Considering the role of radical prostatectomy in 21st century prostate cancer care

MXene and prostate cancer: is there promising news?

Prostate cancer is the most prevalent cancer among men worldwide, and there have been many advances in its diagnosis and treatment. However, critical obstacles remain, including overdiagnosis, high rates of negative biopsies, management of side effects, and the timely detection of relapse. Despite these improvements, surgery and radiotherapy are still associated with a significant risk of short- or long-term side effects. MXenes are a novel class of two-dimensional nanomaterials manufactured through electrochemical procedures that accept a wide-termination of hydrophilic molecules as surface modifications. The importance of MXene has increased owing to many aspects, such as its high-gain synthesis potential, chemical flexibility, and high biocompatibility. Hence, MXene is a convenient nanomaterial that can be modified and synthesized in different models, suggesting its ability to improve screening, diagnosis, and theranostic applications, such as thermal therapy. These features have been used to detect potential urothelial tumor markers as well as the direction and accumulation of cancer medications in the target tissue.

Effect of Dendritic Cells Injection After Radical Prostatectomy on Prostate Cancer in Mice

BACKGROUND

To explore the therapeutic and preventive effect of dendritic cells injection combined with radical prostatectomy on prostate cancer in mice.

METHODS

We extracted antigens from mouse prostate cancer cells RM-1 and cocultured them with dendritic cells to induce maturation. We constructed in situ carcinoma and subcutaneous tumor models of the mouse prostate. The efficacy of dendritic cell injection combined with radical prostatectomy was evaluated in the carcinoma in situ model, and the ability of dendritic cells to prevent prostate cancer was evaluated in the subcutaneous tumor model. Means of assessment included ultrasonography, flow cytometry analysis, and Elisa.

RESULTS

Dendritic cell injection combined with radical prostatectomy effectively inhibited the growth of prostate carcinoma in situ in mice, as well as the growth of subcutaneous tumors of prostate cancer in mice. After dendritic cell injection, the levels of CD4 + T cells and Treg cells in the spleens of mice were significantly increased, and the levels of IL-2 and TNF-γ in the peripheral serum were significantly increased.

CONCLUSIONS

Injection of mature dendritic cells induced by mouse prostate cancer cell RM-1 antigen can inhibit the growth of prostate cancer. Radical prostatectomy combined with dendritic cell injection might be a potential treatment strategy for prostate cancer.

Comparison of robot-assisted laparoscopic radical prostatectomy via modified extraperitoneal approach and transvesical approach

OBJECTIVE

To compare the clinical outcomes of two different surgical approaches for treating localized prostate cancer: extraperitoneal robot-assisted radical prostatectomy (Ep-RARP) and transvesical robot-assisted radical prostatectomy (Tv-RARP).

METHODS

This study collected and analyzed data from patients with localized prostate cancer who underwent robot-assisted radical prostatectomy (RARP) within the same surgical team between October 2018 and March 2024. The cohort included two groups: the Ep-RARP group (37 cases) and the Tv-RARP group (29 cases). The primary outcomes analyzed were postoperative drainage time, length of hospital stay, surgical margin status, postoperative complications, urinary continence, and erectile function.

RESULTS

The baseline characteristics of the two groups of patients were consistent (p > 0.05), making them comparable. The Ep-RARP group had a significantly shorter hospital stay (7 days [5.5-8] vs. 9 days [9-10], p < 0.001) and shorter drain retention time (7 days [6-8] vs. 8 days [7-10], p < 0.001). There were no significant differences in intraoperative blood loss, blood transfusion requirements, and surgical complications. The duration of catheterization was similar in both groups (7 days [7-8] vs. 7 days [7-8], p = 0.135), as well as the distribution of Gleason scores, pathological staging (T1, T2), and positive surgical margin rate (p > 0.05). No significant differences were found in immediate postoperative urinary control rates (Tv-RARP: 20 [68.97%] vs. Ep-RARP: 26 [70.27%], p = 0.909), 3-month urinary control rates (Tv-RARP: 27 [93.10%] vs. Ep-RARP: 35 [94.59%], p = 1.000), or 6-month urinary control rates (Tv-RARP: 29 [100%] vs. Ep-RARP: 37 [100.00%], p = 1.000). The biochemical recurrence rate at 6 months was also comparable (Ep-RARP: 1 [2.70%] vs. Tv-RARP: 1 [3.45%], p = 1.000). Postoperative erectile function recovery at 3 and 6 months was similar between the two groups (3 months: Ep-RARP: 14 [37.84%] vs. Tv-RARP: 12 [41.40%], p = 0.804; 6 months: Ep-RARP: 18 [48.64%] vs. Tv-RARP: 17 [58.62%], p = 0.464).

CONCLUSION

Both extraperitoneal and transvesical robot-assisted radical prostatectomy are feasible approaches for localized prostate cancer, offering comparable oncologic control and functional outcomes. However, the extraperitoneal approach demonstrates advantages in terms of shorter surgery time, drain retention time, and hospital stay.

Global burden of prostate cancer: age-period-cohort analysis from 1990 to 2021 and projections until 2040

BACKGROUND

Prostate cancer (PCa) is the second most common cancer among men worldwide. This study uses data from the 2021 Global Burden of Disease (GBD) study to estimate the global burden of prostate cancer from 1990 to 2021.

METHODS

We analyzed the incidence, mortality, and disability-adjusted life years (DALYs) of prostate cancer globally from 1990 to 2021. Based on the Sociodemographic Index (SDI), we used the estimated annual percentage change (EAPC) and Age-Period-Cohort model to compare the burden of disease across different age groups and regions with varying levels of development. Finally, we used the Bayesian Age-Period-Cohort model to predict the trend of changes in the disease burden of prostate cancer by 2040.

RESULTS

In 2021, the global age-standardized incidence rate (ASIR) of prostate cancer was 15.37 per 100,000, an increase from 13.69 per 100,000 in 1990. However, the age-standardized mortality rate (5.26 per 100,000) and DALY rate (95.94 per 100,000) decreased significantly compared to 1990. The burden of prostate cancer increased with age, but overall, the burden across all age groups was lower in 2021 than in 1990. The only exception was the incidence rate among individuals under 75 in 2021. High-income regions such as North America and Australia exhibited the highest burden in terms of ASIR, though there has been some reduction in recent years. Conversely, the burden of mortality and DALYs was highest in regions such as sub-Saharan Africa, West Africa, and the Caribbean, where rates have continued to rise. Correlation analysis between SDI and the EAPC of the disease burden showed a negative correlation between EAPC of prostate cancer mortality and DALYs with SDI. The APC analysis showed that in 2021, the ASIR of prostate cancer in high SDI regions was still significantly higher across all age groups compared to other regions. In regions with middle SDI and above, the age-standardized mortality rate and DALY rate decreased over time or across birth cohorts, with a faster decline in areas with higher SDI. By 2040, it is projected that the global ASIR of prostate cancer will reverse its current trend and increase, while the age-standardized mortality rate and DALY rate will continue to decline, and the counts of incidence, mortality, and DALYs will keep rising.

CONCLUSION

Although the global mortality rate and DALY rate for prostate cancer show a decreasing trend, the number of new cases, deaths, and DALYs continues to rise due to global population growth and the aging population, and the disease burden remains significant. Furthermore, there are substantial geographic disparities in the disease burden of prostate cancer. Therefore, targeted programs should be implemented to strengthen prostate cancer diagnosis and treatment in these specific regions.

Endovideosurgical methods for treatment of local prostate cancer: Comparative functional and oncological results

INTRODUCTION

Currently, robot-assisted radical prostatectomy (RARP), extraperitoneal radical prostatectomy (ERPE), and laparoscopic radical prostatectomy (LRP) are frequently used for the treatment of localized prostate cancer.

MATERIALS AND METHODS

The study included 2,290 patients with localized prostate cancer. All patients underwent radical prostatectomy (RPE) performed by a single surgeon using different surgical approaches: robot-assisted (RARP, n = 888), laparoscopic (LRP, n = 965), and extraperitoneal (ERPE, n = 437). Oncological outcomes were assessed based on postoperative PSA levels. Functional status was assessed using the following questionnaires: IIEF-5, ICIQ-SF, DRIP-test, and 24-h pad test.

RESULTS

In the NS group (LRP and RARP access), the operative time was (200.0 [180.0; 225.0] vs 180.0 [135.0; 230.0] min; p < 0.0001), and the volume of blood loss was (300.0 [200.0; 350.0] vs. 200.0 [150.0; 250.0]). According to the ICIQ-SF test, the presence of patients with symptoms of severe to moderate urinary incontinence (ICIQ-SF scale) in the early postoperative period (mean 9.0 [4.0; 14.0] for RARP vs 11.0 [5.0; 16.0] for LRP and 12.0 [11.0; 14.0] for ERPE, p < 0.0001) contrasted with the results 12 months after surgery, where only patients with mild to moderate urinary incontinence remained (mean 1.0 [0.0; 5.0] for RARP, 4.0 [2.0; 7.0] for LRP, and 5.0 [3.0; 8.0] for ERPE, p < 0.0001).Postoperative erectile function results were evaluated at 12, 24, and 36 months. In all three groups without the NS technique, all patients had significant erectile dysfunction (p < 0.0001). In contrast, at a median follow-up of 12 months, the postoperative questionnaire results for RARP using the NS technique averaged 14.0 [10.0; 18.0], and for LRP 9.0 [6.0; 11.0] (p < 0.0001).

CONCLUSION

Robot-assisted radical prostatectomy is the preferred method as it provides better functional outcomes. The use of the nerve-sparing technique significantly improved outcomes in terms of urinary continence and also resulted in fewer patients requiring urological pads.

Bi-parametric MRI-based quantification radiomics model for the noninvasive prediction of histopathology and biochemical recurrence after prostate cancer surgery: a multicenter study

RATIONALE AND OBJECTIVES

To develop and evaluate the performance of a noninvasive radiomics combined model based on preoperative bi-parametric MRI to assess biochemical recurrence (BCR) risk factors and to predict biochemical recurrence free survival in PCa patients.

