Prostate International最新文献

{"title":"Utility of transperineal template-guided mapping prostate biopsy in biopsy-naïve men with PI-RADS 1-2 on multiparametric magnetic resonance imaging","authors":"","doi":"10.1016/j.prnil.2024.04.002","DOIUrl":"10.1016/j.prnil.2024.04.002","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the outcomes of transperineal template-guided mapping biopsy (TTMB) in biopsy-naïve men with multiparametric magnetic resonance imaging (mpMRI) results of Prostate Imaging-Reporting and Data System (PI-RADS) 1-2.</p></div><div><h3>Patients and methods</h3><p>We retrospectively reviewed TTMB outcomes in biopsy naïve patients with PI-RADS 1-2 at a single center from August 2018 to May 2023. The patients' clinicopathologic data were reviewed, clinically significant prostate cancer (csPCa) detection rates were identified. We determined significant predictive factors and determined those optimal cutoff point using receiver operating characteristic (ROC) curves.</p></div><div><h3>Results</h3><p>255 biopsy naïve patients with PI-RADS 1-2 underwent TTMB. 72 (28.2%) were diagnosed with prostate cancer and 30 (11.8%) were diagnosed with csPCa. ROC curves were used to identify predictive factors for diagnosing csPCa. Age (area under ROC curve [AUC]: 0.74, 95% CI: 0.65–0.83, <em>P</em> &lt; 0.001) and prostate specific antigen density (PSAD) (AUC: 0.63, 95% CI: 0.53–0.72, <em>P</em> = 0.025) were significant predictive factors, and the optimal cutoff points determined using the Youden index were 65 years and 0.15 ng/mL/mL, respectively.</p></div><div><h3>Conclusion</h3><p>Of biopsy-naïve patients classified as PI-RADS 1–2, 11.8% were diagnosed with csPCa, and we identified age and PSAD as significant predictive factors. Our study will help determine the biopsy method for patients with PI-RADS 1–2 without biopsy experience.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 3","pages":"Pages 134-138"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000278/pdfft?md5=c3656b950e9849c93702a42d05f47111&pid=1-s2.0-S2287888224000278-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140795191","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":"Hematospermia does not increase the risk of prostate cancer detection in prostate biopsy","authors":"","doi":"10.1016/j.prnil.2024.06.004","DOIUrl":"10.1016/j.prnil.2024.06.004","url":null,"abstract":"<div><h3>Background</h3><p>Studies on the association between hematospermia and prostate cancer are insufficient. The purpose of this study was to determine the prevalence of prostate cancer in patients with hematospermia using large United States population data.</p></div><div><h3>Materials and methods</h3><p>This was a retrospective observational cohort study. Administrative claims data were extracted from the IBM® MarketScan Research Database. Patients who had undergone a prostate biopsy and newly diagnosed patients with hematospermia before prostate biopsy from January 2007 to December 2014 were included using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes. Treatment methods were identified with the Current Procedural Terminology (CPT) code.</p></div><div><h3>Results</h3><p>A total of 369,170 adult men had a prostate biopsy. The mean age of patients was 62 years (range, 18 to 100 years). Among the TRUS bx patients, the number of patients with hematospermia was 1,357 (0.4%). The prostate cancer detection rate was significantly lower in patients with hematospermia than in patients without hematospermia (30.4% vs. 48.0%, <em>P</em> &lt; 0.01). During the study period, 83,712 patients had hematospermia, of whom only 1.6% underwent a prostate biopsy.</p></div><div><h3>Conclusions</h3><p>Only 1.6% of hematospermia patients underwent a prostate biopsy. Prostate cancer was detected at a lower rate in those with hematospermia than in those without hematospermia. This study suggests that the presence of hematospermia prior to biopsy does not increase the risk of prostate cancer detection.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 3","pages":"Pages 151-154"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000357/pdfft?md5=7e5ec955a1f764d9fa87d348c6cb5853&pid=1-s2.0-S2287888224000357-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141402584","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 new parameter to increase the predictive value of multiparametric prostate magnetic resonance imaging for clinically significant prostate cancer in targeted biopsies: lesion density","authors":"","doi":"10.1016/j.prnil.2024.06.001","DOIUrl":"10.1016/j.prnil.2024.06.001","url":null,"abstract":"<div><h3>Aim</h3><p>To investigate the predictive value of lesion length in multiparametric prostate magnetic resonance imaging with respect to prostate volume for clinically significant prostate cancer diagnosis in targeted biopsies.