Radical prostatectomy is a commonly used surgical method in cases of localized prostate cancer.In recent years,with the advent of new medical technologies and surgical techniques,the evolution of radical prostatectomy...Radical prostatectomy is a commonly used surgical method in cases of localized prostate cancer.In recent years,with the advent of new medical technologies and surgical techniques,the evolution of radical prostatectomy has revolutionized,especially in robot-assisted radical prostatectomy(RARP).The evolution of surgical approaches for radical prostatectomy has occurred in three stages:open surgery,laparoscopic intervention,and robot-assisted surgery.Regarding the functional recovery of patients who underwent laparoscopic radical prostatectomy or RARP,with the improvement of disease conditions,oncological prognosis of patients was not compromised.Particularly,RARP boasts distinguished novel techniques and approaches for maintaining urinary continence and sexual function in the short-and long-term.In addition,studies in the last two decades have shown its correlation with decreasing postoperative morbidity.In this paper,the available literatures related to the surgical approaches ranging from open surgery to RARP were reviewed,the superiority of any novel procedure was analyzed,and the advantages and disadvantages among the three modalities were compared,hoping to provide guidance to urologists when considering surgical approaches in the treatment of localized prostate cancer.展开更多
Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2...Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2c(cT2c)prostate cancer(PCa)patients.Methods:From January 2018 to December 2022,cT2cN0M0 PCa patients who underwent prostate biopsies and subsequent RARP at the Peking University First Hospital with an interval between biopsy and RARP of ≤90 days were included.Univariable and stepwise multivariable logistic regression analyses were performed to identify independent risk factors associated with APCs.Nomograms were constructed based on these predictive models.The performance of the nomograms was evaluated by receiver operating characteristic curves,decision curve analyses,and calibration plots.Results:A total of 423 eligible cT2cN0M0 PCa patients were included.The rates of upgrading,upstaging,and PSM in our cohortwere 33%,51%,and 35%,respectively.The stepwise multivariate logistic analysis suggested that PSA density and the percentage of positive cores in systematic biopsy were significantly associated with the occurrence of APCs.The score of the Prostate Imaging Reporting and Data System,PSA density,and the International Society of Urological Pathology grade group(IGG)of needle-biopsy specimens(or clinical IGG[cIGG])were significantly associated with upgrading.The PSA density,percentage of positive cores in systematic biopsy,and largest tumor percentage in all cores of each patient(LTP)were significantly associated with upstaging.The PSA density and LTP were significantly associatedwith the PSM.Based on these results,four nomogramswere developed.Receiver operating characteristic curves,decision curve analyses,and calibration plots implied that the nomograms exhibited excellent accuracy.Conclusion:The predictive models we developed could help to identify high-risk PCa early,and optimize clinical decisions of cT2cN0M0 PCa patients.展开更多
Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a m...Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.展开更多
Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet t...Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet this description with marked prostatomegaly,we present a multi-institutional proof of concept study describing an alternative pathway of robotic simple prostatectomy(RASP)followed by external beam radiation therapy(EBRT)for the treatment of clinically significant prostate cancer.Methods:A retrospective study was performed of 17 patients with PCa who underwent RASP followed by EBRT at two institutions from 2015–2023.Demographic,peri-operative,and post-radiation treatment functional outcomes are reported.Results:No postoperative or post-EBRT complications were reported for any of the 17 patients who underwent RASP followed by EBRT during a median follow-up time of 12 months.The median time from RASP to EBRT was 9 months.Median prostate size was 135 g(IQR 110–165).13(76.5%)patients received a pre-EBRT rectal spacer.Median IPSS score preoperatively improved at 90 days post-RASP(13.5 vs.2.5;IQR 10.8–15.2),and this benefit was sustained post-EBRT with a median IPSS at 3 vs.12 months(4 vs.0;IQR 0–5).There was no statistically significant difference between postoperative IPSS and post-EBRT IPSS at 3(p=0.677)or 12(p=0.627)months.In all 14 patients with localized disease and PSA data,none had recurrence during the study period.Conclusions:A subset of patients with clinically significant prostate cancer have marked prostatomegaly and LUTS.We report an alternative treatment approach for patients unwilling to undergo radical prostatectomy.We found robotic simple prostatectomy followed by definitive radiation to be feasible and safe.展开更多
Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing ur...Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing urinary incontinence after RP.Our study aimed to analyze possible predictors of early postoperative(within 3 months)urinary continence(UC)outcomes following extraperitoneal single-site robot-assisted RP(ss-RARP)for localized PCa.Methods:We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023.Patient characteristics(age,body mass index,prostate volume,prostate dimensions,preoperative and postoperative membranous urethral length,and percentage of membranous urethra removed)were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP.From the time of urinary catheter removal after surgery,the recovery of UC was followed up every month,and UC was defined as using≤1 safety pad daily,known as social continence.Results:The proportions of continent patients immediately after urinary catheter removal,1 month,and 3 months after extraperitoneal ss-RARP were 22%,49%,and 82%,respectively.The multivariate logistic regression analysis showed that the percentage of membranous urethra removed(p=0.016)and prostate volume(p=0.049)were associated with social UC recovery immediately after urinary catheter removal,and craniocaudal dimension of the prostate(p=0.042)and age(p=0.014)were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP,respectively.Conclusion:The percentage of membranous urethra removed,prostate volume,craniocaudal dimension of the prostate,and age are independent risk factors for social UC early after extraperitoneal ss-RARP.展开更多
Prostate cancer (PC) is among the most common cancer diagnoses in men worldwide and the fifth leading cause of cancer-related deaths. Approximately 1.5 million new cases of PC were reported worldwide in 2022 with near...Prostate cancer (PC) is among the most common cancer diagnoses in men worldwide and the fifth leading cause of cancer-related deaths. Approximately 1.5 million new cases of PC were reported worldwide in 2022 with nearly 400,000 associated deaths1. Notably, the incidence of PC in China has increased substantially compared to the global average2.展开更多