MATERIALS AND METHODS

Pretreatment bp-MRI and clinicopathology data of 666 (discovery cohort, 545; test cohort, 121) PCa patients from four centers between January 2015 to March 2023 were retrospectively included. To predict BCR, extracapsular extension (ECE), pelvic lymph node metastasis (PLNM), and Gleason Grade group (GG), the pred-BCR, pred-ECE, pred-PLNM, and pred-GG models were developed, respectively. Subsequently, a logistic regression algorithm was used to combine one or more radiomics models and clinicopathology variables into radiomics-clinicopathology combined models (M1, M2) and radiomics-clinical combined model without pathology results (M3) for predicting BCR.

RESULTS

In the test cohort, the AUCs for the pred-BCR, pred-ECE, pred-PLNM, and pred-GG models were 0.841, 0.764, 0.896, and 0.698. Of the three combined models, M3 has the best prediction performance with an AUC of 0.884, M2 is the following with an AUC of 0.863, and M1 has the lowest performance with an AUC of 0.838 (95% CI 0.750-0.925) in the test cohort. Delong's test showed that the M3 was significantly higher (M1 vs. M3, p = 0.028; M2 vs. M3, p = 0.044).

CONCLUSION

The combined model developed in this study, which is not dependent on pathologic biopsies, can noninvasively predict postoperative histopathology and BCR after PCa, therefore may provide decision support for follow-up and treatment strategies for patients in the postoperative period.

ABO blood group system correlates with preoperative serum PSA level in patients with prostate cancer

We previously demonstrated that the non-O blood type is associated with a higher risk of aggressive prostate cancer (PCa) than the O blood type. However, the influence of the ABO blood phenotype on the exact risk stratification parameters, especially prostate-specific antigen (PSA), remains unknown. We retrospectively evaluated 426 patients with PCa underwent radical prostatectomy in our centers. We divided them into three groups based on PSA levels: PSA1 (< 10 ng/ml), PSA2 (10-20 ng/ml), and PSA3 (> 20 ng/ml), and compared the clinicopathological characteristics among the groups. The association of clinicopathological parameters with PSA was determined using logistic regression analyses. The percentages of patients with advanced pathological stage T (pT) and grade, lymph node (pN) involvement, A + AB type, perineural invasion (PNI), vessel carcinoma embolus (VCE), and positive surgical margin rate were significantly higher in the PSA3 group than in the PSA1 group (all p < 0.05). Univariate logistic regression analyses revealed that type A + AB, grade, pT, pN, PNI, and VCE were positively correlated with PSA levels when comparing PSA3 with PSA1. Multivariate analysis showed that the association between blood type A + AB and PSA levels remained significant (OR 1.810, 95% CI 1.061-3.086, for PSA2 vs. PSA1; OR 2.682, 95% CI 1.550-4.641, for PSA3 vs. PSA1) after adjusting for confounding factors. The A + AB blood type was independently associated with PSA levels in PCa patients, indicating that the A-allele might participate in PSA synthesis and PSA screening may be more efficient for A-allele carriers.

Predictive Model of Acute Rectal Toxicity in Prostate Cancer Treated With Radiotherapy

PURPOSE

To aid personalized treatment selection, we developed a predictive model for acute rectal toxicity in patients with prostate cancer undergoing radiotherapy with photons and protons.

MATERIALS AND METHODS

We analyzed a prospective multi-institutional cohort of 278 patients treated from 2012 to 2023 across 10 centers. Dosimetric and nondosimetric variables were collected, and key predictors were identified using purposeful feature selection. The cohort was split into discovery (n = 227) and validation (n = 51) data sets. The dose along the rectum surface was transformed into a two-dimensional surface, and dose-area histograms (DAHs) were quantified. A convolutional neural network (CNN) was developed to extract dosimetric features from the DAH and integrate them with nondosimetric predictors. Model performance was benchmarked against logistic regression (LR) using the AUC.

RESULTS

Key predictors included rectum length, race, age, and hydrogel spacer use. The CNN model demonstrated stability in the discovery data set (AUC = 0.81 ± 0.11) and outperformed LR in the validation data set (AUC = 0.81 v 0.54). Separate analysis of photon and proton subsets yielded consistent AUCs of 0.7 and 0.92, respectively. In the photon high-risk group, the model achieved 83% sensitivity, and in proton subsets, it achieved 100% sensitivity and specificity, indicating the potential to be used for treatment selection in these patients.

CONCLUSION

Our novel approach effectively predicts rectal toxicity across photon and proton subsets, demonstrating the utility of integrating dosimetric and nondosimetric features. The model's strong performance across modalities suggests potential for guiding treatment decisions, warranting prospective validation.

RELATIONSHIP BETWEEN PURINERGIC SIGNALLING AND OXIDATIVE STRESS IN PROSTATE CANCER: PERSPECTIVES FOR FUTURE THERAPY

Prostate cancer (PCa) is a complex and lethal disease in men, influenced by risk factors such as age, heredity, and lifestyle. This article reviews the roles of purinergic signaling and reactive species in PCa progression. The purinergic system involves signaling molecules, such as ATP and adenosine, specific receptors (P1 and P2), and catalytic enzymes (for example, CD39 and CD73), whose alterations contribute to cell proliferation, angiogenesis, and immune evasion. The purinergic receptors P2X7 and P2X4 modulate the prostate tumor microenvironment (TME), impacting hypoxia, apoptosis, and inflammatory pathways. Reactive oxygen species (ROS) and nitrogen species (RNS) also play crucial roles. At elevated levels, they lead to oxidative damage to DNA and mitochondria, promoting genetic instability and uncontrolled cell proliferation. These species interact with the purinergic signaling pathway, with enzymes like CD39 and CD73 playing dual roles: degrading extracellular ATP to generate immunosuppressive adenosine while simultaneously protecting against oxidative damage. This review emphasizes the dynamic interplay between inflammatory and immunosuppressive signals within the TME, mediated by ATP, ROS, and their signaling cascades. This balance determines whether the environment supports tumor progression or regression. Targeting these mechanisms through innovative therapies, including receptor inhibitors and ROS modulation, presents promising avenues for PCa treatment. Understanding the intricate roles of purinergic signaling and reactive species provides valuable insights into potential therapeutic strategies to combat PCa.

Metal nanoparticles as a promising therapeutic approach for prostate cancer diagnosis and therapy: a comprehensive review

Prostate cancer is a leading cause of mortality among men worldwide, particularly in the USA and European nations, with an estimated 1.9 million new cases and over 580,000 deaths annually, according to recent global statistics. The treatment of prostate tumors presents significant clinical challenges, due to the disease's high metastatic potential, specifically to vital organs, such as the liver, lungs, bones, and brain. The intrinsic heterogeneity of prostate cancer cells, characterized by diverse genetic, molecular, and phenotypic profiles, complicates conventional therapeutic strategies, highlighting the need for advanced diagnostic and treatment modalities. Nanoparticles play a critical role in oncology field due to their unique physicochemical properties, including high surface area-to-volume ratio and the ability to be functionalized with targeting ligands. Metallic-based nanoparticles exhibits significant potential for applications in field of nanomedicine, drug delivery systems, gene silencing methods, radiotherapy enhancement, cancer diagnostics, and targeted therapeutic interventions. Metal nanoparticles have substantially improved the sensitivity and specificity of major imaging modalities and have demonstrated remarkable efficacy as biosensors for the detection of prostate cancer-specific biomarkers. This review article provides an in-depth analysis of the utilization of metal nanomaterials in prostate cancer, focusing on their roles in enhancing therapeutic efficacy, advancing diagnostic precision, and supporting the development of novel treatment strategies.

Identification of neutrophil extracellular traps (NETs)-related molecular clusters in prostate cancer: Implications for predicting biochemical recurrence

OBJECTIVE

To identify neutrophil extracellular traps (NETs)-related molecular clusters and establish a novel gene signature for predicting biochemical recurrence in prostate cancer (PCa).

METHODS

The transcriptome and clinicaldata of PCa sampleswere obtained from The TCGA and GEO databases. To identify NET-related molecular clusters, consensus clustering analyses were performed. Using univariate Cox and Lasso regression analysis, a novel NETs-related prognostic model was formulated. To evaluate the validity of the model, both internal and external validations were carried out. At last, preliminary experimental validations were performed to verify the biological functions of ANXA3 in PCa cells.

RESULTS

After screening 75 NETs-related prognostic genes, two NET-related clusters with significantly different clinical features, immune cell infiltration, and biochemical recurrence were established. Next, a new NET-related model was constructed. In training, test, whole TCGA, and GEO cohorts, the biochemical recurrences free survival of the patients with high-risk scores was considerably lower. The AUCs for the four cohorts were 0.827, 0.696, 0.757, and 0.715, respectively. Subgroup analysis suggested that the novel NETs-related prognostic model has a strong clinical value in the identification of high-risk patients. Finally, we confirmed that chemotherapy might be more beneficial for patients at low risk. In preliminary experiments, the inhibition of ANXA3 could reduce the invasion, migration, and proliferation of PCa cells.

CONCLUSIONS

We have identified novel NETs-related clusters and developed a NETs-related model for PCa that has excellent predictive performance for predicting biochemical recurrences as well as chemotherapy efficacy.

Recent trends in the incidence of early-onset prostate cancer

Early-onset prostate cancer (EOPC) is relatively uncommon. It is unclear if the incidence of EOPC is evolving. Utilizing data from the SEER database from 2000 to 2020, the study identified prostate cancer cases in men under 55 years, focusing on trends in annual age-adjusted incidence rates (AAIR), stage at presentation, race/ethnicity, and local treatment patterns. The study encompassed 93 071 cases of EOPC, with the median age at diagnosis being 51 years. From 2000 to 2007, the AAIR of EOPC experienced a wave-like increase from 6.9 to 8.3 per 100 000 people. It then sharply declined to 5.4 by 2014, followed by 6 years of stability, and by 2020 it had dropped to its lowest point of 4.5. The trend observed across different racial groups was consistent with the overall pattern, where non-Hispanic Black patients consistently exhibited the highest incidence and the least reduction rate (annual percent change, -1.0; 95% confidence interval, -1.8 to -0.2; P  < 0.05). Stage II was the most commonly diagnosed, although its AAIR declined from 4.9 to 1.2 per 100 000 people. From 2010 through 2020, the proportion of receiving prostatectomy decreased from 63.0 to 43.6%. The declining rates of EOPC across diverse racial groups emphasize the critical need for focused research and interventions. Specifically, there is an urgent call to establish a tailored screening protocol for prostate cancer targeting Black youth.

