Prostate最新文献

{"title":"Significant Effect of Carbon-Ion Radiation Therapy Combined With Androgen Deprivation on Biochemical Recurrence Rates in High-Risk Prostate Cancer Patients: A Two-Center Controlled Trial Compare With X-Ray External Beam Radiation Therapy.","authors":"Xue Zhao, Shinichi Sakamoto, Hitoshi Ishikawa, Yasutaka Yamada, Shuri Aoki, Mio Nakajima, Kodai Sato, Kana Kobayashi, Shinpei Saito, Masaru Wakatsuki, Tomohiko Ichikawa","doi":"10.1002/pros.24818","DOIUrl":"10.1002/pros.24818","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effects of carbon-ion radiation therapy (CIRT) and external beam radiotherapy (EBRT) on the prognosis of patients with prostate cancer.</p><p><strong>Methods: </strong>The effects of initial prostate-specific antigen (iPSA), clinical Tumor (cT) stage, radiotherapy method, and other clinical factors on the prognosis of 577 patients with radiotherapy were analyzed.</p><p><strong>Results: </strong>Cox regression analysis showed that CIRT (RR: 0.49, p = 0.0215), cT stage ≥ 3 (RR: 2.72, p = 0.0003), and iPSA ≥ 16 ng/mL (RR: 1.74, p = 0.0347) were independent predictors of biochemical recurrence (BCR). After propensity score matching (PSM), CIRT (RR: 0.42, p = 0.0147), cT stage ≥ 3 (RR: 2.55, p = 0.0092), and iPSA ≥ 16 ng/mL (RR: 2.12, p = 0.0366) were still the predictors of univariate analysis. In multivariate analysis, CIRT (RR: 0.42, p = 0.015) and cT stage≥ 3 (RR:2.21, p = 0.0332) were independent predictors of BCR. Among them, we used iPSA and cT stages to establish a new radiotherapy selection model based on BCR risk. Patients who met more than one factor (score ≥ 1) and underwent CIRT had significantly better BCR progression-free survival (PFS) than those who received EBRT (p ≤ 0.01). This was also confirmed by Kaplan-Meier analysis after PSM.</p><p><strong>Conclusion: </strong>CIRT patients exhibited lower 5-year BCR rates compared to the EBRT group. Patients with a risk score of our model ≥ 1 undergoing CIRT were more likely to experience BCR benefits compared to those receiving EBRT.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"232-242"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570214","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":"Dynamics in the Prostate Immune Microenvironment Induced by Androgen Deprivation Therapy.","authors":"Yoshinori Yanai, Takeo Kosaka, Shuji Mikami, Masashi Arai, Keitaro Watanabe, Toshikazu Takeda, Kazuhiro Matsumoto, Makiko Yamashita, Shigehisa Kitano, Mototsugu Oya","doi":"10.1002/pros.24828","DOIUrl":"10.1002/pros.24828","url":null,"abstract":"<p><strong>Background: </strong>The influence of testosterone on the prostate's immune microenvironment remains unclear. This study aims to elucidate the dynamics of immune cells in the prostate following androgen deprivation therapy (ADT).</p><p><strong>Methods: </strong>We retrospectively compared prostate needle biopsy and radical prostatectomy specimens from 33 patients who underwent both procedures, along with neoadjuvant ADT at a single institution. Immune cell infiltration in the cancer and stroma areas was assessed using multiplex fluorescence immunohistochemistry.</p><p><strong>Results: </strong>Post-ADT, all immune cells, including CD4⁺ T cells, CD8⁺ T cells, Foxp3⁺ regulatory T cells, CD204⁺ macrophages, and CD20⁺ B cells, significantly increased in the prostatectomy specimen. However, few immune cells were detected in the biopsy of the same patients (p < 0.001). The number of CD20⁺ B cells in the cancer area was significantly lower post-ADT in high-risk cases according to the NCCN classification (p = 0.020). This difference was significantly associated with the Gleason Grade Group, rather than PSA levels or T classification (p < 0.001). However, no significant difference was observed in the recurrence rate between Grade Groups 1, 2, 3 and 4, 5 (p = 0.991). There was no significant difference in immune cells other than CD20⁺ B cells when divided into NCCN classifications.</p><p><strong>Conclusions: </strong>The marked increase in immune cells following ADT suggests an intensified immune response against prostate cancer.