Incidental finding of prostate cancer in Transurethral Resection of Prostate (TURP) specimens: a retrospective analysis from a Tertiary Care Hospital in Pakistan

Prevalence and potential predictors of incidental prostate Cancer in patients undergoing surgery for Benign Prostatic obstruction: a retrospective study in the MRI era

PURPOSE

Despite advancements in prostate multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy (FB), the management of incidental prostate cancer (IPCa) after surgery for benign prostatic obstruction (BPO) remains unclear. The aim of this retrospective study is to determine the prevalence of IPCa in our cohort and identify potential predictors for its occurrence.

METHODS

We enrolled patients underwent TURP or simple prostatectomy for BPO at our high-volume center between January 2020-December 2022. Data on age, pre-operative total PSA (tPSA) and PSA density (PSAd) levels, prostate volume, previous MRI, biopsies, specimen weight, rates of positive tissue slices, ISUP score and three-month tPSA were collected.

RESULTS

Of 454 patients with negative digital rectal examination who underwent BPO surgery, 74 patients (16.3%) were found to have IPCa. Of these, 33 patients (44.6%) had undergone previous mpMRI. Among the patients who had mpMRI, 23 had negative mpMRI results for suspected prostate cancer, while 10 had positive mpMRI findings (PIRADS ≥ 3) but no evidence of tumor upon FB. KW analysis indicates that PSAd was statistically associated with higher ISUP score, while at univariable regression analysis negative mpMRI (p = 0.03) was the only potential predictor for IPCa.

CONCLUSIONS

Among the ISUP groups, PSAd showed a correlation with the tumor, while negative mpMRI was protective against clinically significant PCa. In the era of mpMRI and FB, the IPCa rates found at our center is higher than reported in existing literature and if it were confirmed with further studies, maybe there is a need for expansion in urology guidelines.

Phenome-wide association study and precision medicine of cardiovascular diseases in the post-COVID-19 era

SARS-CoV-2 infection causes injuries of not only the lungs but also the heart and endothelial cells in vasculature of multiple organs, and induces systemic inflammation and immune over-reactions, which makes COVID-19 a disease phenome that simultaneously affects multiple systems. Cardiovascular diseases (CVD) are intrinsic risk and causative factors for severe COVID-19 comorbidities and death. The wide-spread infection and reinfection of SARS-CoV-2 variants and the long-COVID may become a new common threat to human health and propose unprecedented impact on the risk factors, pathophysiology, and pharmacology of many diseases including CVD for a long time. COVID-19 has highlighted the urgent demand for precision medicine which needs new knowledge network to innovate disease taxonomy for more precise diagnosis, therapy, and prevention of disease. A deeper understanding of CVD in the setting of COVID-19 phenome requires a paradigm shift from the current phenotypic study that focuses on the virus or individual symptoms to phenomics of COVID-19 that addresses the inter-connectedness of clinical phenotypes, i.e., clinical phenome. Here, we summarize the CVD manifestations in the full clinical spectrum of COVID-19, and the phenome-wide association study of CVD interrelated to COVID-19. We discuss the underlying biology for CVD in the COVID-19 phenome and the concept of precision medicine with new phenomic taxonomy that addresses the overall pathophysiological responses of the body to the SARS-CoV-2 infection. We also briefly discuss the unique taxonomy of disease as Zheng-hou patterns in traditional Chinese medicine, and their potential implications in precision medicine of CVD in the post-COVID-19 era.

Incidental carcinoma of the prostate in cystoprostatectomy specimens - is it always a toothless lion?

Incidental prostate carcinoma (iPC) is a subject of debate concerning its definition, incidence, biology, diagnosis, staging, and treatment. The present study aimed to assess the incidence and main clinical-morphological characteristics of iPC identified in radical cystoprostatectomy (RCP) specimens over a 5-year period. Using the database of the Urology and Pathology Departments, we identified all patients with bladder carcinomas (BCs) who underwent RCP within a 5-year frame time. We selected only those patients with synchronous BC and prostate carcinoma (PC). The following parameters were analyzed for these patients: age, type of bladder and prostate tumor, degree of differentiation, pathological stage, and other prognostic parameters. We identified 91 men with bladder tumors treated by RCP among whom 43, aged between 53 and 84 years (mean age: 69.2 years), presented synchronous PC. iPC was more prevalent in older individuals (>65 years: 30 patients, 69.8%), with only six out of the 43 (12.8%) patients with iPC being aged ≤60 years. All iPC cases were conventional adenocarcinoma. Well-differentiated prostate adenocarcinomas (grade group 1) predominated (65.1%). Among the 43 iPCs, 16 (37.2%) were clinically significant PCs. iPC is frequently identified in patients with BC when inclusion and evaluation of all or most of the prostate tissue are performed. Although more than half of iPCs were well-differentiated tumors confined to the prostate, a significant number of cases met the criteria of clinically significant PC. All men over the age of 50 who are candidates for RCP, should undergo evaluation through serum prostate specific antigen determination.