Radical prostatectomy outcomes of prostate cancer cases: Insights from a leading surgeon's experience in Azerbaijan

OBJECTIVE

Prostate cancer is a significant health concern worldwide and ranks as the 4th most frequent cancer among men in Azerbaijan. While robot-assisted laparoscopic radical prostatectomy is the preferred surgical technique in many countries, open retropubic radical prostatectomy (ORP) remains the primary treatment option in Azerbaijan due to limited access to robotic surgical systems. This study aims to analyze the outcomes of ORP in patients with local and locally advanced prostate cancer.

METHODS

We retrospectively evaluated 95 men who underwent extraperitoneal retropubic ORP for prostate cancer at our center between May 2020 and December 2023. Comprehensive data on patient demographics, preoperative parameters, surgical details, and postoperative outcomes were collected. Statistical analyses were conducted using IBM SPSS 27.0 software.

RESULTS

The mean age of the patients was 65.9 years. The median preoperative PSA level was 14.8 ng/mL, and lymph node enlargement was identified in 29.5% of patients. A rectal injury occurred in one patient (1.1%) as the only intraoperative complication. The mean intraoperative blood loss was 330 mL, and the median hospital stay was 6 days. A positive surgical margin was observed in 38.9% of cases. Diabetes mellitus and higher intraoperative blood loss were associated with prolonged hospital stays (≥ 7 days). Erectile dysfunction was reported in 52.6% of patients 6 months postoperatively, while urinary incontinence was observed in 2.2%.

CONCLUSIONS

ORP outcomes in Azerbaijan are comparable to those reported for laparoscopic and robot-assisted techniques in terms of perioperative and oncological results. Despite the absence of advanced surgical technology, ORP remains an effective treatment option for prostate cancer when performed by experienced surgeons.

Preoperative detection of extraprostatic tumor extension in patients with primary prostate cancer utilizing [68Ga]Ga-PSMA-11 PET/MRI

OBJECTIVES

Radical prostatectomy (RP) is a common intervention in patients with localized prostate cancer (PCa), with nerve-sparing RP recommended to reduce adverse effects on patient quality of life. Accurate pre-operative detection of extraprostatic extension (EPE) remains challenging, often leading to the application of suboptimal treatment. The aim of this study was to enhance pre-operative EPE detection through multimodal data integration using explainable machine learning (ML).

METHODS

Patients with newly diagnosed PCa who underwent [68Ga]Ga-PSMA-11 PET/MRI and subsequent RP were recruited retrospectively from two time ranges for training, cross-validation, and independent validation. The presence of EPE was measured from post-surgical histopathology and predicted using ML and pre-operative parameters, including PET/MRI-derived features, blood-based markers, histology-derived parameters, and demographic parameters. ML models were subsequently compared with conventional PET/MRI-based image readings.

RESULTS

The study involved 107 patients, 59 (55%) of whom were affected by EPE according to postoperative findings for the initial training and cross-validation. The ML models demonstrated superior diagnostic performance over conventional PET/MRI image readings, with the explainable boosting machine model achieving an AUC of 0.88 (95% CI 0.87-0.89) during cross-validation and an AUC of 0.88 (95% CI 0.75-0.97) during independent validation. The ML approach integrating invasive features demonstrated better predictive capabilities for EPE compared to visual clinical read-outs (Cross-validation AUC 0.88 versus 0.71, p = 0.02).

CONCLUSION

ML based on routinely acquired clinical data can significantly improve the pre-operative detection of EPE in PCa patients, potentially enabling more accurate clinical staging and decision-making, thereby improving patient outcomes.

CRITICAL RELEVANCE STATEMENT

This study demonstrates that integrating multimodal data with machine learning significantly improves the pre-operative detection of extraprostatic extension in prostate cancer patients, outperforming conventional imaging methods and potentially leading to more accurate clinical staging and better treatment decisions.

KEY POINTS

Extraprostatic extension is an important indicator guiding treatment approaches. Current assessment of extraprostatic extension is difficult and lacks accuracy. Machine learning improves detection of extraprostatic extension using PSMA-PET/MRI and histopathology.

Artificial intelligence-based personalized clinical decision-making for patients with localized prostate cancer: surgery versus radiotherapy

BACKGROUND

Surgery and radiotherapy are primary nonconservative treatments for prostate cancer (PCa). However, personalizing treatment options between these treatment modalities is challenging due to unclear criteria. We developed an artificial intelligence (AI)-based model that can identify patients with localized PCa who would benefit more from either radiotherapy or surgery, thereby providing personalized clinical decision-making.

MATERIAL AND METHODS

Data from consecutive patients with localized PCa who received radiotherapy or surgery with complete records of clinicopathological variables and follow-up results in 12 registries of the Surveillance, Epidemiology, and End Results database were analyzed. Patients from 7 registries were randomly assigned to training (TD) and internal validation datasets (IVD) at a 9:1 ratio. The remaining 5 registries constituted the external validation dataset (EVD). TD was divided into training-radiotherapy (TRD) and training-surgery (TSD) datasets, and IVD was divided into internal-radiotherapy (IRD) and internal-surgery (ISD) datasets. Six models for radiotherapy and surgery were trained using TRD and TSD to predict radiotherapy survival probability (RSP) and surgery survival probability (SSP), respectively. The models with the highest concordance index (C-index) on IRD and ISD were chosen to form the final treatment recommendation model (FTR). FTR recommendations were based on the higher value between RSP and SSP. Kaplan-Meier curves were generated for patients receiving recommended (consistent group) and nonrecommended treatments (inconsistent group), which were compared using the log-rank test.

RESULTS

The study included 118 236 patients, categorized into TD (TRD: 44 621; TSD: 41 500), IVD (IRD: 4949; ISD: 4621), and EVD (22 545). Both radiotherapy and surgery models accurately predicted RSP and SSP (C-index: 0.735-0.787 and 0.769-0.797, respectively). The consistent group exhibited higher survival rates than the inconsistent group, particularly among patients not suitable for active surveillance (P < .001).

CONCLUSION

FTR accurately identifies patients with localized PCa who would benefit more from either radiotherapy or surgery, offering clinicians an effective AI tool to make informed choices between these 2 treatments.

Nerve-sparing techniques in robot-assisted radical prostatectomy - anatomical approach

INTRODUCTION

Nerve-sparing (NS) techniques in robot-assisted radical prostatectomy (RARP) are foundational to preserving sexual function and urinary continence in prostate cancer (PCa) patients.

AREAS COVERED

This article aims to classify nerve-sparing (NS) techniques in RARP based on an anatomical approach to the prostate. We have identified three main NS approaches in RARP: anterior, lateral, and posterior. The anterior approach, which involves early retrograde nerve release, improves early potency rates. The lateral approach, using hybrid techniques and extra-fascial dissection, provides clear nerve visualization and reduces nerve injuries, enhancing continence and potency recovery. The posterior approach, particularly the hood technique, effectively preserves periurethral structures, leading to high continence rates within a year post-surgery. The posterior approach effectively balances nerve preservation with cancer control.

EXPERT OPINION

Re-classifying NS techniques in RARP based on an anatomical approach optimizes patient outcomes and the surgeon choice. A personalized approach to those techniques improves functional recovery and maintains oncological safety in PCa surgery. Further studies are needed to confirm those findings and refine the selection criteria.

A clinical evaluation of robotic-assisted radical prostatectomy (RARP) in located prostate cancer: A systematic review and network meta-analysis

Prostate cancer (PCa) is a prevalent malignant tumor affecting the male reproductive system and there are mainly three widely accepted PCa surgery types in current clinical treatment: open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP). Here, we aimed to evaluate the clinical effect of RARP for PCa patients compared with ORP and LRP based on the context of PCa encompass two dimensions: oncological outcomes (biochemical recurrence (BCR) and positive surgical margin (PSM)) and functional outcomes (urinary continence and recovery of erectile function) in this network meta-analysis (NMA). PubMed, Embase and Cochrane databases were systematically searched in January 7, 2024. 4 randomized controlled trials (RCTs) and 72 non-RCTs were included. RARP displayed significant positive effect on lower BCR and better recovery of erectile function but no significant differences existed among three surgery types for PSM and urinary continence.

Surgical experience overcomes the impact of prostatic-urethral anatomy on continence recovery after robotic prostatectomy: comprehensive analysis on 366 cases

PURPOSE

To investigate the relationship between a set of prostate-urethral complex (PUC) measurements and incontinence after robot-assisted radical prostatectomy (RARP).

METHODS

The study included data from patients undergoing RARP performed by 2 expert surgeons between 2019 and 2022, with data about preoperative magnetic resonance imaging (MRI) and functional follow-up. Continence status was assessed according to a stringent definition (no PADS used). MRIs were evaluated to calculate prostatic urethral length, membranous urethral length, membranous urethral width, levator ani thickness, and prostate shape. The association of PUC measurements with continence after RARP was studied. Secondarily, we evaluated whether pre-determined cut-off values of PUC measurements could be associated with time to continence. Cumulative hazard incidence analysis was performed by the Nelson-Aalen hazard function. Cumulative incidence hazard curves were built; the Peto-Peto test was used to evaluate the difference among the curves.

RESULTS

366 patients were included. At the 12-month follow-up, 333 patients (90.1%) were continent. Classification of PUC measurements overlapped between continent and noncontinent patients. However, a statistically significant difference was observed for levator ani thickness, greater in continent patients (12.8 mm vs. 11.7; p = 0.02). Multivariable models found BMI as independent predictor of incontinence (HR 1.04, 95% C.I 1.00-1.07, p = 0.04). None of PUC measurements associated with incontinence. Also, cumulative hazard incidence analysis at 3 / 6 / 12-months found no statistically significant difference in PUC measurements.

CONCLUSION

No association was found between anatomical characteristics of PUC and continence or time to continence after RARP performed by proficient surgeons. Our data would suggest that once the surgeon has surpassed the learning curve, anatomical variations do not significantly affect the appropriate and proficient execution of the prostate apex dissection during RARP.