This article discusses the coexistence of prostate adenocarcinoma and prostate urothelial carcinoma.Combining existing literature and research results,the potential mechanisms of the co-occurrence of these two cancers...This article discusses the coexistence of prostate adenocarcinoma and prostate urothelial carcinoma.Combining existing literature and research results,the potential mechanisms of the co-occurrence of these two cancers are explored,including the role of androgen receptor,gene mutations,and their complex interactions in cell signaling pathways,etc.Also,the hypothesis of prostate cancer transformation into urothelial carcinoma is explained from some perspectives,including tumor multipotent stem cell differentiation,epithelial-mesenchymal transition,mesenchymal-epithelial transition,and other mechanisms.Ultimately,the goal is to provide more accurate diagnoses and more personalized treatments in clinical practice,as well as to lay the foundation for improving patient prognoses in the future.展开更多
BACKGROUND Vitamin D deficiency has been associated with prostate cancer,particularly in ethnic minorities.Patients with prostate cancer may still be deficient even in areas of high sun exposure.Although androgen depr...BACKGROUND Vitamin D deficiency has been associated with prostate cancer,particularly in ethnic minorities.Patients with prostate cancer may still be deficient even in areas of high sun exposure.Although androgen deprivation therapy(ADT)is well documented to affect bone health,its impact on vitamin D levels is still uncertain.This study investigates the subgroups of prostate cancer patients most associated with vitamin D deficiency and ADT’s relation to this.AIM To examine how prevalent vitamin D deficiency is among prostate cancer patients in a sun-rich environment,with focus on differences by race and disease stage.It also assessed whether ADT is associated with changes in vitamin D levels.METHODS Prostate cancer patients treated at Chao Family Comprehensive Cancer Center between 2014-2024 were retrospectively studied with regards to vitamin D levels across racial groups,disease stages,and ADT exposure.Changes in vitamin D levels pre-and post-ADT over 24 months were assessed by statistical methods including paired t-tests.RESULTS Among 120 patients(mean age:74 years,mean body mass index:27.6 kg/m^(2)),African American(33.3%)and Hispanic(31.8%)patients had the greatest prevalence of vitamin D deficiency(<20 ng/mL).With a 28.6%deficit rate,metastatic castration-resistant prostate cancer had the highest prevalence rates of deficiency.There was no significant difference between pre-and post-ADT vitamin D levels(P=0.45).CONCLUSION Vitamin D deficiency is common in prostate cancer patients,especially racial minorities and those with advanced disease,despite residing in an area with high sun exposure.ADT does not significantly impact vitamin D levels in the short term.Routine screening and supplementation should be considered in these high-risk groups.展开更多
This study investigated the impact of metabolic syndrome (MetS) and its components on prostate volume (PV) in the general Chinese population. In total, 43 455 participants in The First Medical Center of the Chinese PL...This study investigated the impact of metabolic syndrome (MetS) and its components on prostate volume (PV) in the general Chinese population. In total, 43 455 participants in The First Medical Center of the Chinese PLA General Hospital (Beijing, China) from January 1, 2012, to December 31, 2022, undergoing health examinations were included in the study. Participants were categorized into four groups according to PV quartiles: Q1 (PV ≤24.94 ml), Q2 (PV >24.94 ml and ≤28.78 ml), Q3 (PV >28.78 ml and ≤34.07 ml), and Q4 (PV >34.07 ml), with Q1 serving as the reference group. Logistic regression analyses were used to examine the association between MetS and PV, with subgroup analyses conducted by age. Among the participants, 18 787 (43.2%) were diagnosed with MetS. In the multivariate analysis model, a significant correlation between MetS and PV was observed, with odds ratios (ORs) increasing as PV increased (Q2, OR = 1.203, 95% confidence interval [CI]: 1.139–1.271;Q3, OR = 1.300, 95% CI: 1.230–1.373;and Q4, OR = 1.556, 95% CI: 1.469–1.648). Analysis of MetS components revealed that all components were positively associated with PV, with abdominal obesity showing the most significant effect. The number of MetS components was identified as a dose-dependent risk factor for elevated PV. The impact of MetS, its components, and component count on PV exhibited a decreasing trend with advancing age. Overall, the influence of MetS, its components, and component count on PV was predominantly observed in the age groups of 40–49 years and 50–59 years. Early intervention targeting MetS can significantly alleviate the increase in PV, particularly benefiting individuals aged 40–59 years who have abdominal obesity.展开更多
We propose a strategy to reduce unnecessary prostate biopsies in Chinese patients with total prostate-specific antigen(tPSA)>10 ng ml−1 and Prostate Imaging Reporting and Data System(PI-RADS)scores between 1 and 3....We propose a strategy to reduce unnecessary prostate biopsies in Chinese patients with total prostate-specific antigen(tPSA)>10 ng ml−1 and Prostate Imaging Reporting and Data System(PI-RADS)scores between 1 and 3.Clinical data derived from 517 patients of The First Affiliated Hospital of USTC(Hefei,China)from January 2020 to December 2023 who met the screening criteria for the study were retrospectively collected.Independent predictors were identified via univariate and multivariate logistic regression analysis.The diagnostic capacity of clinical variables was evaluated using the receiver operating characteristic(ROC)curves and area under the curve(AUC).A prostate biopsy strategy was developed via risk stratification.Of the 517 patients,17/348(4.9%)with PI-RADS 1–2 were diagnosed with clinically significant prostate cancer(csPCa),and 27/169(16.0%)patients with PI-RADS 3 were diagnosed with csPCa.The appropriate prostate-specific antigen density(PSAD)cut-off values were 0.45 ng ml−2 for PI-RADS 1–2 patients and 0.3 ng ml−2 for PI-RADS 3 patients.The appropriate prostate volume(PV)cut-off values were 40 ml for PI-RADS 1–2 patients and 50 ml for PI-RADS 3 patients.The prostate biopsy strategy based on PSAD and PV developed in this study can reduce unnecessary prostate biopsies in patients with tPSA>10 ng ml−1 and PI-RADS 1–3.In the study,66.5%(344/517)patients did not need to undergo prostate biopsy,at the expense of missing only 1.7%(6/344)patients with csPCa.展开更多
Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and ...Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and within specific regions.It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.Methods:We obtained data on incidence,prevalence,mortality,and disability-adjusted life-years(DALYs)for the aforementioned urologic diseases by age,sex,location,and year from the Global Burden of Disease(GBD)2021.We analyzed the burden associated with urologic diseases based on socio-demographic index(SDI)and attributable risk factors.The trends in burden over time were assessed using estimated annual percentage changes(EAPC)along with a 95%confidence interval(CI).Results:In 2021,BPH and UTI were the leading causes of age-standardized incidence rate(ASIR)and age-standardized prevalence rate(ASPR),with rates of 5531.88 and 2782.59 per 100,000 persons,respectively.Prostate cancer was the leading cause of both age-standardized mortality rate(ASMR)and age-standardized DALYs rate(ASDR),with rates of 12.63 and 217.83 per 100,000 persons,respectively.From 1990 to 2021,there was an upward trend in ASIR,ASPR,ASMR,and ASDR for UTI,while urolithiasis showed a downward trend.The middle and low-middle SDI quintile levels exhibited higher incidence,prevalence,mortality,and DALYs related to UTI,urolithiasis,and BPH,while the high and high-middle SDI quintile levels showed higher rates for the three cancers.The burden of these 6 urologic diseases displayed diverse age and sex distribution patterns.In 2021,a high body mass index(BMI)contributed to 20.07%of kidney cancer deaths worldwide,while smoking accounted for 26.48%of bladder cancer deaths and 3.00%of prostate cancer deaths.Conclusions:The global burden of 6 urologic diseases presents a significant public health challenge.Urgent international collaboration is essential to advance the improvement of urologic disease management,encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.展开更多
Prostate cancer is a significant global health issue with inflammation emerging as a critical driver of progression.The prostate tumor microenvironment(TME)is comprised of tumor cells,mesenchymal stem cells,immune cel...Prostate cancer is a significant global health issue with inflammation emerging as a critical driver of progression.The prostate tumor microenvironment(TME)is comprised of tumor cells,mesenchymal stem cells,immune cells,cancer-associated fibroblasts,adipocytes,and the extracellular matrix.All of these TME components interact via soluble factors,such as growth factors,cytokines,and chemokines.These interactions remodel the TME and drive inflammation and tumor progression.Prolonged inflammation leads to dysregulated activation and infiltration of immune cells in the TME.This process maintains an immunosuppressive environment and facilitates epithelial-to-mesenchymal transition,migration,and invasion.Chronic inflammation causes inflammatory mediators to enter the circulation over time,as evidenced by systemic biomarkers,such as the systemic immune-inflammation index,which links inflammation to disease severity.Interactions between the prostate gland and adipose tissues further exacerbate systemic inflammation.Inflammation in the prostate gland confers resistance to therapy,primes distant metastatic niches,and promotes metastatic spread,resulting in poor clinical outcomes.Therapeutic strategies,such as anti-inflammatory agents and immunotherapies,hold promise in mitigating disease burden.This review explored the immune landscape of systemic inflammation in prostate cancer,discussed the role of the immune landscape in resistance to therapy and metastasis,and offered insights into potential interventions for targeting inflammation to limit prostate cancer burden.展开更多
We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to perman...We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.展开更多
Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we e...Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we examined the association between use of the maximal urethral length preservation(MULP)technique and postoperative urinary continence in patients undergoing RARP.We conducted a comprehensive search of PubMed,Web of Science,Embase,and the Cochrane Library up to December 31,2023.The quality of the literature was assessed using the Newcastle-Ottawa Scale.A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio(OR)from eligible studies on continence and MULP.Six studies involving 1869 patients met the eligibility criteria.MULP was positively associated with both early continence(1 month after RARP;Z=3.62,P=0.003,OR=3.10,95% confidence interval[CI]:1.68-5.73)and late continence(12 months after RARP;Z=2.34,P=0.019,OR=2.10,95%CI:1.13–3.90).Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex(both P>0.05).In conclusion,the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.展开更多
Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional litho...Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional lithotomy and transurethral approaches.This report introduces an innovative,single-port transvesical robot-assisted simple prostatectomy with total urethral preservation.This pioneering technique,tailored for complex BPH management,demonstrated its efficacy and potential through favorable postoperative outcomes.This report underscores single-port transvesical robot-assisted simple prostatectomy with total urethral preservation as a promising surgical option for patients with BPH who are unable to assume the lithotomy position.展开更多
Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelin...Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.展开更多
Prostate cancer is the second most common cancer in men,accounting for 14.1%of new cancer cases in 2020.The aggressiveness of prostate cancer is highly variable,depending on its grade and stage at the time of diagnosi...Prostate cancer is the second most common cancer in men,accounting for 14.1%of new cancer cases in 2020.The aggressiveness of prostate cancer is highly variable,depending on its grade and stage at the time of diagnosis.Despite recent advances in prostate cancer treatment,some patients still experience recurrence or even progression after undergoing radical treatment.Accurate initial staging and monitoring for recurrence determine patient management,which in turn affect patient prognosis and survival.Classical imaging has limitations in the diagnosis and treatment of prostate cancer,but the use of novel molecular probes has improved the detection rate,specificity,and accuracy of prostate cancer detection.Molecular probe-based imaging modalities allow the visualization and quantitative measurement of biological processes at the molecular and cellular levels in living systems.An increased understanding of tumor biology of prostate cancer and the discovery of new tumor biomarkers have allowed the exploration of additional molecular probe targets.The development of novel ligands and advances in nano-based delivery technologies have accelerated the research and development of molecular probes.Here,we summarize the use of molecular probes in positron emission tomography(PET),single-photon emission computed tomography(SPECT),magnetic resonance imaging(MRI),optical imaging,and ultrasound imaging,and provide a brief overview of important target molecules in prostate cancer.展开更多