</p></div><div><h3>Materials and methods</h3><p>The data of biopsy-naïve patients in the Turkish Urooncology Association Prostate Cancer Database who underwent targeted prostate biopsies were included in this study. Lesion density is calculated as the ratio of lesion length (mm) in MR to prostate volume (cc). The biopsy results were divided into either clinically significant or insignificant cancer and benign groups. The difference in parameters between groups is evaluated by multivariable analysis to determine independent risk factors for clinically significant prostate cancer diagnosis.</p></div><div><h3>Results</h3><p>A total of 590 lesion biopsies were included in the study. In univariable analysis, prostate-specific antigen (PSA), PSA density, number of cores taken, lesion length, lesion density, patient age, and digital rectal examination findings were found to be different at a statistically significant level between groups (<em>P</em> values, respectively: 0.001, &lt;0.001, &lt;0.001, &lt;0.001, &lt;0.001, 0.012, 0.001). Subgroup analysis demonstrated that the lesion density was still significantly different between groups for all Prostate Imaging - Reporting and Data System (PI-RADS) 3, 4, and 5 subgroups (<em>P</em> values, respectively: 0.001, &lt;0.001, &lt;0.001). The multivariable analysis demonstrated that lesion density, along with the number of cores taken and the PI-RADS score of the lesion is an independent risk factor for predicting clinically significant prostate cancer, with the highest odds ratio among all parameters (OR: 27.31 [CI: 7.9–94.0]).</p></div><div><h3>Conclusion</h3><p>This study demonstrated that lesion size with respect to prostate volume is an important independent risk factor for the prediction of clinically significant prostate cancer in the lesion-targeted biopsy. Combined with the PI-RADS score and parameters like digital rectal examination (DRE) findings and PSA density may further increase predictive power and help clinicians decide whether to perform a biopsy in low-risk patients or perform a re-biopsy for high-risk patients subsequent to an initial negative biopsy.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 3","pages":"Pages 145-150"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000321/pdfft?md5=e928443ad0100bb55c7ccd02b9735a62&pid=1-s2.0-S2287888224000321-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413064","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":"Does the type of the previous biopsy affect the fusion prostate biopsy results?","authors":"Gokhan Sonmez ,&nbsp;Abdullah Golbasi ,&nbsp;Unsal Bas ,&nbsp;Emre C. Akınsal ,&nbsp;Numan Baydilli ,&nbsp;Sevket T. Tombul ,&nbsp;Halil Tosun ,&nbsp;Abdullah Demirtas ,&nbsp;Deniz Demirci","doi":"10.1016/j.prnil.2024.07.001","DOIUrl":"10.1016/j.prnil.2024.07.001","url":null,"abstract":"<div><h3>Background</h3><p>It has been more than a decade since fusion prostate biopsy (FPB) has been used in the diagnosis of prostate cancer (PCa). Therefore, patients with a previous history of negative FPB and ongoing suspicion of PCa are beginning to emerge. This study investigated whether the first biopsy type (standard or fusion) should be effective in deciding on a second biopsy.</p></div><div><h3>Methods</h3><p>Male patients aged 40–75, with a serum prostate-specific antigen (PSA) value of less than 10 ng/mL and a negative biopsy history within the last 24 months, who underwent FPB in our clinic due to persistent PSA elevation and/or suspicious multiparametric prostate magnetic resonance imaging (MpMRI) findings were included to the study. Patients were divided into groups according to the type of first biopsy (Group 1; those whose first biopsy was FPB, Group 2; those whose first biopsy was standard prostate biopsy). Some demographic and clinical data of the groups, as well as PCa detection rates, were compared. A <em>p</em> value of less than 0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>A total of 275 patients (Group 1: 84, Group 2: 191) were included in this study. The groups were similar in terms of age, PSA values before the first biopsy, PSA values before the second biopsy, family history of PCa, and prostate volume. PCa was detected at a higher rate in Group 2 than Group 1 (23% vs 15.5%, <em>p</em> = 0.044).</p></div><div><h3>Concluison</h3><p>The data obtained from this study indicate that the type of initial biopsy should be taken into account when deciding on FPB in secondary patients with a previous negative biopsy history.