Incidence and associated factors for incidental prostate cancer among patients who underwent surgery for benign prostatic hyperplasia: first report from Somalia

BACKGROUND

The incidence rate of incidental prostate cancer (IPC) differs significantly among the reported studies in the relevant literature. There is a scarcity of studies regarding IPC reported from Sub-Saharan African Countries, including Somalia. The present is the first study that evaluates the incidence and associated factors for IPC among patients who had surgery for benign prostatic hyperplasia at a tertiary hospital in Somalia.

METHOD

This retrospective study reviewed the data of 538 patients with benign prostate hyperplasia, 464 patients who underwent transurethral resection of the prostate (TURP), and 74 patients with open prostatectomy (OP) over 5 years. A binary logistic regression model was used to investigate the association between perioperative factors such as age, prostate volume, total prostate-specific antigen (TPSA) levels, type of surgery, specimen weight, and the finding of IPC.

RESULTS

IPC was detected in 17.6%, 18.3% of TURP, and 13.5% of OP patients (p = 0.002). The mean age of the patients was 71.82 ± 7.4; IPC patients had a significantly higher mean age than the BPH group (74 ± 10.9 vs. 71.3 ± 10.8, p < 0.001). Sixty-two percent of the patients were T1b, while 57.8% had ISUP grade groups 1 and 2. Patients with T1a had significantly higher International Society of Urological Pathology (ISUP) grades 1 and 2 than those with T1b (69.4% in T1a vs. 50.8% in T1b, p < 0.001). Increased age, higher TPSA levels, low prostate volume, and specimen weight were independently associated with the finding of incidental prostate carcinoma (OR 1.978, 95% CI 0.95-1.60, P < 0.04; OR 1.839, 95% CI 0.99-2.02, P < 0.001; OR 1.457, 95% CI 0.7102.99, P < 0.001, OR 0.989, 95% CI 1.07-2.94, P = 0.01). IPC was most commonly managed by active surveillance (54.7%), followed by androgen deprivation therapy in 28.4%. The overall survival rate for a 5-year follow-up in the entire cohort was 79%. The cancer-specific mortality was 8.4%.

CONCLUSION

The study findings revealed a higher incidence and cancer-specific mortality rate of incidental prostate carcinoma. T1b stage, higher ISUP grade, older age, and higher preoperative TPSA were significantly associated with the overall mortality and cancer-specific mortality rate. More than half of the cases were managed by active surveillance, and it is a safe management strategy, particularly in low-income countries like Somalia.

Lutetium-177 Prostate Specific Membrane Antigen Therapy in a Patient With Double Malignancy and Single Functioning Kidney: A Case Report

Lutetium-177 labeled with 617 types of Prostate Specific Membrane Antigen (¹⁷⁷Lu PSMA-617) Radio-ligand Therapy (RLT) is an emerging modality of choice for the treatment of metastatic castration-resistant prostate carcinoma (mCRPC). After it is administered intravenously, it is excreted primarily through the kidneys. Physiological excretion and concomitant expression of PSMA receptors on renal tissues are associated with potential renal toxicity, a matter of concern while treating patients with multiple doses of RLT. There are published articles that have demonstrated the safe use of ¹⁷⁷Lu PSMA-617 in patients with bilateral fair-functioning kidneys; however, only a single study has been published that has evaluated its safety in patients with solitary-functioning kidneys. The uniqueness of this case report lies in the fact that we have documented the renal safety profile of ¹⁷⁷Lu PSMA-617 therapy after multiple doses in a patient who presented with double malignancy (metastatic castration-resistant prostate carcinoma and left renal cell carcinoma) and had a single-functioning right kidney.