Background:Intermediate-risk prostate cancer(IR-PC)represents a heterogeneous group requiring nuanced treatment approaches,and recent advancements in radiotherapy(RT),androgen deprivation therapy(ADT),and prostatespec...Background:Intermediate-risk prostate cancer(IR-PC)represents a heterogeneous group requiring nuanced treatment approaches,and recent advancements in radiotherapy(RT),androgen deprivation therapy(ADT),and prostatespecific membrane antigen positron emission tomography(PSMA-PET/CT)imaging have prompted growing interest in personalized,risk-adapted management strategies.This study by the Turkish Society for Radiation Oncology aims to examine radiation oncologists’practices in managing IR-PC,focusing on RT and imaging modalities to identify trends for personalized treatments.Methods:A cross-sectional survey was conducted among Turkish radiation oncologists treating at least 50 prostate cancer(PC)cases annually.The 22-item questionnaire covered IR-PC management aspects such as risk stratification,imaging preferences,androgen deprivation therapy(ADT)use and duration,RT techniques,and treatment combinations.Anonymous responses were analyzed using descriptive statistics.Results:Thirty radiation oncologists participated,57%with over 20 years of experience.The median annual number of PC cases treated was 130.For risk stratification,43% followed the National Comprehensive Cancer Network(NCCN)guidelines,while 30%used the D’Amico classification.Imaging preferences revealed 47% favored PSMA-PET/CT.External beam RT was universally preferred,with 60% adopting ultra-hypofractionation.ADT was used by 97%,with 73% recommending it for unfavorable IR-PC cases.Short-term ADT(4–6 months)was the standard,administered concurrently with RT by 57%.Cardiovascular status influenced decisions for 97% of respondents,while 37% also considered patient age,preferences,and sexual health.Conclusions:This national survey demonstrates a shift toward personalized care in intermediate-risk prostate cancer in Turkey,marked by selective PSMA-PET/CT use,tailored ADT,and evolving radiotherapy practices.The findings underscore the importance of multidisciplinary collaboration—particularly between urologists and radiation oncologists—to optimize imaging integration and treatment outcomes.展开更多
Robot-assisted surgery has evolved into a crucial treatment for prostate cancer(PCa).However,from its appearance to today,brain-computer interface,virtual reality,and metaverse have revolutionized the field of robot-a...Robot-assisted surgery has evolved into a crucial treatment for prostate cancer(PCa).However,from its appearance to today,brain-computer interface,virtual reality,and metaverse have revolutionized the field of robot-assisted surgery for PCa,presenting both opportunities and challenges.Especially in the context of contemporary big data and precision medicine,facing the heterogeneity of PCa and the complexity of clinical problems,it still needs to be continuously upgraded and improved.Keeping this in mind,this article summarized the 5 stages of the historical development of robot-assisted surgery for PCa,encompassing the stages of emergence,promotion,development,maturity,and intelligence.Initially,safety concerns were paramount,but subsequent research and engineering advancements have focused on enhancing device efficacy,surgical technology,and achieving precise multi modal treatment.The dominance of da Vinci robot-assisted surgical system has seen this evolution intimately tied to its successive versions.In the future,robot-assisted surgery for PCa will move towards intelligence,promising improved patient outcomes and personalized therapy,alongside formidable challenges.To guide future development,we propose 10 significant prospects spanning clinical,research,engineering,materials,social,and economic domains,envisioning a future era of artificial intelligence in the surgical treatment of PCa.展开更多
The overdiagnosis of prostate cancer(PCa)caused by nonspecific elevation serum prostate-specific antigen(PSA)and the overtreatment of indolent PCa have become a global problem that needs to be solved urgently.We aimed...The overdiagnosis of prostate cancer(PCa)caused by nonspecific elevation serum prostate-specific antigen(PSA)and the overtreatment of indolent PCa have become a global problem that needs to be solved urgently.We aimed to construct a prediction model and provide a risk stratification system to reduce unnecessary biopsies.In this retrospective study,clinical data of 1807 patients from three Chinese hospitals were used.The final model was built using stepwise logistic regression analysis.The apparent performance of the model was assessed by receiver operating characteristic curves,calibration plots,and decision curve analysis.Finally,a risk stratification system of clinically significant prostate cancer(csPCa)was created,and diagnosis-free survival analyses were performed.Following multivariable screening and evaluation of the diagnostic performances,a final diagnostic model comprised of the PSA density and Prostate Imaging-Reporting and Data System(PI-RADS)score was established.Model validation in the development cohort and two external cohorts showed excellent discrimination and calibration.Finally,we created a risk stratification system using risk thresholds of 0.05 and 0.60 as the cut-off values.The follow-up results indicated that the diagnosis-free survival rate for csPCa at 12 months and 24 months postoperatively was 99.7%and 99.4%,respectively,for patients with a risk threshold below O.05 after the initial negative prostate biopsy,which was significantly better than patients with higher risk.Our diagnostic model and risk stratification system can achieve a personalized risk calculation of csPCa.It provides a standardized tool for Chinese patients and physicians when considering thenecessity of prostatebiopsy.展开更多
文摘Radical prostatectomy is a commonly used surgical method in cases of localized prostate cancer.In recent years,with the advent of new medical technologies and surgical techniques,the evolution of radical prostatectomy has revolutionized,especially in robot-assisted radical prostatectomy(RARP).The evolution of surgical approaches for radical prostatectomy has occurred in three stages:open surgery,laparoscopic intervention,and robot-assisted surgery.Regarding the functional recovery of patients who underwent laparoscopic radical prostatectomy or RARP,with the improvement of disease conditions,oncological prognosis of patients was not compromised.Particularly,RARP boasts distinguished novel techniques and approaches for maintaining urinary continence and sexual function in the short-and long-term.In addition,studies in the last two decades have shown its correlation with decreasing postoperative morbidity.In this paper,the available literatures related to the surgical approaches ranging from open surgery to RARP were reviewed,the superiority of any novel procedure was analyzed,and the advantages and disadvantages among the three modalities were compared,hoping to provide guidance to urologists when considering surgical approaches in the treatment of localized prostate cancer.