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"308-314"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711913","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":"Comparative Evaluation of Detection Rates for Clinically Significant Prostate Cancer Using MRI-Targeted Biopsy Alone Versus in Combination With Systematic Biopsies: Development of a Risk-Stratification Scoring System.","authors":"Toshifumi Takahashi, Masakazu Nakashima, Kouhei Maruno, Tatsuya Hazama, Yuya Yamada, Kazuro Kikkawa, Shigeaki Umeoka, Masahiro Tamaki, Noriyuki Ito","doi":"10.1002/pros.24821","DOIUrl":"10.1002/pros.24821","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the detection rates for clinically significant prostate cancer (csPCa; grade group 2 or higher disease) using MRI-targeted biopsy (MRI-TB) versus systematic biopsy (SB) or their combination, and identify risk factors for detecting csPCa in MRI-TB with systematic transrectal (TR)/transperineal (TP) biopsies (sTR/TP-bx) and MRI-TB with sTP-bx.</p><p><strong>Methods: </strong>We retrospectively analyzed 216 patients who underwent MRI-TB with SB at our hospital between September 2020 and December 2023 and compared clinical characteristics for patients with and without prostate cancer.</p><p><strong>Results: </strong>csPCa was detected in 132 (61.1%) patients by MRI-TB with sTR/TP-bx, in 121 (56.0%) patients using MRI-TB with sTP-bx, and in 101 (46.8%) patients using MRI-TB. Older age, higher PSA density (PSAD), smaller prostate volume, region of interest in the peripheral zone, higher Prostate Imaging-Reporting and Data System (PI-RADS), and administration of dutasteride were more common in csPCa cases. A scoring system was constructed based on odds ratios for PSAD, PI-RADS ≥ 4, and administration of dutasteride; accordingly, the detection rate of csPCa was 20.3% (14/69) in the low-risk group (RG) and 95.5% (42/44) in high RG for MRI-TB with sTR/TP-bx, and 16.7% (12/72) in the low RG and 97.8% (45/46) in high RG for MRI-TB with sTP-Bx.</p><p><strong>Conclusions: </strong>The addition of SB increased the detection rate of csPCa compared with MRI-TB alone. PSAD, PI-RADS ≥ 4, and administration of dutasteride significantly affect the detection of csPCa using MRI-TB with SB and can be used for deciding whether to perform a biopsy or include sTR-bx with MRI-TB.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"265-272"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632826","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":"Reactive Stroma and Acinar Morphology in Prostate Cancer: Implications for Progression and Prognostic Assessment.","authors":"Eduardo P Júnior, Egleidson F do Amaral Gomes, Mário F R de Lima, João V S Raimundo, Matheus L Marinho, Yuri V C Soares, Alexei M C Machado, Gabriel H C Silva, Francis G J Longford, Jeremy G Frey, Ana M de Paula, Marcelo Mamede","doi":"10.1002/pros.24824","DOIUrl":"10.1002/pros.24824","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate cancer (PC) remains a significant global health concern, with prognostic assessments largely reliant on the Gleason Classification System. While it has proven effective, subjectivity in interpretation persists, prompting the need for complementary approaches. Reactive stroma (RS) has emerged as a potential candidate for enhancing PC characterization, as it reflects intricate interactions among stromal, epithelial, and extracellular matrix components. To shed light on this, we conducted a comprehensive study.</p><p><strong>Methods: </strong>Two expert pathologists independently analyzed consecutive prostate biopsies (n = 120 patients), categorized into four groups based on Gleason scores. Four acinar patterns were described, denoted as A, B, C, and D. Our study uncovered a noteworthy presence of RS, predominantly within poorly differentiated tumors. Stromogenic tumors, characterized by high RS content, were particularly associated with Gleason scores of 4 + 3 and ≥ 8. Intriguingly, acinar patterns, including the distinctive B and D patterns, exhibited strong correlations with stromogenic tumors. Incorporating quantitative imaging techniques (Second Harmonic Generation and Two-Photon Excitation Fluorescence Microscopy), we examined collagen fiber density within the stroma.