Prostate Cancer and Prostatic Diseases最新文献

{"title":"MRI and PSMA PET/CT: Foes or friends for the early detection of prostate cancer?","authors":"Rossano Girometti, Gianluca Giannarini, Alessandro Crestani, Luca Urso","doi":"10.1038/s41391-026-01168-7","DOIUrl":"https://doi.org/10.1038/s41391-026-01168-7","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early apical release versus conventional (non-early apical release) holmium laser enucleation of the prostate: a systematic review and meta-analysis of postoperative urinary incontinence and functional outcomes.","authors":"Islam Mansour, Mostafa Shaheen, Aya J Elkenany, Omar Mohamed Ali, Iyad Walid, Ahmed M Elshal","doi":"10.1038/s41391-026-01153-0","DOIUrl":"https://doi.org/10.1038/s41391-026-01153-0","url":null,"abstract":"<p><strong>Background: </strong>Despite proven safety, efficacy, and durability of Holmium laser enucleation of the prostate (HoLEP), postoperative transient stress urine incontinence (SUI) was a concern for years. A technical modification of the original HoLEP, namely early apical release (EAR) has been suggested to reduce postoperative SUI. This study aimed to collate available evidence on the impact of EAR on the post HoLEP SUI and functional outcomes in comparison to conventional (non-EAR) HoLEP.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a comprehensive literature search was performed until February 2026. The Search focused on studies comparing EAR with conventional HoLEP. The primary outcome was the impact of each technique on SUI. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias-2 tool. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated using random-effects models. Analyses were performed using RevMan 5.3.</p><p><strong>Results: </strong>Five studies with 2821 patients were analyzed. EAR showed a lower risk of early SUI at 4-6 weeks (RR0.47, 95%CI 0.37-0.60; I² = 0.0%). At mid-term follow-up, 3-4 months, EAR was associated with lower risk of SUI (RR 0.44, 95%CI 0.28-0.69; I² = 0%). At 6-12 months, there were no significant differences in urinary incontinence. EAR had fewer intraoperative and late postoperative complications. However, EAR showed more early postoperative complications, mainly Clavien-Dindo grade I-II. Despite this, hospital stay was similar between both groups. Functional outcomes, including IPSS, quality of life, Qmax, and PVR, were comparable between groups throughout follow-up. Lastly, Operative time, enucleation time, morcellation time, and catheter duration were also comparable.</p><p><strong>Conclusion: </strong>EAR reduces early SUI while maintaining comparable functional outcomes compared to conventional HoLEP. These findings indicate EAR is an effective continence-optimizing modification during HoLEP.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative study on barriers and facilitators to genetic testing in Hispanic patients with prostate cancer.","authors":"Perla Chebli, Tatiana Sanchez Nolasco, Mariana Rangel Camacho, Nataliya Byrne, Veda N Giri, Susan T Vadaparampil, Stacy Loeb","doi":"10.1038/s41391-026-01166-9","DOIUrl":"https://doi.org/10.1038/s41391-026-01166-9","url":null,"abstract":"<p><strong>Background: </strong>Despite the importance of germline genetic evaluation in prostate cancer (PCa), fewer U.S. Hispanic patients receive it.</p><p><strong>Methods: </strong>We conducted semi-structured in-depth interviews with U.S. Hispanic patients with PCa in English or Spanish on facilitators and barriers to germline genetic testing.</p><p><strong>Results: </strong>Barriers and facilitators were multidimensional. Key facilitators include family benefit, actionability, trust in clinicians, bilingual educational materials and insurance coverage; whereas key barriers include confusion with other tests, fear of negative implications, low awareness and limited clinician-led counseling.</p><p><strong>Conclusions: </strong>Bilingual informational materials, public messaging, and greater clinician education are needed to promote equity in PCa genetic evaluation.