Prostate International最新文献

{"title":"Plasma circulating tumor deoxyribonucleic acid methylation enables noninvasive disease stratification beyond prostate-specific antigen in prostate cancer","authors":"Da-Won Kim,&nbsp;Min-Hyeok Jung,&nbsp;Hyungseok Cho,&nbsp;Jiwon Cha,&nbsp;Ki-Ho Han,&nbsp;Jae Heon Choi,&nbsp;Mungchan Park,&nbsp;Sang Hyun Park,&nbsp;Cheol Kyu Oh,&nbsp;Seung-Taek Lee,&nbsp;Young-Joon Kim,&nbsp;Jae-Seung Chung","doi":"10.1016/j.prnil.2026.05.002","DOIUrl":"10.1016/j.prnil.2026.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Accurate discrimination between localized and metastatic prostate cancer (PCa) remains a critical unmet need in clinical practice, particularly in patients with equivocal imaging findings or biologically high-risk disease. Circulating tumor DNA (ctDNA) methylation represents a stable epigenetic signal that may reflect tumor burden and disease state. We aimed to evaluate whether plasma ctDNA methylation markers can accurately discriminate disease state beyond conventional clinical parameters.</div></div><div><h3>Methods</h3><div>A total of 174 patients were included, comprising localized PCa (<em>n</em> = 73), metastatic hormone-sensitive PCa (mHSPC, <em>n</em> = 16), and metastatic castration-resistant PCa (mCRPC, <em>n</em> = 85). Candidate methylation markers (C2orf88 and HAPLN3) were identified using a machine learning–based approach and quantified in plasma ctDNA. Associations with metastatic disease were evaluated using logistic regression analyses, and diagnostic performance was assessed using receiver operating characteristic analyses.</div></div><div><h3>Results</h3><div>Plasma methylation levels of C2orf88 and HAPLN3 increased significantly with advancing disease stage (<em>P</em> &lt; 0.05). In multivariable analysis, C2orf88 (OR 3.47, 95% CI 1.95–6.15; <em>P</em> &lt; 0.001) and HAPLN3 (OR 2.82, 95% CI 1.65–4.82; <em>P</em> &lt; 0.001) were independently associated with metastatic disease. The clinical model demonstrated modest discrimination (AUC range, 0.537–0.828), whereas methylation-based models achieved superior performance (AUC range, 0.807–0.843). The integrated two-marker signature provided the highest discriminatory accuracy (AUC = 0.913), indicating substantial incremental value over conventional clinical assessment.</div></div><div><h3>Conclusions</h3><div>A two-marker ctDNA methylation signature enables accurate discrimination between localized and metastatic PCa. This plasma-based epigenetic biomarker captures clinically meaningful disease biology and offers a scalable, noninvasive approach for refined disease stratification.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 264-270"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with high-risk features on active surveillance for prostate cancer","authors":"Sophie Goodman,&nbsp;Yajat Dua,&nbsp;Henry Y.C. Pan,&nbsp;Sachin Perera,&nbsp;Niranjan Sathianathen,&nbsp;Marlon Perera,&nbsp;Declan Murphy,&nbsp;Nathan Lawrentschuk","doi":"10.1016/j.prnil.2026.02.002","DOIUrl":"10.1016/j.prnil.2026.02.002","url":null,"abstract":"<div><h3>Background/objectives</h3><div>With the increasing incidence of prostate cancer worldwide, active surveillance (AS) remains a cornerstone in the management of men with low-risk disease. While the criteria for AS in low-risk prostate cancer are well established, its appropriateness for men with higher-risk features is less clearly defined. This review aims to evaluate the evidence supporting AS in men with a family history of prostate cancer, Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesions, and favorable intermediate-risk International Society of Urological Pathology (ISUP) Grade Group (GG) 2 disease.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted using PubMed, Embase, and The Cochrane Library. Eligible studies included those assessing outcomes of AS in men with higher-risk features, including family history of prostate or associated malignancies, PI-RADS 4–5 lesions on magnetic resonance imaging, or favorable risk ISUP GG2 disease. Studies were excluded if participants had a life expectancy of less than 10 years or had previously received definitive treatment for prostate cancer.