Cytotoxic properties of Thuya occidentalis hydroalcoholic extract on androgen unresponsive prostate cancer cells

Background: Androgen independent phase in prostate cancer (PCa) commonly limits the therapeutic efficacy. Thuya occidentalis through its main active compound, α-thujone, appears to be an option, considering its anti-proliferative, anti-metastatic and pro-apoptotic effects on hepatocellular carcinoma. However, studies on PCa are limited.

Objective: To evaluate if T. occidentalis could be useful against androgen responsive and unresponsive PCa cells.

Methods: Androgen responsive (LNCaP) and unresponsive (DU145 and PC3) cell lines were exposed to T. occidentalis hydroalcoholic extract (0.05 mL/mL) for different periods. Further, α-thujone was measured in the extract and tested in the cell lines.

Results: T. occidentalis and α-thujone showed the highest cytotoxicity on LNCaP cells. In androgen unresponsive cells, T. occidentalis decreased cell viability and density, and promoted apoptosis, necrosis and cell cycle arrest, possibly associated with Cav-1 downregulation. The α-thujone present in the extract significantly LNCaP cells density, but did not affect DU145 and PC3 cells, suggesting that other compounds may also be cytotoxic to androgen unresponsive cells.

Androgen deprivation therapy, neoadjuvant androgen deprivation therapy, and adjuvant androgen deprivation therapy in patients with locally advanced prostate cancer: a multi-center real-world retrospective study

PURPOSE

Determining the potential benefit of neoadjuvant androgen deprivation therapy (ADT) and adjuvant ADT in patients with locally advanced prostate cancer (LAPC) undergoing complete resection.

METHODS

139 patients diagnosed with cT3-4, or cN+ LAPC in Xiangya Hospital and The First Affiliated Hospital of University of South China from 2010 to 2021 were collected. Cancer-specific survival (CSS) and overall survival (OS) of patients were assessed using Kaplan-Meier and Cox proportional risk analysis. We also analyzed the functional outcomes of two subgroups of patients who underwent radical prostatectomy (RP).

RESULTS

Of the 182 patients with cT3-4, or cN+ LAPC, 139 patients (76.4%) were enrolled in the study with a 5-year survival rate of 82.3%. 45 patients (32.4%) received ADT alone, 46 patients (33.1%) received neoadjuvant ADT before surgery, and the remaining 48 patients (34.5%) received surgery with adjuvant ADT. Neoadjuvant ADT before surgery and surgery with adjuvant ADT were associated with significantly improved survival compared with ADT alone. Multivariate Cox models showed that neoadjuvant ADT before surgery (hazard ratio [HR], 0.29; 95% CI 0.13-0.92) or surgery with adjuvant ADT (HR, 0.26; 95% CI 0.16-0.78) was associated with improved CSS compared with ADT alone. Regional lymph node metastasis, positive lymphovascular invasion, and Gleason score 9 + were independent predictors of LAPC CSS and OS. More patients in the neoadjuvant ADT before surgery group achieved final continence status within 12 months after surgery (93.48% v 77.08%).

CONCLUSION

CSS and OS were significantly prolonged in cT3-4, or cN+ LAPC patients who received neoadjuvant ADT before surgery and surgery with adjuvant ADT compared to ADT alone.

Clinical insights into nanomedicine and biosafety: advanced therapeutic approaches for common urological cancers

Urological cancers including those of the prostate, bladder, and kidney, are prevalent and often lethal malignancies besides other less common ones like testicular and penile cancers. Current treatments have major limitations like side effects, recurrence, resistance, high costs, and poor quality of life. Nanotechnology offers promising solutions through enhanced diagnostic accuracy, targeted drug delivery, controlled release, and multimodal imaging. This review reflects clinical challenges and nanomedical advances across major urological cancers. In prostate cancer, nanoparticles improve delineation and radiosensitization in radiation therapy, enable fluorescent guidance in surgery, and enhance chemotherapy penetration in metastatic disease. Nanoparticles also overcome bladder permeability barriers to increase the residence time of intravesical therapy and chemotherapy agents. In renal cancer, nanocarriers potentiate tyrosine kinase inhibitors and immunotherapy while gene vectors and zinc oxide nanoparticles demonstrate antiproliferative effects. Across modalities, urological applications of nanomedicine include polymeric, liposomal, and metal nanoparticles for targeted therapy, prodrug delivery, photodynamic therapy, and thermal ablation. Biosafety assessments reveal favorable profiles but clinical translation remains limited, necessitating further trials. In conclusion, nanotechnology holds significant potential for earlier detection, precise intervention, and tailored treatment of urological malignancies, warranting expanded research to transform patient outcomes.

Applications of wearable activity monitors for prostate cancer survivors: A systematic scoping review

BACKGROUND

Wearable technology is used to monitor and motivate physical activity (PA) and provides continuous, objective PA and sleep data outside the clinical setting. We reviewed the literature to understand how wearables are integrated into prostate cancer (PC) investigations in order to identify current practices, gaps, and research opportunities.

METHODS

We conducted a literature search for articles using wearables, among PC survivors published between 2012 and 2022. We extracted study details, interventions and outcomes, participant baseline characteristics, and device characteristics and grouped them by study type: randomized control trials (RCTs) and non-randomized studies.

RESULTS

Of 354 articles screened, 44 met eligibility criteria (23 RCTs, and 21 non-randomized). 89% used wearables to monitor PA metrics, 11%, sleep metrics, and 6.8%, both. Most studies involved exercise (70% RCTs, 9% non-randomized studies) or lifestyle interventions (30% RCTs, 9% non-randomized studies). Intervention delivery methods included personalized computer-based (48%), in-person (e.g., trainer) (20%), and education web or print-based (20%). Interventions occurred at the participant's home (48%) or at a gym (20%). 57% of the studies evaluated the feasibility and acceptability of the wearable as an activity-measuring device or as part of a remotely delivered computer-based intervention. Studies used wearables to monitor adherence to PA interventions, motivate behavior change, to assess patient outcomes (e.g., patient function, quality of life, mood), or as data collection tools.

CONCLUSIONS

Wearables are primarily being used to assess daily activity and monitor adherence to exercise interventions in clinical studies involving PC survivors. Findings suggest that they are feasible for use in this population. More research is needed to understand how to integrate wearables into routine clinical care, expand their use to predict clinical outcomes, or to deliver tailored interventions for PC survivors.

Intraoperative workload of the surgeon in robot-assisted radical prostatectomy: a systematic review

In the present study, we aimed to systematically evaluate the current evidence regarding the intraoperative workload of surgeons performing robot-assisted radical prostatectomy (RARP) for prostate cancer. A systematic search was carried out in the PubMed-MEDLINE and Web of Science databases through April 2024 using the following search terms: "workload AND robot assisted radical prostatectomy", "workload AND robotic radical prostatectomy", "task load AND robotic radical prostatectomy", "task load AND robot assisted radical prostatectomy" and "NASA-TLX AND robot assisted radical prostatectomy" by combining population, intervention, comparison, and outcome (PICO) terms, following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We therefore selected studies that included patients with prostate cancer (P) who underwent robotic radical prostatectomy (I) and reported a workload/task load questionnaire (C) to assess the intraoperative workload/task load of the surgeon performing robot-assisted radical prostatectomy (O). A total of 11 studies were identified. The surgeon's workload during RARP was assessed using the National Aeronautics and Space Administration task load index (NASA-TLX) and/or the surgery task load index (SURG-TLX) in the studies. Total NASA-TLX scores of the studies ranged from 22.7 ± 3.2 to 62.0 ± 6.4. Mental and physical demands, flow interruptions, surgeon experience, the use of single or multiple ports, and the relationship between the surgeon and other staff in the operating theater may play a role in the intraoperative workload of the console surgeon. The studies we reviewed suggest that RARP offers an acceptable workload for the console surgeon despite its mental demands.

Environmental explanation of prostate cancer progression based on the comprehensive analysis of polychlorinated biphenyls

OBJECTIVE

Polychlorinated biphenyls (PCBs) have caused great environmental concerns. The study aims to investigate underlying molecular mechanisms between PCBs exposure and prostate cancer (PCa).

METHODS

To investigate the association between PCBs exposure and prostate cancer by using CTD, TCGA, and GEO datasets. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to explore pathways associated with PCBs-related genes (PRGs). Using Lasso regression analysis, a novel PCBs-related prognostic model was developed. Both internal and external validations were conducted to assess the model's validity. Molecular docking was utilized to assess the binding capacity of PCBs to crucial genes. At last, preliminary experimental validations were conducted to confirm the biological roles of Aroclor 1254 in PCa cells.

RESULTS

The GO enrichment analysis of PRGs revealed that the biological processes were most enriched in the regulation of transcription from the RNA polymerase II promoter and signal transduction. The KEGG enrichment analysis showed that of the pathways in cancer is the most significantly enriched. Next, a PCBs-related model was constructed. In the training, test, GSE70770, and GSE116918 cohorts, the biochemical recurrences free survival of the patients with high-risk scores was considerably lower. The AUCs at 5 years were 0.691, 0.718, 0.714, and 0.672 in the four cohorts, demonstrating the modest predictive ability. A nomogram that incorporated clinical characteristics was constructed. The results of the anti-cancer drug sensitivity analysis show chemotherapy might be more beneficial for patients at low risk. The molecular docking analysis demonstrated PCBs' ability to bind to crucial genes. PCa cells exposed to Aroclor 1254 at a concentration of 1 μM showed increased proliferation and invasion capabilities.

CONCLUSIONS

This study provides new insights into the function of PCBs in PCa and accentuates the need for deeper exploration into the mechanistic links between PCBs exposure and PCa progression.

Mesenchymal stem cell-derived exosomes for management of prostate cancer: An updated view

Prostate cancer represents the second most prevalent form of cancer found in males, and stands as the fifth primary contributor to cancer-induced mortality on a global scale. Research has shown that transplanted mesenchymal stem cells (MSCs) can migrate by homing to tumor sites in the body. In prostate cancer, researchers have explored the fact that MSC-based therapies (including genetically modified delivery vehicles or vectors) and MSC-derived exosomes are emerging as attractive options to improve the efficacy and safety of traditional cancer therapies. In addition, researchers have reported new insights into the application of extracellular vesicle (EV)-MSC therapy as a novel treatment option that could provide a more effective and targeted approach to prostate cancer treatment. Moreover, the new generation of exosomes, which contain biologically functional molecules as signal transducers between cells, can simultaneously deliver different therapeutic agents and induce an anti-tumor phenotype in immune cells and their recruitment to the tumor site. The results of the current research on the use of MSCs in the treatment of prostate cancer may be helpful to researchers and clinicians working in this field. Nevertheless, it is crucial to emphasize that although dual-role MSCs show promise as a therapeutic modality for managing prostate cancer, further investigation is imperative to comprehensively grasp their safety and effectiveness. Ongoing clinical trials are being conducted to assess the viability of MSCs in the management of prostate cancer. The results of these trials will help determine the viability of this approach. Based on the current literature, engineered MSCs-EV offer great potential for application in targeted tumor therapy.

