Overexpression of Glypican 5 (GPC5) Inhibits Prostate Cancer Cell Proliferation and Invasion via Suppressing Sp1-Mediated EMT and Activation of Wnt/β-Catenin Signaling

Glypican 5 (GPC5) belongs to the family of heparan sulfate proteoglycans (HSPGs). It was initially known as a regulator of growth factors and morphogens. Recently, there have been reports on its correlation with the tumorigenic process in the development of some cancers. However, little is known about its precise role in prostate cancer (PCa). In the present study, we explored the expression pattern and biological functions of GPC5 in PCa cells. Our results showed that GPC5 was lowly expressed in PCa cell lines. Upregulation of GPC5 significantly inhibited PCa cell proliferation and invasion in vitro as well as attenuated tumor growth in vivo. We also found that overexpression of GPC5 inhibited the epithelial-mesenchymal transition (EMT) and Wnt/β-catenin signaling activation, which was mediated by Sp1. Taken together, we suggest GPC5 as a tumor suppressor in PCa and provide promising therapeutic strategies for PCa.

Prostate cancer: the need for biomarkers and new therapeutic targets

Prostate cancer (PCa) incidence and mortality have decreased in recent years. Nonetheless, it remains one of the most prevalent cancers in men, being a disquieting cause of men's death worldwide. Changes in many cell signaling pathways have a predominant role in the onset, development, and progression of the disease. These include prominent pathways involved in the growth, apoptosis, and angiogenesis of the normal prostate gland, such as androgen and estrogen signaling, and other growth factor signaling pathways. Understanding the foundations of PCa is leading to the discovery of key molecules that could be used to improve patient management. The ideal scenario would be to have a panel of molecules, preferably detectable in body fluids, that are specific and sensitive biomarkers for PCa. In the early stages, androgen deprivation is the gold standard therapy. However, as the cancer progresses, it eventually becomes independent of androgens, and hormonal therapy fails. For this reason, androgen-independent PCa is still a major therapeutic challenge. By disrupting specific protein interactions or manipulating the expression of some key molecules, it might be possible to regulate tumor growth and metastasis formation, avoiding the systemic side effects of current therapies. Clinical trials are already underway to assess the efficacy of molecules specially designed to target key proteins or protein interactions. In this review, we address that recent progress made towards understanding PCa development and the molecular pathways underlying this pathology. We also discuss relevant molecular markers for the management of PCa and new therapeutic challenges.

Prostate cancer risk-associated genetic markers and their potential clinical utility

Prostate cancer (PCa) is one of the most common cancers among men in Western developed countries and its incidence has increased considerably in many other parts of the world, including China. The etiology of PCa is largely unknown but is thought to be multifactorial, where inherited genetics plays an important role. In this article, we first briefly review results from studies of familial aggregation and genetic susceptibility to PCa. We then recap key findings of rare and high-penetrance PCa susceptibility genes from linkage studies in PCa families. We devote a significant portion of this article to summarizing discoveries of common and low-penetrance PCa risk-associated single-nucleotide polymorphisms (SNPs) from genetic association studies in PCa cases and controls, especially those from genome-wide association studies (GWASs). A strong focus of this article is to review the literature on the potential clinical utility of these implicated genetic markers. Most of these published studies described PCa risk estimation using a genetic score derived from multiple risk-associated SNPs and its utility in determining the need for prostate biopsy. Finally, we comment on the newly proposed concept of genetic score; the notion is to treat it as a marker for genetic predisposition, similar to family history, rather than a diagnostic marker to discriminate PCa patients from non-cancer patients. Available evidence to date suggests that genetic score is an objective and better measurement of inherited risk of PCa than family history. Another unique feature of this article is the inclusion of genetic association studies of PCa in Chinese and Japanese populations.

Effect of adjuvant hormone therapy in patients with prostate cancer: A meta-analysis of randomized controlled trials

OBJECTIVES

To summarize the evidence regarding the treatment effect of adjuvant hormone therapy (AHT) in patients with prostate cancer (PCa). AHT following radiotherapy, chemotherapy, or surgery is widely used in patients with PCa. However, the treatment effect is inconsistent in individual trials.