基金supported by the Interdepartmental Research Project of Peking University First Hospital(No.2023IR27 to Liu Y)the Scientific Research Seed Fund of Peking University First Hospital(No.2023SF40 to Qiu J)+3 种基金the High Quality Clinical Research Project of Peking University First Hospital(No.2022CR75 to Gong K)the Beijing Natural Science Foundation(No.QY23068 to Deng R)the National Natural Science Foundation of China(No.82141103,No.82172617,and No.81872081 to Gong K)the Capital’s Funds for Health Improvement and Research(No.2022-2-4074 to Gong K).
文摘Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2c(cT2c)prostate cancer(PCa)patients.Methods:From January 2018 to December 2022,cT2cN0M0 PCa patients who underwent prostate biopsies and subsequent RARP at the Peking University First Hospital with an interval between biopsy and RARP of ≤90 days were included.Univariable and stepwise multivariable logistic regression analyses were performed to identify independent risk factors associated with APCs.Nomograms were constructed based on these predictive models.The performance of the nomograms was evaluated by receiver operating characteristic curves,decision curve analyses,and calibration plots.Results:A total of 423 eligible cT2cN0M0 PCa patients were included.The rates of upgrading,upstaging,and PSM in our cohortwere 33%,51%,and 35%,respectively.The stepwise multivariate logistic analysis suggested that PSA density and the percentage of positive cores in systematic biopsy were significantly associated with the occurrence of APCs.The score of the Prostate Imaging Reporting and Data System,PSA density,and the International Society of Urological Pathology grade group(IGG)of needle-biopsy specimens(or clinical IGG[cIGG])were significantly associated with upgrading.The PSA density,percentage of positive cores in systematic biopsy,and largest tumor percentage in all cores of each patient(LTP)were significantly associated with upstaging.The PSA density and LTP were significantly associatedwith the PSM.Based on these results,four nomogramswere developed.Receiver operating characteristic curves,decision curve analyses,and calibration plots implied that the nomograms exhibited excellent accuracy.Conclusion:The predictive models we developed could help to identify high-risk PCa early,and optimize clinical decisions of cT2cN0M0 PCa patients.
文摘Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.
文摘Background:Radical prostatectomy has long been the treatment of choice for men with clinically significant prostate cancer(PCa)in those with concurrent significant lower urinary tract symptoms(LUTS).For men who meet this description with marked prostatomegaly,we present a multi-institutional proof of concept study describing an alternative pathway of robotic simple prostatectomy(RASP)followed by external beam radiation therapy(EBRT)for the treatment of clinically significant prostate cancer.Methods:A retrospective study was performed of 17 patients with PCa who underwent RASP followed by EBRT at two institutions from 2015–2023.Demographic,peri-operative,and post-radiation treatment functional outcomes are reported.Results:No postoperative or post-EBRT complications were reported for any of the 17 patients who underwent RASP followed by EBRT during a median follow-up time of 12 months.The median time from RASP to EBRT was 9 months.Median prostate size was 135 g(IQR 110–165).13(76.5%)patients received a pre-EBRT rectal spacer.Median IPSS score preoperatively improved at 90 days post-RASP(13.5 vs.2.5;IQR 10.8–15.2),and this benefit was sustained post-EBRT with a median IPSS at 3 vs.12 months(4 vs.0;IQR 0–5).There was no statistically significant difference between postoperative IPSS and post-EBRT IPSS at 3(p=0.677)or 12(p=0.627)months.In all 14 patients with localized disease and PSA data,none had recurrence during the study period.Conclusions:A subset of patients with clinically significant prostate cancer have marked prostatomegaly and LUTS.We report an alternative treatment approach for patients unwilling to undergo radical prostatectomy.We found robotic simple prostatectomy followed by definitive radiation to be feasible and safe.
文摘Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing urinary incontinence after RP.Our study aimed to analyze possible predictors of early postoperative(within 3 months)urinary continence(UC)outcomes following extraperitoneal single-site robot-assisted RP(ss-RARP)for localized PCa.Methods:We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023.Patient characteristics(age,body mass index,prostate volume,prostate dimensions,preoperative and postoperative membranous urethral length,and percentage of membranous urethra removed)were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP.From the time of urinary catheter removal after surgery,the recovery of UC was followed up every month,and UC was defined as using≤1 safety pad daily,known as social continence.Results:The proportions of continent patients immediately after urinary catheter removal,1 month,and 3 months after extraperitoneal ss-RARP were 22%,49%,and 82%,respectively.The multivariate logistic regression analysis showed that the percentage of membranous urethra removed(p=0.016)and prostate volume(p=0.049)were associated with social UC recovery immediately after urinary catheter removal,and craniocaudal dimension of the prostate(p=0.042)and age(p=0.014)were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP,respectively.Conclusion:The percentage of membranous urethra removed,prostate volume,craniocaudal dimension of the prostate,and age are independent risk factors for social UC early after extraperitoneal ss-RARP.
文摘Prostate cancer (PC) is among the most common cancer diagnoses in men worldwide and the fifth leading cause of cancer-related deaths. Approximately 1.5 million new cases of PC were reported worldwide in 2022 with nearly 400,000 associated deaths1. Notably, the incidence of PC in China has increased substantially compared to the global average2.
