Asian Journal of Urology最新文献

{"title":"A review based on expert opinions for robot-assisted simple prostatectomy for large benign prostatic hyperplasia","authors":"Bin Xu ,&nbsp;Linhui Wang ,&nbsp;Qingyi Zhu ,&nbsp;Xing Ai ,&nbsp;Wei Guan ,&nbsp;Guoqing Ding ,&nbsp;Dongliang Xu ,&nbsp;Liaoyuan Li ,&nbsp;Gutian Zhang ,&nbsp;Liping Xie ,&nbsp;Chinese Benign Prostatic Hyperplasia Consortium","doi":"10.1016/j.ajur.2025.03.002","DOIUrl":"10.1016/j.ajur.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>Robot-assisted simple prostatectomy (RASP) is increasingly used as a surgical treatment option for large benign prostatic hyperplasia (BPH) (&gt;80 mL). However, there is no sufficient expert consensus or guidelines to guide clinical practice. We aimed to obtain expert opinions for RASP for large BPH.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was performed in April 2024 using the PubMed, Embase, and Web of Science databases. Search terms were combined to construct the following search strings: (robotic) AND (simple OR benign) AND (prostatectomy). Search results were filtered by language (English only), species (human), and publication type (original article). This study used a two-phase modified Delphi approach.</div></div><div><h3>Results</h3><div>In this expert consensus, some frequently used RASP techniques, including robot-assisted retropubic prostatectomy, robot-assisted transvesical prostatectomy, and robot-assisted urethra-sparing prostatectomy, are described. RASP offers a short learning curve for surgeons with experience in robotic surgery. Severe complications are rare in patients who undergo RASP.</div></div><div><h3>Conclusion</h3><div>RASP technique can be recommended as a safe and effective minimally invasive treatment for symptomatic BPH patients with large prostate glands.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 290-294"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological features and prognosis of small cell carcinoma of the urinary bladder","authors":"Xintao Tian ,&nbsp;Huiqing Jia ,&nbsp;Yue Liu ,&nbsp;Ye Liang ,&nbsp;Shaonan Yang ,&nbsp;Zhijuan Liang ,&nbsp;Guofeng Ma ,&nbsp;Haitao Niu","doi":"10.1016/j.ajur.2024.10.008","DOIUrl":"10.1016/j.ajur.2024.10.008","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder (SCCUB).</div></div><div><h3>Methods</h3><div>Clinicopathological data and prognosis of 24 patients with primary SCCUB treated at the Affiliated Hospital of Qingdao University (from January 2016 to December 2021) were retrospectively collected and compared with 335 patients with primary high-grade urothelial carcinoma (HG-UC) during the same period. The study endpoints were disease-free survival (DFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>Of the 24 patients with SCCUB, 19 were male and five were female. Eight (33%) cases were pure SCCUB (pSCCUB). Sixteen (67%) cases were mixed SCCUB (mSCCUB), all of which were mixed with urothelial carcinoma. All patients underwent surgery and 13 (76%, 13/17; seven patients were lost to follow-up) patients received postoperative adjuvant chemotherapy. We found no significant difference in clinicopathological features between pSCCUB and mSCCUB. However, compared to HG-UC, SCCUB had higher lymph node metastasis (<em>p</em>=0.014), more lymphovascular invasion (<em>p</em>=0.024), higher Ki-67 expression (<em>p</em>&lt;0.001), and more disease progression events (<em>p</em>=0.001). Median DFS and OS for SCCUB were 22 months and 38 months, respectively. The Kaplan-Meier survival curve showed that the pathological type or surgical type did not affect DFS or OS of SCCUB. However, SCCUB patients had worse DFS and OS than HG-UC patients (both <em>p</em>&lt;0.05). The multivariate Cox analysis showed that the tumor size (hazard ratio 1.44, 95% CI 1.96–2.15, <em>p</em>=0.048) was an independent factor affecting DFS of SCCUB patients.</div></div><div><h3>Conclusion</h3><div>Compared with the common HG-UC, SCCUB is rare with specific clinicopathological features and a worse prognosis.