METHODS

The electronic databases including PubMed, EmBase, and Cochrane Library were searched to identify randomized controlled trials (RCTs) in September 2016. RCTs that evaluated the effects of AHT in patients with PCa were included. Hazard ratio (HR) and relative risks (RR) were used to measure the treatment effects of AHT using a random effects model. The analyses were further stratified by factors that could affect the treatment efficacy.

RESULTS

A total of 14,594 potential studies were identified, and 27 RCTs were included. Compared with the control group, patients who received AHT were associated with a significant improvement in overall survival (OS) (HR: 0.78; 95% confidence interval [CI]: 0.71-0.85; P <.001), disease-free survival (DFS) (HR: 0.50; 95% CI: 0.39-0.65; P <.001), total mortality (RR: 0.90; 95% CI: 0.85-0.96; P = .001), recurrence (RR: 0.70; 95% CI: 0.60-0.81; P <.001), and disease-specific mortality (RR: 0.70; 95% CI: 0.56-0.87; P <.001). However, no significant difference was observed between AHT and control for response rate (RR: 1.75; 95% CI: 0.91-3.37; P = .095).

CONCLUSIONS

The findings of this meta-analysis confirmed that patients who received AHT had a significant improvement in OS, DFS, total mortality, recurrence, and disease-specific mortality. Further, large-scale RCTs are required to evaluate the treatment effect in specific subpopulations.

Association of Prostate-Specific Antigen With Age, Digital Rectal Examination, and Lower Urinary Tract Symptoms in the Lebanese Population: A Cross-Sectional Study

BACKGROUND

Prostate cancer (PCa) is a leading cause of mortality in men worldwide. Prostate-specific antigen (PSA) testing is a standard method for PCa detection, yet its association with age, digital rectal examination (DRE) results, and lower urinary tract symptoms (LUTS) remains understudied, particularly in the Lebanese population.

OBJECTIVE

This study aimed to investigate the association of PSA levels with age, DRE results, and LUTS severity among Lebanese men.

METHODS

A total of 725 men aged 55-70 years were recruited from a men's health campaign at Saint George Hospital University Medical Center in Lebanon. PSA levels, DRE results, and International Prostate Symptom Score (IPSS) were assessed. Statistical analysis included Kruskal-Wallis tests and Spearman's rho correlation coefficient.

RESULTS

Participants exhibited a significant correlation between age and PSA levels (r = 0.138, p < 0.01). PSA levels varied significantly across age groups (p = 0.029), with higher mean PSA levels observed in older age groups. IPSS status correlated positively with PSA levels (r = 0.23, p < 0.001), indicating higher PSA levels associated with increased LUTS severity. Abnormal DRE findings were significantly associated with elevated PSA levels (p < 0.00), suggesting their potential as an indicator of prostate abnormalities.

CONCLUSION

This study highlights the importance of age-specific reference ranges for PSA levels in the Lebanese population. Elevated PSA levels were associated with older age, increased LUTS severity, and abnormal DRE findings. These findings highlight the significance of integrating PSA testing with clinical assessments for PCa detection and risk stratification in Lebanon.

AB129. Role of routine examination in diagnose of prostate cancer

Purpose

There is still no consensus exist about the importance of routine diagnostic procedures in diagnosing of the prostate cancer (PCa). In the purpose of defining the roles in diagnosing of the PCa, commonly used procedures such as ordinary digital rectal examination (DRE), transrectal ultrasonography of the prostate (TRUS), elevated levels of prostate-specific antigen (PSA) and PSA density (PSA D) were investigated in the frames of single clinic.

Study materials, procedures and methods

We retrospectively analyzed medical records of 231 patients who underwent transrectal prostate biopsy (TRPB) in the Republican specialized center of urology (Tashkent, Uzbekistan) within year 2013. Indications for performing TRBP were suspicions of the presence of the PCa at any level of investigation, during DRE, elevated PSA/PSA D or TRUS. In the cases of positive TRPB result, Gleason score was calculated for defining the stage of PCa. We calculated sensitivity and specificity of each procedure using area under curve (ROC-curve analysis) and crosstabs and we also used Spearman’s rho coefficient of bivariate correlations for evaluating the strength of associations between diagnostic procedures and positive TRPB result.