Analysis of factors associated with positive surgical margins and the five-year survival rate after prostate cancer resection and predictive modeling

Background

This study analyzed the risk factors associated with positive surgical margins (PSM) and five-year survival after prostate cancer resection to construct a positive margin prediction model.

Methods

We retrospectively analyzed the clinical data of 148 patients treated with prostatectomy. The patients were divided into PSM group and Negative surgical margins (NSM) group. Several parameters were compared between the groups. All patients were followed up for 60 months. The risk factors for PSM and five-year survival were evaluated by univariate analysis, followed by multifactorial dichotomous logistic regression analysis. Finally, ROC curves were plotted for the risk factors to establish a predictive model for PSM after prostate cancer resection.

Results

(1) Serum PSA, percentage of positive puncture stitches, clinical stage, surgical approach, Gleason score on puncture biopsy, and perineural invasion were significantly associated with the risk of PSM (P < 0.05). Serum PSA, perineural invasion, Gleason score on puncture biopsy, and percentage of positive puncture stitches were independent risk factors for PSM. (2) Total prostate-specific antigen (tPSA) by puncture, nutritional status, lymph node metastasis, bone metastasis, and seminal vesicle invasion may be risk factors for five-year survival. Lymph node metastasis and nutritional status were the main risk factors for the five-year survival of patients with prostate cancer. (3) After plotting the ROC curve, the area under the curve (AUC) [AUC: 0.776, 95%, confidence interval (CI): 0.725 to 0.854] was found to be a valid predictor of PSM; the AUC [AUC: 0.664, 95%, confidence interval (CI): 0.576 to 0.753] was also a valid predictor of five-year survival (P < 0.05). (4) The scoring system had a standard error of 0.02 and a cut-off value of 6. It predicted PSM after prostate cancer resection with moderate efficacy.

Conclusions

Serum PSA, perineural invasion, puncture biopsy Gleason score, and percentage of positive puncture stitches were independent risk factors for positive surgical margins (PSM). Also, lymph node metastasis and nutritional status were the main risk factors for the five-year survival of patients with prostate cancer. Overall, the prediction efficacy of this scoring system concerning the risk of PSM after prostate cancer resection was moderate.

Suitability of the MP1000 Platform for Robot-assisted Prostatectomy: A Prospective Randomised Controlled Trial

Background and objective

Robot-assisted radical prostatectomy (RARP) is widely used because of the many advantages of a robotic approach. The da Vinci Si robot is one of the most commonly used surgical robot systems, but it may be associated with higher costs owing to the use of consumable surgical supplies. Our aim was to conduct a preliminary investigation of the capability of the MP1000 system for RARP.

Methods

In this prospective, multicentre, single-blinded study, we randomly assigned 42 patients scheduled to undergo RARP between April and September 2021 to a da Vinci Si group (control) or an MP1000 group (intervention). Patients underwent RARP performed using the assigned robotic system and were followed up at 3-mo intervals. The primary outcome was the rate of conversion to open/laparoscopic surgery. Secondary outcomes were installation and operation times, intraoperative blood loss, postoperative surgical margin status, hospital stay, incontinence, complications, safety indicators, and surgeon ergonomics.

Key findings and limitations

All procedures were successfully completed without conversion to open/laparascopic surgery or major complications. Secondary outcomes, including oncological and ergonomic indicators, did not differ significantly between the groups over the study period. One patient in the control group experienced dysuria (Clavien-Dindo grade 3). No patients had incontinence at 3 mo. A limitation of the study is the small sample size.

Conclusions and clinical implications

RARP with the MP1000 system is feasible, safe, and effective in the management of localised prostate cancer.

Patient summary

We assessed the effectiveness and safety of the new MP1000 robot system for robot-assisted removal of the prostate in comparison to the da Vinci Si robot. We found no difference in effectiveness or safety among 42 patients with prostate cancer who were assigned randomly to one of the two systems. We conclude that the MP1000 is a suitable robot for this surgery.

Exploring the Hidden Struggles: A Qualitative Insight into Urinary Incontinence Among Prostate Cancer Survivors Post-Surgery

Objective

This study aimed to explore the experiences and challenges of prostate cancer patients suffering from urinary incontinence following radical prostatectomy.

Methods

A descriptive qualitative research design was employed. Purposeful sampling was used to select 22 prostate cancer patients who underwent radical prostatectomy and experienced urinary incontinence after surgery. These patients were interviewed between August to October 2023 at a tertiary B-grade hospital's pelvic floor center in Shanghai. The data were collected through semi-structured in-depth interviews and analyzed using content analysis to identify and refine themes.

Results

The experiences of urinary incontinence in patients can be categorized into four main themes: (1) Daily life disturbances (including 4 sub-themes: sleep disorders, fluid intake restriction, travel inconvenience, loss of sexual life); (2) Negative emotional experiences (including 4 sub-themes: perceived discrimination, concerns about recovery, loss of confidence in life, doubts about the surgical decision); (3) Social withdrawal (including 2 sub-themes: reduced desire for social interaction, decreased ability to socialize); (4) Limited support obtained (including 4 sub-themes: reliance on personal experience, seeking help from relatives and friends, difficulty discerning online information, lack of professional guidance).

Conclusion

Postoperative urinary incontinence in prostate cancer patients presents a multidimensional experience. Healthcare professionals need to pay attention to these patients' daily life, psychological state, and social interactions. Integrating various resources to provide professional support and rehabilitation guidance is crucial.

Index tumor location affected early biochemical recurrence after radical prostatectomy in patients with negative surgical margin: a retrospective study

BACKGROUND

Index tumors are the most aggressive tumors of the prostate. However, their clinical significance remains unclear. This study aimed to assess the incidence of index tumor location according to the zonal origin and whether these locations affect the prognosis after radical prostatectomy in patients with negative surgical margins.

METHODS

This single-centered, retrospective study evaluated 1,109 consecutive patients who underwent radical prostatectomies. An index tumor was defined as the largest tumor in the prostate gland. We detected these locations based on McNeal's zonal origin using whole-mount sections. Biochemical recurrence (BCR) free survival curves were generated using the Kaplan-Meier method. Univariate and multivariate analyses using the Cox proportional hazards model were performed to determine the predictive factors for early BCR (within 1-year).

RESULTS

A total of 621 patients with negative surgical margins who did not receive adjuvant therapy were included in this study. The index tumor were located in the transitional zone in 191 patients (30.8%), the peripheral zone in 399 patients (64.3%), and the central zone in 31 patients (5.0%). In total, 22 of 621 patients (3.5%) experienced early BCR and 70 patients (11.2%) experienced overall BCR at a median follow-up of 61.7 months. According to the index tumor location, the early BCR-free rates were 99.5%, 95.7 %, and 83.3% in the transitional, peripheral, and central zones, respectively. On multivariate analysis, the index tumor in the central zone was an independent predictor of early BCR with negative surgical margins following radical prostatectomy, followed by prostatectomy pathological grade, index tumor in the peripheral zone, and high prostate-specific antigen level.

CONCLUSIONS

We assessed the significance of index tumor location in patients with negative surgical margins following radical prostatectomy. Index tumors located in the central zone, although infrequent, were the strongest predictive factors for early BCR. Our results may allow urologists and patients to reconsider the therapeutic strategies for prostate cancer.

Surgical Outcome of Open Radical Prostatectomy in Nigeria: A Five-Years Single-Surgeon Experience

BACKGROUND

Organ-confined prostate cancer is curable through surgical treatment by radical prostatectomy.

AIM

To report initial outcomes of open radical prostatectomy in Nigeria from 2014 to 2019.

METHODS

Open radical prostatectomy in private hospital settings. Thirty-five patients underwent open radical prostatectomy in private hospital settings from 2014 to 2019. A retrospective study of the case notes was undertaken.

RESULTS

The age range was 56-77 years (mean: 67.7 ± 5.6 years); presenting total PSA 7.3-32.0 ng/ml (mean: 16.2 ± 6.4); Gleason score range 6-10 and clinical stage T2c. Mean operation duration 192.4 ± 52.0 min. All patients received blood transfusion (average blood transfusion 4.58 ± 1.9 pints). The median length of hospital stay was 7 days and the catheterization duration was 16.6 days. The Gleason score ranges from 6 to 10. Biopsy and specimen histology Gleason scores correlated in all cases. Biochemical relapse within 1 year occurred in 12 (34.3%) patients. Adequate PSA control was achieved in 23 (65.7%) patients. Two cancer-related deaths occurred within 2 years of surgery. All patients voided well following removal of the catheter; persisting mild stress urinary incontinence resolved on conservative measures within 3-6 months. Anastomotic stricture occurred in one patient 1 (2.9%) in this present. Information on preoperative potency rate was unavailable; however, postoperation, 11 (31.4%) patients achieved erections sufficient for intercourse with oral therapy. All surviving 33 (94.3%) patients reported satisfactory performance status.