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic health's influence on the efficacy of pre-operative hormone therapy for men with localized high-risk prostate cancer.","authors":"Mitchell Boshkos, Maria Julia Moura Nascimento Santos, Rebecca S Tidwell, Neha Venkatesh, Sagar S Mukhida, Patrick G Pilie, Sumit K Subudhi, Paul G Corn, Ana M Aparicio, Bilal A Siddiqui, Debanjan Pain, Efstratios Koutroumpakis, Amado J Zurita, Daniel E Frigo, Justin R Gregg, Christopher J Logothetis, Johannes F Fahrmann, Andrew W Hahn","doi":"10.1038/s41391-026-01163-y","DOIUrl":"https://doi.org/10.1038/s41391-026-01163-y","url":null,"abstract":"<p><strong>Background: </strong>Altered lipid metabolism, adiposity, and androgens have been linked to cardiac disease and prostate cancer. Adiposity increases risk of recurrence for prostate cancer and may enhance response to androgen receptor pathway inhibition (ARPI). We evaluated whether adiposity and circulating lipid metabolites are associated with response to pre-operative ADT + /- ARPI in localized high-risk prostate cancer (HRPCa).</p><p><strong>Methods: </strong>We performed a post hoc analysis of 104 men with localized HRPCa treated with 3-6 months of preoperative ADT + /- ARPI across three trials. Body composition was quantified from L3 CT imaging at baseline and at radical prostatectomy (RP; end-of-treatment [EOT] n = 56). Plasma lipid metabolites were profiled by UPLC-MS at baseline (n = 60) and in paired baseline/EOT samples (n = 59). Pathologic response was defined as ≤ T2N0 at RP. PSA progression-free survival (PFS) was defined as time from RP to PSA ≥ 0.2 ng/mL or initiation of radiotherapy.</p><p><strong>Results: </strong>Median age was 63 years, 76.9% had Gleason grade group 4-5, and 43.7% had clinical T3-4 disease. At RP, lower visceral (VATi, p = 0.002) and subcutaneous adiposity (SATi, p = 0.004) were associated with pathologic response. Increasing adiposity at RP was associated with PSA progression (per 10-unit increase: VATi HR 1.09, p = 0.04; SATi HR 1.14, p = 0.03). In paired analyses (n = 59), pathologic responders demonstrated decreases (p < 0.05) in diacylglycerols and polyunsaturated fatty acyl chain-containing triacylglycerols (PUFA-TAGs) and elevations in ceramide species. Non-responders exhibited increases (p < 0.05) in PUFA-TAGs and glycerophospholipids with reductions in lysophosphatidylcholine species, long-chain acylcarnitine, and cholesterol.</p><p><strong>Conclusions: </strong>Higher post-treatment adiposity and intrapatient changes in lipid metabolite pathways were associated with inferior outcomes after pre-operative hormone therapy, supporting a stage-dependent link between cardiometabolic health and prostate cancer that warrants further elucidation.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture risk and fracture risk factor assessment among men at prostate cancer diagnosis.","authors":"Michael J Shulman, Jeanne A Darbinian, Malini Chandra, Andrea L Harzstark, Joan C Lo","doi":"10.1038/s41391-026-01151-2","DOIUrl":"https://doi.org/10.1038/s41391-026-01151-2","url":null,"abstract":"<p><strong>Background: </strong>Older men with prostate cancer, particularly those receiving androgen deprivation therapy, have an increased fracture risk. However, contemporary studies assessing baseline fracture risk in ethnically diverse populations of men at initial prostate cancer diagnosis remain limited.</p><p><strong>Methods: </strong>Men aged 50-89 years with newly diagnosed prostate cancer (2010-2022) in a US integrated healthcare system were identified. Demographic data, smoking, prior fracture, rheumatoid arthritis, recent glucocorticoid therapy, body mass index (FRAX variables), and other risk factors (diabetes, low 25OH-vitamin D level) were ascertained from electronic health records. Ten-year risks of hip (10yHIP) and major osteoporotic fractures (10yMOF) were calculated using the US FRAX (race/ethnicity-specific, without bone density); additional scores removed race/ethnicity calibration. High fracture risk was defined as 10yMOF ≥ 20% and 10yHIP ≥ 3%.