Prostate最新文献

{"title":"Efficacy of Treatments for T3bN0M0 Prostate Cancer Patients: A Systematic Review and Meta-Analysis.","authors":"Casper Reijnen, Wilma D Heemsbergen, Kimberley E Wever, Aishly Panneflek, Floris J Pos, J P Michiel Sedelaar, Uulke A van der Heide, Luca Incrocci, Robert Jan Smeenk","doi":"10.1002/pros.70024","DOIUrl":"10.1002/pros.70024","url":null,"abstract":"<p><strong>Background: </strong>Patients with prostate cancer (PC) invading into the seminal vesicles (SV) constitute a specific subgroup of high-risk patients (staged as T3b) with a particularly high risk of disease recurrence, even when lymph node or distant metastases are absent (N0M0). The aim of the current systematic review and meta-analysis was to investigate efficacy of available treatments for men with PC invading the SV without metastasis.</p><p><strong>Methods: </strong>A systematic review was performed according to the Cochrane guidance and reported according to the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The review protocol was registered prospectively in the PROSPERO database. Studies identified in MEDLINE, EMBASE, and trial registries were selected by two independent reviewers. Treatment modalities included radical prostatectomy with pelvic lymphadenectomy; external beam radiotherapy (EBRT), high-dose rate or low-dose rate brachytherapy, androgen deprivation therapy (ADT), or a combination of treatments. Primary outcome measure was 5-year biochemical recurrence free survival (BRFS).</p><p><strong>Results: </strong>Twenty-five studies, comprising 2 881 patients, were included. For EBRT and ADT pooled estimated 5-year BRFS was 68%, varying from 56% in studies on low-dose radiotherapy (< 74 Gray [Gy]), up to 78% in studies on high-dose radiotherapy (≥ 74 Gy). For EBRT with brachytherapy and ADT pooled estimated 5-year BRFS was 83%. For radical prostatectomy pooled estimated 5-year BRFS was 32%. When combining surgery with adjuvant treatment (EBRT or ADT) pooled estimated 5-year BRFS was 54% and 63%, respectively.</p><p><strong>Conclusions: </strong>These results indicate a role for high-dose radiotherapy (≥ 74 Gy) and long-term ADT in T3bN0 PC rather than primary surgical treatment. In addition to dose-escalated radiotherapy to the entire prostate gland (≥ 74 Gy), selected patients should be offered focal dose-escalation to the tumor, by high-dose rate brachytherapy. If proven safe for this patient group, focal dose-escalation could also be offered with EBRT.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"1395-1411"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Male Breast Cancer Incidence Among Prostate Cancer Survivors: Real World Evidence From Veterans Affairs National Prostate Cancer Data Core.","authors":"Erum Z Whyne, Sung-Hee Choi, Nisha Unni, Shifa Kanjwal, Jonathan E Dowell, Haekyung Jeon-Slaughter","doi":"10.1002/pros.70074","DOIUrl":"https://doi.org/10.1002/pros.70074","url":null,"abstract":"<p><strong>Background: </strong>While male breast cancer incidence is rare, veteran status is found to be associated with increased risk, for incidence, a higher prevalence of male breast cancer patients was observed among male veteran prostate cancer survivors. This study leveraged the existing large-scale Veterans Affairs (VA) Prostate Cancer Data Core and examined factors associated with increased risk of male breast cancer incidence in veterans with prior prostate cancer diagnoses.</p><p><strong>Methods: </strong>A retrospective cohort study of 1.3 million male veterans treated for prostate cancer at VA hospitals was conducted using the VA Prostate Cancer Data Core. Of these, 11,327 (0.86%) were newly diagnosed with male breast cancer on average 5.4 years post prostate cancer diagnosis.