</p><p><strong>Results: </strong>Our analysis revealed a direct relationship between RS intensity and collagen fiber counts, particularly prominent in patterns B and D. These findings suggest that the stromal reaction in PC is closely linked to acinar morphology and collagen deposition. Moreover, rudimentary microacini at the tumor periphery, associated with intense RS and patterns B and D, may signify an unfavorable prognosis.</p><p><strong>Conclusion: </strong>Our study highlights the potential of RS as an additional prognostic factor in PC. It underscores the intricate interplay between acinar patterns, RS intensity, and collagen fiber density, providing valuable insights for future prognostic assessments and therapeutic strategies. Further exploration of these relationships is essential for a comprehensive understanding of PC progression and management.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"273-282"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632829","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":"Retzius-sparing versus standard robot-assisted laparoscopic prostatectomy: A two-year patient-reported and oncological assessment.","authors":"Romain Diamand, Pierre-Loup Bernard, Georges Mjaess, Jan Benijts, Christophe Assenmacher, Grégoire Assenmacher","doi":"10.1002/pros.24807","DOIUrl":"10.1002/pros.24807","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the two-year functional and oncological outcomes of Retzius-sparing robot-assisted laparoscopic prostatectomy (rsRALP) and standard approach (sRALP).</p><p><strong>Methods: </strong>A total of 200 consecutive patients who underwent either sRALP (n = 100) or rsRALP (n = 100) for clinically localized PCa at a single referral European center between 2015 and 2020 were identified from a prospectively cohort, as part of the Belgian Cancer Registry. Primary outcomes included functional outcomes and quality of life (QoL) using validated patient-reported outcome measures (PROMs) assessed at 1-, 3-, 12-, and 24-months post-surgery. Secondary outcomes comprised oncological outcomes reported as positive surgical margins (PSM) and 5-year biochemical recurrence (BCR). Kaplan-Meier analysis with log-rank test and multivariable Cox regression were used.</p><p><strong>Results: </strong>The median follow-up was 60 months. No significant differences were observed between the surgical approaches in terms of patient and tumor characteristics. Urinary function and QoL were significantly better at each follow-up period (all p ≤ 0.01) with rsRALP, while sexual function was not significantly different 12 months after surgery. No significant difference in positive surgical margins rate was observed between surgical approaches (31% vs 32%, p = 0.9). Retzius-sparing RALP was associated with longer PSM lengths (5 mm vs 2.5 mm, p = 0.02), a higher multifocality rate (34% vs. 13%, p < 0.001), more occurrences in organ-confined disease (59% vs. 39%, p < 0.001) and at anterior locations (37% vs. 16%, p = 0.05). Five-year BCR-free survival was not significantly different, and surgical approach was not a predictor of BCR.</p><p><strong>Conclusions: </strong>The rsRALP approach significantly improves both early and short-term urinary function and QoL compared to sRALP. Despite being associated with worse PSM characteristics, no significant decrease in BCR-free survival was observed with rsRALP.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"115-122"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395279","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":"Quality of Chatbot Information Related to Benign Prostatic Hyperplasia.","authors":"Christopher J Warren, Nicolette G Payne, Victoria S Edmonds, Sandeep S Voleti, Mouneeb M Choudry, Nahid Punjani, Haider M Abdul-Muhsin, Mitchell R Humphreys","doi":"10.1002/pros.24814","DOIUrl":"10.1002/pros.24814","url":null,"abstract":"<p><strong>Background: </strong>Large language model (LLM) chatbots, a form of artificial intelligence (AI) that excels at prompt-based interactions and mimics human conversation, have emerged as a tool for providing patients with information about urologic conditions. We aimed to examine the quality of information related to benign prostatic hyperplasia surgery from four chatbots and how they would respond to sample patient messages.