</div></div><div><h3>Results</h3><div>Recent evidence suggests that a family history of prostate cancer may confer an increased risk of disease progression on AS; however, current data do not justify exclusion from surveillance on this basis alone. Two single-center studies demonstrated that men with PI-RADS 5 lesions at AS enrolment exhibited a higher rate of disease upgrading, with 70% progressing to ISUP GG2 and 25–33% to GG3 or higher at confirmatory biopsy. Increasing evidence supports the inclusion of selected men with favorable GG2 disease in AS protocols, provided the absence of high-risk clinical, biochemical, or radiological features. Approximately 50% may require definitive treatment within five years.</div></div><div><h3>Conclusions</h3><div>AS remains a viable management option for appropriately selected men with higher-risk features, accompanied by rigorous monitoring and informed patient counselling. The emerging role of prostate-specific membrane antigen positron emission tomography imaging in risk stratification for intermediate-risk disease warrants further investigation through prospective studies.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 217-224"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors predicting the success of ejaculation preserving transurethral resection of the prostate: a prospective cohort study","authors":"Ahmed Higazy,&nbsp;Marco Sawiris,&nbsp;Mohamed Kotb,&nbsp;Mohamed Ismail,&nbsp;Ahmed Tawfick,&nbsp;Ahmed Lotfy","doi":"10.1016/j.prnil.2026.06.001","DOIUrl":"10.1016/j.prnil.2026.06.001","url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study was to evaluate the clinical and anatomical factors predicting the preservation of antegrade ejaculation following ejaculation-preserving transurethral resection of the prostate (EP-TURP).</div></div><div><h3>Materials and methods</h3><div>This prospective cohort study included sexually active men undergoing EP-TURP. Preoperative evaluation included the International Prostate Symptom Score, quality of life, and assessment of ejaculatory function using the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form. Transrectal ultrasonography was used to evaluate prostate size, intravesical prostatic protrusion, supramontanal length, and the presence of a median lobe. The surgical technique involved preserving 1 cm of circumferential urethral mucosa around the verumontanum while performing standard bipolar TURP. Patients were followed up at 3 months postoperatively. Multivariable regression analysis was used to identify predictors of ejaculation preservation.</div></div><div><h3>Results</h3><div>A total of 108 patients were included in the final analysis. Significant improvements were observed in postoperative voiding parameters (<em>P</em> &lt; 0.001). Antegrade ejaculation was preserved in 63 patients (58.3%). Preservation was significantly higher in patients with a prostate size &lt;80 g than in those with a prostate size ≥80 g (81.1% vs 36.4%). On multivariable analysis, larger prostate volume (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.95–0.99, <em>P</em> = 0.018), increased intravesical prostatic protrusion (OR: 0.75, 95% CI: 0.56–0.99, <em>P</em> = 0.023), and the presence of a median lobe (OR: 0.73, 95% CI: 0.54–0.99, <em>P</em> = 0.048) were independently associated with a lower odds of ejaculation preservation.</div></div><div><h3>Conclusions</h3><div>EP-TURP provides significant improvement in voiding parameters while preserving antegrade ejaculation in a substantial proportion of patients. Larger prostate size, significant intravesical prostatic protrusion, and median lobe enlargement are associated with lower preservation rates and should be considered during patient selection and preoperative counseling.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 271-277"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Prostate Imaging Reporting and Data System equally predictive across racial groups? A narrative review of multiparametric magnetic resonance imaging performance in Black versus White men","authors":"Laeticia Creidy,&nbsp;Antoine Gougé,&nbsp;Charles Dariane,&nbsp;Grégory Rembeyo,&nbsp;Kevin Kaulanjan,&nbsp;Fred Saad,&nbsp;Daniel Taussky","doi":"10.1016/j.prnil.2026.02.004","DOIUrl":"10.1016/j.prnil.2026.02.004","url":null,"abstract":"<div><h3>Background</h3><div>Multiparametric magnetic resonance imaging (mpMRI) has become integral to prostate cancer (PCa) screening, improving detection and reducing unnecessary biopsies. This study investigated radiological disparities in mpMRI between Black and White PCa patients to improve diagnostic equity.