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 3","pages":"Pages 155-159"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000527/pdfft?md5=1296520cd0b28655a5b737462386ff44&pid=1-s2.0-S2287888224000527-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701799","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":"Current status and therapeutic value of extended pelvic lymph node dissection during radical prostatectomy for prostate cancer","authors":"","doi":"10.1016/j.prnil.2024.03.002","DOIUrl":"10.1016/j.prnil.2024.03.002","url":null,"abstract":"<div><p>Pelvic lymph node dissection (PLND) is important for accurate staging and prognosis of prostate cancer. Several guidelines recommend extended pelvic lymph node dissection (ePLND) for patients with non-low-risk prostate cancer. However, the therapeutic benefits of ePLND are unclear. Therefore, we reviewed the literature regarding the therapeutic value of PLND for prostate cancer. Although some reports showed that ePLND improves postoperative biochemical recurrence and postoperative overall survival compared with limited lymph node dissection, other reports show no benefits. Overall, the current evidence supporting ePLND is poor. The extent of PLND varied among studies concerning the therapeutic value of ePLND, and study design issues such as patient background and length of follow-up period were different. Some reports demonstrated potential therapeutic value for ePLND when adjusting for patient background. Focusing on patients with high-grade prostate cancer may be important in demonstrating the therapeutic benefits of ePLND. Although the incidence of major adverse events related to ePLND was low, the possibility of adverse events such as lymphedema and lymphocele formation should be considered. In the future, we hope that evidence for optimal selection criteria for ePLND and the extent of ePLND will become more definitive and evidence for the therapeutic value of ePLND will be developed.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 3","pages":"Pages 117-127"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000229/pdfft?md5=ef02bb073d73982face4a6c8ed64de7b&pid=1-s2.0-S2287888224000229-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140201896","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":"Insights from immunomics and metabolomics on the associations between prostatic diseases and coronavirus disease 2019","authors":"Feixiang Yang ,&nbsp;Peng Guo ,&nbsp;Kun Wang ,&nbsp;Xiangyu Zhang ,&nbsp;Zhehao Hu ,&nbsp;Qiyue Lou ,&nbsp;Qintao Ge ,&nbsp;Yiding Chen ,&nbsp;Chaozhao Liang ,&nbsp;Jialin Meng","doi":"10.1016/j.prnil.2024.07.003","DOIUrl":"10.1016/j.prnil.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><p>The causal associations and potential mechanisms between prostatic diseases, the predominant male urological disorders, and the course of COVID-19 remain unclear.</p></div><div><h3>Methods</h3><p>A two-sample Mendelian randomization (MR) analysis was performed to evaluate causal associations between prostate cancer, benign prostatic hyperplasia, and prostatitis and different COVID-19 outcomes (SARS-CoV-2 infection, hospitalized COVID-19, and severe COVID-19). Reverse MR, linkage disequilibrium score regression, and Bayesian colocalization analyses were subsequently performed to strengthen the identified causal relationships. Furthermore, immunome- and metabolome-wide MR analysis was conducted to prioritize COVID-19-associated immune characteristics and metabolites. Two-step MR analysis was performed to evaluate the mediating effects of the immunome and metabolome on the associations between prostatic diseases and COVID-19.</p></div><div><h3>Results</h3><p>Genetically predicted prostatic diseases were not causally associated with severe COVID-19, while prostatitis was suggested to be an independent risk factor for SARS-CoV-2 infection (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.01 to 1.23; <em>P</em> = 0.03). Multiple sensitivity tests verified the reliability of the established causal relationships. Dozens of blood immune and metabolic features were identified to reveal the immune and metabolic profiles of different COVID-19 courses. Moreover, PDL-1 on monocyte was found to mediate the interaction between prostatitis and SARS-CoV-2 infection, with a mediation proportion of 9.2%.</p></div><div><h3>Conclusion</h3><p>Our study identified the causal relationships of prostatic diseases with COVID-19 and suggested pathways explaining these associations through alterations in the blood immunome and metabolome.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 3","pages":"Pages 167-177"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000540/pdfft?md5=9c4bcd3cc546cce97c2f5f9585e46dc6&pid=1-s2.0-S2287888224000540-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853386","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":"Comparison of oncological outcomes between extended and no pelvic lymph node dissection in patients with high- or very high-risk prostate cancer: a multi-institutional study","authors":"Satoshi Washino ,&nbsp;Makoto Kawase ,&nbsp;Masaki Shimbo ,&nbsp;Takeshi Yamasaki ,&nbsp;Kojiro Ohba ,&nbsp;Jun Miki ,&nbsp;Tomoaki Miyagawa ,&nbsp;Takuya Koie","doi":"10.1016/j.prnil.2024.07.002","DOIUrl":"10.1016/j.prnil.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><p>Despite providing valuable staging and prognostic information, the therapeutic benefit of pelvic lymph node dissection (PLND) remains uncertain. We sought to assess the effect of extended PLND (ePLND) on the biochemical recurrence (BCR) of patients with National Comprehensive Cancer Net (NCCN) high- or very high-risk prostate cancer treated via robot-assisted radical prostatectomy (RARP).