Objective:Current research highlights periodontal disease as a systemic inflammatory condition that may influence extra-oral diseases such as prostatic diseases,which prompted us to explore the potential association.T...Objective:Current research highlights periodontal disease as a systemic inflammatory condition that may influence extra-oral diseases such as prostatic diseases,which prompted us to explore the potential association.To evaluate whether periodontal disease is associated with an increased risk of prostatic disease,including prostate cancer,benign prostatic hyperplasia(BPH),and prostatitis.Methods:A systematic search of observational studies concerning the relationship between periodontal disease and prostatic disease was performed in online databases PubMed,Embase,Web of Science,Scopus,CENTRAL,CNKI,and WanFang.Searches were conducted from database inception to 31 July 2025.Pooled hazard ratio(HR)or odds ratio(OR)with 95%confidence intervals(CIs)were synthesized.Subgroup analysis was used to detect the origin of heterogeneity,sensitivity analysis was employed to evaluate the robustness of the results,and publication bias analyses were also performed.R software was used to perform statistical analyses.Results:Sixteen studies that met the preset criteria were included in this study.In the pooled analysis,periodontal disease was associated with increased risk of prostate cancer(HR=1.23,95%CI:1.16-1.29,p<0.001)or BPH(OR=1.55,95%CI:1.41-1.70,p<0.001).Sensitivity analysis confirmed the robustness of the results.No obvious publication biaswas found in the meta-analysis.Only one cohort study reported that chronic periodontitis increases the risk of prostatitis(HR=2.521,95%CI:1.685-4.005,p<0.001).The effect of periodontal treatment on prostatic disease is still unclear.Conclusions:The systematic review and meta-analysis identified an observational association between periodontal disease and increased risks of prostate cancer and BPH.Because all included studies were observational,these results indicate association rather than causation,and further prospective and mechanistic studies are required to clarify temporality and causality.展开更多
Background:In clinical practice,approximately 80%of prostate cancer(PC)cases are localized and can achieve favorable outcomes with appropriate treatment.Conversely,some remaining cases exhibit an aggressive phenotype ...Background:In clinical practice,approximately 80%of prostate cancer(PC)cases are localized and can achieve favorable outcomes with appropriate treatment.Conversely,some remaining cases exhibit an aggressive phenotype or develop resistance to therapeutic interventions,leading to tumor metastasis and a poorer prognosis.When PC metastasizes to distant sites,the bone remains the predominant location,and brain metastases are regarded as exceedingly rare.Case Description:The current study focused on a rare clinical PC case that presented multiple brain metastases after prostate surgery.The patient was initially diagnosed with PC through prostate biopsy and subsequently underwent prostate debulking surgery while continuing androgen deprivation therapy,which maintained low prostatespecific antigen(PSA)levels for 4 years.However,a sudden PSA surge to 7.858 ng/mL led to the emergence of two brain metastatic tumors,which were confirmed to have originated from the prostate.Conclusions:Patients with advanced PC require comprehensive evaluations to detect rare metastatic sites,such as the brain,to avoid missed diagnoses.For patients with brain metastases,a multimodal approach combining surgical resection,postoperative radiotherapy,and endocrine therapy can effectively alleviate symptoms and enhance survival.展开更多
Background:The Da Vinci Single-Port Robotic System(Da Vinci-SP),introduced by Intuitive(CA,USA)in 2018 in the USA and in 2024 in Europe,integrates advanced features like a flexible camera and articulating instruments....Background:The Da Vinci Single-Port Robotic System(Da Vinci-SP),introduced by Intuitive(CA,USA)in 2018 in the USA and in 2024 in Europe,integrates advanced features like a flexible camera and articulating instruments.It has garnered significant interest in urology.Our report presents the first described European series of Radical Prostatectomies using the Da Vinci SP at the leading Italian center,Istituto Nazionale Tumori di Napoli,IRCCS“G.Pascale”Foundation,detailing the technical differences and challenges faced by experienced multiport robotic surgeons.Methods:Sixteen patients have been enrolled and underwent Single-Port(SP)Robot-Assisted Radical Prostatectomy(SP-RARP).Baseline characteristics of the patients were collected.We provided a step-by-step description of the surgical technique.Oncological outcomes have been evaluated and compared with magnetic resonance imaging(MRI)and biopsy results.Intraoperative,perioperative,and postoperative complications,surgical outcomes,functional outcomes,and technical issues of the new system were also documented.Results:All surgeries were successfully performed without the need for conversion.An extraperitoneal approach was used for all patients.Median Console time was 110 min.No complications were reported.The estimated median blood loss was 175 cc.Discharge from the hospital was on the first post-operative day for all patients.Bladder catheter removal was on day 7 without the need for cystography.Conclusions:We presented the first European case series of SP-RARP,reporting our experience and confirming the procedure’s feasibility for a highly experienced robotic surgeon.Experience with an extraperitoneal approach using the multiport(MP)platform,combined with well-conducted training for the SP system,may facilitate the transition to SP surgery.Further procedures and studies are needed to evaluate the oncological and functional outcomes.展开更多