Findings

The age of patients varied from 47 to 85 (Mean ± SD =69.2±7.1) years. Among 97 of patients with suspected PCa during DRE 76 (78.4%) resulted in positive TRPB. Average Gleason score among these positive results was 7.6. Of 29 patients with TRUS signs of PCa suspicion, results of the TRBP were positive in 26 (89.7%) with mean Gleason score of 5.9. TRPB positive for PCa resulted in 100 (52.6%) of 190 patients with elevated PSA. Average Gleason score in this group of patients was 3.3. Sensitivity and specificity of the DRE for diagnosing PCa were most optimal among all procedures resulting in 74.5% and 76.9% respectively. Sensitivity of elevated PSA was highest among all diagnostic procedures—98.0%, but specificity was the lowest—1.1%. Lower values of the sensitivity were observed for TRUS (25.5%), but specificity of this procedure was very high (96.7%). Sensitivity for evaluated PSA D was as high as 91.2%, but specificity was too low as 7.7%. Highest levels of correlation were found between positive TRPB and DRE (rho =0.51; P=0.0). Positive TRPB also associated with serum PSA level with strength of 0.43 and with suspicion of PCa by TRUS with rho =0.39. Gleason score correlated with DRE (rho =0.54), with TRUS (rho =0.39), PSA (rho =0.46) and PSA D (rho =0.49).

Conclusions

Unfortunately, even nowadays there no effective noninvasive procedures with confirmed efficacy and available for common use exist for diagnosing of PCa possessing high levels of validity. Transrectal prostate biopsy remains the most valuable diagnostic procedure for PCa. In other hand, such easy-to-do screening procedure as digital rectal examination has not lost its relevance. But at the same time, according to the results of our study, patients with DRE signs of the PCa, has an average Gleason score over 7 thus having potentially aggressive advanced cancer with poor prognosis.

AB17. ADT treatment promotes PCa EMT and metastasis

Epithelial–mesenchymal transition (EMT) has been linked to cancer stem-like (CD44+) cell in the prostate cancer (PCa) metastasis. However, the molecular mechanism remains elusive. Here, we found EMT contributed to metastasis in PCa patients failed in androgen deprivation therapy (ADT). Castration TRAMP model also proved PCa treated with ADT promoted EMT with increased CD44+ stem-like cells. Switched CD44+ cell to EMT cell is a key step for luminal PCa cell metastasis. Our results also suggested ADT might go through promoting TGFβ1-CD44 signaling to enhance swift to EMT. Targeting CD44 with salinomycin and siRNA could inhibit cell transition and decrease PCa invasion. Together, cancer stem-like (CD44+) cells could be the initiator cells of EMT modulated by TGFβ1-CD44 signaling. Combined therapy of ADT with anti-CD44 may become a new potential therapeutic approach to battle later stage PCa.

Abiraterone-Induced Hypokalemia: A Case Report

Abiraterone, an androgen biosynthesis inhibitor drug approved by the Food and Drug Administration (FDA) in 2011 for the treatment of metastatic prostate cancer, has seen an increase in prescriptions over the years, owing largely to the aging population and the association of prostate cancer with increasing age. As the rate of abiraterone prescription increases, it is important for physicians to be aware of its adverse effects profile to improve patient outcomes. This case report explains the mechanism, clinical presentation, and management of abiraterone-induced hypokalemia in a 67-year-old male with prostate cancer and highlights the importance of close monitoring and management of electrolyte levels for patients on abiraterone.

Diffuse, Bilateral Prostate Imaging Reporting and Data System (PI-RADS) 3 Changes Reported as Inflammation and Their Relation to Clinically Significant Prostate Cancer: A Retrospective Observational Study

Aim/Objective The aim of this study was to investigate if diffuse, bilateral PI-RADS (Prostate Imaging Reporting and Data System) 3 changes, reported on MRI Prostate, harbour clinically significant prostate cancer (csPCa) within them. Methods Data from 108 men with diffuse, bilateral PI-RADS 3 changes on MRI of the prostate who underwent systematic prostate biopsy between January 2000 and November 2023 were analyzed. Histology results were classified as benign or malignant, and clinically significant prostate cancer (csPCa) was defined according to the European Association of Urology (EAU) guidelines as ISUP GG (International Society for Urological Pathology Grade Group) 2 or higher. Data were analyzed using SPSS software, version 26.0 (IBM Corp., Armonk, NY, USA). Results The analysis showed that 30.5% of men with bilateral diffuse PI-RADS 3 changes had a diagnosis of clinically significant prostate cancer. There was a correlation (p-value < 0.05) of prostate-specific antigen density (PSAd) to the diagnosis of cancer in these diffuse PI-RADS 3 changes. Conclusion The likelihood of clinically significant prostate cancer in diffuse PI-RADS 3 changes is quite high, especially when associated with a high PSA density. Therefore, caution is necessary before deciding against biopsying these changes, even if they appear inflammatory on MRI.