</p><p><strong>Results: </strong>Multivariate Cox and competing risk model results found that younger onset age of prostate cancer (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.97-0.98), metastasized prostate cancer (HR 2.03, 95% CI 1.90-2.17), being Non-Hispanic (N-H) Black (HR 1.10, 95% CI: 1.05-1.15), radiation (HR 1.06, 95% CI: 1.02-1.11) and androgen deprivation therapy (ADT; HR 1.24, 95% CI 1.17-1.32) were associated with significantly increased risk of male breast cancer diagnosis. Prolonged use of cardiovascular disease (CVD) medications, furosemide (HR 1.51, 95% CI 1.39-1.63), spironolactone (HR 1.36; 95% CI 1.15-1.61), and digoxin (HR 1.50, 95% CI: 1.29-1.72), significantly increased risk for male breast cancer incidence.</p><p><strong>Conclusions: </strong>Younger age onset of prostate cancer, metastasized prostate cancer, prolonged use of CVD medications, radiation, and ADT cancer treatment were factors significantly associated with increased risk of being diagnosed with male breast cancer among male veteran prostate cancer survivors. The study findings may shed insights in cardio-oncology specific risk factors for male breast cancer among prostate cancer survivors.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253617","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":"Lessons Learned From a Mindfulness Intervention Study in Men With Newly Diagnosed Prostate Cancer.","authors":"Jack Mulcrone, Jarrett Noakes, Taylor Braunagel, Kathleen Hankins-Chace, Jennifer Cunningham, Anthony Mega, Elias Hyams","doi":"10.1002/pros.70076","DOIUrl":"https://doi.org/10.1002/pros.70076","url":null,"abstract":"","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240254","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":"Diagnostic Performance of the Novel Biomarker S2,3PSA Density for Prostate Biopsy Optimization in Prostate Imaging Reporting and Data System 3-5 Lesions.","authors":"Takanori Tokunaga, Mitsuaki Nishioka, Keita Kobayashi, Hiroshi Hirata, Kosuke Shimizu, Nakanori Fujii, Shoma Yoneda, Rui Ebisui, Aki Fujinaga, Toshihiko Kobayashi, Masahiro Tanabe, Yutaka Suehiro, Takahiro Yamasaki, Koji Shiraishi","doi":"10.1002/pros.70078","DOIUrl":"https://doi.org/10.1002/pros.70078","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the diagnostic accuracy of the novel biomarkers α2,3-sialylated prostate-specific antigen percentage (S2,3PSA%) and S2,3PSA density (S2,3PSAD) in patients classified into Prostate Imaging Reporting and Data System (PI-RADS) categories 3-5 and examined their utility in optimizing prostate cancer (PCa) diagnosis. S2,3PSA% reflects cancer-specific N-glycan modifications of free PSA, and its volume-adjusted index S2,3PSAD may improve diagnostic precision.</p><p><strong>Methods: </strong>We enrolled patients who underwent prostate biopsy at our institution between October 2023 and May 2025, all with measurable S2,3PSA%, S2,3PSAD, and PI-RADS 3-5 lesions on magnetic resonance imaging (MRI) scans. S2,3PSA% was measured using the μTASWako i50 system, and S2,3PSAD was calculated by dividing S2,3PSA% by prostate volume. The diagnostic performance (area under the curve [AUC], sensitivity, and specificity) of S2,3PSA% and S2,3PSAD was compared with that of conventional markers (prostate-specific antigen [PSA] and prostate-specific antigen density [PSAD]). Avoided biopsies and missed clinically significant PCa (csPCa, ISUP Grade Group ≥ 2) were also evaluated.</p><p><strong>Results: </strong>Among 150 patients (median PSA, 7.18 ng/mL; prostate volume, 33.0 mL; PSAD, 0.20; S2,3PSA%, 43.2%; S2,3PSAD, 1.21), PCa and csPCa were detected in 95 (63%) and 84 (56%) patients, respectively. PSA and PSAD showed AUCs of 0.607/0.736 and specificities of 23.6%/40.0%, at 85.3% sensitivity. By contrast, S2,3PSA% and S2,3PSAD achieved higher AUCs of 0.737/0.757 and specificities of 45.5%/49.1%. In MRI-targeted biopsy (MRI-TBx) cases (n = 85), PSA and PSAD had AUCs of 0.615/0.758 and specificities of 18.8%/43.8% at 88.7% sensitivity, whereas S2,3PSA% and S2,3PSAD reached 0.799/0.810 with specificities of 53.1%/56.3%. In PI-RADS 3/4, S2,3PSAD exhibited the highest AUC (0.773). At < 0.85, avoided biopsy and csPCa miss rates were 26.4%/8.8% (MRI-TBx: 29.2%/7.5%). No csPCa was missed in PI-RADS 4 MRI-TBx group, while PI-RADS 5 showed higher miss rates.