</p><p><strong>Methods: </strong>We identified the top three queries in Google Trends related to \"treatment for enlarged prostate.\" These were entered into ChatGPT (OpenAI), Bard (Google), Bing AI (Microsoft), and Doximity GPT (Doximity), both unprompted and prompted for specific criteria (optimized). The chatbot-provided answers to each query were evaluated for overall quality by three urologists using the DISCERN instrument. Readability was measured with the built-in Flesch-Kincaid reading level tool in Microsoft Word. To assess the ability of chatbots to answer patient questions, we prompted the chatbots with a clinical scenario related to holmium laser enucleation of the prostate, followed by 10 questions that the National Institutes of Health recommends patients ask before surgery. Accuracy and completeness of responses were graded with Likert scales.</p><p><strong>Results: </strong>Without prompting, the quality of information was moderate across all chatbots but improved significantly with prompting (mean [SD], 3.3 [1.2] vs. 4.4 [0.7] out of 5; p < 0.001). When answering simulated patient messages, the chatbots were accurate (mean [SD], 5.6 [0.4] out of 6) and complete (mean [SD], 2.8 [0.3] out of 3). Additionally, 98% (39/40) had a median score of 5 or higher for accuracy, which corresponds to \"nearly all correct.\" The readability was poor, with a mean (SD) Flesch-Kincaid reading level grade of 12.1 (1.3) (unprompted).</p><p><strong>Conclusions: </strong>LLM chatbots hold promise for patient education, but their effectiveness is limited by the need for careful prompting from the user and by responding at a reading level higher than that of most Americans (grade 8). Educating patients and physicians on optimal LLM interaction is crucial to unlock the full potential of chatbots.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"175-180"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607486","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":"Immunohistochemical Analysis of Androgen Receptor Expression Predicts the Prognosis of Metastatic Castration-Sensitive Prostate Cancer Patients Receiving Abiraterone Acetate.","authors":"Mitsuhisa Nishimoto, Marco A De Velasco, Yutaka Yamamoto, Saizo Fujimoto, Yasunori Akashi, Shingo Toyoda, Mamoru Hashimoto, Shogo Adomi, Eri Banno, Yoshitaka Saito, Takafumi Minami, Akihide Hirayama, Kazuhiro Yoshimura, Hirotsugu Uemura, Kazutoshi Fujita","doi":"10.1002/pros.24865","DOIUrl":"https://doi.org/10.1002/pros.24865","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of abiraterone acetate varies among patients with high-risk metastatic castration-sensitive prostate cancer (mCSPC). Both androgen receptor (AR) and cytokeratin 18 (CK18) are markers of the luminal lineage of prostate cancer, and their expression levels have been suggested to affect the response to androgen deprivation therapy (ADT). This study aimed to predict the efficacy of abiraterone acetate in high-risk mCSPC via immunohistochemical staining of biopsy specimens obtained at the time of prostate cancer diagnosis.</p><p><strong>Methods: </strong>We retrospectively analyzed 44 patients treated with abiraterone acetate in combination with ADT. AR and CK18 expression in prostate biopsy specimens were assessed using immunohistochemical staining.</p><p><strong>Results: </strong>AR and CK18 staining was not significantly associated with overall survival (OS). However, low AR staining was significantly associated with a shorter time to castration-resistant prostate cancer (TTCRPC) compared with high AR staining (log-rank test, p = 0.018). Similarly, low CK18 staining was significantly associated with a shorter TTCRPC compared with high CK18 staining (log-rank test, p = 0.037).</p><p><strong>Conclusions: </strong>Immunohistochemical analysis of AR or CK18 expression in biopsy specimens may serve as a predictive biomarker of high-risk mCSPC treated with abiraterone acetate.