</div></div><div><h3>Materials and methods</h3><div>A PubMed literature search was conducted using keywords related to PCa, MRI, and racial disparities. Articles discussing mpMRI outcomes in White and Black PCa patients were selected.</div></div><div><h3>Results</h3><div>From 13 studies, two reported higher Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 scores among Black patients, while three showed higher proportions in White patients without increased clinically significant prostate cancer (csPCa). csPCa is defined as International Society of Urological Pathology (ISUP) grade group ≥2. The csPCa detection rate in Black patients was equal to or higher than in White patients, with some studies showing more PI-RADS 3 lesions among Black patients with csPCa. Key findings include the following: (1) Development bias: PI-RADS may not account for racial variations; (2) inconsistent lesion detection across racial groups; (3) lower PI-RADS scores may mask clinically relevant cancer in Black patients; and (4) inadequate representation of the disease in Black men. Anatomical variations may affect lesion visibility, requiring dedicated imaging pathology studies.</div></div><div><h3>Conclusions</h3><div>While valuable for PCa detection, current mpMRI applications may contribute to racial disparities and biopsies should not be omitted in black patients with negative mpMRI or PI-RADS 3 lesions. Addressing these disparities requires inclusive research and consideration of racial variations in diagnostic pathways.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 225-229"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cfDNA-based DNA methylation classifier for distinguishing prostate cancer from benign prostatic hyperplasia","authors":"Jong Hoo Lee,&nbsp;Hye Jin Oh,&nbsp;Hyo Jeong Koo,&nbsp;Mee Young Kim,&nbsp;Choung-Soo Kim,&nbsp;Bumjin Lim,&nbsp;Ji Youl Lee,&nbsp;Woong-Yang Park","doi":"10.1016/j.prnil.2026.02.003","DOIUrl":"10.1016/j.prnil.2026.02.003","url":null,"abstract":"<div><h3>Background</h3><div>Differentiating benign prostatic hyperplasia (BPH) from prostate cancer (PCa) remains a diagnostic challenge due to overlapping clinical features and the limited specificity of prostate-specific antigen (PSA) testing. Recent studies highlight the promise of DNA methylation patterns in cell-free DNA (cfDNA) as non-invasive biomarkers for prostate disease stratification. This study aimed to develop a targeted methylation-based diagnostic model capable of distinguishing PCa from BPH using cfDNA. We hypothesized that specific genomic regions exhibit consistent hyper- or hypomethylation signatures that could serve as robust diagnostic markers.</div></div><div><h3>Materials and methods</h3><div>We applied a custom panel targeting 748 predefined differentially methylated regions (DMRs) to cfDNA from 365 participants (PCa: 230; BPH: 135). Methylation was quantified by targeted enzymatic methyl-sequencing. Following feature selection, a 43 DMR-based model was built using a stacking ensemble framework (Random Forest + XGBoost with stacking). Data were split by stratified sampling into training/test sets and a validation cohort. Uncertainty was quantified via 1,000-iteration non-parametric bootstraps. Functional relevance was assessed by gene ontology (GO) enrichment stratified by genomic context.</div></div><div><h3>Results</h3><div>The diagnostic model exhibited robust discriminative performance across both test and validation cohorts. In the test set, the model achieved an area under the receiver operating characteristic curve (ROC-AUC) of 0.99 and overall accuracy of 0.95, with balanced sensitivity (0.96) and specificity (0.93). Consistent results were observed in the validation set, with a ROC-AUC of 0.98, overall accuracy of 0.93, sensitivity of 0.94, and specificity of 0.93. Importantly, in the validation cohort, the model retained a high sensitivity of 0.94 (95 % CI: 0.84-0.98), underscoring its potential clinical applicability. GO analysis revealed promoter-proximal hypermethylation enriched for developmental programs, transcription factor activity, and chromatin remodeling, whereas gene body hypermethylation mapped to RNA metabolic processes and intracellular transport, supporting biological plausibility.