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 393-401"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney-sparing approach for upper tract urothelial carcinoma: An update on current evidence","authors":"Ivan Ching Ho Ko ,&nbsp;Chris Ho Ming Wong ,&nbsp;David Ka Wai Leung ,&nbsp;Alex Qin-yang Liu ,&nbsp;Kevin Cheuk Kin Cheng ,&nbsp;Brian Wai Hei Siu ,&nbsp;Steffi Kar Kei Yuen ,&nbsp;Nikhil Vasdev ,&nbsp;Keiichiro Mori ,&nbsp;Karl H. Tully ,&nbsp;Dmitry Enikeev ,&nbsp;Anthony Chi Fai Ng ,&nbsp;Jeremy Yuen Chun Teoh","doi":"10.1016/j.ajur.2024.08.003","DOIUrl":"10.1016/j.ajur.2024.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>This article reviews the latest updates and outcomes of kidney-sparing surgery (KSS) in patients with upper tract urothelial carcinoma (UTUC).</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed using the PubMed and Embase databases to identify related English-language studies published within the last 10 years. Key search words included “upper urinary tract tumour/cancer/carcinoma”, “kidney-sparing surgery or approach”, “endoscopic treatment for upper tract tumour/cancer/carcinoma”, “topical instillation in the upper urinary tract”, and “urinary marker for urothelial carcinoma”. References within the identified literature were explored and evaluated for relevance.</div></div><div><h3>Results</h3><div>KSS is recommended for both low-risk and selected high-risk UTUC with imperative indications such as solitary kidney. Studies have shown comparable oncological outcomes after KSS including endoscopic ablation, segmental ureterectomy, and topical instillation of novel agents when compared to radical nephroureterectomy in well-selected cases. The development of novel diagnostic tools and risk-stratifying models allows optimal case selection for KSS without compromising oncological outcomes.</div></div><div><h3>Conclusion</h3><div>Kidney-sparing approach for UTUC is an evolving and promising area in urologic oncology, driven by advances in technology, better diagnostic tools, and novel therapeutic agents. Our article provides a comprehensive review of the latest advancements and clinical recommendations. While current evidence is mainly based on retrospective studies, prospective trials are required to address important but unanswered clinical questions in this field.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 295-308"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experimental evaluation of the optimum applied pressure and number of cuffs for artificial sphincter in fluid flow control in an ex vivo model","authors":"Pourya Shokri ,&nbsp;Seyed Amir Mohsen Ziaee ,&nbsp;Nasrin Borumandnia ,&nbsp;Shahin Tabatabaei","doi":"10.1016/j.ajur.2024.12.004","DOIUrl":"10.1016/j.ajur.2024.12.004","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design, and to investigate the relationship between the number of cuffs used in urinary control and the change in demand force.</div></div><div><h3>Method</h3><div>In this study, five sheep bladders were used to design and build a biomechanical evaluation system. The biomechanical system included the bladder, pressure gauge, pressure regulator system of the bladder, and force application system by the cuff. In this study, we increased the fluid pressure inside the bladder from 0 cmH₂O to 200 cmH₂O (1 cmH₂O=0.098 kPa), and at each point, the force applied by the cuff to prevent fluid leakage was measured and recorded.</div></div><div><h3>Results</h3><div>The study revealed that a mean tensile force of 2.81 (standard deviation 0.23) N for a single cuff and 1.63 (standard deviation 0.16) N for double cuffs with symmetrical pressure effectively prevented bladder fluid leakage in the pressure range from 75 cmH₂O to 100 cmH₂O (<em>p</em>&lt;0.001). However, there were no significant differences in results when comparing the applied tensile force required by double cuffs with asymmetric tensile force to that of the single cuff use. Furthermore, using three cuffs instead of two did not yield significantly different outcomes.