Blood metabolites mediate the causal relationship between circulating CX3CL1 levels and prostate cancer: A 2-step Mendelian randomization study

Chemokines influence the progression of prostate cancer (PCa) through multiple mechanisms. However, the effect of C-X3-C chemokine ligand 1 (CX3CL1) on PCa risk remains controversial. Our study aimed to investigate whether circulating CX3CL1 is causally associated with PCa and to identify metabolites that have mediating effects using the 2-step bidirectional Mendelian randomization (MR) analysis process. Inverse variance weighting (IVW) results were used as the primary observations, while additional sensitivity analyses were conducted. For each standard deviation increase exhibited by the circulating CX3CL1 levels, the risk of PCa was reduced by 0.4% (IVW: OR = 0.996, [95% CI = 0.994-0.998], P < .001), and blood alliin levels increased by 19% (IVW: OR = 1.185, [95% CI = 1.01-1.54], P = .003). For each standard deviation increase in the blood alliin levels, the risk of PCa was reduced by 0.1% (IVW: OR = 0.999, [95% CI = 0.997-0.999], P = .03). Therefore, the protective effect of circulating CX3CL1 on PCa may be mediated by blood alliin levels (mediated proportion = 6.7%). The results supported the notion that high levels of circulating CX3CL1 indicate a lower PCa risk and the idea that the food-derived antioxidant alliin may mediate this association. We emphasize that the use of CX3CL1 as a protective factor against PCa may provide new strategies for PCa prevention and care in the future.

Stauffer Syndrome as the Initial Presentation of Advanced Metastatic Prostate Cancer

Stauffer's syndrome is a paraneoplastic syndrome that has historically been associated with renal cell carcinoma. It is defined by the anicteric elevation of liver enzymes in the absence of liver metastasis, and the reversibility of clinical and biochemical changes upon treatment of the primary pathology. Here, we discuss the rare presentation of Stauffer's syndrome in a patient with advanced metastatic prostate cancer. A 72-year-old male presented with generalized weakness, dizziness, weight loss, and icterus who was incidentally found to have a prostatic enlargement on physical examination. The laboratory investigations and radiographic imaging confirmed the diagnosis of metastatic prostatic cancer without any evidence of mechanical biliary obstruction as confirmed by biopsy and imaging. The cancer had metastasized to pelvic sidewalls, pelvic bones, ribs, urinary bladder, and local lymph nodes. Our case signifies that a high index of suspicion for underlying cancer should be maintained in patients presenting with cholestatic liver dysfunction, with or without jaundice, especially in the absence of a recognizable mechanical etiology of cholestasis.

Exploring the Use of Artificial Intelligence and Robotics in Prostate Cancer Management

Integrating artificial intelligence (AI) and robotics in prostate cancer (PCa) offers a game-changing breakthrough with far-reaching implications for diagnosis, treatment, and research. AI-driven algorithms have tremendous promise for assisting early diagnosis by analyzing invisible trends within medical imaging devices such as MRI and ultrasounds. In addition, by evaluating big datasets containing patient data, genetic attributes, and treatment outcomes, these AI algorithms offer the possibility of allowing individualized treatment regimens. This ability to personalize actions to specific patients might improve therapy efficacy while reducing side effects. Robotics can increase accuracy in less invasive surgery, revolutionize therapies like prostatectomies, and improve recovery time for patients. Robotic-assisted procedures provide clinicians with remarkable skills and flexibility, allowing clinicians to negotiate complicated anatomical structures more precisely. However, the symbiotic combination of AI and robotics has several drawbacks. Concerns about data privacy, algorithm biases, and the need to continually assess AI's diagnostic proficiency offer significant hurdles. To ensure patient privacy and data security, the ethical and regulatory aspects of integrating AI and robotics require proper attention. However, combining AI and robotics opens up a galaxy of possibilities. The joint use of AI and robotics can potentially speed up drug development procedures by filtering through massive databases, resulting in the identification of new medicinal compounds. Furthermore, combining AI and robotics might usher in an innovative era of personalized medicine, allowing healthcare providers to design therapies based on detailed patient profiles. The merging of AI and robotics in PCa care gives up unprecedented prospects. While limitations highlight the necessity for caution, the possibilities of better diagnostics, tailored therapies, and new research pathways highlight the transformational abilities of AI and robotics in determining the future of PCa management. This study explores the limitations and opportunities presented by using AI and robotics in the context of PCa.