Background:Low-dose rate(LDR)prostate brachytherapy is a recommended treatment of localized prostate cancer in current guidelines.The study aimed to determine biochemical relapse-free survival(BRFS)in patients treated...Background:Low-dose rate(LDR)prostate brachytherapy is a recommended treatment of localized prostate cancer in current guidelines.The study aimed to determine biochemical relapse-free survival(BRFS)in patients treated with dynamic real-time low-dose rate(LDR)brachytherapy using Iodine 125(I^(125)).Methods:We retrospectively reviewed 499 patients with localized prostate cancer treated with I^(125) LDR realtime brachytherapy between 2003 and 2021.The mean patient age was 65 years(range:45–84 years).Based on the National Comprehensive Cancer Network(NCCN)risk classification,230 patients(46.1%)were categorized as low risk,235(47.1%)as intermediate risk,and 34(6.8%)as high risk.Gleason scores were distributed as follows:3+3 in 283 cases(56.7%),3+4 in 157 cases(31.5%),4+3 in 46 cases(9.2%),and 4+4 in 13 cases(2.6%).The mean follow-up was 70.5 months.Results:Tumor relapse was observed in 47 patients(9.4%)over a mean follow-up period of 6.26 years(SD 4.16).Local recurrence within the prostate occurred in 20 cases(4%).Patients with nadir PSA<0.2 ng/mL at 5 years of follow-up had a significantly lower incidence of tumor recurrence(3%)compared to those with a nadir PSA>0.2 ng/mL(21.9%)(p=0.0001).Biochemical relapse-free(BRFS)rates at 5,10 and 15 years were 96%,91.5% and 88.9%,respectively.When stratified by NCCCN risk groups,5-year BRFS was 96% in low risk,98% in intermediate risk and 85% in high risk patients(p=0.003).Inmultivariate analysis,only age at the time of brachytherapy(p=0.009),initial PSA(p=0.007)and Gleason grade(p=0.007)were significantly associated with tumor recurrence.Cancer-specific survival and overall survival were 99.8% and 98.0%,respectively.Conclusions:LDR with I^(125) has excellent longterm oncological outcomes for patients with low and intermediate-risk prostate cancer,in particular,patients achieving a nadir PSA<0.2 ng/mL at 5 years post-treatment.展开更多
Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Va...Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Vapor Thermal Therapy(WVTT)is a minimally invasive BPH treatment,but its safety and efficacy in this setting are unclear.Case Description:We report three men with localized PCa on active surveillance who underwent WVTT for LUTS.Conclusions:WVTT appears safe and potentially effective in treating LUTS,especially in those with lower-risk disease and smaller prostate volumes.Further research is needed to confirm safety,efficacy,and optimal patient selection.展开更多
Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advanc...Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advancements,transurethral approaches continue to pose risks such as urethral strictures and urinary incontinence due to mechanical and thermal stress.To address these limitations,the Suprapubic Transvesical Adenoma Resection of the Prostate(STARP)was developed,offering a direct suprapubic route that bypasses the urethra entirely.Recent studies have validated STAR-P as both feasible and safe,emphasizing advantages such as enhanced visualization of the urinary sphincter,minimized urethral trauma,effective hemostasis,and reduced operative stress.The procedure utilizes specially designed instrumentation,including a large-caliber bipolar resectoscope(42 Fr),allowing the efficient removal of substantial adenoma tissue in fewer resection passes compared to traditional methods.Objectives:This article provides a comprehensive,step-by-step description of the STAR-P technique.The primary objective is to detail patient selection criteria,preoperative assessments,procedural steps including mini-open suprapubic access,specialized instrumentation usage,resection techniques,and postoperative management protocols.Highlighting technical considerations and procedural innovations aims to inform urologists about the potential benefits of STAR-P,particularly in patients at higher risk for urethral complications or those with large prostate volumes.By documenting the procedural intricacies and outcomes clearly and thoroughly,we seek to encourage informed adoption of STAR-P as an alternative,effective surgical approach for managing benign prostatic hyperplasia,thus contributing to the evolving landscape ofminimally invasive urological surgery.展开更多
Prostate-specific membrane antigen(PSMA)is a surface membrane antigen that is highly overexpressed in prostate cancer,with heterogenous expression throughout the natural history of the disease.This has generated signi...Prostate-specific membrane antigen(PSMA)is a surface membrane antigen that is highly overexpressed in prostate cancer,with heterogenous expression throughout the natural history of the disease.This has generated significant interest as a potential biomarker for use in early diagnosis and treatment of prostate cancer.We reviewed the literature surrounding PSMA and its current clinical applications in diagnosing and managing early prostate cancer that is confined to the prostate and local lymph nodes.A search on PubMed,Medline,and Web of Science was performed using the following keywords:“PSMA”,“Prostate Specific Membrane Antigen”,“Prostate cancer”,“Biomarker”,“Diagnosis”.We considered all available articles relevant to the topic of PSMA as a biomarker in early prostate cancer when developing this narrative review.Key articles assessing the biology of PSMA,as well as its use as a potential diagnostic and therapeutic target in early prostate cancer,were assessed.The role of PSMA PET as a potential diagnostic and risk stratification tool was assessed.The current use of antibody-drug conjugates and radioligand therapy targeting PSMA was assessed,along with any current evidence to support their use in early prostate cancer.PSMA is heavily expressed throughout the early stages of prostate cancer,and this has significant therapeutic implications.There is a growing body of evidence that shows PSMA PET can play a role in the diagnosis,risk stratification,and prognostication of localised prostate cancer.PSMA-targeted therapies such as Lu-177 currently do not have any proven benefit in treating early prostate cancer;however,this remains an area of ongoing research.展开更多