</div></div><div><h3>Conclusions</h3><div>Integrating cfDNA methylation with machine learning delivers a minimally invasive, clinically actionable assay that robustly differentiates PCa from BPH. These results motivate prospective, multi-center validation and position cfDNA methylation profiling as a scalable strategy for prostate disease stratification.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 236-246"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathologic profile of Filipino men with low-risk prostate cancer and predictors of unfavorable pathology at radical prostatectomy","authors":"Pia N.A. Duque,&nbsp;Jeffrey S. So","doi":"10.1016/j.prnil.2026.04.005","DOIUrl":"10.1016/j.prnil.2026.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Active surveillance (AS) is the preferred initial management for low-risk prostate cancer; however, a substantial proportion of patients are found to harbor more advanced disease at radical prostatectomy. This study evaluated the clinicopathologic features and surgical outcomes of Filipino men with low-risk prostate cancer and identified predictors of unfavorable pathology.</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort study included 65 Filipino men with low-risk prostate cancer who underwent radical prostatectomy. Low-risk disease was defined as grade group 1 (Gleason score: 3 + 3 = 6) and prostate-specific antigen (PSA) &lt; 10 ng/mL. Clinicopathologic features included age, PSA, biopsy characteristics, and measures of tumor volume such as the number of positive cores and percent positive cores (PPC). Unfavorable pathology was defined as upgrading to grade group ≥2 or grade group 1 with tertiary pattern 4, pathologic upstaging (pT3–pT4 or pN1), or both. Logistic regression and receiver operating characteristic analyses were performed to identify predictors of unfavorable pathology and determine an optimal cutoff for PPC.</div></div><div><h3>Results</h3><div>Unfavorable pathology was observed in 56.92% of patients, predominantly due to upgrading, with fewer cases demonstrating upstaging. No cases of regional lymph node metastasis were identified. On multivariable analysis, PPC (per 10% increase) was a significant predictor of unfavorable pathology (odds ratio: 2.95, 95% confidence interval: 1.60–6.58; <em>P</em> = 0.003), whereas age and PSA were not significant predictors. The receiver operating characteristic analysis identified a cutoff value of 12.22% positive cores.</div></div><div><h3>Conclusions</h3><div>A substantial proportion of Filipino patients with low-risk prostate cancer harbor more advanced disease at radical prostatectomy. Tumor volume, as measured by PPC, may help identify patients at risk of unfavorable pathology and aid in refining selection of candidates for active surveillance.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 247-252"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary detection of clinically significant prostate cancer by magnetic resonance imaging fusion-targeted and systematic transrectal ultrasound-guided biopsy: influence of prostate-specific antigen and prostate-specific antigen density in a retrospective paired cohort","authors":"Thanakrit Visuthikosol,&nbsp;Wit Viseshsindh","doi":"10.1016/j.prnil.2026.06.003","DOIUrl":"10.1016/j.prnil.2026.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Multiparametric magnetic resonance imaging (MRI)-targeted biopsy has improved prostate cancer detection, yet the relative diagnostic contributions of MRI-fusion-targeted biopsy and systematic transrectal ultrasound-guided (TRUS) biopsy across prostate-specific antigen (PSA) and PSA density (PSAD) levels remain uncertain. We evaluated the incremental detection of clinically significant prostate cancer (csPCa) between these techniques.</div></div><div><h3>Methods</h3><div>This retrospective single-center paired cohort study included 376 men with biopsy-proven prostate cancer who underwent both MRI fusion-targeted and 12-core systematic TRUS biopsy in the same session for a Prostate Imaging Reporting and Data System ≥3 lesion. csPCa was defined as International Society of Urological Pathology Grade Group ≥2. Detection was compared overall and across PSA strata (&lt;4, 4–10, 10.01–20, 20.01–50, &gt;50 ng/mL) and PSAD groups (&lt;0.10, 0.10–&lt;0.15, ≥0.15 ng/mL/cc) using exact McNemar testing on discordant pairs.