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
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: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
Radical prostatectomy （RP） continues to be an effective surgical therapy for prostate carcinoma, particularly for organ-confined prostate cancer （PCa）. Recently, RP has also been used in the treatment of locally a...Radical prostatectomy （RP） continues to be an effective surgical therapy for prostate carcinoma, particularly for organ-confined prostate cancer （PCa）. Recently, RP has also been used in the treatment of locally advanced prostate cancer. However, little research has been performed to elucidate the perioperative complications associated with RP in patients with clinically localized or locally advanced PCa. We sought to analyse the incidence of complications in these two groups after radical retropubic prostatectomy （RRP）. From June 2002 to July 2010, we reviewed 379 PCa patients who underwent RRP in our hospital. Among these cases, 196 had clinically localized PCa （Tla-T2c group 1）, and 183 had locally advanced PCa （ ≥ T3,： group 2）. The overall complication incidence was 21.9%, which was lower than other studies have reported. Perioperative complications in patients with locally advanced PCa mirror those in patients with clinically localized PCa （26.2% vs. 17.8%, P=0.91）. Our results showed that perioperative complications could not be regarded as a factor to consider in regarding RP in patients with cT3 or greater.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
Objective:In prostate specimens,chronic inflammatory infiltrate(CII)type Ⅳ has been detected,but its association with prostate cancer(PCa)is controversial.The aim of the present study is to investigate on association...Objective:In prostate specimens,chronic inflammatory infiltrate(CII)type Ⅳ has been detected,but its association with prostate cancer(PCa)is controversial.The aim of the present study is to investigate on associations of CII with PCa detection in patients undergoing prostate first biopsy set.Methods:Ultrasound transrectal-guided biopsies by the transperineal approach were retrospectively evaluated in 441 consecutive patients.The study excluded patients who were in active surveillance,prostate specific antigen(PSA)30 ng/mL,re-biopsies,incidental PCa after transurethral resection of the prostate(TURP),less than 14 cores or metastatic.Analysis of population and subpopulations(with or without PCa)was performed by statistical methods which included ManneWhitney(U test),KruskaleWallis test,Chi-squared statistic,logistic regression.Multivariate logistic regression models predicting mean probability of PCa detection were established.Results:PCa detection rate was 46.03%.Age,PSA,prostate volume(PV),prostate intraepithelial neoplasia(PIN)and CII were the significant independent predictors of PCa detection.PV(OR Z 0.934)and CII(OR Z 0.192)were both negative independent predictors.CII was a significant negative independent predictor in multivariate logistic regression models predicting the mean probability of PCa detection by age,PSA and PV.The inverse association of CII with PCa does not necessary mean protection because of PSA confounding.Conclusion:In a population of patients undergoing prostate first biopsy set,CII was a strong negative independent predictor of PCa detection.CII type Ⅳ should be considered as an adjunctive parameter in re-biopsy or active surveillance protocols.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 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
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 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
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:Multiparametric magnetic resonance imaging(mpMRI)has significantly advanced prostate cancer(PCa)detection,yet decisions on invasive biopsy with moderate prostate imaging reporting and data system(PI-RADS)sc...Background:Multiparametric magnetic resonance imaging(mpMRI)has significantly advanced prostate cancer(PCa)detection,yet decisions on invasive biopsy with moderate prostate imaging reporting and data system(PI-RADS)scores remain ambiguous.Methods:To explore the decision-making capacity of Generative Pretrained Transformer-4(GPT-4)for automated prostate biopsy recommendations,we included 2299 individuals who underwent prostate biopsy from 2018 to 2023 in 3 large medical centers,with available mpMRI before biopsy and documented clinical-histopathological records.GPT-4 generated structured reports with given prompts.The performance of GPT-4 was quantified using confusion matrices,and sensitivity,specificity,as well as area under the curve were calculated.Multiple artificial evaluation procedures were conducted.Wilcoxon’s rank sum test,Fisher’s exact test,and Kruskal-Wallis tests were used for comparisons.Results:Utilizing the largest sample size in the Chinese population,patients with moderate PI-RADS scores(scores 3 and 4)accounted for 39.7%(912/2299),defined as the subset-of-interest(SOI).The detection rates of clinically significant PCa corresponding to PI-RADS scores 2-5 were 9.4%,27.3%,49.2%,and 80.1%,respectively.Nearly 47.5%(433/912)of SOI patients were histopathologically proven to have undergone unnecessary prostate biopsies.With the assistance of GPT-4,20.8%(190/912)of the SOI population could avoid unnecessary biopsies,and it performed even better[28.8%(118/410)]in the most heterogeneous subgroup of PI-RADS score 3.More than 90.0%of GPT-4-generated reports were comprehensive and easy to understand,but less satisfied with the accuracy(82.8%).GPT-4 also demonstrated cognitive potential for handling complex problems.Additionally,the Chain of Thought method enabled us to better understand the decision-making logic behind GPT-4.Eventually,we developed a ProstAIGuide platform to facilitate accessibility for both doctors and patients.Conclusions:This multi-center study highlights the clinical utility of GPT-4 for prostate biopsy decision-making and advances our understanding of the latest artificial intelligence implementation in various medical scenarios.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
