Prostate Cancer and Prostatic Diseases最新文献

{"title":"PHI for adverse pathology and PHI density for upgrading: two complementary predictors in localized prostate cancer.","authors":"Daniela Terracciano, Francesco Pellegrino, Mariano Fiorenza, Carmela Polito, Rosa Sirica, Giuseppe Fallara, Roberto Bianchi, Francesco Chierigo, Martina Maggi, Marco Tozzi, Letizia Maria Ippolita Jannello, Emanuela Santangelo, Vincenzo Martorello, Andrea Triggiani, Felice Crocetto, Ciro Imbimbo, Francesco Del Giudice, Biagio Barone, Antonio Cincione, Riccardo Autorino, Cosimo De Nunzio, Matteo Ferro","doi":"10.1038/s41391-026-01158-9","DOIUrl":"https://doi.org/10.1038/s41391-026-01158-9","url":null,"abstract":"<p><strong>Background: </strong>The Prostate Health Index (PHI) has emerged as a promising biomarker for improving prostate cancer (PCa) detection. However, its role in predicting pathological aggressiveness at radical prostatectomy (RP) requires further elucidation. We aimed to assess the ability of PHI and PHI density (PHId) to predict adverse pathological features and ISUP upgrading in men undergoing robot-assisted RP.</p><p><strong>Methods: </strong>We conducted a prospective, single-center observational study including 130 patients who underwent RP. Total PSA, free PSA, and p2PSA were measured using the Access 2 platform, and PHI and PHId were calculated accordingly. Multivariable logistic regression models evaluated the association of PSA, PSA density, PHI, and PHId with two predefined endpoints: (i) adverse pathological features (pT ≥3 and/or pN1), and (ii) upgrading from biopsy to RP. Models were adjusted for DRE status, PI-RADS score, and biopsy ISUP grade. Discrimination was assessed using AUC and the DeLong test.</p><p><strong>Results: </strong>Median PSA, PHI, PSA density, and PHId were 6.21 ng/mL, 58, 0.15 ng/mL/cc, and 1.40, respectively. Adverse pathological features were identified in 39% of cases, and upgrading occurred in 59% (after exclusion of biopsy ISUP 5 cases). PHI emerged as the strongest independent predictor of adverse pathology (OR 1.04; 95% CI 1.02-1.07), yielding the highest model accuracy (AUC 0.86) and showing a sharp risk increase above PHI > 40. PHId was the only marker independently associated with upgrading (OR 1.54; 95% CI 1.10-2.29), achieving the best discrimination (AUC 0.83), with risk escalation particularly evident in patients with PI-RADS 4-5 lesions.</p><p><strong>Conclusions: </strong>PHI and PHId provide complementary information in localized PCa. PHI accurately identifies patients at risk of adverse pathological extension, whereas PHId effectively captures the probability of grade reclassification at RP. Integrating these biomarkers into patient assessment may support precision-based decision-making and helping to minimize undertreatment.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031311","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":"MUSegNet: Automated detection of clinically significant prostate cancer on micro-ultrasound.","authors":"Mirabela Rusu, Steve R Zhou, Lichun Zhang, Moon Hyung Choi, Sulaiman Vesal, Adam S Kinnaird, Wayne G Brisbane, Giovanni Lughezzani, Davide Maffei, Vittorio Fasulo, Patrick Albers, Ahmed El-Kaffas, Wei Shao, Richard E Fan, Geoffrey A Sonn","doi":"10.1038/s41391-026-01157-w","DOIUrl":"https://doi.org/10.1038/s41391-026-01157-w","url":null,"abstract":"<p><strong>Background: </strong>Micro-ultrasound (microUS) is a non-inferior alternative to multi-parametric MRI for clinically significant prostate cancer (csPCa) diagnosis, yet cancer's subtle features result in missed cancers and large inter-reader variability. We seek to automate the detection of csPCa on microUS by developing the microUS Prostate Cancer Detection Network (MUSegNet).</p><p><strong>Methods: </strong>Implemented using the well-established segmentation framework, nnUnet, MUSegNet automatically outlines the prostate, transitional zone, and csPCa. Our study explored strategies to train such segmentation models given reduced data, which is common with new imaging modalities such as microUS and/or when labeling data is tedious. MUSegNet was trained using three datasets: (1) 53 microUS exams manually labeled using MRI and pathology references (53 patients), (2) 565 unlabeled microUS exams (106 patients), and (3) 2749 conventional b-mode ultrasound exams (2281 patients). We evaluated MUSegNet in 73 independent patients from two institutions, against manual labels and in direct comparison with six expert readers.