文摘This article discusses the coexistence of prostate adenocarcinoma and prostate urothelial carcinoma.Combining existing literature and research results,the potential mechanisms of the co-occurrence of these two cancers are explored,including the role of androgen receptor,gene mutations,and their complex interactions in cell signaling pathways,etc.Also,the hypothesis of prostate cancer transformation into urothelial carcinoma is explained from some perspectives,including tumor multipotent stem cell differentiation,epithelial-mesenchymal transition,mesenchymal-epithelial transition,and other mechanisms.Ultimately,the goal is to provide more accurate diagnoses and more personalized treatments in clinical practice,as well as to lay the foundation for improving patient prognoses in the future.
文摘BACKGROUND Vitamin D deficiency has been associated with prostate cancer,particularly in ethnic minorities.Patients with prostate cancer may still be deficient even in areas of high sun exposure.Although androgen deprivation therapy(ADT)is well documented to affect bone health,its impact on vitamin D levels is still uncertain.This study investigates the subgroups of prostate cancer patients most associated with vitamin D deficiency and ADT’s relation to this.AIM To examine how prevalent vitamin D deficiency is among prostate cancer patients in a sun-rich environment,with focus on differences by race and disease stage.It also assessed whether ADT is associated with changes in vitamin D levels.METHODS Prostate cancer patients treated at Chao Family Comprehensive Cancer Center between 2014-2024 were retrospectively studied with regards to vitamin D levels across racial groups,disease stages,and ADT exposure.Changes in vitamin D levels pre-and post-ADT over 24 months were assessed by statistical methods including paired t-tests.RESULTS Among 120 patients(mean age:74 years,mean body mass index:27.6 kg/m^(2)),African American(33.3%)and Hispanic(31.8%)patients had the greatest prevalence of vitamin D deficiency(<20 ng/mL).With a 28.6%deficit rate,metastatic castration-resistant prostate cancer had the highest prevalence rates of deficiency.There was no significant difference between pre-and post-ADT vitamin D levels(P=0.45).CONCLUSION Vitamin D deficiency is common in prostate cancer patients,especially racial minorities and those with advanced disease,despite residing in an area with high sun exposure.ADT does not significantly impact vitamin D levels in the short term.Routine screening and supplementation should be considered in these high-risk groups.
基金supported by the Beijing NOVA Program(grant No.20220484230)National Key Research and Development Program of China(grant No.2023YFC3605305).
文摘This study investigated the impact of metabolic syndrome (MetS) and its components on prostate volume (PV) in the general Chinese population. In total, 43 455 participants in The First Medical Center of the Chinese PLA General Hospital (Beijing, China) from January 1, 2012, to December 31, 2022, undergoing health examinations were included in the study. Participants were categorized into four groups according to PV quartiles: Q1 (PV ≤24.94 ml), Q2 (PV >24.94 ml and ≤28.78 ml), Q3 (PV >28.78 ml and ≤34.07 ml), and Q4 (PV >34.07 ml), with Q1 serving as the reference group. Logistic regression analyses were used to examine the association between MetS and PV, with subgroup analyses conducted by age. Among the participants, 18 787 (43.2%) were diagnosed with MetS. In the multivariate analysis model, a significant correlation between MetS and PV was observed, with odds ratios (ORs) increasing as PV increased (Q2, OR = 1.203, 95% confidence interval [CI]: 1.139–1.271;Q3, OR = 1.300, 95% CI: 1.230–1.373;and Q4, OR = 1.556, 95% CI: 1.469–1.648). Analysis of MetS components revealed that all components were positively associated with PV, with abdominal obesity showing the most significant effect. The number of MetS components was identified as a dose-dependent risk factor for elevated PV. The impact of MetS, its components, and component count on PV exhibited a decreasing trend with advancing age. Overall, the influence of MetS, its components, and component count on PV was predominantly observed in the age groups of 40–49 years and 50–59 years. Early intervention targeting MetS can significantly alleviate the increase in PV, particularly benefiting individuals aged 40–59 years who have abdominal obesity.
基金supported by the National Natural Science Foundation of China(No.82072807)the Scientific Research Project of Universities of the Department of Education of Anhui Province(No.2022AH040182)the Anhui Province Key Clinical Specialties Construction Project(2023).
文摘We propose a strategy to reduce unnecessary prostate biopsies in Chinese patients with total prostate-specific antigen(tPSA)>10 ng ml−1 and Prostate Imaging Reporting and Data System(PI-RADS)scores between 1 and 3.Clinical data derived from 517 patients of The First Affiliated Hospital of USTC(Hefei,China)from January 2020 to December 2023 who met the screening criteria for the study were retrospectively collected.Independent predictors were identified via univariate and multivariate logistic regression analysis.The diagnostic capacity of clinical variables was evaluated using the receiver operating characteristic(ROC)curves and area under the curve(AUC).A prostate biopsy strategy was developed via risk stratification.Of the 517 patients,17/348(4.9%)with PI-RADS 1–2 were diagnosed with clinically significant prostate cancer(csPCa),and 27/169(16.0%)patients with PI-RADS 3 were diagnosed with csPCa.The appropriate prostate-specific antigen density(PSAD)cut-off values were 0.45 ng ml−2 for PI-RADS 1–2 patients and 0.3 ng ml−2 for PI-RADS 3 patients.The appropriate prostate volume(PV)cut-off values were 40 ml for PI-RADS 1–2 patients and 50 ml for PI-RADS 3 patients.The prostate biopsy strategy based on PSAD and PV developed in this study can reduce unnecessary prostate biopsies in patients with tPSA>10 ng ml−1 and PI-RADS 1–3.In the study,66.5%(344/517)patients did not need to undergo prostate biopsy,at the expense of missing only 1.7%(6/344)patients with csPCa.
基金supported(in part)by the National Key Research and Development Program(2022YFC3600700)the Fundamental Research Funds for the Central Universities(2042024YXA008)the Young Top-Notch Talent Cultivation Program of Hubei Province(for Prof.Xian-Tao Zeng).