Objectives:PSMA PET/CT(Prostate-Specific MembraneAntigen Positron Emission Tomography/Computed Tomography)offers improved accuracy in detecting lymph node invasion(LNI)in prostate cancer(PC)patients,potentially reduci...Objectives:PSMA PET/CT(Prostate-Specific MembraneAntigen Positron Emission Tomography/Computed Tomography)offers improved accuracy in detecting lymph node invasion(LNI)in prostate cancer(PC)patients,potentially reducing the need for extended pelvic lymph node dissection(ePLND).This study aims to evaluate a patient-tailored care pathway in which ePLND is performed only in patients with unfavorable intermediate-or high-risk PC who are deemed at risk for LNI based on PSMA PET/CT findings.Methods:In this interventional cohort study,81 patients were managed according to the new care pathway.ePLND was omitted in cases of negative PSMA PET/CT findings(N0M0),while those with positive PSMA PET/CT findings(N1M0)underwent ePLND.A comparator group of 81 patients was selected from a prospectively generated database for comparison.Results:The intervention group experienced a 75% reduction in the number of ePLNDs performed compared to the comparator group(p<0.001).ePLND-related complications were significantly lower in the intervention group(p=0.008).No significant difference was observed in 3-year biochemical-recurrence free survival(BRFS)between the two groups(p=0.958).Conclusion:Omitting ePLND in patients with negative PSMA PET/CT findings(N0M0)leads to a substantial reduction in the number of ePLNDs performed,resulting in a decrease in morbidity,without compromising early oncological outcomes.展开更多
Prostatic carcinoma(PCa)has become one of the most common cancers among men worldwide,with both incidence and mortality rates steadily rising.Although current treatments are effective in the early stages of PCa,many c...Prostatic carcinoma(PCa)has become one of the most common cancers among men worldwide,with both incidence and mortality rates steadily rising.Although current treatments are effective in the early stages of PCa,many cases eventually progress to castration-resistant prostate cancer(CRPC),and led to treatment failure.To develop new therapeutic strategies to ameliorate the survival of PCa patients then has pressed the need on medicinal researchers.Of traditional Chinese medicinal herbs,Angelica gigas Naka(AGN),and its major pyranocoumarins were broadly reported on the effect of anti-PCa.However,existing reviews mainly focus on decursin(D),decursinol angelate(DA),and decursinol(DOH),without fully exploring other coumarins in AGN.Moreover,most reviews discuss general anticancer effects,with limited emphasis on PCa specifically.This review made a comprehensive summary of the coumarin components of AGN,and depicted the anti-PCa effects and mechanisms,giving a solid research support for drug discovery and development.This review also featured pharmacokinetic advantages and therapeutic potential of DOH,in order to suggest possibilities to overcome the in vivo transformation limitations of D and DA,and shed light on CRPC treatment.We also recommend future studies focus on more in vivo evidence,safety and toxicity evaluation,and clinical validation in humans.展开更多
Prostate cancer(PCa)remains a major cause of cancer-related mortality in men,largely due to therapy resistance and metastatic progression.Increasing evidence highlights the tumor microenvironment(TME),particularly can...Prostate cancer(PCa)remains a major cause of cancer-related mortality in men,largely due to therapy resistance and metastatic progression.Increasing evidence highlights the tumor microenvironment(TME),particularly cancer-associated fibroblasts(CAFs),as a critical determinant of disease behavior.CAFs constitute a heterogeneous population originating from fibroblasts,mesenchymal stem cells,endothelial cells,epithelial cells undergoing epithelial-mesenchymal transition(EMT),and adipose tissue.Through dynamic crosstalk with tumor,immune,endothelial,and adipocyte compartments,CAFs orchestrate oncogenic processes including tumor proliferation,invasion,immune evasion,extracellular matrix remodeling,angiogenesis,and metabolic reprogramming.This review comprehensively summarizes the cellular origins,phenotypic and functional heterogeneity,and spatial distribution of CAFs within the prostate TME.We further elucidate the molecular mechanisms by which CAFs regulate PCa progression and therapeutic resistance,and critically evaluate emerging strategies to therapeutically target CAFmediated signaling,metabolic,and immune pathways.By integrating recent advances from single-cell and spatial transcriptomics(ST),our objective is to provide a holistic framework for understanding CAF biology and to highlight potential avenues for stromal reprogramming as an adjunct to current PCa therapies.展开更多
Background:The gut microbiome has emerged as a critical modulator of cancer immunotherapy response.However,the mechanisms by which gut-associated metabolites influence checkpoint blockade efficacy in prostate cancer(P...Background:The gut microbiome has emerged as a critical modulator of cancer immunotherapy response.However,the mechanisms by which gut-associated metabolites influence checkpoint blockade efficacy in prostate cancer(PC)remain not fully explored.The study aimed to explore how gut metabolites regulate death-ligand 1(PD-L1)blockade via exosomes and boost immune checkpoint inhibitors(ICIs)in PC.Methods:We recruited 70 PC patients to set up into five subgroups.The integrated multi-omics analysis was performed.In parallel,we validated the function of gut microbiome-associated metabolites on PD-L1 production and immunotherapy treatment efficacy in PC cell lines and transgenic adenocarcinoma of the mouse prostate(TRAMP)models.Results:We identified two metabolites,16(R)-Hydroxyeicosatetraenoic acid(16(R)-HETE)and 6-Keto-Prostaglandin E1(6-Keto-PGE1),that positively correlated with the plasma exosomal PD-L1 levels.The in vitro experiments found that both 16(R)-HETE and 6-Keto-PGE1 can enhance PD-L1 expression at the mRNA,protein,and exosome levels in both human and mouse PC cell lines,which were also validated in vivo based on subcutaneous mouse models.Both metabolites significantly promoted the anti-PD-L1 efficacy against PC in situ on a TRAMP mouse model.Conclusions:Targeting the“gut-tumor metabolic axis”is a promising strategy to improve the efficacy of immune checkpoint inhibitors in tumors.展开更多