</p><p><strong>Results: </strong>MUSegNet was significantly better at detecting csPCa than the baseline models trained using manual labels (area under the receiver operating characteristic curve - AUROC; 0.85 vs. 0.73, Delong p-value < 0.01, sensitivity: 0.74 vs. 0.27, dice similarity coefficient: 0.29 vs. 0.09, Wilcoxon p-value < 0.001). MUSegNet was better at detecting posterior vs. anterior lesions (AUROC: 0.94 vs. 0.72, sensitivity: 0.86 vs. 0.49, Dice: 0.31 vs. 0.11) and outperformed the six human readers for all lesions (AUROC: 0.85 vs. 0.78, sensitivity: 0.74 vs. 0.63). While evaluation in a larger cohort is needed, MUSegNet found csPCA in 33% of cases with csPCa and MRI invisible cancers (1 in 3).</p><p><strong>Conclusions: </strong>MUSegNet reliably detected the extent of clinically significant prostate cancer on micro-ultrasound exams, paving the way for improving cancer detection for biopsy targeting and reducing inter-reader variability. MUSegNet was best at capturing posterior cancers, with some benefit for the challenging anterior cancers.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025965","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":"Vesicourethral anastomotic stenosis after radical prostatectomy: a preoperative classification to capture heterogeneity and guide surgical management.","authors":"Clément Sarrazin, Agathe Escoffier, Paul Neuville, Alice Bourillon, Félix Campos-Juanatey, Wesley Verla, Marjan Waterloos, Jakob Klemm, Malte W Vetterlein, Tarek Ghoneim, François-Xavier Madec","doi":"10.1038/s41391-026-01155-y","DOIUrl":"https://doi.org/10.1038/s41391-026-01155-y","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991161","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":"Re-evaluating the long-term efficacy and safety of the Zenflow spring system: insights from a multidisciplinary perspective.","authors":"Chengxun Chen, Yichen Jiang, Zhou Yi","doi":"10.1038/s41391-026-01154-z","DOIUrl":"https://doi.org/10.1038/s41391-026-01154-z","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983023","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":"Beyond nuclear AR-V7: rethinking subcellular localization as a dynamic biomarker of endocrine resistance in mCRPC.","authors":"Xinze Li, Zilong Chen, Chuanxin Liu","doi":"10.1038/s41391-026-01152-1","DOIUrl":"https://doi.org/10.1038/s41391-026-01152-1","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970821","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":"Association between smoking, tumor genetics, and outcomes in men with metastatic prostate cancer.","authors":"Christopher Choi, Matthew Labriola, Nicholas Henderson, Alec Chu, Clara Hwang, Pedro C Barata, Frank Cameron Cackowski, Amanda Broderick, Rana R McKay, Mehmet Asim Bilen, Deepak Kilari, Laura S Graham, Abhishek Tripathi, Rohan Garje, Vadim S Koshkin, Tanya B Dorff, Michael Thomas Schweizer, Zachery R Reichert, Alexandra O Sokolova, Catherine H Marshall, Andrew J Armstrong","doi":"10.1038/s41391-026-01150-3","DOIUrl":"https://doi.org/10.1038/s41391-026-01150-3","url":null,"abstract":"<p><strong>Purpose: </strong>Smoking has been associated with increased metastatic prostate cancer mortality, but the mechanisms behind this are largely unknown. We hypothesized that smoking increases the risk of genetic alterations associated with aggressive disease and/or the transformation to neuroendocrine prostate cancer (NEPC).</p><p><strong>Patients and methods: </strong>We utilized the Prostate Cancer Precision Medicine Multi-institutional Collaborative Effort (PROMISE) clinical genomic database for this retrospective analysis. We associated patient characteristics and tumor genetic data with smoking exposure at diagnosis (current, former, never and pack years) and with clinical outcomes, including overall survival (OS) from diagnosis or time to developing metastatic disease and NEPC status.</p><p><strong>Results: </strong>We identified 2353 men with prostate cancer and next generation somatic tumor sequencing evaluable for analysis in PROMISE, including 8% current, 39% former, and 52% never smokers. Current smokers were more likely to be younger and to have metastatic (M1 or N1) disease at diagnosis, and less likely to have prior local therapy (all p < 0.001). Current smoking was associated with worse OS from diagnosis (99.9 mo vs 137.6 mo, HR 1.42, 95% CI 1.14-1.77), which remained significant after adjusting for disease characteristics. We found no difference in the percentage of NEPC at initial diagnosis or at any time between current, former, and never smokers (p = 0.8). We found positive associations between smoking status and genetic alterations in SPOP (current: 15%, former 6.7%, never 3.8%; p = 0.018), FGFR1 (current 10%, former 0.4%, never 1.1% p = 0.001), and ARID1A (current 5.1%, former 2.2%, never 0.4%; p = 0.035) in patients with metastatic androgen pathway modulator sensitive prostate cancer (APMS).