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
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:To investigate the diagnostic and predictive value of MRI features combined with clinical indicators for prostate cancer(PCa)and clinically significant prostate cancer(csPCa),and to establish a non-invasive ...Objective:To investigate the diagnostic and predictive value of MRI features combined with clinical indicators for prostate cancer(PCa)and clinically significant prostate cancer(csPCa),and to establish a non-invasive combined model.Methods:A total of 36 patients with pathologically confirmed benign lesions(44 foci)and 23 patients with PCa(49 foci),including 25 foci of csPCa and 68 foci of non-csPCa,were included.SyMRI quantitative maps and clinical indicators were collected,and 224 imaging features were extracted.The intra-and inter-group correlation coefficients(ICC)for each feature were calculated using intra-and inter-group correlation analysis,and features with an ICC>0.75 were selected as stable features that could be reproducibly extracted.Independent predictors were screened using logistic regression to construct single and combined models,and the performance was evaluated using ROC curves.Results:Age,PSAD,PD map contrast,and T2 map joint entropy were significantly higher in the PCa group compared to the benign group,while the median ADC was significantly lower(p<0.05).The above-mentioned indicators were significantly correlated with PCa and csPCa,and the diagnostic performance of the combined model was superior to that of a single MRI or clinical model.Conclusion:MRI features combined with PSAD can effectively differentiate PCa and predict csPCa,providing a non-invasive quantitative diagnostic basis for clinical practice.展开更多
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.
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: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Radical prostatectomy （RP） continues to be an effective surgical therapy for prostate carcinoma, particularly for organ-confined prostate cancer （PCa）. Recently, RP has also been used in the treatment of locally advanced prostate cancer. However, little research has been performed to elucidate the perioperative complications associated with RP in patients with clinically localized or locally advanced PCa. We sought to analyse the incidence of complications in these two groups after radical retropubic prostatectomy （RRP）. From June 2002 to July 2010, we reviewed 379 PCa patients who underwent RRP in our hospital. Among these cases, 196 had clinically localized PCa （Tla-T2c group 1）, and 183 had locally advanced PCa （ ≥ T3,： group 2）. The overall complication incidence was 21.9%, which was lower than other studies have reported. Perioperative complications in patients with locally advanced PCa mirror those in patients with clinically localized PCa （26.2% vs. 17.8%, P=0.91）. Our results showed that perioperative complications could not be regarded as a factor to consider in regarding RP in patients with cT3 or greater.
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Objective:In prostate specimens,chronic inflammatory infiltrate(CII)type Ⅳ has been detected,but its association with prostate cancer(PCa)is controversial.The aim of the present study is to investigate on associations of CII with PCa detection in patients undergoing prostate first biopsy set.Methods:Ultrasound transrectal-guided biopsies by the transperineal approach were retrospectively evaluated in 441 consecutive patients.The study excluded patients who were in active surveillance,prostate specific antigen(PSA)30 ng/mL,re-biopsies,incidental PCa after transurethral resection of the prostate(TURP),less than 14 cores or metastatic.Analysis of population and subpopulations(with or without PCa)was performed by statistical methods which included ManneWhitney(U test),KruskaleWallis test,Chi-squared statistic,logistic regression.Multivariate logistic regression models predicting mean probability of PCa detection were established.Results:PCa detection rate was 46.03%.Age,PSA,prostate volume(PV),prostate intraepithelial neoplasia(PIN)and CII were the significant independent predictors of PCa detection.PV(OR Z 0.934)and CII(OR Z 0.192)were both negative independent predictors.CII was a significant negative independent predictor in multivariate logistic regression models predicting the mean probability of PCa detection by age,PSA and PV.The inverse association of CII with PCa does not necessary mean protection because of PSA confounding.Conclusion:In a population of patients undergoing prostate first biopsy set,CII was a strong negative independent predictor of PCa detection.CII type Ⅳ should be considered as an adjunctive parameter in re-biopsy or active surveillance protocols.