</div></div><div><h3>Conclusion</h3><div>Using double cuffs with symmetrical pressure had a greater effect compared with a single cuff with the same tensile force. Although multiple cuffs with varying tensile forces were not found to be useful in controlling urine leakage in this study, it is suggested that applying variable forces alternately and rotationally among several cuffs may reduce long-term risks such as atrophy and necrosis. Future <em>in vivo</em> studies are recommended to further evaluate efficiency.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 402-406"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder preservation alternatives in non-metastatic muscle-invasive bladder tumor: A systematic review and meta-analysis","authors":"Diego Parrao ,&nbsp;Nemecio Lizana ,&nbsp;Catalina Saavedra ,&nbsp;Valentina Fernández ,&nbsp;Carolina B. Lindsay ,&nbsp;Matías Larrañaga ,&nbsp;Mario I. Fernández ,&nbsp;Juan Cristóbal Bravo","doi":"10.1016/j.ajur.2024.08.005","DOIUrl":"10.1016/j.ajur.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically review the most recent scientific literature regarding modern strategies for organ preservation in the treatment of non-metastatic muscle-invasive bladder cancer.</div></div><div><h3>Methods</h3><div>Literature search was made using PubMed, Google Scholar, EMBASE, Wiley Library, and ClinicalTrials.gov following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. The primary outcome was 5-year overall survival rate, which was addressed by a systematic review and meta-analysis. The risk of bias and quality of evidence were assessed according to the Cochrane Collaboration and the Grading of Recommendations, Assessment, Development and Evaluation system.</div></div><div><h3>Results</h3><div>The evidence is consistent in showing that 5-year survival of trimodality therapy is similar to radical cystectomy in selected patients, ranging between 29% and 73%. Patients undergoing bladder-sparing therapy were found to have better outcomes in terms of quality of life and sociability than those undergoing radical cystectomy. Immunotherapy is establishing itself as a strategy for organ-preservation treatment, showing complete response rates between 42% and 100%. However, most of these results have been obtained from ongoing clinical trials. Furthermore, there are still no studies comparing the efficacy among the different available therapies.</div></div><div><h3>Conclusion</h3><div>Although radical cystectomy remains the gold standard treatment for muscle-invasive bladder cancer, its significant morbidity has prompted the exploration of alternative therapies. In this context, bladder preservation therapies, though supported by limited literature, emerge as a potential alternative that could offer comparable oncological outcomes in selected patients.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 309-319"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-port transvesical robot-assisted simple prostatectomy with total urethral preservation for patients unable to adopt the lithotomy position: A case report","authors":"Lichen Chen ,&nbsp;Guanqun Ju ,&nbsp;Xinglin Chen ,&nbsp;Mingyue Tan ,&nbsp;Dongliang Xu","doi":"10.1016/j.ajur.2024.10.003","DOIUrl":"10.1016/j.ajur.2024.10.003","url":null,"abstract":"<div><div>Benign prostatic hyperplasia (BPH), prevalent in the aging male population, presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries, precluding conventional lithotomy and transurethral approaches. This report introduces an innovative, single-port transvesical robot-assisted simple prostatectomy with total urethral preservation. This pioneering technique, tailored for complex BPH management, demonstrated its efficacy and potential through favorable postoperative outcomes. This report underscores single-port transvesical robot-assisted simple prostatectomy with total urethral preservation as a promising surgical option for patients with BPH who are unable to assume the lithotomy position.