Background:Chronic inflammation is closely associated with the most common and socially significant prostate conditions,including benign prostatic hyperplasia(BPH),prostate cancer(PCa),and prostatitis syndromes.NIHcat...Background:Chronic inflammation is closely associated with the most common and socially significant prostate conditions,including benign prostatic hyperplasia(BPH),prostate cancer(PCa),and prostatitis syndromes.NIHcategory IV prostatitis(histologic prostatitis,HP)is defined as asymptomatic chronic inflammation of the prostate.The presence of lymphoid follicles,referred to as tertiary lymphoid structures(TLSs),along with benign lympho-epithelial lesions(BLELs),is among the key histological indicators of immune inflammation and can be assessed relatively easily.This study aimed to quantitatively assess TLSs and BLELs,as well as their relationship with the severity of HP.Methods:We investigated TLSs and BLELs in 110 prostatic specimens,including inflammatory and normal tissues,within the context of common prostate pathologies such as BPH and PCa.HP was graded as low-grade(LG)or high-grade(HG)based on the severity of inflammation.Results:TLSs were observed in 51 out of 110 cases(46.4%),while BLELs were identified in 78 cases(70.44%).Both TLSs and BLELs co-occurred in 45 cases(40.9%).Statistical analysis revealed a significant correlation between the presence of TLSs,BLELs(individually or combined),and HG-HP(p<0.001).Conclusions:This study is the first to quantitatively evaluate the immunopathologic patterns in the inflamed human prostate by analyzing the presence and cooccurrence of TLSs and BLELs.Their formation,likely triggered by antigenic stimuli and external factors,indicates a chronic inflammatory microenvironment.The strong association between TLSs,BLELs,and HG-HP underscores their potential role in HP aggressiveness.These findings suggest that TLSs and BLELs may be crucial contributors to the pathophysiology and morphogenesis of NIH-category IV prostatitis.Furthermore,TLS/BLEL formation may represent a hallmark of tissue autoimmunity,reflecting the immune or autoimmune phase of this prostatitis subtype.展开更多
Post-translational modifications(PTMs)regulate the occurrence and development of cancer,and lactylation modification is a new form of PTMs.Recent studies have found that lactic acid modification can regulate the immun...Post-translational modifications(PTMs)regulate the occurrence and development of cancer,and lactylation modification is a new form of PTMs.Recent studies have found that lactic acid modification can regulate the immune tolerance of cancer cells.The classical theory holds that prostate apoptosis response-4(PAR-4)is a tumor suppressor protein.However,our recent research has found that PAR-4 has a biological function of promoting cancer in hepatocellular carcinoma(HCC),and our analysis shows that PAR-4 can be modified of lactic acid.These research evidences suggest that PAR-4 lactylation modification may drive immune tolerance in HCC.Therefore,inhibiting PAR-4 lactylation modification is very likely to increase the sensitivity of HCC to immunotherapy.展开更多
Background:Prostate cancer(PCa)is the most prevalent malignancy in men and often correlates with distant metastasis in its advanced stages.The study aimed to investigate the effects of Ugonin J,a natural compound isol...Background:Prostate cancer(PCa)is the most prevalent malignancy in men and often correlates with distant metastasis in its advanced stages.The study aimed to investigate the effects of Ugonin J,a natural compound isolated from Helminthostachys zeylanica,on PCa metastasis.Methods:The effects of Ugonin J on cell motility were assessed using migration and invasion assays.Reverse Transcription Quantitative PCR(RT-qPCR)and Western blotting were used to evaluate the impact of Ugonin J on mRNA and protein expression.RNA sequencing(RNA-seq)analysis was performed to investigate candidate mechanisms.Differential gene expression analysis in PCa patients was conducted using multiple databases.Results:Here,we reveal that Ugonin J blocks migration and invasion in PCa cells without affecting cell viability.RNA-seq analysis suggests that epithelial-mesenchymal transition(EMT)is potentially involved in Ugonin J’s anti-motility effects.Ugonin J also suppresses the expression of mesenchymal markers N-cadherin,β-catenin,Snail,and Slug while upregulating the expression of the epithelial marker E-cadherin.Furthermore,among 13 A disintegrin and metalloproteinase(ADAM)proteins,A disintegrin and metalloproteinase domain-containing protein 9(ADAM9)is the most downregulated following Ugonin J treatment,according to our RNA-seq data.Importantly,clinical data revealed that ADAM9 expression are higher in PCa patients than in healthy controls and are associated with distant metastasis.Transfection with ADAM9 cDNA reverses Ugonin J-regulated downregulation of EMT,migration,and invasion in PCa cells.Ugonin J inhibits ADAM9-dependent motility by downregulating the phosphoinositide 3-kinase(PI3K),protein kinase B(Akt)and nuclear factor-κB(NF-κB)pathways.Conclusions:Our evidence suggests that Ugonin J is a novel therapeutic candidate for further development as a treatment for metastatic PCa.展开更多
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
In Western countries, clinical trials on prostate cancer screening demonstrated a limited benefit for patient survival. In the Asia-Pacific region, including Japan, the rate of prostate-specific antigen （PSA） testin...In Western countries, clinical trials on prostate cancer screening demonstrated a limited benefit for patient survival. In the Asia-Pacific region, including Japan, the rate of prostate-specific antigen （PSA） testing remains very low compared with Western countries, and the benefits of population-based screening remain unclear. This review describes the current status of population screening and diagnosis for prostate cancer in Japan and discusses the efficacy of population screening for the Asian population. Since the 1990s, screening systems have been administered by each municipal government in Japan, and decreases in the prostate cancer mortality rate are expected in some regions where the exposure rate to PSA screening has increased markedly. A population-based screening cohort revealed that the proportion of metastatic disease in cancer detected by screening gradually decreased according to the increased exposure rate, and a decreasing trend in the proportion of cancer with high serum PSA levels after population screening was started. The prognosis of the prostate cancer detected by population screening was demonstrated to be more favorable than those diagnosed outside of the population screening. Recent results in screening cohorts demonstrated the efficacy of PSA. These recent evidences regarding population-based screening in Japan may contribute to establishing the optimal prostate cancer screeninK system in Asian individuals.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