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.
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.
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.
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.
基金supported by the Beijing Key Clinical Specialty Project(20240930)the National Natural Science Foundation of China(NSFC 82373436)+7 种基金the Beijing Hospitals Authority’Youth Program(BHAYP,QML20230114)the Beijing Natural Science Foundation(BNSF Z200027)the Beijing Chaoyang Hospital Multi-disciplinary Team Program(CYDXK202204),the NSFC(62331001)the BNSF(Z200027)the NSFC(82202097)the BHAYP(QML20230113)the Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University(CCMU2022ZKYXY010)the Beijing Scholars Program(No.[2015]160).
文摘Background:Multiparametric magnetic resonance imaging(mpMRI)has significantly advanced prostate cancer(PCa)detection,yet decisions on invasive biopsy with moderate prostate imaging reporting and data system(PI-RADS)scores remain ambiguous.Methods:To explore the decision-making capacity of Generative Pretrained Transformer-4(GPT-4)for automated prostate biopsy recommendations,we included 2299 individuals who underwent prostate biopsy from 2018 to 2023 in 3 large medical centers,with available mpMRI before biopsy and documented clinical-histopathological records.GPT-4 generated structured reports with given prompts.The performance of GPT-4 was quantified using confusion matrices,and sensitivity,specificity,as well as area under the curve were calculated.Multiple artificial evaluation procedures were conducted.Wilcoxon’s rank sum test,Fisher’s exact test,and Kruskal-Wallis tests were used for comparisons.Results:Utilizing the largest sample size in the Chinese population,patients with moderate PI-RADS scores(scores 3 and 4)accounted for 39.7%(912/2299),defined as the subset-of-interest(SOI).The detection rates of clinically significant PCa corresponding to PI-RADS scores 2-5 were 9.4%,27.3%,49.2%,and 80.1%,respectively.Nearly 47.5%(433/912)of SOI patients were histopathologically proven to have undergone unnecessary prostate biopsies.With the assistance of GPT-4,20.8%(190/912)of the SOI population could avoid unnecessary biopsies,and it performed even better[28.8%(118/410)]in the most heterogeneous subgroup of PI-RADS score 3.More than 90.0%of GPT-4-generated reports were comprehensive and easy to understand,but less satisfied with the accuracy(82.8%).GPT-4 also demonstrated cognitive potential for handling complex problems.Additionally,the Chain of Thought method enabled us to better understand the decision-making logic behind GPT-4.Eventually,we developed a ProstAIGuide platform to facilitate accessibility for both doctors and patients.Conclusions:This multi-center study highlights the clinical utility of GPT-4 for prostate biopsy decision-making and advances our understanding of the latest artificial intelligence implementation in various medical scenarios.
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 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.
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:To investigate the diagnostic and predictive value of MRI features combined with clinical indicators for prostate cancer(PCa)and clinically significant prostate cancer(csPCa),and to establish a non-invasive combined model.Methods:A total of 36 patients with pathologically confirmed benign lesions(44 foci)and 23 patients with PCa(49 foci),including 25 foci of csPCa and 68 foci of non-csPCa,were included.SyMRI quantitative maps and clinical indicators were collected,and 224 imaging features were extracted.The intra-and inter-group correlation coefficients(ICC)for each feature were calculated using intra-and inter-group correlation analysis,and features with an ICC>0.75 were selected as stable features that could be reproducibly extracted.Independent predictors were screened using logistic regression to construct single and combined models,and the performance was evaluated using ROC curves.Results:Age,PSAD,PD map contrast,and T2 map joint entropy were significantly higher in the PCa group compared to the benign group,while the median ADC was significantly lower(p<0.05).The above-mentioned indicators were significantly correlated with PCa and csPCa,and the diagnostic performance of the combined model was superior to that of a single MRI or clinical model.Conclusion:MRI features combined with PSAD can effectively differentiate PCa and predict csPCa,providing a non-invasive quantitative diagnostic basis for clinical practice.
