions, and $8214 U.S. dollars. For patients with Prostate Imaging Reporting & Data System (PIRADS) 3–5, the clinically significant PCa detection (53% vs. 50%, p = 0.55) was similar for the One-Stop and Standard pathways, respectively.
The One-Stop PCa diagnostic pathway reduces carbon footprint, distance travelled, and patient-level cost while maintaining clinical outcomes comparable to the Standard pathway. It facilitates access to tertiary-level care for minorities and underserved populations.
The objective of this study is to compare the early oncological outcomes of delayed (>90 days) versus scheduled (≤90 days) radical prostatectomy (RP).
Patients with prostate cancer due to undergo surgery between March 2020 and June 2020 who were enrolled in the COVIDSurg-Cancer international, observational study were prospectively followed up for 1 year. Time to surgery was defined as the difference between the operation date and the multi-disciplinary team decision to offer surgery. The primary outcome was the positive surgical margin (PSM) rate. Biochemical recurrence (BCR), upgradation and upstaging were secondary oncological outcomes. The Independent t-test and Mann Whitney U test were used to compare means between groups and regression models and were used to investigate factors associated with the primary outcome.
Four hundred seventy-six (78.7%) patients underwent RP from 605 that were eligible. Three hundred seven (64.5%) patients underwent scheduled RP, and 169 (35.5%) underwent delayed RP. A small proportion of men (n = 35, 6.8%) did not undergo RP within the 1-year follow-up period. More men with high-risk disease (72.8%) underwent scheduled RP compared to men with intermediate-risk disease (60.2%) (p < 0.05). There was no statistically significant difference in the PSM rate between the two groups (p = 0.512). Delay in surgery was not associated with an increased PSM or BCR on univariable or multivariable analyses. There was statistically significantly greater upstaging (p < 0.05) in the delayed group but no difference in upgradation.
High-risk men were prioritised for surgery during the COVID-19 pandemic. Our prospective data support previous retrospective, cancer-registry evidence suggesting no adverse oncological impact after delaying RP across all risk groups. Our study is limited by the short follow-up period, and therefore, longer term conclusions cannot be drawn.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：