文摘Background:The burden of common urologic diseases,including benign prostatic hyperplasia(BPH),urinary tract infections(UTI),urolithiasis,bladder cancer,kidney cancer,and prostate cancer,varies both geographically and within specific regions.It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.Methods:We obtained data on incidence,prevalence,mortality,and disability-adjusted life-years(DALYs)for the aforementioned urologic diseases by age,sex,location,and year from the Global Burden of Disease(GBD)2021.We analyzed the burden associated with urologic diseases based on socio-demographic index(SDI)and attributable risk factors.The trends in burden over time were assessed using estimated annual percentage changes(EAPC)along with a 95%confidence interval(CI).Results:In 2021,BPH and UTI were the leading causes of age-standardized incidence rate(ASIR)and age-standardized prevalence rate(ASPR),with rates of 5531.88 and 2782.59 per 100,000 persons,respectively.Prostate cancer was the leading cause of both age-standardized mortality rate(ASMR)and age-standardized DALYs rate(ASDR),with rates of 12.63 and 217.83 per 100,000 persons,respectively.From 1990 to 2021,there was an upward trend in ASIR,ASPR,ASMR,and ASDR for UTI,while urolithiasis showed a downward trend.The middle and low-middle SDI quintile levels exhibited higher incidence,prevalence,mortality,and DALYs related to UTI,urolithiasis,and BPH,while the high and high-middle SDI quintile levels showed higher rates for the three cancers.The burden of these 6 urologic diseases displayed diverse age and sex distribution patterns.In 2021,a high body mass index(BMI)contributed to 20.07%of kidney cancer deaths worldwide,while smoking accounted for 26.48%of bladder cancer deaths and 3.00%of prostate cancer deaths.Conclusions:The global burden of 6 urologic diseases presents a significant public health challenge.Urgent international collaboration is essential to advance the improvement of urologic disease management,encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.
文摘Prostate cancer is a significant global health issue with inflammation emerging as a critical driver of progression.The prostate tumor microenvironment(TME)is comprised of tumor cells,mesenchymal stem cells,immune cells,cancer-associated fibroblasts,adipocytes,and the extracellular matrix.All of these TME components interact via soluble factors,such as growth factors,cytokines,and chemokines.These interactions remodel the TME and drive inflammation and tumor progression.Prolonged inflammation leads to dysregulated activation and infiltration of immune cells in the TME.This process maintains an immunosuppressive environment and facilitates epithelial-to-mesenchymal transition,migration,and invasion.Chronic inflammation causes inflammatory mediators to enter the circulation over time,as evidenced by systemic biomarkers,such as the systemic immune-inflammation index,which links inflammation to disease severity.Interactions between the prostate gland and adipose tissues further exacerbate systemic inflammation.Inflammation in the prostate gland confers resistance to therapy,primes distant metastatic niches,and promotes metastatic spread,resulting in poor clinical outcomes.Therapeutic strategies,such as anti-inflammatory agents and immunotherapies,hold promise in mitigating disease burden.This review explored the immune landscape of systemic inflammation in prostate cancer,discussed the role of the immune landscape in resistance to therapy and metastasis,and offered insights into potential interventions for targeting inflammation to limit prostate cancer burden.
文摘We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.
基金supported by the National Natural Science Foundation of China(No.82170783).
文摘Urinary incontinence is a common complication following robot-assisted radical prostatectomy(RARP).Urethral length has been identified as a factor affecting postoperative continence recovery.In this meta-analysis,we examined the association between use of the maximal urethral length preservation(MULP)technique and postoperative urinary continence in patients undergoing RARP.We conducted a comprehensive search of PubMed,Web of Science,Embase,and the Cochrane Library up to December 31,2023.The quality of the literature was assessed using the Newcastle-Ottawa Scale.A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio(OR)from eligible studies on continence and MULP.Six studies involving 1869 patients met the eligibility criteria.MULP was positively associated with both early continence(1 month after RARP;Z=3.62,P=0.003,OR=3.10,95% confidence interval[CI]:1.68-5.73)and late continence(12 months after RARP;Z=2.34,P=0.019,OR=2.10,95%CI:1.13–3.90).Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex(both P>0.05).In conclusion,the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.
文摘Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional lithotomy and transurethral approaches.This report introduces an innovative,single-port transvesical robot-assisted simple prostatectomy with total urethral preservation.This pioneering technique,tailored for complex BPH management,demonstrated its efficacy and potential through favorable postoperative outcomes.This report underscores single-port transvesical robot-assisted simple prostatectomy with total urethral preservation as a promising surgical option for patients with BPH who are unable to assume the lithotomy position.
基金funded by National Natural Science Foundation of China(82072846 to Xu B).
文摘Objective:Robot-assisted simple prostatectomy(RASP)is increasingly used as a surgical treatment option for large benign prostatic hyperplasia(BPH)(>80 mL).However,there is no sufficient expert consensus or guidelines to guide clinical practice.We aimed to obtain expert opinions for RASP for large BPH.Methods:A systematic review of the literature was performed in April 2024 using the PubMed,Embase,and Web of Science databases.Search terms were combined to construct the following search strings:(robotic)AND(simple OR benign)AND(prostatectomy).Search results were filtered by language(English only),species(human),and publication type(original article).This study used a two-phase modified Delphi approach.Results:In this expert consensus,some frequently used RASP techniques,including robot-assisted retropubic prostatectomy,robot-assisted transvesical prostatectomy,and robot-assisted urethra-sparing prostatectomy,are described.RASP offers a short learning curve for surgeons with experience in robotic surgery.Severe complications are rare in patients who undergo RASP.Conclusion:RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.
基金supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Com-mission(No.2022RC146)the Zhejiang Provincial Natural Science Foundation of China(No.LQ22H050003).