</p><p><strong>Results: </strong>Among 25,413 men with prostate cancer (mean age 66.1 ± 8.1 years; 64.8% White, 12.3% Black, 10.7% Hispanic, 11.5% Asian/Pacific Islander (PI)), 87.5%, 3.4%, and 9.1% had local or locally advanced disease, node-positive, and metastatic disease, respectively. Overall, 7.2% smoked, 20.4% had diabetes, and 6.4% had a prior fracture with demographic variation; <1% had rheumatoid arthritis or extended glucocorticoid therapy. Few (0.2%) had 10yMOF ≥ 20% but 11.6% had 10yHIP ≥ 3%, ranging from 15.5% (White), 7.3% (Asian/PI), 4.8% (Hispanic) and 1.4% (Black) and increasing to 14.9% (Asian/PI), 10.9% (Hispanic), and 8.1% (Black) without race/ethnicity calibration. Age was a major risk factor; 20.5% of men aged ≥65 years, increasing to 87.3% of men aged 80-89 years had 10yHIP ≥ 3%. Diabetes and hypovitaminosis D were especially prevalent among non-White populations.</p><p><strong>Conclusion: </strong>1 in 9 men with prostate cancer had a high calculated hip fracture risk at diagnosis, increasing to 1 in 5 men aged ≥65 years, with key demographic differences. These observations in real-world populations underscore the importance of skeletal health assessment among older men with prostate cancer and evaluation of fracture risk assessment tools to inform clinical management.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic and oncological effects of metformin added to ADT in prostate cancer: systematic review and meta-analysis including STAMPEDE.","authors":"Farah Fakhri, Zeid Alkhairi, Talal Sarhan, Gozeel Imran, Lyaba Imran, Raeesah Moola, Radwan Darwish, Abdulrahman Al-Majmuei","doi":"10.1038/s41391-026-01165-w","DOIUrl":"https://doi.org/10.1038/s41391-026-01165-w","url":null,"abstract":"<p><strong>Background: </strong>Androgen-deprivation therapy (ADT) is the cornerstone of advanced prostate cancer treatment but induces a metabolic syndrome phenotype that heightens cardiovascular risk. Metformin, an insulin-sensitising biguanide with emerging anticancer properties, is a rational ADT adjunct. Following STAMPEDE's 2025 publication, we aimed to quantify metformin's metabolic benefit and characterise its oncological signal by disease volume.</p><p><strong>Methods: </strong>This PRISMA 2020-guided review (PROSPERO CRD420261384520) searched five databases through 12 May 2026. Eligible RCTs compared metformin plus ADT versus ADT alone in prostate cancer. Primary metabolic outcomes were body weight, waist circumference, HbA1c, fasting glucose, and LDL cholesterol. Secondary (exploratory) oncological outcomes were overall survival (OS) and castration-resistant prostate cancer-free survival (CRPC-FS), derived predominantly from a single trial. Random-effects models with Hartung-Knapp correction were used; GRADE assessed certainty.</p><p><strong>Results: </strong>Six trials enroling 2415 participants (78% from STAMPEDE) were included: STAMPEDE (n = 1 874), PRIME (n = 166), PREMIUM (n = 83), MANSMED (n = 124), Mahalingam (n = 36), and Alagizy (n = 132). Disease status ranged from metastatic (STAMPEDE, Alagizy, majority MANSMED) to locally advanced or biochemically recurrent (PREMIUM, PRIME, Mahalingam); all excluded diabetes mellitus except MANSMED ( ~ 20%). At 12 months, metformin significantly reduced waist circumference (MD -1.12 cm; p = 0.014), HbA1c (MD -0.070%; p = 0.029), and fasting glucose (MD -0.100 mmol/L; p = 0.031). Body weight and LDL cholesterol reductions were non-significant (MD -1.60 kg; p = 0.090 and MD -0.130 mmol/L; p = 0.343, respectively). In STAMPEDE, metformin did not improve OS (HR 0.91; p = 0.15); the high-volume subgroup showed a survival benefit (HR 0.79; p = 0.007; volume interaction p = 0.12, non-significant). In MANSMED, CRPC-free survival was significantly prolonged (HR 0.50; p = 0.01), though this signal derives from a single small, open-label trial.</p><p><strong>Conclusions: </strong>Metformin added to ADT produces moderate-certainty reductions in waist circumference and HbA1c. Oncological benefit in unselected patients was not demonstrated; the hypothesis-generating STAMPEDE high-volume subgroup signal, derived from a single trial, warrants evaluation in a prospective, volume-stratified RCT.