</p><p><strong>Conclusion: </strong>S2,3PSA% and S2,3PSAD offer superior diagnostic accuracy compared to conventional markers, especially in MRI-TBx and PI-RADS 3/4, reducing unnecessary biopsies and minimizing missed csPCa. A biopsy remains warranted for PI-RADS 5.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240240","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":"The Infiltration of IL-18-Related Immune Cells and Their Bidirectional Regulatory Roles in the Pathogenesis of Prostate Cancer.","authors":"Yuqi Liu, Han Wang, Zhenjiang Wang, Jiayi Wang, Lijuan Yang, Helin Wang, Zishen Xiao, Teng Zhao, Jian Liu, Jihong Zhang, Dongrui Ma, Yanbo Liu","doi":"10.1002/pros.70077","DOIUrl":"https://doi.org/10.1002/pros.70077","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the incidence and mortality of prostate cancer (PCa) have risen significantly, rendering it a serious health concern for middle-aged and elderly men. Interleukin-18 (IL-18), an important pro-inflammatory cytokine within the interleukin-1 superfamily, has been implicated in various malignancies, yet there is a notable scarcity of comprehensive studies exploring the regulatory role of IL-18 in the onset and progression of PCa.</p><p><strong>Methods: </strong>This study employed integrated bioinformatics and immunohistochemical analyses to investigate the expression patterns and potential mechanistic roles of IL-18 and its receptors in PCa. Differential expression analyses were performed on IL-18 mRNA and protein levels in normal prostate (NP), benign prostatic hyperplasia (BPH), and PCa tissues. Correlations between IL-18 expression and clinical features were also assessed. Additionally, immune cell infiltration was analyzed to explore the immunological landscape associated with IL-18 expression.</p><p><strong>Results: </strong>A comparative analysis of IL-18 mRNA and protein expression levels between paracancerous and PCa tissues revealed an obvious decrease in IL-18 expression in both benign prostatic hyperplasia (BPH) and PCa tissues compared to normal prostate (NP) tissue (p < 0.05). The expression of IL-18 was found to be significantly elevated in correlation with the progression of pathological T-stage and an increase in the Gleason score among patients with PCa. Immune infiltration analysis, which examined 24 immune cell types, showed that IL-18 was correlated with the infiltration of Th17 cells negatively, while exhibiting positive correlations with other immune cell types. Congo red staining revealed that eosinophils were predominantly localized in the entravascular and perivascular regions of prostate tissues. Notably, Eosinophil infiltration was significantly increased PCa tissues when compared to NP tissues (p < 0.05). Immunohistochemical staining also showed that CD20⁺ B cells were mainly present in perivascular areas, with significantly higher infiltration levels observed in PCa compared to NP and BPH (p < 0.05). Similarly, CD4⁺ T cell infiltration was significantly increased in PCa compared to NP and BPH (p < 0.05). Additionally, the number of mast cell infiltration increased significantly in PCa tissues relative to NP and BPH through Toluidine blue staining (p < 0.05).</p><p><strong>Conclusions: </strong>IL-18 may play a dual regulatory role in PCa development. In the early stages of the disease, IL-18 may act to inhibit tumorigenesis, whereas, in later stages, it may promote tumor progression in a pro-carcinogenic manner.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240313","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":"Diagnostic Utility of 18F-DCFPyL PSMA PET/CT-Ultrasound Fusion Biopsies Across the Prostate Cancer Spectrum.","authors":"Neeraja Tillu, Kacie Schussel, Kaushik P Kolanukuduru, Manish Choudhary, Coskun Kacagan, Ugo Falagario, Yashaswini Agarwal, Asher Mandel, Ashutosh Maheshwari, Hannah Sur, Henry Jodka, Reuben Ben David, Ahmed Eraky, Vinayak Wagaskar, Murilo de Almeida Luz, Ashutosh Tewari","doi":"10.1002/pros.70068","DOIUrl":"https://doi.org/10.1002/pros.70068","url":null,"abstract":"<p><strong>Background: </strong>Multiparametric MRI (mpMRI) is the standard imaging for detecting clinically significant prostate cancer (csPCa), but its limitations in MRI-invisible lesions demand complementary strategies. We aimed to evaluate the diagnostic utility of 18F-DCFPyL PSMA PET/CT-ultrasound fusion-guided biopsies in patients by determining the optimal cut-off for the lesion's standardized uptake value (SUV).