文摘Objective:Current research highlights periodontal disease as a systemic inflammatory condition that may influence extra-oral diseases such as prostatic diseases,which prompted us to explore the potential association.To evaluate whether periodontal disease is associated with an increased risk of prostatic disease,including prostate cancer,benign prostatic hyperplasia(BPH),and prostatitis.Methods:A systematic search of observational studies concerning the relationship between periodontal disease and prostatic disease was performed in online databases PubMed,Embase,Web of Science,Scopus,CENTRAL,CNKI,and WanFang.Searches were conducted from database inception to 31 July 2025.Pooled hazard ratio(HR)or odds ratio(OR)with 95%confidence intervals(CIs)were synthesized.Subgroup analysis was used to detect the origin of heterogeneity,sensitivity analysis was employed to evaluate the robustness of the results,and publication bias analyses were also performed.R software was used to perform statistical analyses.Results:Sixteen studies that met the preset criteria were included in this study.In the pooled analysis,periodontal disease was associated with increased risk of prostate cancer(HR=1.23,95%CI:1.16-1.29,p<0.001)or BPH(OR=1.55,95%CI:1.41-1.70,p<0.001).Sensitivity analysis confirmed the robustness of the results.No obvious publication biaswas found in the meta-analysis.Only one cohort study reported that chronic periodontitis increases the risk of prostatitis(HR=2.521,95%CI:1.685-4.005,p<0.001).The effect of periodontal treatment on prostatic disease is still unclear.Conclusions:The systematic review and meta-analysis identified an observational association between periodontal disease and increased risks of prostate cancer and BPH.Because all included studies were observational,these results indicate association rather than causation,and further prospective and mechanistic studies are required to clarify temporality and causality.
基金supported by the National Natural Science Foundation[Grant Number:82102788]Anhui Province Key Project for Clinical Medical Research Translation and Advancement[202204295107020031,202204295107020007]Anhui Provincial University Excellent Scientific Research and Innovation Team Project[2022AH010071].
文摘Background:In clinical practice,approximately 80%of prostate cancer(PC)cases are localized and can achieve favorable outcomes with appropriate treatment.Conversely,some remaining cases exhibit an aggressive phenotype or develop resistance to therapeutic interventions,leading to tumor metastasis and a poorer prognosis.When PC metastasizes to distant sites,the bone remains the predominant location,and brain metastases are regarded as exceedingly rare.Case Description:The current study focused on a rare clinical PC case that presented multiple brain metastases after prostate surgery.The patient was initially diagnosed with PC through prostate biopsy and subsequently underwent prostate debulking surgery while continuing androgen deprivation therapy,which maintained low prostatespecific antigen(PSA)levels for 4 years.However,a sudden PSA surge to 7.858 ng/mL led to the emergence of two brain metastatic tumors,which were confirmed to have originated from the prostate.Conclusions:Patients with advanced PC require comprehensive evaluations to detect rare metastatic sites,such as the brain,to avoid missed diagnoses.For patients with brain metastases,a multimodal approach combining surgical resection,postoperative radiotherapy,and endocrine therapy can effectively alleviate symptoms and enhance survival.
文摘Background:The Da Vinci Single-Port Robotic System(Da Vinci-SP),introduced by Intuitive(CA,USA)in 2018 in the USA and in 2024 in Europe,integrates advanced features like a flexible camera and articulating instruments.It has garnered significant interest in urology.Our report presents the first described European series of Radical Prostatectomies using the Da Vinci SP at the leading Italian center,Istituto Nazionale Tumori di Napoli,IRCCS“G.Pascale”Foundation,detailing the technical differences and challenges faced by experienced multiport robotic surgeons.Methods:Sixteen patients have been enrolled and underwent Single-Port(SP)Robot-Assisted Radical Prostatectomy(SP-RARP).Baseline characteristics of the patients were collected.We provided a step-by-step description of the surgical technique.Oncological outcomes have been evaluated and compared with magnetic resonance imaging(MRI)and biopsy results.Intraoperative,perioperative,and postoperative complications,surgical outcomes,functional outcomes,and technical issues of the new system were also documented.Results:All surgeries were successfully performed without the need for conversion.An extraperitoneal approach was used for all patients.Median Console time was 110 min.No complications were reported.The estimated median blood loss was 175 cc.Discharge from the hospital was on the first post-operative day for all patients.Bladder catheter removal was on day 7 without the need for cystography.Conclusions:We presented the first European case series of SP-RARP,reporting our experience and confirming the procedure’s feasibility for a highly experienced robotic surgeon.Experience with an extraperitoneal approach using the multiport(MP)platform,combined with well-conducted training for the SP system,may facilitate the transition to SP surgery.Further procedures and studies are needed to evaluate the oncological and functional outcomes.