</p><p><strong>Trial registration: </strong>None.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"e24865"},"PeriodicalIF":2.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069525","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":"Transcriptome-Wide Association Study Identified Novel Blood Tissue Gene Biomarkers for Prostate Cancer Risk.","authors":"Yanfa Sun, Jingjing Zhu, Hua Zhong, Zichen Zhang, Fubo Wang, Akira Nakamura, Yanhui Liu, Jiawen Liu, Jie Yu, Guanghua Zeng, Xin Lin, Dan Zhou, Chong Wu, Liang Wang, Youping Deng, Lang Wu","doi":"10.1002/pros.24859","DOIUrl":"https://doi.org/10.1002/pros.24859","url":null,"abstract":"<p><strong>Objective: </strong>A number of susceptibility genes in prostate tissue have been identified to be associated with prostate cancer (PCa) risk. However, the reported genes based on assessing prostate tissue could not fully explain PCa genetic susceptibility. It is believed that genes functioning in the immune system may fill in the gap of some missing heritability.</p><p><strong>Methods: </strong>To study potential susceptibility genes acting in such pathways, we performed a transcriptome-wide association study (TWAS) of 79,194 PCa cases and 61,112 control of European ancestry by using three sets of gene expression prediction models of blood tissue.</p><p><strong>Results: </strong>A total of 470 genes were associated at false discovery rates-corrected p-value < 0.05, of which 51 were implicated as likely causal genes based on fine-mapping analysis. Compared with previous literature, 133 novel genes were reported for the first time. Of the identified genes, five (CREB3L4, GSTP1, MAPK3, NKX3-1, and PIK3C2B) were enriched in a PCa signaling pathway, and 128 genes were enriched in five PCa categories. Importantly, 13 genes (SCP2, LMNA, ZNF148, H2AFV, TACC1, FLII, SUPT4H1, CD300LF, MYO9B, COX6B1, CTSA, EP300, and TSPO) showed consistent effect directions for the measured levels in circulating immune cells between PCa cases and controls, and 14 genes (SLC39A1, ZBTB7B, TRIM59, NCEH1, N4BP2, TAGAP, TACC1, TRAF1, AIP, SECTM1, C18orf54, ZNF793, YIF1B, and TSPO) showed consistency for levels in blood exosomes between PCa patients and controls.</p><p><strong>Conclusion: </strong>The identified blood-based candidate susceptibility genes provide further insights into the genetic basis of PCa risk.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"e24859"},"PeriodicalIF":2.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061478","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":"Reassessing the Role of Low PSA in Prognosis Across Grades of Prostate Cancer: A Cohort Study.","authors":"Cheng Shen, Zhan Chen, Fei-Hong Hu, Wei Wang, Yong-Shen Pan, Yong Zhang, Wei Zhang, Xin-Feng Chen, Hong-Lin Chen, Hua Zhu, Bing Zheng","doi":"10.1002/pros.24860","DOIUrl":"https://doi.org/10.1002/pros.24860","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have concentrated exclusively on how different prostate-specific antigen (PSA) levels affect the prognosis of high-grade prostate cancer (PCa), often overlooking the prognosis of low-grade PCa.</p><p><strong>Methods: </strong>The present cohort study included individuals diagnosed with PCa from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2021. The all-cause mortality (ACM) and prostate cancer-specific mortality (PCSM) for each treatment group was calculated stratified by the four PSA levels (≤ 4.0, 4.1-10.0, 10.1-20.0, and > 20.0 ng/mL). Fine and Gray competing-risks analyses were conducted to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Cox proportional hazards regression analyses using PSA as a continuous variable with restricted cubic splines (RCS) were conducted to allow for potential nonlinear relationships.</p><p><strong>Results: </strong>This study encompassed 416,825 male patients diagnosed with PCa. Compared to individuals with PSA value between 4.1 and 10.0 ng/mL, a significant association between low levels of PSA (≤ 4.0 ng/mL) and an increased risk of ACM (AHR = 1.15, 95% CI: 1.12-1.19; p < 0.001) and PCSM (AHR = 1.49, 95% CI: 1.38-1.61; p < 0.001) was observed. Additionally, the increased risk of ACM (AHR = 1.35, 95% CI: 1.29-1.40; p < 0.001) and PCSM (AHR = 1.84, 95% CI: 1.67-2.02; p < 0.001) are more pronounced within the first 5 years post-diagnosis. In most subgroups, similar results were observed. The RCS curves further corroborated the correlation between PSA value and the risk of mortality.