Simultaneous Thoracic Spine Metastatic Melanoma and Pre-existing Prostate Adenocarcinoma: A Unique Case Presentation and Literature Review

In melanoma patients, distant metastases frequently manifest in the skin, lung, brain, liver, bone, and intestine. Notably, bone metastasis predominantly occurs within the axial skeleton, with the lumbar and thoracic spines being the most affected regions. Conversely, prostate cancer often disseminates to the bone, lung, liver, pleura, and adrenal glands. The spinal column, particularly the lumbar region, frequently harbors metastases in prostate cancer cases. Given the proximity of axial lesions to the spinal cord, patients commonly experience pain, weakness, and urinary dysfunction. This article presents a compelling case report of a patient initially diagnosed with metastatic prostate cancer, who later exhibited a metastatic lesion in the thoracic spine, subsequently identified as originating from acral melanoma on the plantar surface of the right foot. Histopathological examination confirmed the presence of acral melanoma in both the spine and the right foot. The patient received comprehensive treatment for advanced melanoma from a multidisciplinary team comprising medical and radiation oncologists. Considering the overlapping pathophysiology of prostate cancer and melanoma, simultaneous screening for both diseases in cases where one is detected could yield significant benefits, including enhanced morbidity and mortality outcomes and the facilitation of early detection for secondary malignancies.

Prostate Cancer Support Groups: The Unadvertised Camaraderie

Prostate cancer (PCa), in particular, is known to cause significant psychosocial distress during the duration of a patient’s treatment due to its uncertainty and demasculinizing side effects. Prostate cancer support groups (PCSGs) have been proven to be beneficial, yet are underutilized by the majority of PCa patients and physicians. A thorough review of the literature was performed for articles pertaining to prostate cancer support groups. We sought to identify factors contributing to the psychological burden of the disease, factors that influenced patients to join, and barriers to participation in a PCSG. Additionally, the characteristics and format of PCSGs, as well as outcomes (i.e. quality of life), were evaluated.

AB99. Association of mitochondrial DNA copy number in peripheral blood leukocytes with risk and prognosis of prostate

Objective

To investigate the relationship between mitochondrial DNA (mtDNA) copy number in peripheral blood leukocytes (PBLs) and the risk and the prognosis of prostate cancer (PCa).

Methods

In a case-control study of 196 PCa patients and 196 age-paired normal controls, the association between mtDNA copy number in PBLs and PCa risk was evaluated. The relative mtDNA copy number was measured by using real-time PCR. Among the case cohort, 89 patients were subject to follow-up. Two endpoints i.e., progression-free survival (PFS) and overall survival (OS), were selected to evaluate the association between the prognosis of PCa and the mtDNA copy number.

Results

PCa patients had significantly higher mtDNA copy numbers than controls (medians 0.91 and 0.82, respectively; P<0.001). High mtDNA copy number was also associated with an increased risk of PCa (highest quartile vs. lowest: odds ratio =2.52, 95% confidence intervals: 1.35-4.70; Ptrend =0.011). Patients with higher AJCC stage and Gleason score tended to have higher mtDNA copy numbers (P=0.002 and P=0.012, respectively). Cox univariate and multivariate survival analysis indicated that mtDNA copy number was an effective predictor of PFS and OS. The Kaplan-Meier survival curves revealed that high mtDNA copy number was associated with poor PFS and OS in patients with PCa (P=0.007 and P<0.001, respectively).

Conclusions

Our findings provide the first evidence that increased mtDNA copy number in PBLs is significantly associated with an increased risk of PCa and, similarly, a poor prognosis in PCa patients. Quantification of mtDNA copy number in PBLs could be helpful to diagnosis and prognosis of PCa.