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 407-411"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term urinary continence outcomes after extraperitoneal single-site robot-assisted radical prostatectomy: A retrospective study","authors":"Fadi Mousa Al Kalailah ,&nbsp;Di Gu ,&nbsp;Yubo Wang ,&nbsp;Mingzhao Li ,&nbsp;Guohua Zeng","doi":"10.1016/j.ajur.2025.03.006","DOIUrl":"10.1016/j.ajur.2025.03.006","url":null,"abstract":"<div><h3>Objective</h3><div>Radical prostatectomy (RP) is considered the gold standard treatment for patients with localized prostate cancer (PCa). All patients undergoing RP, either open, laparoscopic, or robotic, are at risk of developing urinary incontinence after RP. Our study aimed to analyze possible predictors of early postoperative (within 3 months) urinary continence (UC) outcomes following extraperitoneal single-site robot-assisted RP (ss-RARP) for localized PCa.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023. Patient characteristics (age, body mass index, prostate volume, prostate dimensions, preoperative and postoperative membranous urethral length, and percentage of membranous urethra removed) were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP. From the time of urinary catheter removal after surgery, the recovery of UC was followed up every month, and UC was defined as using ≤1 safety pad daily, known as social continence.</div></div><div><h3>Results</h3><div>The proportions of continent patients immediately after urinary catheter removal, 1 month, and 3 months after extraperitoneal ss-RARP were 22%, 49%, and 82%, respectively. The multivariate logistic regression analysis showed that the percentage of membranous urethra removed (<em>p</em>=0.016) and prostate volume (<em>p</em>=0.049) were associated with social UC recovery immediately after urinary catheter removal, and craniocaudal dimension of the prostate (<em>p</em>=0.042) and age (<em>p</em>=0.014) were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP, respectively.</div></div><div><h3>Conclusion</h3><div>The percentage of membranous urethra removed, prostate volume, craniocaudal dimension of the prostate, and age are independent risk factors for social UC early after extraperitoneal ss-RARP.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 350-356"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimized graph neural network-multilayer perceptron fusion classifier for metastatic prostate cancer detection in Western and Asian populations","authors":"Fengxian Han ,&nbsp;Xiaohui Fan ,&nbsp;Pengwei Long ,&nbsp;Wenhui Zhang ,&nbsp;Qiting Li ,&nbsp;Yingxuan Li ,&nbsp;Xingpeng Guo ,&nbsp;Yinran Luo ,&nbsp;Rongqi Wen ,&nbsp;Sheng Wang ,&nbsp;Shan Zhang ,&nbsp;Yizhuo Li ,&nbsp;Yan Wang ,&nbsp;Xu Gao ,&nbsp;Jing Li","doi":"10.1016/j.ajur.2024.09.009","DOIUrl":"10.1016/j.ajur.2024.09.009","url":null,"abstract":"<div><h3>Objective</h3><div>Prostate cancer (PCa) exhibits significant genomic differences between Western and Asian populations. This study aimed to design a predictive model applicable across diverse populations while selecting a limited set of genes suitable for clinical implementation.</div></div><div><h3>Methods</h3><div>We utilized an integrated dataset of 1360 whole-exome and whole-genome sequences from Chinese and Western PCa cohorts to develop and evaluate the model. External validation was conducted using an independent cohort of patients. A graph neural network architecture, termed the pathway-aware multi-layered hierarchical network-Western and Asian (P-NETwa), was developed and trained on combined genomic profiles from Chinese and Western cohorts. The model employed a multilayer perceptron (MLP) to identify key signature genes from multi-omics data, enabling precise prediction of PCa metastasis.</div></div><div><h3>Results</h3><div>The model achieved an accuracy of 0.87 and an F1-score of 0.85 on Western population datasets. The application of integrated Chinese and Western population data improved the accuracy to 0.88, achieving an F1-score of 0.75. The analysis identified 18 signature genes implicated in PCa progression, including established markers (<em>AR</em> and <em>TP53</em>) and novel candidates (<em>MUC16, MUC4,</em> and <em>ASB12</em>). For clinical adoption, the model was optimized for commercially available gene panels while maintaining high classification accuracy. Additionally, a user-friendly web interface was developed to facilitate real-time prediction of primary versus metastatic status using the pre-trained P-NETwa-MLP model.