</p><p><strong>Conclusion: </strong>Low PSA levels are notably linked to a heightened risk for both ACM and PCSM, irrespective of the grade of PCa being high or low. There is a need to initiate new studies that tackle novel diagnostics and therapeutics.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"e24860"},"PeriodicalIF":2.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061554","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":"Optimizing Prostate Cancer Diagnostic Work-Up Through Micro-Ultrasound: Minimizing Unnecessary Procedures and Reducing Overdiagnoses.","authors":"Edoardo Beatrici, Fabio De Carne, Nicola Frego, Stefano Moretto, Marco Paciotti, Vittorio Fasulo, Alessandro Uleri, Giuseppe Garofano, Pier Paolo Avolio, Giuseppe Chiarelli, Roberto Contieri, Paola Arena, Cesare Saitta, Federica Sordelli, Alberto Saita, Rodolfo Hurle, Paolo Casale, NicolòMaria Buffi, Massimo Lazzeri, Giovanni Lughezzani","doi":"10.1002/pros.24862","DOIUrl":"https://doi.org/10.1002/pros.24862","url":null,"abstract":"<p><strong>Introduction: </strong>We aim to critically assess Microultrasound (mUS) clinical performance in an outpatient setting, focusing on its ability to reduce unnecessary diagnostic procedures, potentially reshape prostate cancer (PCa) diagnostic protocols, and increase the ability to rule out clinically significant (Gleason Score ≥ 3 + 4) PCa (csPCa).</p><p><strong>Materials and methods: </strong>Between November 2018 and April 2022, we conducted a prospective study involving men who underwent mUS examination due to clinical symptoms, PSA elevation, or opportunistic early detection of PCa. Experienced urologists performed mUS assessments in an outpatient setting using the prostate risk identification using micro-ultrasound (PRI-MUS) protocol to identify lesions suspicious of csPCa (PRI-MUS score ≥ 3). Men with negative mUS results were followed through consistent phone follow-up calls and visits until October 2023 to assess their diagnostic and therapeutic pathways. Using Cox regression models adjusted for PSA levels, DRE results, age, and previous biopsy history, we calculated the hazard ratio (HR) for biopsy-free (BFS), defined as the time from mUS to biopsy or last follow-up, cancer-free survival (CFS), and clinically significant cancer-free survival (csCFS) within the cohort based on mUS results.</p><p><strong>Results: </strong>Overall, 425 men were enrolled. The median (IQR) age was 66 (59-72) years, PSA levels were 5.7 (4.0-7.9) ng/mL, prostate volume was 44 (31.5-62.1) mL, and the median follow-up was 39 months (27-53). mUS identified lesions suggesting csPCa in 201/425 (47.3%) men. Overall, mUS resulted negative in 224/425 (52.7%) men, of whom 207/224 (92.4%) did not undergo subsequent mpMRI, while 22/224 (9.8%) proceeded with mpMRI according to the referring physician's decision. The latter detected suspicious lesions in 12/22 cases (54.5%), but only 2/12 (16.7%) were confirmed by biopsy as csPCa. Among those with negative mUS results, 192/224 (85.7%) men avoided additional biopsies during follow-up. Men with negative mUS results exhibited superior BFS (aHR: 0.17; p < 0.001), CFS (aHR:0.12; p < 0.001), and csCFS (aHR:0.09; p < 0.001) survival rates compared to their mUS-positive counterparts.</p><p><strong>Conclusions: </strong>Our findings suggest that mUS can potentially refine patient stratification and transform PCa screening and diagnostic protocols. Pending validation by other studies, a wider implementation of mUS could optimize resource allocation, minimize wastage, and reserve additional costly tests.</p>","PeriodicalId":54544,"journal":{"name":"Prostate","volume":" ","pages":"e24862"},"PeriodicalIF":2.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061549","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}