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in prostate cancer care from performance to clinical integration.","authors":"Riccardo Lombardo, Daniele Amparore","doi":"10.1038/s41391-026-01164-x","DOIUrl":"https://doi.org/10.1038/s41391-026-01164-x","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How does PSA change after water vapor therapy? A systematic review and meta-analysis.","authors":"Pietro Scilipoti, Marie Chicaud, Federico Zorzi, Giuseppe Rosiello, Luca Villa, Marco Bianchi, Giorgio Gandaglia, Alberto Briganti, Francesco Montorsi, Frédéric Panthier, Olivier Traxer, Steeve Doizi, Stessy Kutchukian","doi":"10.1038/s41391-026-01162-z","DOIUrl":"https://doi.org/10.1038/s41391-026-01162-z","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate-specific antigen (PSA) kinetics following minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia (BPH) remain incompletely characterized. Water vapor thermal therapy (Rezūm™) induces targeted tissue ablation and inflammatory remodeling, potentially affecting PSA levels over time. The aim of this review was to quantify PSA changes after Rezūm therapy and explore study-level correlates of PSA dynamics through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>This systematic review followed PRISMA guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched for studies reporting baseline and post-treatment PSA after Rezūm therapy. The primary outcome was pooled mean change in PSA (ΔPSA) versus baseline at prespecified timepoints (1, 3, 6, 12 months, and last follow-up). Random-effects models using restricted maximum likelihood (REML) were applied, with heterogeneity assessed using Cochrane Q. Meta-regression explored associations between ΔPSA and study-level variables, including acute urinary retention (AUR), reintervention rates, symptom and flow improvements, and prostate volume.</p><p><strong>Results: </strong>Thirteen studies were included. PSA followed a biphasic pattern. At 1 month, an early postoperative increase was observed (2 studies; ΔPSA = +2.38 ng/mL, 95% CI 1.62-3.14). From 3 months onward, PSA levels declined, reaching a moderate but non-statistically significant reduction at the last available follow-up (12 studies; ΔPSA = -0.44 ng/mL, 95% CI - 0.92 to 0.04), corresponding to an approximate 10% decrease from baseline. Meta-regression showed associations between ΔPSA and AUR (β = 0.0799, p = 0.034), reintervention rates (β = -0.226, p = 0.026), Qmax improvement (β = -0.0308, p = 0.028), baseline PSA (β = -0.536, p < 0.001), and baseline prostate volume (β = -0.0861, p = 0.002).</p><p><strong>Conclusions: </strong>Rezūm therapy is associated with a reproducible PSA trajectory characterized by an early transient increase followed by a moderate decline from 3-12 months (~10%). Because this late change is non-significant and within the expected variability of PSA, it is unlikely to modify follow-up strategy. Awareness of this pattern may support appropriate interpretation of PSA measurements after MIST for BPH.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretable machine learning identifies health system levers for survival outcomes of patients with prostate cancer.","authors":"Milit S Patel, James Janopaul-Naylor, Frederic Ivan L Ting, James Fan Wu, Sean M McBride, Dana E Rathkopf, Erin Jay G Feliciano, Hong Truong, Puneeth Iyengar, Jonas Willmann, Daniel E Gorovets, Paul L Nguyen, Vedang Murthy, Brandon A Mahal, Nancy Y Lee, Himanshu Nagar, Edward Christopher Dee","doi":"10.1038/s41391-026-01156-x","DOIUrl":"https://doi.org/10.1038/s41391-026-01156-x","url":null,"abstract":"<p><strong>Background: </strong>Advances in the care of patients with prostate cancer across the disease spectrum have resulted in substantial survival gains over recent decades. However, global disparities in prostate cancer survival, stage at diagnosis, and access to timely diagnosis and treatment remain among the greatest across all malignancies. We aimed to quantify country-level health system correlates of the prostate cancer mortality-to-incidence ratio (MIR).</p><p><strong>Methods: </strong>We applied interpretable machine learning using CatBoost with SHAP (SHapley Additive exPlanations) to all 185 countries with prostate cancer MIR estimates in GLOBOCAN 2022. National age-standardized MIR estimates were linked to 11 health system indicators from the World Health Organization Global Health Observatory, World Bank World Development Indicators, United Nations agencies, and the Directory of Radiotherapy Centres. Model performance was evaluated using repeated leave-one-country-out cross-validation with bootstrap-based uncertainty estimation. CatBoost handled missing predictor values natively, allowing inclusion of all countries without imputation.