文摘Prostate cancer is the second most common cancer in men,accounting for 14.1%of new cancer cases in 2020.The aggressiveness of prostate cancer is highly variable,depending on its grade and stage at the time of diagnosis.Despite recent advances in prostate cancer treatment,some patients still experience recurrence or even progression after undergoing radical treatment.Accurate initial staging and monitoring for recurrence determine patient management,which in turn affect patient prognosis and survival.Classical imaging has limitations in the diagnosis and treatment of prostate cancer,but the use of novel molecular probes has improved the detection rate,specificity,and accuracy of prostate cancer detection.Molecular probe-based imaging modalities allow the visualization and quantitative measurement of biological processes at the molecular and cellular levels in living systems.An increased understanding of tumor biology of prostate cancer and the discovery of new tumor biomarkers have allowed the exploration of additional molecular probe targets.The development of novel ligands and advances in nano-based delivery technologies have accelerated the research and development of molecular probes.Here,we summarize the use of molecular probes in positron emission tomography(PET),single-photon emission computed tomography(SPECT),magnetic resonance imaging(MRI),optical imaging,and ultrasound imaging,and provide a brief overview of important target molecules in prostate cancer.
文摘Background:Intermediate-risk prostate cancer(IR-PC)represents a heterogeneous group requiring nuanced treatment approaches,and recent advancements in radiotherapy(RT),androgen deprivation therapy(ADT),and prostatespecific membrane antigen positron emission tomography(PSMA-PET/CT)imaging have prompted growing interest in personalized,risk-adapted management strategies.This study by the Turkish Society for Radiation Oncology aims to examine radiation oncologists’practices in managing IR-PC,focusing on RT and imaging modalities to identify trends for personalized treatments.Methods:A cross-sectional survey was conducted among Turkish radiation oncologists treating at least 50 prostate cancer(PC)cases annually.The 22-item questionnaire covered IR-PC management aspects such as risk stratification,imaging preferences,androgen deprivation therapy(ADT)use and duration,RT techniques,and treatment combinations.Anonymous responses were analyzed using descriptive statistics.Results:Thirty radiation oncologists participated,57%with over 20 years of experience.The median annual number of PC cases treated was 130.For risk stratification,43% followed the National Comprehensive Cancer Network(NCCN)guidelines,while 30%used the D’Amico classification.Imaging preferences revealed 47% favored PSMA-PET/CT.External beam RT was universally preferred,with 60% adopting ultra-hypofractionation.ADT was used by 97%,with 73% recommending it for unfavorable IR-PC cases.Short-term ADT(4–6 months)was the standard,administered concurrently with RT by 57%.Cardiovascular status influenced decisions for 97% of respondents,while 37% also considered patient age,preferences,and sexual health.Conclusions:This national survey demonstrates a shift toward personalized care in intermediate-risk prostate cancer in Turkey,marked by selective PSMA-PET/CT use,tailored ADT,and evolving radiotherapy practices.The findings underscore the importance of multidisciplinary collaboration—particularly between urologists and radiation oncologists—to optimize imaging integration and treatment outcomes.
基金supported by the Fundamental Research Funds for the Central Universities(2023SCU12057)the National Natural Science Foundation of China(82373106,82372831,and 32270690).
文摘Robot-assisted surgery has evolved into a crucial treatment for prostate cancer(PCa).However,from its appearance to today,brain-computer interface,virtual reality,and metaverse have revolutionized the field of robot-assisted surgery for PCa,presenting both opportunities and challenges.Especially in the context of contemporary big data and precision medicine,facing the heterogeneity of PCa and the complexity of clinical problems,it still needs to be continuously upgraded and improved.Keeping this in mind,this article summarized the 5 stages of the historical development of robot-assisted surgery for PCa,encompassing the stages of emergence,promotion,development,maturity,and intelligence.Initially,safety concerns were paramount,but subsequent research and engineering advancements have focused on enhancing device efficacy,surgical technology,and achieving precise multi modal treatment.The dominance of da Vinci robot-assisted surgical system has seen this evolution intimately tied to its successive versions.In the future,robot-assisted surgery for PCa will move towards intelligence,promising improved patient outcomes and personalized therapy,alongside formidable challenges.To guide future development,we propose 10 significant prospects spanning clinical,research,engineering,materials,social,and economic domains,envisioning a future era of artificial intelligence in the surgical treatment of PCa.
基金This study was supported by the Key Research and Development Program of Anhui Province(No.202204295107020003)the National Natural Science Foundation of Anhui Province(No.2108085MH293)+1 种基金the Distinguished Young Scholars Fund of Anhui Province(No.2022AH020078)the Key health Project of Anhui Province(AHWJ2022a037).
文摘The overdiagnosis of prostate cancer(PCa)caused by nonspecific elevation serum prostate-specific antigen(PSA)and the overtreatment of indolent PCa have become a global problem that needs to be solved urgently.We aimed to construct a prediction model and provide a risk stratification system to reduce unnecessary biopsies.In this retrospective study,clinical data of 1807 patients from three Chinese hospitals were used.The final model was built using stepwise logistic regression analysis.The apparent performance of the model was assessed by receiver operating characteristic curves,calibration plots,and decision curve analysis.Finally,a risk stratification system of clinically significant prostate cancer(csPCa)was created,and diagnosis-free survival analyses were performed.Following multivariable screening and evaluation of the diagnostic performances,a final diagnostic model comprised of the PSA density and Prostate Imaging-Reporting and Data System(PI-RADS)score was established.Model validation in the development cohort and two external cohorts showed excellent discrimination and calibration.Finally,we created a risk stratification system using risk thresholds of 0.05 and 0.60 as the cut-off values.The follow-up results indicated that the diagnosis-free survival rate for csPCa at 12 months and 24 months postoperatively was 99.7%and 99.4%,respectively,for patients with a risk threshold below O.05 after the initial negative prostate biopsy,which was significantly better than patients with higher risk.Our diagnostic model and risk stratification system can achieve a personalized risk calculation of csPCa.It provides a standardized tool for Chinese patients and physicians when considering thenecessity of prostatebiopsy.