CONCLUSIONS

Open radical prostatectomy was successfully performed in all the patients. Reasonable, comparative functional, and oncological outcomes were achieved during the study period.

snRNAs from Radical Prostatectomy Specimens Have the Potential to Serve as Prognostic Factors for Clinical Recurrence after Biochemical Recurrence in Patients with High-Risk Prostate Cancer

In patients with high-risk prostate cancer (HRPC) after radical prostatectomy (RP), biochemical recurrence (BCR) increases the risk of distant metastasis. Accordingly, additional prognostic biomarkers are required to identify the subpopulation of patients with HRPC who develop clinical recurrence (CR) after BCR. The objective of this study was to identify biomarkers in formalin-fixed paraffin-embedded (FFPE) RP samples that are prognostic for CR in patients with HRPC who experience BCR after RP (post-RP BCR). First, we performed a preliminary RNA sequencing analysis to comprehensively profile RNA expression in FFPE RP samples obtained from patients with HRPC who developed CR after post-RP BCR and found that many snRNAs were very abundant in preserved FFPE samples. Subsequently, we used quantitative polymerase chain reaction (qPCR) to compare the expression levels of highly abundant snRNAs in FFPE RP samples from patients with HRPC with and without CR after post-RP BCR (21 CR patients and 46 non-CR patients who had more than 5 years of follow-up after BCR). The qPCR analysis revealed that the expression levels of snRNA RNU1-1/1-2 and RNU4-1 were significantly higher in patients with CR than in patients without CR. These snRNAs were significantly correlated with clinical recurrence-free survival (RFS) in patients with HRPC who experienced post-RP BCR. Furthermore, snRNA RNU1-1/1-2 could serve as an independent prognostic factor for clinical RFS in post-RP BCR of HRPC cases where known prognostic factors (e.g., Gleason score) cannot distinguish between CR and non-CR patients. Our findings provide new insights into the involvement of snRNAs in prostate cancer progression.

AAT resistance-related AC007405.2 and AL354989.1 as novel diagnostic and prognostic markers in prostate cancer

OBJECTIVE

Prostate cancer (PCa) is the second disease threatening men's health, and anti-androgen therapy (AAT) is a primary approach for treating this condition. Increasing evidence suggests that long non-coding RNAs (lncRNAs) play crucial roles in the development of PCa and the process of AAT resistance. The objective of this study is to utilize bioinformatics methods to excavate lncRNAs association with AAT resistance and investigate their biological functions.

METHODS

AAT resistance-related risk score model (ARR-RSM) was established by multivariate Cox analysis. Paired clinical tissue samples of 36 PCa patients and 42 blood samples from patients with PSA over 4 ng/ml were collected to verify the ARR-RSM. In vitro, RT-qPCR, CCK-8 and clone formation assays were displayed to verify the expression and function of AL354989.1 and AC007405.2.

RESULTS

Pearson correlation analysis identified 996 lncRNAs were associated with AAT resistance (ARR-LncRs). ARR-RSM was established using multivariate Cox regression analysis, and PCa patients were divided into high-risk and low-risk groups. High-risk patients showed increased expression of AL354989.1 and AC007405.2 had poorer prognoses. The high-risk score correlated with advanced T-stage and N-stage. The AUC of ARR-RSM outperformed tPSA in diagnosing PCa. Silencing of AC007405.2 and AL354989.1 inhibited PCa cells proliferation and AAT resistance.

CONCLUSIONS

In this study, we have discovered the clinical significance of AC007405.2 and AL354989.1 in predicting the prognosis and diagnosing PCa patients. Furthermore, we have confirmed their correlation with various clinical features. These findings provide potential targets for PCa treatment and a novel diagnostic and predictive indicator for precise PCa diagnosis.

Predictive model of positive surgical margins after radical prostatectomy based on Bayesian network analysis

Objective

This study aimed to analyze the independent risk factors for marginal positivity after radical prostatectomy and to evaluate the clinical value of the predictive model based on Bayesian network analysis.

Methods

We retrospectively analyzed the clinical data from 238 patients who had undergone radical prostatectomy, between June 2018 and May 2022. The general clinical data, prostate specific antigen (PSA)-derived indicators, puncture factors, and magnetic resonance imaging (MRI) characteristics were included as predictive variables, and univariate and multivariate analyses were conducted. We established a nomogram model based on the independent predictors and adopted BayesiaLab software to generate tree-augmented naive (TAN) and naive Bayesian models based on 15 predictor variables.

Results

Of the 238 patients included in the study, 103 exhibited positive surgical margins. Univariate analysis revealed that PSA density (PSAD) (P = 0.02), Gleason scores for biopsied tissue (P = 0.002) and the ratio of positive biopsy cores (P < 0.001), preoperative T staging (P < 0.001), and location of abnormal signals (P = 0.002) and the side of the abnormal signal (P = 0.009) were all statistically significant. The area under curve (AUC) of the established nomogram model based on independent predictors was 73.80%, the AUC of the naive Bayesian model based on 15 predictors was 82.71%, and the AUC of the TAN Bayesian model was 80.80%.

Conclusion

The predictive model of positive resection margin after radical prostatectomy based on Bayesian network demonstrated high accuracy and usefulness.

Microfluidics-Based Technologies for the Assessment of Castration-Resistant Prostate Cancer

Castration-resistant prostate cancer remains a significant clinical challenge, wherein patients display no response to existing hormone therapies. The standard of care often includes aggressive treatment options using chemotherapy, radiation therapy and various drugs to curb the growth of additional metastases. As such, there is a dire need for the development of innovative technologies for both its diagnosis and its management. Traditionally, scientific exploration of prostate cancer and its treatment options has been heavily reliant on animal models and two-dimensional (2D) in vitro technologies. However, both laboratory tools often fail to recapitulate the dynamic tumor microenvironment, which can lead to discrepancies in drug efficacy and side effects in a clinical setting. In light of the limitations of traditional animal models and 2D in vitro technologies, the emergence of microfluidics as a tool for prostate cancer research shows tremendous promise. Namely, microfluidics-based technologies have emerged as powerful tools for assessing prostate cancer cells, isolating circulating tumor cells, and examining their behaviour using tumor-on-a-chip models. As such, this review aims to highlight recent advancements in microfluidics-based technologies for the assessment of castration-resistant prostate cancer and its potential to advance current understanding and to improve therapeutic outcomes.

Multicolor fluorescence microscopy for surgical guidance using a chip-scale imager with a low-NA fiber optic plate and a multi-bandpass interference filter

In curative-intent cancer surgery, intraoperative fluorescence imaging of both diseased and healthy tissue can help to ensure the successful removal of all gross and microscopic diseases with minimal damage to neighboring critical structures, such as nerves. Current fluorescence-guided surgery (FGS) systems, however, rely on bulky and rigid optics that incur performance-limiting trade-offs between sensitivity and maneuverability. Moreover, many FGS systems are incapable of multiplexed imaging. As a result, clinical FGS is currently limited to millimeter-scale detection of a single fluorescent target. Here, we present a scalable, lens-less fluorescence imaging chip, VISION, capable of sensitive and multiplexed detection within a compact form factor. Central to VISION is a novel optical frontend design combining a low-numerical-aperture fiber optic plate (LNA-FOP) and a multi-bandpass interference filter, which is affixed to a custom CMOS image sensor. The LNA-FOP acts as a planar collimator to improve resolution and compensate for the angle-sensitivity of the interference filter, enabling high-resolution and multiplexed fluorescence imaging without lenses. We show VISION is capable of detecting tumor foci of less than 100 cells at near video framerates and, as proof of principle, can simultaneously visualize both tumors and nerves in ex vivo prostate tissue.

Feasibility of same-day discharge of robotic-assisted laparoscopic radical prostatectomy with pelvic lymph node dissection

PURPOSE

Prostate cancer is one of the most common oncologic diseases. Outpatient robotic-assisted laparoscopic radical prostatectomy (RALP) has gained popularity due to its ability to minimize patient costs while maintaining low complication rates. Few studies have analyzed the possibility of performing outpatient RALP specifically in patients undergoing concurrent pelvic lymph node dissections (PLND).

METHODS

Using the National Surgical Quality Improvement Program Database (NSQIP), we identified total number of RALP, stratified into inpatient and outpatient groups including those with and without PLND from 2016 to 2021. Baseline characteristics, intraoperative and postoperative complications, and unplanned readmission rates were summarized. Proportions of outpatient procedures were calculated to assess adoption of outpatient protocol.

RESULTS

Between 2016 and 2021, a total of 58,527 RALP were performed, 3.7% (2142) outpatient and 96.3% inpatient. Altogether, patients undergoing outpatient RALP without PLND were more likely to have hypertension (52.6% vs. 46.3%, p < 0.01). Patients undergoing outpatient RALP without PLND were more likely to have sepsis or urinary tract infections (3.4% vs. 1.9%, p = 0.04) when compared to outpatient RALP with PLND. Cardiopulmonary, renal, thromboembolic complications, and 30-day events such as unplanned readmission, reoperation rates, and mortality were similar in both groups. However, among multivariate analysis regarding 30-day readmission and complications, there were no significant differences between outpatient RALP with or without PLND.

CONCLUSION

Patients undergoing outpatient RALP without PLND were more likely to have baseline hypertension and higher rates of postoperative infection, when compared to outpatient RALP with PLND. No significant differences were seen regarding 30-day readmission or complications on multivariate analysis.

Multicolor fluorescence microscopy for surgical guidance using a chip-scale imager with a low-NA fiber optic plate and a multi-bandpass interference filter

In curative-intent cancer surgery, intraoperative fluorescence imaging of both diseased and healthy tissue can help to ensure successful removal of all gross and microscopic disease with minimal damage to neighboring critical structures, such as nerves. Current fluorescence-guided surgery (FGS) systems, however, rely on bulky and rigid optics that incur performance-limiting trade-offs between sensitivity and maneuverability. Moreover, many FGS systems are incapable of multiplexed imaging. As a result, clinical FGS is currently limited to millimeter-scale detection of a single fluorescent target. Here we present a scalable, lens-less fluorescence imaging chip, VISION, capable of sensitive and multiplexed detection within a compact form factor. Central to VISION is a novel optical frontend design combining a low-numerical-aperture fiber optic plate (LNA-FOP) and a multi-bandpass interference filter, which is affixed to a custom CMOS image sensor. The LNA-FOP acts as a planar collimator to improve resolution and compensate for the angle-sensitivity of the interference filter, enabling high-resolution and multiplexed fluorescence imaging without lenses. We show VISION is capable of detecting tumor foci of less than 100 cells at near video framerates and, as proof of principle, can simultaneously visualize both tumor and nerves in ex vivo prostate tissue.

Quantified treatment effect at the individual level is more indicative for personalized radical prostatectomy recommendation: implications for prostate cancer treatment using deep learning

BACKGROUND

There are potential uncertainties and overtreatment existing in radical prostatectomy (RP) for prostate cancer (PCa) patients, thus identifying optimal candidates is quite important.