Socioeconomic Barriers to Receiving Early Salvage Radiotherapy for Locally Advanced Prostate Adenocarcinoma: A Retrospective Single-Center Study

Purpose This study aimed to identify factors associated with delays in initiating early salvage radiation therapy in prostate cancer patients with prostate-specific antigen (PSA) failure after prostatectomy. Methods We conducted a single-institution, retrospective study of patients receiving salvage radiation therapy after radical prostatectomy from 2011 to 2022. Patient demographics and clinical data were examined to identify factors that may have influenced the time to start of radiation therapy after surgery. Utilizing a PSA cut off of 0.25 ng/ml or less, we classified patients as receiving either early "PSA low" or late "PSA high" salvage therapy depending on their PSA at the time of initiating treatment. Results Of the 81 patients evaluated, the median age was 61.9 years (IQR 57.9 - 66.5), with most presenting with pT3 (65.4%), Grade Group 2 disease (35.8%), and positive margins 55%). Median PSA at salvage radiation therapy commencement was 0.30 ng/mL (0.18 - 0.48). 40 patients completed early salvage and 41 patients completed late salvage in the overall cohort. A significant association was found between patient insurance carrier and pre-radiation PSA levels. Patients with HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) insurance were more likely to complete late salvage radiation compared to non-managed Medicare patients (HMO OR 4.0, p <0.05 & PPO OR 3.3 p <0.05 vs non-managed Medicare). All uninsured patients in the cohort received late salvage radiation. Conclusions Insurance type was significantly associated with the timing of salvage radiation therapy post-prostatectomy, suggesting a relationship with providers requiring prior authorization (HMO and PPO coverage). This study supports proper PSA surveillance, in particular for those with HMO or PPO coverage.

Extremely Elevated Prostate-Specific Antigen in Acute Prostatitis: A Case Report

Elevated prostate-specific antigen (PSA) levels are mostly suggestive of prostate cancer, but they are elevated in non-cancerous prostatic conditions as well. However, extreme levels of PSA as reported here have not been observed in cases other than prostatic cancer so far. Our patient had a significantly elevated PSA of 1,398 ng/mL in acute prostatitis. The purpose of this case report is to review the patient's atypical and rare presentation of extremely high PSA in acute prostatitis in the background of benign prostatic hyperplasia (BPH) and chronic prostatitis.

Comparing the Efficacy and Safety of the Transperineal Versus Transrectal Prostate Biopsy Approach in the Diagnosis of Prostate Cancer: A Systematic Review and Meta-Analysis

Prostate cancer (PCa) has high prevalence rates in men and is a leading cause of cancer-related death. Transrectal (TR) biopsy has traditionally been the gold standard for diagnosis, but transperineal (TP) biopsy is increasingly favoured due to its lower infection risk. However, debate remains regarding which method has superior cancer detection rates. This review compares the efficacy and safety of the TP as compared to the TR prostate biopsy approach, summarizing the largest body of evidence available to date. A literature search was performed on the PubMed, Google Scholar, Cochrane Library, and Embase databases. We searched from the inception of the databases up to August 2024 for relevant studies comparing the cancer detection rate of TP versus TR prostate biopsy and compared their complication rates. Twenty-one studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences between the TR and TP groups in the PCa detection rate. This meta-analysis included 21 studies (6 randomized control trials and 15 cohort studies) with a total of 13,818 patients (TP = 7917; TR = 5901), who were accrued between 2008 and 2024 and divided into the TR group and the TP group. The analysis revealed no significant difference in prostate cancer detection rates between the TP and TR approaches in both RCTs (OR 1.02, 95% CI (0.74, 1.41), p = 0.90) and cohort studies (OR 1.07, 95% CI (0.85, 1.35), p = 0.36). Complication profiles were largely comparable; TP demonstrated a significantly lower risk of urinary tract infections (OR 0.26, 95% CI (0.11, 0.61)) but no notable differences in acute urinary retention, haematuria, or rectal bleeding. Our findings advocate the TP approach as a safer biopsy alternative where feasible, particularly in infection-sensitive populations, without compromising diagnostic accuracy. MRI should complement biopsy strategies to enhance diagnostic precision. Future research should focus on standardized, large-scale RCTs to further refine and personalize prostate cancer diagnostic pathways.