</p><p><strong>Methods: </strong>This was a single-center cohort study of 89 men with suspected PCa or low-risk PCa on active surveillance; all underwent PSMA PET/CT before biopsy. Transperineal PSMA PET/US fusion-guided biopsy was performed using the KOELIS Trinity platform. Biopsy outcomes, SUVmax values, and Gleason Grade Group (GGG) were analyzed. Outcomes were compared between MRI-visible and MRI-invisible lesions and among patients with and without prior biopsy. ROC curves and Youden's index were used to assess predictive accuracy and determine optimal SUVmax cut-offs. Decision curve analysis (DCA) was used to evaluate net clinical benefit.</p><p><strong>Results: </strong>Eighty seven patients had an MRI, of which 34 lesions were MRI invisible. MRI-visible lesions had higher detection rates of PCa (83.3%) compared to MRI-invisible lesions (45.7%, p < 0.001). PET-only identified csPCa in 28% of MRI-invisible lesions (SUVmax mean 9.2 ± 1.8), with 32.4% of these patients proceeding to definitive treatment. Among patients with prior biopsies (60), 35.3% were upgraded, including 18.3% with reassuring/equivocal MRI (PI-RADS ≤ 3) findings. Overall, PET-guided biopsy detected PCa in 47.2% of all patients and csPCa in 24.7%. For the entire cohort, SUVmax ≥ 7.6 provided optimal discrimination between benign and csPCa (AUC = 0.73, 95% CI 0.64-0.82) with a clinical net benefit.</p><p><strong>Conclusion: </strong>PSMA PET-fusion targeting can improve accuracy for PCa detection at SUV ≥ 7.7. PET-targeted biopsy can complement standard biopsy methods, especially in those with MRI-invisible lesions or patients with prior negative biopsies.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234083","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":"Are NCCN and EAU Active Surveillance Criteria Reliable in Patients With ISUP Grade-2 Intermediate-Risk Prostate Cancer? A Novel Model Integrating MRI to Predict Adverse Pathology.","authors":"Serdar Madendere, Barış Esen, Umut Can Karaarslan, Mustafa Müdüroğlu, Mert Veznikli, Bengi Gürses, Metin Vural, Dilek Ertoy Baydar, Mehmet Onur Demirkol, Yakup Kordan, Tarık Esen","doi":"10.1002/pros.70073","DOIUrl":"https://doi.org/10.1002/pros.70073","url":null,"abstract":"<p><strong>Introduction: </strong>To assess adverse pathology (AP) rates in patients with grade group (GG) 2 prostate cancer (PCa) based on biopsy characteristics and treated with radical prostatectomy (RP). Performance of active surveillance (AS) guidelines in distinguishing patients with AP has also been investigated.</p><p><strong>Methods: </strong>Records of 345 patients who underwent RP for GG 2 disease detected in prostate biopsy were retrospectively reviewed. Patients with suspicion of extracapsular disease on imaging, PSA ≥ 20 ng/dL, unavailable biopsy data, and in-bore biopsy were excluded from the study. AP was defined as the presence of ISUP GG ≥ 3 or extracapsular disease. AP rates in patients meeting the AS criteria of NCCN and EAU guidelines were recorded. A novel model was developed to determine AP predictors by using a multivariable logistic regression analysis and a backward stepwise method.</p><p><strong>Results: </strong>Among 231 patients, median age was 64 (45-79), median PSA was 6.1 (1.2-19) ng/dL. According to biopsy and clinical characteristics, 124 patients (53.7%) met the NCCN, 31 patients (13.4%) met the EAU AS criteria. Pathological examination after RP revealed AP in 105 patients (45.5%); GG ≥ 3 disease in 31 (13.4%), pT3a disease in 78 (33.7%), pT3b disease in 18 (7.8%), and pN1 disease in four patients (1.7%). AP rates in patients meeting NCCN and EAU criteria were 37.9% and 22.6%, respectively. Age ( > 63.5), PSA level ( > 5.04 ng/dL), GG2 PCa-bearing index lesion size on mpMRI ( > 11.5 mm), maximum tumor length/core length ( > 51.5%) and Gleason Pattern 4 percentage (>%17.5) were independent predictors of AP in our new model.