文摘Background:Low-dose rate(LDR)prostate brachytherapy is a recommended treatment of localized prostate cancer in current guidelines.The study aimed to determine biochemical relapse-free survival(BRFS)in patients treated with dynamic real-time low-dose rate(LDR)brachytherapy using Iodine 125(I^(125)).Methods:We retrospectively reviewed 499 patients with localized prostate cancer treated with I^(125) LDR realtime brachytherapy between 2003 and 2021.The mean patient age was 65 years(range:45–84 years).Based on the National Comprehensive Cancer Network(NCCN)risk classification,230 patients(46.1%)were categorized as low risk,235(47.1%)as intermediate risk,and 34(6.8%)as high risk.Gleason scores were distributed as follows:3+3 in 283 cases(56.7%),3+4 in 157 cases(31.5%),4+3 in 46 cases(9.2%),and 4+4 in 13 cases(2.6%).The mean follow-up was 70.5 months.Results:Tumor relapse was observed in 47 patients(9.4%)over a mean follow-up period of 6.26 years(SD 4.16).Local recurrence within the prostate occurred in 20 cases(4%).Patients with nadir PSA<0.2 ng/mL at 5 years of follow-up had a significantly lower incidence of tumor recurrence(3%)compared to those with a nadir PSA>0.2 ng/mL(21.9%)(p=0.0001).Biochemical relapse-free(BRFS)rates at 5,10 and 15 years were 96%,91.5% and 88.9%,respectively.When stratified by NCCCN risk groups,5-year BRFS was 96% in low risk,98% in intermediate risk and 85% in high risk patients(p=0.003).Inmultivariate analysis,only age at the time of brachytherapy(p=0.009),initial PSA(p=0.007)and Gleason grade(p=0.007)were significantly associated with tumor recurrence.Cancer-specific survival and overall survival were 99.8% and 98.0%,respectively.Conclusions:LDR with I^(125) has excellent longterm oncological outcomes for patients with low and intermediate-risk prostate cancer,in particular,patients achieving a nadir PSA<0.2 ng/mL at 5 years post-treatment.
文摘Background:Prostate cancer is a common malignancy,with many men on active surveillance for localized,low-risk disease also experiencing lower urinary tract symptoms(LUTS)from benign prostatic hyperplasia(BPH).Water Vapor Thermal Therapy(WVTT)is a minimally invasive BPH treatment,but its safety and efficacy in this setting are unclear.Case Description:We report three men with localized PCa on active surveillance who underwent WVTT for LUTS.Conclusions:WVTT appears safe and potentially effective in treating LUTS,especially in those with lower-risk disease and smaller prostate volumes.Further research is needed to confirm safety,efficacy,and optimal patient selection.
文摘Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advancements,transurethral approaches continue to pose risks such as urethral strictures and urinary incontinence due to mechanical and thermal stress.To address these limitations,the Suprapubic Transvesical Adenoma Resection of the Prostate(STARP)was developed,offering a direct suprapubic route that bypasses the urethra entirely.Recent studies have validated STAR-P as both feasible and safe,emphasizing advantages such as enhanced visualization of the urinary sphincter,minimized urethral trauma,effective hemostasis,and reduced operative stress.The procedure utilizes specially designed instrumentation,including a large-caliber bipolar resectoscope(42 Fr),allowing the efficient removal of substantial adenoma tissue in fewer resection passes compared to traditional methods.Objectives:This article provides a comprehensive,step-by-step description of the STAR-P technique.The primary objective is to detail patient selection criteria,preoperative assessments,procedural steps including mini-open suprapubic access,specialized instrumentation usage,resection techniques,and postoperative management protocols.Highlighting technical considerations and procedural innovations aims to inform urologists about the potential benefits of STAR-P,particularly in patients at higher risk for urethral complications or those with large prostate volumes.By documenting the procedural intricacies and outcomes clearly and thoroughly,we seek to encourage informed adoption of STAR-P as an alternative,effective surgical approach for managing benign prostatic hyperplasia,thus contributing to the evolving landscape ofminimally invasive urological surgery.
文摘Prostate-specific membrane antigen(PSMA)is a surface membrane antigen that is highly overexpressed in prostate cancer,with heterogenous expression throughout the natural history of the disease.This has generated significant interest as a potential biomarker for use in early diagnosis and treatment of prostate cancer.We reviewed the literature surrounding PSMA and its current clinical applications in diagnosing and managing early prostate cancer that is confined to the prostate and local lymph nodes.A search on PubMed,Medline,and Web of Science was performed using the following keywords:“PSMA”,“Prostate Specific Membrane Antigen”,“Prostate cancer”,“Biomarker”,“Diagnosis”.We considered all available articles relevant to the topic of PSMA as a biomarker in early prostate cancer when developing this narrative review.Key articles assessing the biology of PSMA,as well as its use as a potential diagnostic and therapeutic target in early prostate cancer,were assessed.The role of PSMA PET as a potential diagnostic and risk stratification tool was assessed.The current use of antibody-drug conjugates and radioligand therapy targeting PSMA was assessed,along with any current evidence to support their use in early prostate cancer.PSMA is heavily expressed throughout the early stages of prostate cancer,and this has significant therapeutic implications.There is a growing body of evidence that shows PSMA PET can play a role in the diagnosis,risk stratification,and prognostication of localised prostate cancer.PSMA-targeted therapies such as Lu-177 currently do not have any proven benefit in treating early prostate cancer;however,this remains an area of ongoing research.
基金supported by a grant from Kom op tegen Kanker(Stand Up to Cancer,Belgium).