AB36. Three-port laparoscopic radical prostatectomy (LRP) for prostate cancer (PCa)

Objective

To introduce a more cost-effective therapy of three-port laparoscopic radical prostatectomy (LRP) for prostate cancer (PCa) in developing countries like China.

Materials and methods

We retrospectively reviewed 112 patients with PCa receiving LRP between January 2011 and December 2013 at our institution. They were divided into group A (three-port LRP, 24 patients) and group B (conventional four-five port LRP, 88 patients). A learning curve was analyzed by dividing patients of group A into the early and late stage.

Results

Both groups were comparable with regard to all of the preoperative characteristics. All three-port LRP were performed successfully without conversion to open radical prostatectomy (ORP) or four-five port LRP. In group A, the mean operative time (OT) was 89.3 min, the mean estimated blood loss (EBL) was 132.5 mL, the mean hospitalization was 4.2 d, and 29.2% of the prostate specimen margins (PSM) were positive. In group B, the figures were 100.6 min, 216.7 mL, 5.2 d respectively and 33.0% of PSM were positive. The differences of OT and EBL were statistically significant between both groups (P<0.05). After undergoing the early stage of a learning curve in three-port LRP, the OT and EBL could be decreased evidently.

Conclusions

Three-port LRP is a modified technique, which exhibits superior intraoperative advantages to the conventional LRP. Due to its lower cost and less EBL with a shorter learning curve and OT, it should be recommended that three-port LRP is a more cost-effective therapy in developing countries like China. Please keep your head when faced to the hot topic!

Cell division cycle 42 effector protein 4 inhibits prostate cancer progression by suppressing ERK signaling pathway

Prostate cancer (PCa) is the most common malignancy among men worldwide. The cell division cycle 42 effector protein 4 (CDC42EP4) functions downstream of CDC42, yet its role and molecular mechanisms in PCa remain unexplored. This study aimed to elucidate the role of CDC42EP4 in the progression of PCa and its underlying mechanisms. Bioinformatical analysis indicated that CDC42EP4 expression was significantly lower in PCa tissue compared to normal prostate tissue. Cellular phenotyping analysis suggested that CDC42EP4 markedly inhibited the proliferation, migration, and invasion of PCa cells. Xenograft tumor assays further demonstrated that CDC42EP4 suppressed the growth of PCa cells in vivo. Mechanistically, the study established that CDC42EP4 inhibited the ERK pathway in PCa cells. Additionally, the ERK pathway inhibitor PD0325901 was employed, revealing that PD0325901 significantly nullified the effects of CDC42EP4 on PCa cell proliferation, migration, and invasion. Collectively, our findings demonstrate that CDC42EP4 acts as a critical tumor suppressor gene, inhibiting PCa cell proliferation, migration, and invasion through the ERK pathway, thereby presenting potential targets for PCa therapy.

Abiraterone-Induced Secondary Hypertension: Two Wrongs Don't Make a Right

Abiraterone, an inhibitor of both 17α-hydroxylase and 17,20-lyase, is considered a novel, state-of-the-art, life-prolonging therapy in the urologists' arsenal when treating prostate cancer. Despite its efficacy, it is linked with an increased risk of cardiovascular adverse effects. Herein, we report a case in which the administration of abiraterone resulted in a full-blown syndrome of apparent mineralocorticoid excess despite the concomitant administration of prednisolone; that is, secondary hypertension, hypokalemia, metabolic alkalosis, as well as elevated levels of adrenocorticotropic hormone (ACTH).

Overall Survival and Associations of Insurance Status Among Hispanic Men With High-Risk Prostate Cancer