</p><p><strong>Conclusions: </strong>NCCN AS criteria were associated with nearly a twofold higher rate of AP compared with patients meeting EAU criteria. Our new model, including parameters derived from age, PSA, mpMRI and biopsy characteristics, demonstrated superior performance relative to both NCCN and EAU criteria regarding AP prediction among patients with GG 2 PCa.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233889","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":"Evaluating Local Doses for Prostate Cancer Treatment Using Low-Dose-Rate Brachytherapy Considering Oncological Control and Toxicity.","authors":"Yasushi Nakai, Kenta Onishi, Isao Asakawa, Makito Miyake, Kaori Yamaki, Fumiaki Isohashi, Akihiko Yoshizawa, Kiyohide Fujimoto, Nobumichi Tanaka","doi":"10.1002/pros.70039","DOIUrl":"https://doi.org/10.1002/pros.70039","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated factors associated with clinical failure and toxicity in patients with low-, intermediate-, and high-risk prostate cancer treated with low-dose-rate brachytherapy (LDR-BT) alone or combined with external beam radiation therapy (EBRT).</p><p><strong>Methods: </strong>Seven hundred thirteen patients (low risk: n = 323; intermediate-risk: n = 390) underwent LDR-BT alone, whereas 534 patients (intermediate-risk: n = 225; high risk: n = 309) underwent LDR-BT combined with EBRT. The Fine-Gray hazard model was used to identify factors associated with clinical failure, and the Youden index was employed to determine BED cut-off values for Grade 3 or higher toxicity.</p><p><strong>Results: </strong>In patients treated with LDR-BT alone, BED thresholds of ≥ 180 Gy2 (low-risk; hazard ratio [HR]: 0.38; 95% confidence interval [95% CI], 0.15-0.98, intermediate-risk; HR: 0.29; 95% CI, 0.12-0.70) was significantly associated with better clinical outcomes. Patients with Grade 3 or higher toxicity had significantly higher BEDs than those without toxicity (p = 0.008). A BED threshold of 200 Gy2 was identified as a cut-off value for toxicity risk. In patients treated with LDR-BT combined with EBRT, BED was not significantly associated with improved clinical failure-free rates. Patients experiencing Grade 3 or higher toxicity exhibited significantly higher BEDs than those without toxicity (p = 0.04). A BED cut-off of 220 Gy2 was determined for toxicity.</p><p><strong>Conclusion: </strong>For patients undergoing LDR-BT alone, a BED of 180-200 Gy2 is optimal. For patients undergoing LDR-BT combined with EBRT, a BED of 200-220 Gy2 may be more appropriate.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234030","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":"Genetics-Driven, Intensity-Modulated Adaptive Management of Patients With Metastatic Prostate Cancer.","authors":"Reynier D Rodriguez Rosales, Arjun Venkatesh, Jean-Pierre Kanumuambidi, Yudai Ishiyama, Mohammed Al-Toubat, Hunter Sceats, Thomas D Metzner, Shelby Sparks, Nicole Murray, Mark Bandyk, K C Balaji","doi":"10.1002/pros.70070","DOIUrl":"https://doi.org/10.1002/pros.70070","url":null,"abstract":"<p><strong>Background: </strong>Survival differs markedly between men with metastatic prostate cancer (mPC) confined to lymph nodes (LNM) versus bone (BM). We examined whether site-specific genomic alterations-and their combinations-explain this disparity and could inform intensity-modulated follow-up or therapy.</p><p><strong>Methods: </strong>Clinical and targeted-sequencing data for 1011 men with mPC in the cBioPortal for Cancer Genomics registry were analyzed (LNM-only = 622; BM-only = 389). Genes altered in > 5% of tumors (two-sided p < 0.05) were assessed individually and in every possible multigene cluster for associations with overall survival (OS). Survival was evaluated with Kaplan-Meier curves and the difference in restricted mean survival time (dRMST) to pinpoint the first significant curve divergence. Synthetic-lethal (SL) interactions were explored via the SLOAD database.