文摘Objectives:PSMA PET/CT(Prostate-Specific MembraneAntigen Positron Emission Tomography/Computed Tomography)offers improved accuracy in detecting lymph node invasion(LNI)in prostate cancer(PC)patients,potentially reducing the need for extended pelvic lymph node dissection(ePLND).This study aims to evaluate a patient-tailored care pathway in which ePLND is performed only in patients with unfavorable intermediate-or high-risk PC who are deemed at risk for LNI based on PSMA PET/CT findings.Methods:In this interventional cohort study,81 patients were managed according to the new care pathway.ePLND was omitted in cases of negative PSMA PET/CT findings(N0M0),while those with positive PSMA PET/CT findings(N1M0)underwent ePLND.A comparator group of 81 patients was selected from a prospectively generated database for comparison.Results:The intervention group experienced a 75% reduction in the number of ePLNDs performed compared to the comparator group(p<0.001).ePLND-related complications were significantly lower in the intervention group(p=0.008).No significant difference was observed in 3-year biochemical-recurrence free survival(BRFS)between the two groups(p=0.958).Conclusion:Omitting ePLND in patients with negative PSMA PET/CT findings(N0M0)leads to a substantial reduction in the number of ePLNDs performed,resulting in a decrease in morbidity,without compromising early oncological outcomes.
基金supported by the Natural Science Foundation of Guangdong Province(grant number 2021A1515011485)the Traditional Chinese Medicine Multidisciplinary Innovation Team Program of Liaoning Province(grant number LNZYYCXTD-JCCX-002)+1 种基金the Key Laboratory foundation of Ministry of Education for TCM Viscera State Theory and Applications of Liaoning University of Traditional Chinese Medicine(grant number.zyzx1807)“Three levels”Talent Construction Projects in Zhuhai College of Science and Technology.
文摘Prostatic carcinoma(PCa)has become one of the most common cancers among men worldwide,with both incidence and mortality rates steadily rising.Although current treatments are effective in the early stages of PCa,many cases eventually progress to castration-resistant prostate cancer(CRPC),and led to treatment failure.To develop new therapeutic strategies to ameliorate the survival of PCa patients then has pressed the need on medicinal researchers.Of traditional Chinese medicinal herbs,Angelica gigas Naka(AGN),and its major pyranocoumarins were broadly reported on the effect of anti-PCa.However,existing reviews mainly focus on decursin(D),decursinol angelate(DA),and decursinol(DOH),without fully exploring other coumarins in AGN.Moreover,most reviews discuss general anticancer effects,with limited emphasis on PCa specifically.This review made a comprehensive summary of the coumarin components of AGN,and depicted the anti-PCa effects and mechanisms,giving a solid research support for drug discovery and development.This review also featured pharmacokinetic advantages and therapeutic potential of DOH,in order to suggest possibilities to overcome the in vivo transformation limitations of D and DA,and shed light on CRPC treatment.We also recommend future studies focus on more in vivo evidence,safety and toxicity evaluation,and clinical validation in humans.
文摘Prostate cancer(PCa)remains a major cause of cancer-related mortality in men,largely due to therapy resistance and metastatic progression.Increasing evidence highlights the tumor microenvironment(TME),particularly cancer-associated fibroblasts(CAFs),as a critical determinant of disease behavior.CAFs constitute a heterogeneous population originating from fibroblasts,mesenchymal stem cells,endothelial cells,epithelial cells undergoing epithelial-mesenchymal transition(EMT),and adipose tissue.Through dynamic crosstalk with tumor,immune,endothelial,and adipocyte compartments,CAFs orchestrate oncogenic processes including tumor proliferation,invasion,immune evasion,extracellular matrix remodeling,angiogenesis,and metabolic reprogramming.This review comprehensively summarizes the cellular origins,phenotypic and functional heterogeneity,and spatial distribution of CAFs within the prostate TME.We further elucidate the molecular mechanisms by which CAFs regulate PCa progression and therapeutic resistance,and critically evaluate emerging strategies to therapeutically target CAFmediated signaling,metabolic,and immune pathways.By integrating recent advances from single-cell and spatial transcriptomics(ST),our objective is to provide a holistic framework for understanding CAF biology and to highlight potential avenues for stromal reprogramming as an adjunct to current PCa therapies.
基金supported by Tianjian advanced biomedical laboratory key research and development projectHenan Province Natural Science Foundation(Grant Number 242300421283)Major Science and Technology Project of Henan Province(221100310200)。
文摘Background:The gut microbiome has emerged as a critical modulator of cancer immunotherapy response.However,the mechanisms by which gut-associated metabolites influence checkpoint blockade efficacy in prostate cancer(PC)remain not fully explored.The study aimed to explore how gut metabolites regulate death-ligand 1(PD-L1)blockade via exosomes and boost immune checkpoint inhibitors(ICIs)in PC.Methods:We recruited 70 PC patients to set up into five subgroups.The integrated multi-omics analysis was performed.In parallel,we validated the function of gut microbiome-associated metabolites on PD-L1 production and immunotherapy treatment efficacy in PC cell lines and transgenic adenocarcinoma of the mouse prostate(TRAMP)models.Results:We identified two metabolites,16(R)-Hydroxyeicosatetraenoic acid(16(R)-HETE)and 6-Keto-Prostaglandin E1(6-Keto-PGE1),that positively correlated with the plasma exosomal PD-L1 levels.The in vitro experiments found that both 16(R)-HETE and 6-Keto-PGE1 can enhance PD-L1 expression at the mRNA,protein,and exosome levels in both human and mouse PC cell lines,which were also validated in vivo based on subcutaneous mouse models.Both metabolites significantly promoted the anti-PD-L1 efficacy against PC in situ on a TRAMP mouse model.Conclusions:Targeting the“gut-tumor metabolic axis”is a promising strategy to improve the efficacy of immune checkpoint inhibitors in tumors.