</p><p><strong>Results: </strong>The model demonstrated strong predictive performance for prostate cancer MIR (R² = 0.80, RMSE = 0.078, MAE = 0.060, Pearson correlation = 0.89). The health system features most strongly associated with lower MIR were gross domestic product per capita, the universal health coverage (UHC) service coverage index, and radiotherapy infrastructure. Country-level SHAP decompositions demonstrated heterogeneous feature contributions across settings, identifying context-specific priorities. Greater radiotherapy capacity and more comprehensive UHC were consistently associated with lower MIR, whereas higher aggregate health expenditure alone showed weaker associations with improved outcomes.</p><p><strong>Conclusions: </strong>Interpretable machine learning identified radiotherapy infrastructure, universal health coverage, and national wealth as the health system features most consistently associated with lower prostate cancer mortality-to-incidence ratios across countries. These findings suggest that targeted investment in treatment capacity and service coverage may have greater relevance to prostate cancer outcomes than increases in aggregate health spending alone. Although ecological and hypothesis-generating, this framework may inform future health systems research, prospective evaluation, and global prostate cancer control.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in quality of physician communication in prostate cancer consultations.","authors":"Nadine A Friedrich, Michael Luu, Renning Zheng, Alexander Hernandez-Tirado, Stephen J Freedland, Brennan Spiegel, Paul Kokorowski, Timothy J Daskivich","doi":"10.1038/s41391-026-01159-8","DOIUrl":"https://doi.org/10.1038/s41391-026-01159-8","url":null,"abstract":"<p><strong>Background: </strong>Clear communication of treatment risks and benefits is essential for shared decision making (SDM) in prostate cancer (PC). However, the quality of physician communication in real-world consultations remains poorly characterized. We assessed variation in quality of risk communication in PC consultations and its association with patient, tumor, and provider characteristics.</p><p><strong>Materials and methods: </strong>We conducted a prospective cohort study of 50 PC consultations in a multispecialty cohort of physicians (3 urologists, 3 medical oncologists, 3 radiation oncologists), with an analytic sample comprising 19,388 sentences. Transcripts were coded for five AUA-endorsed SDM content areas: cancer severity, life expectancy (LE), oncologic endpoints, baseline function, and treatment side effects (SEs). Analysts extracted all statements on these topics and scored communication quality using a validated 6-point scale (0 = omission, 1 = name only, 2 = binary assessment of risk, 3 = imprecise quantification, 4 = specific quantification, and 5 = patient-specific estimate). For each consultation, we calculated overall (weighted average) and content-specific scores. We then conducted an exploratory analysis of variation in communication quality by patient, tumor, and provider characteristics.</p><p><strong>Results: </strong>Communication quality varied substantially across consultations and content areas. Cancer severity had the highest median score (5, IQR 4-5), indicating this information was typically communicated using patient-specific estimates. LE had a median of 3 (IQR 2-5), indicating imprecise quantification. Oncologic endpoints also had a median of 3 (IQR 2-3). Baseline function and SEs had the lowest median of 1 (IQRs 1-2 and 0-2), indicating name-only communication. Exploratory analyses revealed that overall communication quality was lower for Black patients, higher among urologists, increased with higher tumor risk, and varied by physician. Content-specific quality did not improve in subgroups where the content was clinically relevant (e.g., LE quality was not higher for patients with limited LE).</p><p><strong>Conclusions: </strong>Quality of physician communication in PC consultations varies across content areas and may be influenced by patient, tumor, and provider characteristics.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}