</p><p><strong>Conclusion: </strong>Active smoking is associated with worse overall and prostate cancer specific survival as compared to never/former smoking and was associated with specific tumor genetic alterations but not small cell/NEPC transformation.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892314","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":"Oncological and functional outcomes of focal irreversible electroporation for localised prostate cancer: a single institution series of 171 cases.","authors":"Z Mian, T Gianduzzo, B Kua, J Yaxley","doi":"10.1038/s41391-026-01148-x","DOIUrl":"https://doi.org/10.1038/s41391-026-01148-x","url":null,"abstract":"<p><strong>Background: </strong>Focal irreversible electroporation (IRE) is an attractive choice for patients aiming to obtain local control of prostate cancer, while decreasing the postoperative risk of impotence and incontinence compared to whole-gland treatments.</p><p><strong>Methods: </strong>Retrospective review of a single centre prospective database of 171 consecutive primary IRE procedures for localised prostate cancer. Primary outcomes include oncological infield and out-of-field progression. Secondary objectives include post-IRE continence and impotence.</p><p><strong>Results: </strong>The median follow-up is 35 months (3-90 months). The median diameter of the treated lesions is 11 mm (4-24 mm). Most patients had PI-RADS 4-5 abnormalities on prostate MRI, and 25 patients (15%) had ISUP grade 4-5 cancer. Of the 135 patients with >12 months follow-up, 84 had a surveillance biopsy of whom 8.3% had significant infield persistence, with significant out-of-field cancer in 14.3%. There was no difference in the risk of infield cancer persistence regardless of the pre-IRE ISUP score (p = 0.8), or tumour location (p > 0.9). The presence of low volume out-of-field cancer at diagnosis did not increase the risk of post-IRE cancer persistence/progression (p = 0.7). The prostate PSMA PET SUVmax of ≥10 did not increase the risk of infield or out-of-field recurrence of cancer (p = 0.3). A PSAD > 0.15 did not increase the risk of infield persistence or out-of-field progression of cancer (p = 0.8). Urinary continence was maintained in 167/171 (97.6%), while erectile function was maintained in 94/112 (84%) of sexually active patients who completed questionnaires.</p><p><strong>Conclusions: </strong>Of the patients who proceeded to post-IRE biopsy, 92% had infield ablation of clinically significant cancer with a low risk of urinary incontinence or impotence. Focal IRE of prostate cancer has promising short to medium-term outcomes and is associated with low risks of impotence and incontinence. Long-term follow-up of out-of-field progression risk is required.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875893","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":"Prostate size and its effect on sexual function following convective water vapor thermal therapy.","authors":"Amandip Cheema, Bronwyn Long, Owen Lewer, Olivia Copelan, Sarang Janakiraman, Amy Wozniak, Kevin T McVary","doi":"10.1038/s41391-026-01139-y","DOIUrl":"https://doi.org/10.1038/s41391-026-01139-y","url":null,"abstract":"<p><strong>Background/objective: </strong>Convective water vapor thermal therapy (CWVTT) effectively treats Lower Urinary Tract Symptoms (LUTS) from Benign Prostatic Hyperplasia (BPH). While sexual outcomes have been studied across BPH procedures, the influence of prostate size on sexual function after CWVTT is unclear. We aimed to determine whether preservation of sexual function, measured by the Sexual Health Inventory for Men (SHIM), differs by prostate volume, particularly in larger glands.</p><p><strong>Subjects/methods: </strong>Following IRB approval, patients aged ≥18 undergoing CWVTT from October 2018 to August 2022 were identified by CPT codes 53,852 and 53,854. After applying inclusion/exclusion criteria, patients were stratified into prostate tertiles: small (≤38.5 cc), medium (38.5-55.6 cc), and large (>55.6 cc). SHIM scores were tracked longitudinally.