</p><p><strong>Results: </strong>In total, 18 of 184 profiled genes (9.8%) exceeded the 5% alteration threshold. FOXA1 was enriched in BM, whereas TMPRSS2, ERG, PTEN, ZFHX3, CDK12, and KMT2C were enriched in LNM (p < 0.05). Among 9143 tested gene clusters, 65 were associated with inferior OS; 48 occurred in the LNM subgroup, 17 in the combined cohort, and none in the BM alone. High-risk clusters showed first OS divergence 10-60 months after diagnosis of metastasis. SLOAD identified 615 putative SL pairs involving these genes.</p><p><strong>Conclusions: </strong>We identified 65 site-specific multigene clusters-chiefly in lymph node-only mPC-that underlie the survival gap between nodal and bone metastases. These signatures suggest a 10-60-month interval that may lend itself for intensity-modulated follow-up. We also discovered hundreds of synthetic-lethal gene-alteration pairs, opening future research opportunities in combinatorial therapeutic targeting.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234106","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":"Diagnostic Value of Micro-Ultrasound in Identifying Local Recurrence After Radical Prostatectomy.","authors":"Basil Kaufmann, Manish Choudhary, Ashutosh Maheshwari, Swati Bhardwaj, Adriana Pedraza, Reuben Ben-David, Asher Mandel, Neeraja Tillu, Vinayak G Wagaskar, Mani Menon, Michael A Gorin, Ashutosh K Tewari","doi":"10.1002/pros.70069","DOIUrl":"https://doi.org/10.1002/pros.70069","url":null,"abstract":"<p><strong>Purpose: </strong>The limited resolution of standard transrectal ultrasound (TRUS) has made it difficult to perform biopsies of the prostate bed in cases of suspected local recurrence following radical prostatectomy. The aim of this study was to benchmark the performance of using high resolution micro-ultrasound (microUS) in place of standard TRUS for performing post-prostatectomy biopsies.</p><p><strong>Materials and methods: </strong>We conducted a retrospective review of pathology reports from January 2013 to October 2024, identifying patients who underwent biopsies of the prostate bed for suspected local recurrence after radical prostate. Sensitivity and specificity were compared for biopsies performed using standard TRUS. A biopsy was deemed diagnostic if it revealed prostate tissue (cancerous or benign) or non-prostatic tissue when a previously suspicious lesion was no longer detectable on subsequent imaging. The ground truth for local recurrence was defined by biochemical recurrence (prostate-specific antigen [PSA] ≥ 0.2 ng/mL in two consecutive measurements) accompanied by reproducible findings in the prostate bed on MRI and/or PET.</p><p><strong>Results: </strong>Of the 24 patients included, 10 (42%) underwent microUS-guided biopsy and 14 (58%) underwent TRUS-guided biopsy. The median PSA levels at biopsy for the microUS and TRUS cohorts were 0.39 ng/mL (range 0.39-6.40) and 0.45 ng/mL (range 0.20-30.82), respectively. The median lesion sizes on MRI were 0.9 cm (IQR 0.7-1.8) for microUS and 2.5 cm (IQR 1.2-6) for TRUS. MicroUS demonstrated a sensitivity of 89% (95% CI: 52-100), compared with 43% (95% CI: 18-71) for TRUS. Specificity could not be reliably assessed, as only one recurrence-negative patient was available in the microUS group and none in the TRUS group.</p><p><strong>Conclusion: </strong>MicroUS-guided transrectal biopsies appear to offer superior diagnostic performance in detecting local recurrences following radical prostatectomy compared to standard TRUS-guided biopsy. Further study is needed to confirm our findings and to evaluate the performance of microUS-guided biopsies independently of pre-biopsy imaging results.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234044","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}