</div></div><div><h3>Results</h3><div>Overall prostate cancer detection was similar between MRI fusion-targeted and systematic TRUS biopsy (318/376, 84.6% vs. 316/376, 84.0%; <em>P</em> = 0.927). csPCa was detected in 226/376 patients (60.1%) by MRI fusion-targeted biopsy and 212/376 (56.4%) by systematic biopsy; 60 MRI-only and 46 systematic-only discordant cases were observed (<em>P</em> = 0.206). MRI fusion-targeted biopsy showed numerically higher csPCa detection across the intermediate PSA range (4–50 ng/mL), with the largest absolute difference of 9.1 percentage points at PSA 20.01–50 ng/mL (<em>n</em> = 33); no PSA-stratified comparison reached statistical significance. csPCa detection increased with PSAD for both techniques across all three PSAD strata.</div></div><div><h3>Conclusion</h3><div>MRI fusion-targeted and systematic TRUS biopsies were complementary for csPCa detection. MRI fusion-targeted biopsy showed a numerical advantage in the intermediate PSA range, while csPCa detection increased with PSA density for both techniques. These findings support risk-stratified interpretation of biopsy yield and do not support routine omission of systematic cores when MRI-fusion-targeted biopsy is performed.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 278-282"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testosterone dynamics and oncologic safety in biochemically recurrent prostate cancer: An analysis of intermittent androgen deprivation therapy schedules","authors":"Jeong Hyun Lee,&nbsp;Sung Un Bang,&nbsp;Byung Ha Chung,&nbsp;Kyo Chul Koo,&nbsp;Tae Jin Kim","doi":"10.1016/j.prnil.2026.01.004","DOIUrl":"10.1016/j.prnil.2026.01.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Continuous androgen deprivation therapy (cADT) remains the standard treatment for advanced prostate cancer; however, it is associated with morbidity and a reduced quality of life. Intermittent ADT (iADT) is a potential strategy to mitigate these effects; however, the optimal scheduling for iADT remains unclear. This study evaluates the testosterone (T) suppression efficacy and the oncologic safety of different iADT schedules in patients with biochemically recurrent (BCR) prostate cancer.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 119 men with castrate T levels (&lt;20 ng/dL) and stable prostate-specific antigen (PSA) nadirs following cADT for BCR after radical prostatectomy or radiotherapy. Patients underwent iADT using one of three schedules: 1-on/1-off, 1-on/2-off, or 3-on/3-off months. We tracked serum T and PSA kinetics, and incidence rates of T breakthrough during a median follow-up of 12.0 months. Predictors of T breakthrough were investigated.</div></div><div><h3>Results</h3><div>The three groups had no differences in baseline clinicopathological and laboratory features. The 1-on/1-off regimen effectively suppressed serum T for up to six months, while 1-on/2-off and 3-on/3-off schedules were associated with higher incidences of T breakthrough (<em>P</em> = 0.002). Despite corresponding PSA rises, no radiographic progression was observed across groups. Predictors of successful T suppression included 1-on/1-off schedule and lower baseline T at iADT initiation.</div></div><div><h3>Conclusion</h3><div>A 1-on/1-off iADT schedule may offer a clinically viable alternative to cADT in maintaining successful T suppression. iADT may be particularly useful in patients seeking to reduce ADT side effects. Further studies are needed to validate these findings and optimize iADT protocols.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 230-235"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infectious complications after transrectal prostate biopsy in Algeria: A prospective study in a high-resistance setting","authors":"Samir Bouras","doi":"10.1016/j.prnil.2026.05.001","DOIUrl":"10.1016/j.prnil.2026.05.001","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to assess infectious outcomes and safety of fosfomycin trometamol compared with ciprofloxacin for the prevention of infectious complications following transrectal ultrasound–guided prostate biopsy (TRPB) in a local setting characterized by high fluoroquinolone resistance.