</p><p><strong>Results: </strong>Baseline demographics were similar across tertiles. Mean SHIM change from baseline to 3 months was -1.02, -2.10, and -0.46 for small, medium, and large prostates, respectively; only the medium group showing a statistically significant decline. Beyond 3 months, SHIM scores improved across all tertiles. Large prostates demonstrated a significant increase in SHIM over time (+0.18/month, p = 0.01) though significance was lost after adjusting for age, comorbidities, and baseline SHIM. Severe baseline erectile dysfunction (ED) predicted the greatest postoperative improvement, while men with no ED experienced mild decline. Age and baseline SHIM were the strongest predictors of outcomes.</p><p><strong>Conclusions: </strong>Men with larger prostates who undergoe CWVTT do not appear at increased risk of ED. In fact, the men with larger prostates have a faster recovery of sexual function than other prostate sizes. Patients with severe ED should be counseled on the potential for improvement in their sexual function following their procedure, especially 3 months onward with the exact mechanism being unknown. Finally, prostate volume likely plays a role in timing of recovery, although it is overshadowed by the influence of baseline SHIM scores and age.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813844","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":"Correlation of intraprostatic lesional SUVmax during PSMA PET/CT and adverse pathology at radical prostatectomy.","authors":"Felix Preisser, Florian Nohe, Ken Herrmann, Philipp Mandel, Tobias Maurer, Markus Graefen, Derya Tilki","doi":"10.1038/s41391-026-01137-0","DOIUrl":"https://doi.org/10.1038/s41391-026-01137-0","url":null,"abstract":"<p><strong>Objective: </strong>Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is a novel staging modality for prostate cancer (PCa) patients with a high positive predictive value for lesions within and outside of the prostate. To assess the ability of the maximum standardized uptake value (SUVmax) at PSMA PET/CT to predict adverse pathology at radical prostatectomy (RP).</p><p><strong>Material and methods: </strong>Within a high-volume center database, we identified intermediate and high-risk PCa patients who had a PSMA PET/CT with an available intraprostatic SUVmax before RP between 2016 and 2021. Logistic regression modeling was used to test for the ability of SUVmax to predict non-organ confined disease or adverse pathology (non-organ confined and/or Gleason grade group ≥3) during RP. Kaplan-Meier analyses were used to compare biochemical recurrence (BCR)-free survival after RP stratified according to SUVmax.</p><p><strong>Results: </strong>Overall, 544 patients were identified. Of those, median lesional intraprostatic SUVmax was 9.5 at PSMA PET/CT. Median PSA was 8.1 ng/ml prior to RP. 50.7% vs. 49.3% had D'Amico intermediate and high-risk characteristics. Median follow-up was 24.6 months. BCR-free survival at 48 months after RP was 72.1% vs. 62.2% (p = 0.03) for patients with SUVmax <9.5 vs. SUVmax ≥9.5 at PSMA PET. In logistic regression models, SUVmax (continuously coded and stratified in <9.5 vs. ≥9.5) represented an independent predictor for non-organ confined disease and adverse pathology.</p><p><strong>Conclusions: </strong>SUVmax ≥9.5 at PSMA PET/CT is an independent predictor of adverse pathology at RP. Moreover, it is associated with worse BCR-free survival after RP.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813773","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":"Successful cabazitaxel desensitization after severe taxane hypersensitivity reactions: a brief report.","authors":"Stephanie Sun, Bilal Ashraf, Kallie White, Andrew J Armstrong","doi":"10.1038/s41391-026-01149-w","DOIUrl":"https://doi.org/10.1038/s41391-026-01149-w","url":null,"abstract":"<p><strong>Background: </strong>Hypersensitivity reactions (HSRs) are common complications of taxane chemotherapy and serve as a barrier to key therapies such as cabazitaxel for patients with metastatic androgen receptor modulation-resistant (mAPMR) prostate cancer.</p><p><strong>Methods: </strong>We developed a multidisciplinary cabazitaxel rapid desensitization protocol and enacted it for two patients.</p><p><strong>Results: </strong>Both patients tolerated this protocol well and demonstrated at least a PSA50 response and delayed progression.</p><p><strong>Conclusion: </strong>We demonstrate that cabazitaxel desensitization is safe and clinically impactful in patients with severe hypersensitivity reactions to taxanes. Wider implementation of desensitization protocols may help ensure access to this critical therapy in mAPMR prostate cancer.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797413","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}