文摘Background:Chronic inflammation is closely associated with the most common and socially significant prostate conditions,including benign prostatic hyperplasia(BPH),prostate cancer(PCa),and prostatitis syndromes.NIHcategory IV prostatitis(histologic prostatitis,HP)is defined as asymptomatic chronic inflammation of the prostate.The presence of lymphoid follicles,referred to as tertiary lymphoid structures(TLSs),along with benign lympho-epithelial lesions(BLELs),is among the key histological indicators of immune inflammation and can be assessed relatively easily.This study aimed to quantitatively assess TLSs and BLELs,as well as their relationship with the severity of HP.Methods:We investigated TLSs and BLELs in 110 prostatic specimens,including inflammatory and normal tissues,within the context of common prostate pathologies such as BPH and PCa.HP was graded as low-grade(LG)or high-grade(HG)based on the severity of inflammation.Results:TLSs were observed in 51 out of 110 cases(46.4%),while BLELs were identified in 78 cases(70.44%).Both TLSs and BLELs co-occurred in 45 cases(40.9%).Statistical analysis revealed a significant correlation between the presence of TLSs,BLELs(individually or combined),and HG-HP(p<0.001).Conclusions:This study is the first to quantitatively evaluate the immunopathologic patterns in the inflamed human prostate by analyzing the presence and cooccurrence of TLSs and BLELs.Their formation,likely triggered by antigenic stimuli and external factors,indicates a chronic inflammatory microenvironment.The strong association between TLSs,BLELs,and HG-HP underscores their potential role in HP aggressiveness.These findings suggest that TLSs and BLELs may be crucial contributors to the pathophysiology and morphogenesis of NIH-category IV prostatitis.Furthermore,TLS/BLEL formation may represent a hallmark of tissue autoimmunity,reflecting the immune or autoimmune phase of this prostatitis subtype.
基金supported by the National Natural Science Foundation of China(Nos.82573045,82460602,82560459)the Hainan Provincial Graduate Student Innovative Research Project(No.Qhys2024-440).
文摘Post-translational modifications(PTMs)regulate the occurrence and development of cancer,and lactylation modification is a new form of PTMs.Recent studies have found that lactic acid modification can regulate the immune tolerance of cancer cells.The classical theory holds that prostate apoptosis response-4(PAR-4)is a tumor suppressor protein.However,our recent research has found that PAR-4 has a biological function of promoting cancer in hepatocellular carcinoma(HCC),and our analysis shows that PAR-4 can be modified of lactic acid.These research evidences suggest that PAR-4 lactylation modification may drive immune tolerance in HCC.Therefore,inhibiting PAR-4 lactylation modification is very likely to increase the sensitivity of HCC to immunotherapy.
基金supported by the National Science and Technology Council(NSTC 113-2320-B-039-049-MY3 and NSTC 114-2314-B-039-051-MY3)China Medical University(CMU113-ASIA-05,CMU-114-ASIA-01).
文摘Background:Prostate cancer(PCa)is the most prevalent malignancy in men and often correlates with distant metastasis in its advanced stages.The study aimed to investigate the effects of Ugonin J,a natural compound isolated from Helminthostachys zeylanica,on PCa metastasis.Methods:The effects of Ugonin J on cell motility were assessed using migration and invasion assays.Reverse Transcription Quantitative PCR(RT-qPCR)and Western blotting were used to evaluate the impact of Ugonin J on mRNA and protein expression.RNA sequencing(RNA-seq)analysis was performed to investigate candidate mechanisms.Differential gene expression analysis in PCa patients was conducted using multiple databases.Results:Here,we reveal that Ugonin J blocks migration and invasion in PCa cells without affecting cell viability.RNA-seq analysis suggests that epithelial-mesenchymal transition(EMT)is potentially involved in Ugonin J’s anti-motility effects.Ugonin J also suppresses the expression of mesenchymal markers N-cadherin,β-catenin,Snail,and Slug while upregulating the expression of the epithelial marker E-cadherin.Furthermore,among 13 A disintegrin and metalloproteinase(ADAM)proteins,A disintegrin and metalloproteinase domain-containing protein 9(ADAM9)is the most downregulated following Ugonin J treatment,according to our RNA-seq data.Importantly,clinical data revealed that ADAM9 expression are higher in PCa patients than in healthy controls and are associated with distant metastasis.Transfection with ADAM9 cDNA reverses Ugonin J-regulated downregulation of EMT,migration,and invasion in PCa cells.Ugonin J inhibits ADAM9-dependent motility by downregulating the phosphoinositide 3-kinase(PI3K),protein kinase B(Akt)and nuclear factor-κB(NF-κB)pathways.Conclusions:Our evidence suggests that Ugonin J is a novel therapeutic candidate for further development as a treatment for metastatic PCa.
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.
文摘In Western countries, clinical trials on prostate cancer screening demonstrated a limited benefit for patient survival. In the Asia-Pacific region, including Japan, the rate of prostate-specific antigen （PSA） testing remains very low compared with Western countries, and the benefits of population-based screening remain unclear. This review describes the current status of population screening and diagnosis for prostate cancer in Japan and discusses the efficacy of population screening for the Asian population. Since the 1990s, screening systems have been administered by each municipal government in Japan, and decreases in the prostate cancer mortality rate are expected in some regions where the exposure rate to PSA screening has increased markedly. A population-based screening cohort revealed that the proportion of metastatic disease in cancer detected by screening gradually decreased according to the increased exposure rate, and a decreasing trend in the proportion of cancer with high serum PSA levels after population screening was started. The prognosis of the prostate cancer detected by population screening was demonstrated to be more favorable than those diagnosed outside of the population screening. Recent results in screening cohorts demonstrated the efficacy of PSA. These recent evidences regarding population-based screening in Japan may contribute to establishing the optimal prostate cancer screeninK system in Asian individuals.
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.