</div></div><div><h3>Material and methods</h3><div>This prospective single-center cohort study included 423 consecutive patients undergoing TRPB between February 2023 and December 2025. An initial comparative phase involved 200 patients receiving either ciprofloxacin (n=83) or fosfomycin trometamol (n=117). Fosfomycin was subsequently adopted as the standard prophylactic regimen in an additional 223 patients. Infectious complications occurring within 30 days were recorded. A univariate analysis was performed to explore factors associated with infectious complications.</div></div><div><h3>Results</h3><div>The overall rate of infectious complications was 8.3% (35/423), mainly transient isolated fever (5.2%). Five patients (1.2%) required hospitalization for acute prostatitis. No statistically significant association with infectious complications was observed in the univariate analysis. In the initial comparative phase, no significant difference was observed between ciprofloxacin and fosfomycin regarding infectious outcomes.</div></div><div><h3>Conclusions</h3><div>In a context of high fluoroquinolone resistance, single-dose fosfomycin trometamol may represent a pragmatic prophylactic option, although comparative efficacy cannot be concluded from the present design.</div></div><div><h3>Level of Evidence</h3><div>Level 2.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 260-263"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Context-dependent role of digital rectal examination in a contemporary prostate biopsy cohort: differential predictive value with and without multiparametric magnetic resonance imaging","authors":"Horst E. Lagos-Beitz,&nbsp;Alexa Borbolla-Ruíz,&nbsp;Wolfgang González-Sosa,&nbsp;Carlos A. González-Quirós,&nbsp;Ricardo A. Castillejos-Molina,&nbsp;Jorge A. Alcacio-Mendoza,&nbsp;Gerardo Tena-Gonzalez Mendez","doi":"10.1016/j.prnil.2026.04.006","DOIUrl":"10.1016/j.prnil.2026.04.006","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify the context-dependent contribution of digital rectal examination (DRE) to the prediction of clinically significant prostate cancer (csPCa, International Society of Urological Pathology [ISUP] grade group ≥2) in a contemporary biopsy cohort, comparing a nonmultiparametric magnetic resonance imaging (mpMRI) clinical pathway with an mpMRI-informed pathway including prostate imaging–reporting and data system (PI-RADS).</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective analysis of 666 consecutive prostate biopsies at a single academic center (July 2017–December 2024). DRE was performed by urology residents and attending urologists. Two multivariable logistic regression models were constructed: Model A (full cohort, <em>n</em> = 612) included age, log-prostate-specific antigen (PSA), log-PSA density (PSAD), prior biopsy, and DRE; Model B (mpMRI subcohort, <em>N</em> = 306) additionally included PI-RADS score. Discrimination was assessed using area under the curve (AUC) and likelihood ratio tests. Sensitivity analyses evaluated any cancer (ISUP ≥1) and high-grade cancer (ISUP ≥4).</div></div><div><h3>Results</h3><div>csPCa prevalence was 30.7% (202/660), and DRE was suspicious in 52.3% (346/662). In Model A, DRE was independently associated with csPCa (adjusted odds ratio [aOR], 2.18, 95% confidence interval [CI]: 1.45–3.28, <em>P</em> &lt; 0.001), although the gain in discrimination was modest (ΔAUC = 0.009). In Model B, DRE showed borderline significance (aOR, 1.88, 95% CI: 1.01–3.52, <em>P</em> = 0.048) with negligible discrimination gain (ΔAUC = 0.002). Sensitivity analyses showed consistent findings. A dose–response gradient was observed: csPCa rates were 19.2% (normal), 31.6% (cT2a), and 58.9% (cT2b–T4) (p-trend &lt;0.0001).</div></div><div><h3>Conclusions</h3><div>DRE was independently associated with csPCa in the absence of mpMRI, but its incremental discriminative contribution was modest and became negligible once PI-RADS was incorporated. These findings support a limited, context-dependent role for DRE in contemporary biopsy pathways.</div></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"14 3","pages":"Pages 253-259"},"PeriodicalIF":4.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149014160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}