PURPOSE

This study aims to establish a novel causal inference deep learning (DL) model to discern whether a patient can benefit more from RP and to identify heterogeneity in treatment responses among PCa patients.

METHODS

We introduce the Self-Normalizing Balanced individual treatment effect for survival data (SNB). Six models were trained to make individualized treatment recommendations for PCa patients. Inverse probability treatment weighting (IPTW) was used to avoid treatment selection bias.

RESULTS

35,236 patients were included. Patients whose actual treatment was consistent with SNB recommendations had better survival outcomes than those who were inconsistent (multivariate hazard ratio (HR): 0.76, 95% confidence interval (CI), 0.64-0.92; IPTW-adjusted HR: 0.77, 95% CI, 0.61-0.95; risk difference (RD): 3.80, 95% CI, 2.48-5.11; IPTW-adjusted RD: 2.17, 95% CI, 0.92-3.35; the difference in restricted mean survival time (dRMST): 3.81, 95% CI, 2.66-4.85; IPTW-adjusted dRMST: 3.23, 95% CI, 2.06-4.45). Keeping other covariates unchanged, patients with 1 ng/mL increase in PSA levels received RP caused 1.77 months increase in the time to 90% mortality, and the similar results could be found in age, Gleason score, tumor size, TNM stages, and metastasis status.

CONCLUSIONS

Our highly interpretable and reliable DL model (SNB) may identify patients with PCa who could benefit from RP, outperforming other models and clinical guidelines. Additionally, the DL-based treatment guidelines obtained can provide priori evidence for subsequent studies.

Robotic-assisted radical prostatectomy: a multicenter experience with the Senhance Surgical System

PURPOSE

Robotic-assisted surgery for radical prostatectomy is becoming a standard treatment, and respective implementations are expanding. The Senhance Surgical System is a robotic system with existing but limited data on radical prostatectomy, including a lack of multicenter study experiences. The TRUST study aims to fill this gap and explores observations for radical prostatectomy with the Senhance Surgical System.

METHODS

Between August 2019 and November 2022, 375 patients met inclusion criteria from two European sites. Patients' surgical procedure times, data on conversion, malfunction, adverse events, and pain scores were registered and evaluated. Outcomes were calculated for both sides, combined as a total and compared between the initial (1st-150th case) and later (> 150th case) period.

RESULTS

The median operating time was 190 min (IQR: 167.5-215.0) and the median docking time was 3 min (IQR: 2.0-5.0). Eighteen cases (4.8%) were converted to standard laparoscopy and two (0.5%) to open. Two perioperative (0.5%) and eleven postoperative adverse events (2.9%) occurred, mostly (83.3%) categorized as mild. Pain scores were reduced from an average of 3.4 (± 1.4) on the postoperative day to 0.9 (± 0.7) at discharge. Compared to our previous data and based on a comparison between our initial and later period, operating time seems to plateau. However, docking time, complication, and conversion rates were successfully reduced.

CONCLUSION

We demonstrate progressing safety and efficiency for robotic-assisted radical prostatectomy with the Senhance Surgical System.

Contemporary Strategies for Clinical Chemoprevention of Localized Prostate Cancer

Prostate cancer (PCa) is the most common cancer among men in the United States and the second leading cause of cancer-related deaths. Metastatic castration-resistant PCa is still a fatal disease. On the other hand, between 2016 and 2020, about 70% of PCa cases were diagnosed at a localized stage. Evolving data demonstrates that men with low-grade cancers treated with definitive therapies may now be exposed to morbidities of overtreatment and poor quality of life, with little or no benefit in terms of cancer specific mortality. Active surveillance (AS) is thus the recommended management strategy for men with low-grade disease. Although this subgroup of men have reported anxiety during the AS period, they account to be highly motivated to make positive lifestyle changes to further reduce their risk of PCa progression, underscoring the urgent need to identify novel strategies for preventing progression of localized PCa to metastatic disease through pharmacologic means, an approach termed chemoprevention. Although several promising agents and approaches have been examined over the past 2 decades, currently, there are several limitations in the approach used to systematically examine agents for chemoprevention targeting men on AS. The goal of this review is to summarize the current agents and approaches evaluated, targeting men on AS, recognize the gaps, and identify a contemporary and comprehensive path forward. Results of these studies may inform the development of phase III clinical trials and ultimately provide a strategy for clinical chemoprevention in men on AS, for whom, currently, there are no options for reducing the risk of progression to metastatic disease.

Reliability of Systematic and Targeted Biopsies versus Prostatectomy

Systematic Biopsy (SBx) has been and continues to be the standard staple for detecting prostate cancer. The more expensive MRI guided biopsy (MRITBx) is a better way of detecting cancer. The prostatectomy can provide an accurate condition of the prostate. The goal is to assess how reliable SBx and MRITBx are vis à vis prostatectomy. Graded Gleason scores are used for comparison. Cohen's Kappa index and logistic regression after binarization of the graded Gleason scores are some of the methods used to achieve our goals. Machine learning methods, such as classification trees, are employed to improve predictability clinically. The Cohen's Kappa index is 0.31 for SBx versus prostatectomy, which means a fair agreement. The index is 0.34 for MRITBx versus prostatectomy, which again means a fair agreement. A direct comparison of SBx versus prostatectomy via binarized graded scores gives sensitivity 0.83 and specificity 0.50. On the other hand, a direct comparison of MRITBx versus prostatectomy gives sensitivity 0.78 and specificity 0.67, putting MRITBx on a higher level of accuracy. The SBx and MRITBx do not yet match the findings of prostatectomy completely, but they are useful. We have developed new biomarkers, considering other pieces of information from the patients, to improve the accuracy of SBx and MRITBx. From a clinical point of view, we provide a prediction model for prostatectomy Gleason grades using classification tree methodology.

Effect of preoperative PI-RADS assessment on pathological outcomes in patients who underwent radical prostatectomy

OBJECTIVE

To assess the effect of preoperative MRI with standardized Prostate Imaging-Reporting and Data System (PI-RADS) assessment on pathological outcomes in prostate cancer (PCa) patients who underwent radical prostatectomy (RP).

PATIENTS AND METHODS

This retrospective cohort study included patients who had undergone prostate MRI and subsequent RP for PCa between January 2017 and December 2022. The patients were divided into the PI-RADS group and the non-PI-RADS group according to evaluation scheme of presurgery MRI. The preoperative characteristics and postoperative outcomes were retrieved and analyzed. The pathological outcomes included pathological T stage (pT2 vs. pT3-4) and positive surgical margins (PSMs). Patients were further stratified according to statistically significant preoperative variables to assess the difference in pathological outcomes. A propensity score matching based on the above preoperative characteristics was additionally performed.

RESULTS

A total of 380 patients were included in this study, with 201 patients in the PI-RADS group and 179 in the non-PI-RADS group. The two groups had similar preoperative characteristics, except for clinical T stage (cT). As for pathological outcomes, the PI-RADS group showed a significantly lower percentage of pT3-4 (21.4% vs. 48.0%, p < 0.001), a lower percentage of PSMs (31.3% vs. 40.9%, p = 0.055), and a higher concordance between the cT and pT (79.1% vs. 64.8%, p = 0.003). The PI-RADS group also showed a lower proportion of pT3-4 (p < 0.001) in the cT1-2 subgroup and the cohort after propensity score matching. The PSM rate of cT3 patients was reduced by 39.2% in the PI-RADS group but without statistical significance (p = 0.089).

CONCLUSIONS

Preoperative MRI with standardized PI-RADS assessment could benefit the decision-making of patients by reducing the rate of pathologically confirmed non-organ-confined PCa after RP and slightly reducing the PSM rate compared with non-PI-RADS assessment.

Automatic search for photoacoustic marker using automated transrectal ultrasound

Real-time transrectal ultrasound (TRUS) image guidance during robot-assisted laparoscopic radical prostatectomy has the potential to enhance surgery outcomes. Whether conventional or photoacoustic TRUS is used, the robotic system and the TRUS must be registered to each other. Accurate registration can be performed using photoacoustic (PA markers). However, this requires a manual search by an assistant [IEEE Robot. Autom. Lett8, 1287 (2023).10.1109/LRA.2022.3191788]. This paper introduces the first automatic search for PA markers using a transrectal ultrasound robot. This effectively reduces the challenges associated with the da Vinci-TRUS registration. This paper investigated the performance of three search algorithms in simulation and experiment: Weighted Average (WA), Golden Section Search (GSS), and Ternary Search (TS). For validation, a surgical prostate scenario was mimicked and various ex vivo tissues were tested. As a result, the WA algorithm can achieve 0.53°±0.30° average error after 9 data acquisitions, while the TS and GSS algorithm can achieve 0.29 ∘ ± 0.31 ∘ and 0.48°±0.32° average errors after 28 data acquisitions.

Surgical and functional outcomes of Retzius-sparing robotic-assisted radical prostatectomy versus conventional robotic-assisted radical prostatectomy in patients with biopsy-confirmed prostate cancer. Are outcomes worth it? Systematic review and meta-analysis

BACKGROUND

Radical prostatectomy is the standard of care for prostate cancer. Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) is being widely adopted due to positive functional outcomes compared to conventional robotic-assisted radical prostatectomy (c-RARP). Concerns regarding potency, oncological outcomes, and learning curve are still a matter of debate.

METHODS

Following Preferred Instrument for Systematic Reviews and Meta-Analysis guidelines and PROSPERO registration CRD42023398724, a systematic review was performed in February 2023 on RS-RARP compared to conventional c-RARP. Outcomes of interest were continence recovery, potency, positive surgical margins (PSM), biochemical recurrence (BCR), estimated blood loss (EBL), length of stay (LOS), operation time and complications. Data were analyzed using R version 4.2.2.