Objectives Our objectives were to (1) determine the association between ethnicity and high-risk prostate cancer (PCa) survival and (2) determine whether this association is modified by insurance status. Methods We performed a retrospective review of the National Cancer Database (NCDB) from 2004 to 2017 of non-Hispanic White (NHW), Hispanic White (HW), or Black men with high-risk PCa. A multivariate Cox regression model was built to test the association between overall survival (OS) and race/ethnicity, insurance status, and their interaction, controlling for various socioeconomic and disease-specific variables. Results A total of 94,708 men with high-risk PCa were included in the analysis. Both HW and Black men had lower socioeconomic status characteristics and lower rates of private insurance. Race/ethnicity was significantly associated with OS in the adjusted analysis. Only Medicare demonstrated significantly worse OS. NHW (covariate-adjusted hazard ratio (aHR): 1.83, 95% CI: 1.45-2.32) and Black (aHR: 1.71, 05% CI: 1.34-2.19) men demonstrated significantly worse survival when compared to HW men. Subgroup analysis demonstrated significant differences occurring among HW men with private insurance/managed care when compared to those not insured, Medicaid, Medicare, and other government insurance types. Conclusion Despite socioeconomic and demographic disadvantages, HW men demonstrate improved OS compared to NHW men. Furthermore, HW men demonstrated improved OS compared to NHW men within nearly each insurance status type. This finding is likely the result of a complex multifactorial web and as such serves as an interesting hypothesis-generating study.

Update on PSMA-based Prostate Cancer Imaging

The increased use of prostate-specific membrane antigen (PSMA) based PET imaging for prostate cancer (Pca) detection has revolutionized the clinical management of Pca, with higher diagnostic sensitivity for extraprostatic disease and increasing clinical utility across different stages of the disease. The integration of PSMA PET imaging into clinical guidelines and consensus documents reflects its growing importance in the personalized management of Pca. This review of recent literature highlights the rapid evolution of PSMA PET into the mainstream of staging and restaging and the decreasing reliance on conventional imaging modalities. This comprehensive review serves as a resource for clinicians and researchers involved in the domains of Pca diagnosis and management.

AB37. The combination of I brachytherapy with intermittent androgen deprivation in treating locally advanced prostate cancer

Objective

Method

Results

Conclusion

AB101. Nerve-sparing laparoscopic radical prostatectomy (report on 186 cases)

Introduction and objective

To evaluate the effect of nerve-sparing laparoscopic radical prostatectomy (NSLRP) on the postoperative quality of life.

Materials and methods

Between February 2001 and July 2014, we performed LRP on 852 patients with localized prostate cancer (PCa). Of them, 186 patients with preoperative erectile function (IIEF5 scores range from 14 to 26 and indications (PSA <10 ng/mL; Gleason scores <7; age<65 years old) underwent NSLRP. Among them, 116 cases had bilateral NSLRP, and 70 cases had unilateral NSLRP; of them, 42 cases were underwent single-port transvesical laparoscopic radical prostatectomy (STLRP), which first transvesical dissect the bladder neck and can mostly preserve bilateral cavernosal nerve in the most. Briefly, the key steps of the techniques following: opened the Denonvillier’s fascia and dissected posterior wall of prostate; raised the bilateral seminal vesicles and exposed the bilateral pedicle of prostate; prostate pedicle was dissected outside the base of seminal vesicle and cut off with scissors close to the prostate capsular with hemo-lock. Then opened pelvic levator ani fascia longitudinally from the lateral of the prostate lateral, the lateral prostate ligament was dissected longitudinally above the neurovascular bundles using hemo-lock and scissor until to the apex of prostate. Dissociated the urethra at the apex of prostate and avoided the damage of cavernous nerves which go into the urethra from 4 to 8 o’clock. In the case of STLRP, after surgery, continually low dose of PDE5 (25 mg/d) inhibitor therapy, intracavernous injection or vacuum constriction devices was performed postoperatively one month later to restore the function of penis at the early stage. The patients’ erectile function and urinary control were evaluate done year after the surgery.

Results

About 65% patients who had NSLRP preserved sexual function 1 year after the surgery, in which 52% (97/186) of patients engage in intercourse with the assistance of PDE5 inhibitor, IIEF5 scores 0-7 in 16% (31/186), 8-11 in 29% (54/186), 13-21 in 47%(89/186), 22-25 in 6% (12/186), respectively. Urinary control rate at 6 and 12 months after the surgery were 90.5% and 96.4%, respectively. However, the IIEF in STLRP, were especially higher than other group, 75% of patients (31/42) potent with IIEF >18.

Conclusions

The NSLRP, especially with STLRP approach, could effectively preserve the most of the patients’ sexual function and improve the recovery of sexual function and urinary continence. In addition, postoperative rehabilitation of penile potent at early stage could benefit the recovery the patients’ erectile function.