</div></div><div><h3>Conclusion</h3><div>The P-NETwa-MLP model integrates a query system that allows for efficient retrieval of prediction outcomes and associated genomic signatures via sample ID, enhancing its potential for seamless integration into clinical workflows.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 327-337"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two DNAH5 mutations in a Kartagener syndrome patient with azoospermia","authors":"Yang Xiong ,&nbsp;Mingyu Hu ,&nbsp;Qing Jiang,&nbsp;Wei Wang,&nbsp;Jiuhong Yuan,&nbsp;Yangchang Zhang,&nbsp;Feng Qin","doi":"10.1016/j.ajur.2025.04.001","DOIUrl":"10.1016/j.ajur.2025.04.001","url":null,"abstract":"","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 414-416"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of the clinical significance of the expression of immunohistochemical biomarkers Enhancer of zeste homolog 2 and Forkhead box M1 in localized prostate cancer tissue: A Greek retrospective study","authors":"Sotirios Koubardas ,&nbsp;Dimitrios Goutas ,&nbsp;Iliana Mani ,&nbsp;Evangelia Krikou ,&nbsp;Ourania Mpatsi ,&nbsp;Harikleia Gakiopoulou ,&nbsp;Christos Alamanis ,&nbsp;Andreas C. Lazaris","doi":"10.1016/j.ajur.2024.09.007","DOIUrl":"10.1016/j.ajur.2024.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>In recent decades, studies have underscored nuclear proteins and signaling pathways in prostate cancer (PCa) development. Key biomarkers like Enhancer of zeste homolog 2 (EZH2) and Forkhead box M1 (FOXM1) are expressed in both healthy and malignant prostate cells. This study aimed to demonstrate the relationship between pathological characteristics, survival, recurrence, and tissue expression of EZH2 and FOXM1 in high-risk PCa patients.</div></div><div><h3>Methods</h3><div>PCa tissues were used in a retrospective analysis that spanned from September 2009 to August 2019. Inclusion criteria comprised pathological tumor stage (pT) 3 patients with positive surgical margins or tumor proximity to inked margins within 5 mm. After case selection, tissue slides were stained for EZH2 and FOXM1 antibodies, and Allred scores were calculated. Patients or relatives of deceased patients were contacted for signed agreements and disease follow-ups.</div></div><div><h3>Results</h3><div>The pT3b, ductal carcinoma component, and moderate EZH2 expression were associated with relapse (odds ratio [OR] 6.21, 95% confidence interval [CI] 1.41–27.27, <em>p</em>=0.016; OR 7.29, 95% CI 1.03–51.43, <em>p</em>=0.046; OR 5.96, 95% CI 1.09–32.48, <em>p</em>=0.039; respectively). The unilateral and bilateral seminal vesicle invasion increased the likelihood of recurrence by 9.98 times and 5.36 times, and the risk of death by around 9.78 times and 10.79 times, respectively. The pT3b was linked to higher death likelihood (OR 7.16, 95% CI 1.38–37.23, <em>p</em>=0.019), while moderate EZH2 expression did not show statistical significance (OR 4.54, 95% CI 0.87–23.60, <em>p</em>=0.072, marginally). Pathological regional lymph node stage (pN) 1 had significantly higher probability of mortality than pN unknown (3.9% <em>vs.</em> 27%, <em>p</em>&lt;0.001). PCa in the neck and apex of the prostate gland increased death risk tenfold.</div></div><div><h3>Conclusion</h3><div>Sufficient immunoexpression of EZH2, ductal carcinoma component, and neoplastic proliferation in the seminal vesicles, apex and neck of the prostate gland correlates with elevated risks of recurrence and mortality. Clinicians should use these criteria for appropriate patient referrals, and a multicenter trial could provide accurate classifications.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 3","pages":"Pages 357-365"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}