RESULTS

A total of 17 studies were included, totaling 2751 patients, out of which 1221 underwent RS-RARP and 1530 underwent c-RARP. Continence was analyzed using two definitions: zero pad and one safety pad. Cumulative analysis showed with both definitions statistical difference in terms of continence recovery at 1 month (0 pad odds ratio [OR] = 4.57; 95% confidence interval [CI] = [1.32-15.77]; Safety pad OR = 13.19; 95% CI = [8.92-19.49]), as well as at 3 months (0 pad OR, 2.93; 95% CI = [1.57-5.46]; Safety pad OR = 5.31; 95% CI = [1.33-21.13]). Continence recovery at 12 months was higher in the one safety pad group after RS-RARP (OR = 4.37; 95% CI = [1.97-9.73]). The meta-analysis revealed that overall PSM rates without pathologic stage classification were not different following RS-RARP (OR = 1.13; 95% CI = [0.96-1.33]. Analysis according to the tumor stage revealed PSM rates in pT2 and pT3 tumors are not different following RS-RARP compared to c-RARP (OR = 1.46; 95% CI = [0.84-2.55]) and (OR = 1.41; 95% CI = [0.93-2.13]), respectively. No difference in potency at 12 months (OR = 0.98; 95% CI = [0.69-1.41], BCR at 12 months (OR = 0.99; 95% CI = [0.46-2.16]), EBL (standardized mean difference [SMD] = -0.01; 95% CI = [-0.31 to 0.29]), LOS (SMD = -0.01; 95% CI = [-0.48 to 0.45]), operation time (SMD = -0.14; 95% CI = [-0.41 to 0.12]) or complications (OR = 0.9; 95% CI = [0.62-1.29]) were observed.

CONCLUSIONS

Our analysis suggests that RS-RARP is safe and feasible. Faster continence recovery rate is seen after RS-RARP. Potency outcomes appear to be similar. PSM rates are not different following RS-RARP regardless of pathologic stage. Further quality studies are needed to confirm these findings.

Analysis of risk factors for positive surgical margin after laparoscopic radical prostatectomy with and without neoadjuvant hormonal therapy

Background

Positive surgical margins (PSM) is not only an independent risk factor for recurrence, metastasis, and prognosis, but also an important indicator of adjuvant therapy for prostate cancer (PCa) patients treated with radical prostatectomy (RP). At present, there are few reports analyzing risk factors of PSM in laparoscopic RP (LRP), especially for those PCa cases who accepted neoadjuvant hormonal therapy (NHT). Hence, the aim of the current study was to explore risk factors for PSM after LRP in PCa patients with and without NHT.

Methods

The clinicopathological data of patients who underwent LRP from January 2012 to July 2020 was retrospectively analyzed. Risk factors for PSM after LRP in NHT and non-NHT groups were respectively explored.

Results

The overall PSM rate was 33.3% (90/270), PSM rate was 39.3% (64/163) in patients without NHT and 24.3% (26/107) in those with NHT. The apex was the most common location of PSM in non-NHT group (68.8%, 44/64), while the fundus was the most common location of PSM in NHT group (57.7%, 15/26). Multiple logistic regression revealed that body mass index (BMI), PSA, ISUP grade after LRP, pathological stage T (pT) and pathological lymph node status (pN) were independent factors affecting the PSM for patients without NHT (OR=1.160, 95%CI:1.034-1.301, p=0.011; OR=3.385, 95%CI:1.386-8.268, p=0.007; OR=3.541, 95%CI:1.008-12.444, p=0.049; OR=4.577, 95%CI:2.163-9.686, p<0.001; OR=3.572, 95%CI:1.124-11.347, p=0.031), while pT, pN, and lymphovascular invasion (LVI) were independent risk factors affecting PSM for patients with NHT (OR=18.434, 95%CI:4.976-68.297, p<0.001; OR=7.181, 95%CI:2.089-24.689, p=0.002; OR=3.545, 95%CI:1.109-11.327, p=0.033).

Conclusions

The apex was the most common location in NHT group, and BMI, PSA, ISUP after LRP, pT and pN were independent risk factors affecting PSM for NHT patients; while the fundus was the most common location in non-NHT group, and pT, pN, and LVI were independent risk factors affecting PSM for non-NHT patients.

Clinical characteristics analysis and prognostic nomogram for predicting survival in patients with second primary prostate cancer: a population study based on SEER database

BACKGROUND AND AIMS

Second primary prostate cancer (SPPCa) is a common type of secondary malignancy that negatively impacts patient prognosis. This study aimed to identify prognostic factors for SPPCa patients and develop nomograms to assess their prognosis.

METHODS

Patients diagnosed with SPPCa between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The study cohort was randomly divided into a training set and a validation set. Cox regression analysis, Kaplan‒Meier survival analysis, and least absolute shrinkage and selection operator regression analysis were used to identify independent prognostic factors and develop the nomogram. The nomograms were evaluated using the concordance index (C-index), calibration curve, area under the curve (AUC), and Kaplan-Meier analysis.

RESULTS

A total of 5342 SPPCa patients were included in the study. Independent prognostic factors for overall survival (OS) and cancer-specific survival (CSS) were identified as age, interval between diagnoses, first primary tumor site, and AJCC stage, N stage, M stage, PSA, Gleason score, and SPPCa surgery. Nomograms were constructed based on these prognostic factors, and the performance was evaluated using the C-index (OS: 0.733, CSS: 0.838), AUC, calibration curve, and Kaplan-Meier analysis, which demonstrated excellent predictive accuracy.

CONCLUSION

We successfully established and validated nomograms to predict OS and CSS in SPPCa patients using the SEER database. These nomograms provide an effective tool for risk stratification and prognosis assessment in SPPCa patients, which will aid clinicians in optimizing treatment strategies for this patient population.

Identification of senescence-related lncRNA prognostic index correlating with prognosis and radiosensitivity in prostate cancer patients

BACKGROUND

An increasing number of studies are shown how crucial a role cellular senescence plays in tumor development. In this study, we developed a senescence-related lncRNA prognostic index (SRLPI) to forecast radiosensitivity and the probability of biochemical recurrence (BCR) in patients with prostate cancer (PCa).

METHODS

PCa cohorts in TCGA and GEO databases were downloaded. Senescence-and prognosis-related lncRNA with differential expression in tumor and normal samples were identified and used to establish the SRLPI score. Mutation landscape, function pathway, tumor stemness and heterogeneity and tumor immune microenvironment were also analyzed. We performed the analysis using R 3.6.3 and the appropriate tools.

RESULTS

A SRLPI score was constructed based on SNHG1 and MIAT in the TCGA cohort. Our classification of PCa patients into high- and low-risk groups was based on the median SRLPI score. When compared to the low-SRLPI group, the high-SRLPI group was more vulnerable to BCR (HR: 3.33). In terms of BCR-free survival and metastasis-free survival, the GSE116918 showed similar findings. Surprisingly, the SRLPI score demonstrated a high level of radiosensitivity for diagnosis (AUC: 0.98). Age, Gleason score, T stage, N stage, positive lymph nodes, and residual tumor were all significantly greater in patients with high SRLPI scores. Furthermore, this score was significantly related to markers of senescence. Protein secretion and androgen response were found to be substantially enriched in the low-SRLPI group, whereas E2F targets were found to be strongly enriched in the high-SRLPI group for pathway analysis. For the tumor microenvironment assessment, B cells, CD8+ T cells, immune score and TIDE score were positively related to SRLPI score while endothelial level was negatively associated with SRLPI score with statistical significance.

CONCLUSIONS

We developed a SRLPI score that was related to prognosis and radiosensitivity and might be helpful in clinical practice.

Post-chemotherapy robot-assisted retroperitoneal lymph node dissection for metastatic germ cell tumors: safety and perioperative outcomes

PURPOSE

To evaluate the feasibility, safety, and early oncologic outcomes after post-chemotherapy robot-assisted retroperitoneal lymph node dissection (PC-RARPLND) for metastatic germ cell tumors (mGCT).

METHODS

We retrospectively analyzed patients from four tertiary centers who underwent PC-RARPLND for mGCT, from 2011 to 2021. Previous treatment of mGCT, intraoperative and postoperative complications, and early oncologic outcomes were assessed.

RESULTS

Overall, 66 patients were included. The majority of patients had non-seminoma mTGCT (89%). Median size of retroperitoneal lymph node (RLN) before surgery was 26 mm. Templates of PC-RARPLND were left modified, right modified, and full bilateral in 56%, 27%, and 14%, respectively. Median estimated blood loss and length of stay were 50 mL [50-150] and 2 [1-3] days. Four patients (6.1%) had a vascular injury, only one with significant blood loss and conversion to open surgery (OS). Two other patients had a conversion to OS for difficulty of dissection. No patient had transfusion, most frequent complications were ileus (10.6%) and symptomatic lymphorrea (7.6%) and no complications grade IIIb or more occurred. With a median follow-up of 16 months, two patients had a relapse, all outside of the surgical template (one in the retrocrural space with reascending markers, one in lungs).

CONCLUSION

PC-RARPLND is a challenging surgery. In expert centers and for selected patients, it seemed safe and feasible, with a low morbidity. Further prospective evaluation of this procedure and long-term oncologic results are needed.

The role of cytoreductive radical prostatectomy and lymph node dissection in bone-metastatic prostate cancer: A population-based study

BACKGROUNDS

The role of cytoreductive radical prostatectomy (cRP) for bone-metastatic prostate cancer (bmPCa) remains controversial. We aimed to figure out whether cRP and lymph node dissection (LND) can benefit bmPCa.

METHODS

11,271 PCa patients with bone metastatic burden from 2010 to 2019 were identified using SEER-Medicare. Overall survival (OS) and cancer-specific survival (CSS) rates were visualized using Kaplan-Meier plots. Multivariable Cox regression analyses were constructed to examine the effects of cRP and LND on survival, after stratifying to age, prostate specific antigen (PSA), clinical stages, Gleason score, metastatic burden, radiotherapy, and chemotherapy status.

RESULTS

317 PCa patients underwent cRP and cRP was increasingly performed for bmPCa from 2010 (2.2%) to 2019 (3.0%) (p < 0.05). In multi analyses, cRP was predisposed to a better OS or CSS in patients with age < 75, PSA < 98 ng/mL, bone-only metastatic sites or patients not receiving chemotherapy (all p < 0.05). For the patients undergoing cRP, LND especially extended LND was associated with a better OS or CSS (all p < 0.05).

CONCLUSIONS

cRP might benefit OS or CSS in young patients with low PSA and bone-only metastatic sites not receiving chemotherapy. And a clear OS or CSS benefit of LND especially extended LND was observed in patients undergoing cRP.