</p></div><div><h3>Methods</h3><p>We used a multi-institutional database (six centers) to assess 989 patients who underwent RARP from 2014 to 2022 with or without ePLND, among which 699 patients underwent BCR analysis. We performed 1:1 propensity score matching to account for potential differences between the two groups and compared them in terms of BCR-free survival. Cox's regression models were used to test the effect of ePLND on BCR.</p></div><div><h3>Results</h3><p>A total of 585 patients underwent ePLND and 404 did not. A median of 19 lymph nodes was removed in the ePLND cohort. After propensity score matching, no significant differences in BCR-free survival were observed between the two cohorts (HR 1.108, 95% CI 0.776–1.582, <em>p</em> = 0.556). Multivariable Cox's regression models adjusted for the preoperative and postoperative tumor characteristics revealed that PLND was not an independent predictor of BCR.</p></div><div><h3>Conclusion</h3><p>No significant differences in BCR-free survival were observed between NCCN high- or very high-risk prostate cancer patients who underwent PLND during RARP and those who did not. The therapeutic utility of PLND thus remains unclear.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 3","pages":"Pages 160-166"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000539/pdfft?md5=002f028d717b55fb0893bcf6f2a21686&pid=1-s2.0-S2287888224000539-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853177","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":"Association between preradiation therapy prostate-specific antigen levels and radiation therapy failure after prostatectomy: a propensity score matched analysis","authors":"Younsoo Chung ,&nbsp;Sang Hun Song ,&nbsp;Hakmin Lee ,&nbsp;Jong Ho Park ,&nbsp;Sung Kyu Hong","doi":"10.1016/j.prnil.2024.03.001","DOIUrl":"10.1016/j.prnil.2024.03.001","url":null,"abstract":"<div><h3>Purpose</h3><p>We sought to determine the association between the pre-radiation therapy prostate-specific antigen (pre-RT PSA) 0.5 and RT failure in post-radical prostatectomy (post-RP) patients. Our study also investigated the prognostic factors for the failure of RT given concurrently with hormone therapy (HT) after RP.</p></div><div><h3>Materials and methods</h3><p>We retrospectively reviewed our institutional RP data from July 2004 to November 2021. Patients without concurrent hormone therapy were excluded. Propensity score matching was performed. Kaplan–Meier (KM) curve analysis was employed for RT failure-free survival, overall survival (OS), and cancer-specific survival (CSS). Cox regression analysis was used for the RT failure hazard ratio (HR).</p></div><div><h3>Results</h3><p>After propensity score matching, 193 patients were assigned to the pre-RT PSA ≥0.5 (high-P) arm, and 193 patients were assigned to the pre-RT PSA &lt;0.5 (low-P) arm. There were no significant differences between the two arms after propensity score matching in terms of baseline characteristics and pathologic outcomes. High-P was associated with RT failure-free survival (<em>P</em> = 0.004), OS (<em>P</em> = 0.046), and CSS (<em>P</em> = 0.027). In a multi-variable Cox proportional hazards regression analysis, seminal vesicle invasion, lymph node invasion, the absence of prostatic intraepithelial neoplasia (PIN), and high-P were identified as significant risk factors for RT failure.</p></div><div><h3>Conclusion</h3><p>High-P was significantly unfavorable with RT failure-free survival, OS, and CSS in patients who underwent RT after radical prostatectomy with concurrent HT. Seminal vesicle invasion, lymph node invasion, and the absence of PIN were identified as significant prognostic factors for RT failure.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 2","pages":"Pages 90-95"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000059/pdfft?md5=1a328ae2b6adac464828d10be09cd55b&pid=1-s2.0-S2287888224000059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140127234","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":"The impact of obesity and sexual behavior on prostate cancer risk is mediated by testosterone levels: a mendelian randomization study and mediation analysis","authors":"Huajie Di ,&nbsp;Yi Wen ,&nbsp;Junyan Wang ,&nbsp;Jiayu Wang ,&nbsp;Yeqing Wang ,&nbsp;Yuan Li ,&nbsp;Fanghao Sun","doi":"10.1016/j.prnil.2024.03.003","DOIUrl":"10.1016/j.prnil.2024.03.003","url":null,"abstract":"<div><h3>Background</h3><p>The relationship between obesity, sexual behavior, and prostate cancer (PCa) has been widely debated, contributing to a lack of understanding of its potential mechanisms and hindering the development of effective prevention measures.</p></div><div><h3>Purpose</h3><p>The aim of this study was to examine the causal effect of body mass index (BMI), age at first sexual intercourse (AFS), and bioavailable testosterone levels on PCa while also quantifying the potential roles of mediators.</p></div><div><h3>Method</h3><p>We conducted a Mendelian randomization (MR) study using summary statistics from genome-wide associations of BMI (152,893 European males), AFS (182,791 European males), bioavailable testosterone (184,205 European males), and PCa (79,148 cases, 61,106 controls, European ancestry). Inverse-variance weighted method, weighted median method, MR-Egger regression, Least Absolute Shrinkage and Selection Operator (LASSO), and outlier test were used for MR analyses. Reverse MR and mediation analysis were performed. Data analyses were conducted from December 2022 to July 2023.</p></div><div><h3>Results</h3><p>The results showed that genetic liability to BMI was protective of PCa (OR, 0.82; 95% CI: 0.74-0.91; <em>P</em> = 3.29 × 10⁻⁴). Genetic liability to later AFS (OR, 1.28; 95% CI: 1.08-1.53; <em>P</em> = 5.64 × 10⁻³) and higher bioavailable testosterone levels (OR = 1.11, 95% CI: 1.01–1.24, <em>P</em> = 0.04) were associated with an increased risk of PCa. All of these potential causal effects could only be forwarded and were not affected by prostate specific antigen (PSA) screening. After controlling for bioavailable testosterone levels, the causal impact of BMI and AFS on PCa was no longer significant. The mediation analysis suggested that the causal influence of AFS/BMI on PCa relied on bioavailable testosterone levels.</p></div><div><h3>Conclusion</h3><p>In conclusion, the difference between the univariable and multivariable MR results suggested that the causal influence of BMI and AFS on PCa relied on bioavailable testosterone levels. Further work is needed to identify other risk factors and to elucidate the specific mechanisms that underlie this causal pathway.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 2","pages":"Pages 96-103"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000230/pdfft?md5=ff5b57541bc01564214d012434eb8ab7&pid=1-s2.0-S2287888224000230-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399036","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":"Propensity score matched analysis of functional outcome in five thousand cases of robot-assisted radical prostatectomy versus high-intensity focused ultrasound","authors":"Junhyun Nam ,&nbsp;Jung Kwon Kim ,&nbsp;Jong Jin Oh ,&nbsp;Sangchul Lee ,&nbsp;Seok-Soo Byun ,&nbsp;Sung Kyu Hong ,&nbsp;Sang Hun Song","doi":"10.1016/j.prnil.2024.03.004","DOIUrl":"10.1016/j.prnil.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>To evaluate functional outcome after robot-assisted radical prostatectomy (RARP) and high-intensity focused ultrasound (HIFU) ablation for prostate cancer.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 4,983 RARP and 230 HIFU procedures performed at a single tertiary center. A 1:4 ratio propensity score matching (PSM) was performed to achieve baseline equivalence in age, body mass index (BMI), comorbidities, clinical stage, prostate specific antigen (PSA), prostate volume, biopsy grade, and number of positive cores. Functional outcomes based on International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) scores, and incontinence rates were evaluated at 6, 12, and 24 months.</p></div><div><h3>Results</h3><p>total of 193 HIFU cases matched to 760 cases of RARP, were included. No differences were observed in perioperative IPSS at all follow-up periods. Despite comparative erectile function at baseline, HIFU showed significantly better erectile function preservation compared to RARP, with mean IIEF-5 scores of 9.5 versus 4.8, 9.5 versus 5.8, and 8.4 versus 6.7 at 6, 12, and 24 months, respectively (all <em>P</em> &lt; 0.001). Pad-free rates at 6 and 12 months were comparable, with over 96% achieving continence at 12 months in both groups, although the rate of ≤1 pad/day at last follow-up was slightly better in HIFU (98.9% vs. 96.7%, <em>P</em> = 0.049). Subgroup analysis on partial (PGA) and whole gland ablation (WGA) showed no differences in IIEF-5 and incontinence but increased voiding difficulty in WGA versus PGA after 12 months of therapy (<em>P</em> &lt; 0.05). Preoperative IIEF-5 ≥17 and HIFU were significant predictors of early erectile function recovery at 6 months (HR 4.4 and 5.0; all <em>P</em> &lt; 0.001). No differences were observed in treatment-free survival between PGA, WGA, and RARP.</p></div><div><h3>Conclusion</h3><p>HIFU shows better performance in early recovery and preservation of erectile function after treatment for prostate cancer without increasing the risk of treatment failure. Patients with moderate to severe erectile dysfunction (IIEF-5 &lt;17) prior to surgery should be warned of poor recovery after treatment.</p></div>","PeriodicalId":20845,"journal":{"name":"Prostate International","volume":"12 2","pages":"Pages 104-109"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2287888224000242/pdfft?md5=f1637b0c9f5fa45b613b5aec5c2d86ba&pid=1-s2.0-S2287888224000242-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407001","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}