Grade Group Research Articles

Single-Port Robotic Transvesical Partial Prostatectomy: A Novel Approach for Focal Treatment in Prostate Cancer.

Introduction and Objective: Given the favorable cancer-specific survival rates in localized prostate cancer and the negative impact of whole-gland treatments on functional outcomes, the field is moving toward precision strategies such as focal therapy and organ-sparing surgery. We aim to report medium-term functional and oncologic outcomes for the initial Single-Port Robotic Transvesical Partial Prostatectomy (SP-TVRAPP) patient cohort. Materials and Methods: We analyzed a prospectively maintained database of 20 patients who underwent SP-TVRAPP between February 2021 and March 2024. Inclusion criteria were prostate-specific antigen (PSA) ≤10 ng/mL, clinical stage ≤ cT2b, ISUP Grade Group ≤3, unilateral lesions on multiparametric magnetic resonance imaging (mpMRI) with positive biopsy cores on the same side, and preoperative IIEF-5 ≥ 17. We also considered bilateral prostate cancer in the anterior zone and invisible mpMRI tumors confirmed by unilateral positive biopsies. Results: At baseline, patients had an average age of 61 years, a median PSA of 4.8 ng/mL (interquartile range [IQR]: 3.7-7.7), and a median Sexual Health Inventory for Men (SHIM) score of 24 (IQR: 18-25). All procedures were completed without complications, need for additional ports, or conversion. After a median hospital stay of 4.2 hours, 94% of cases were discharged without opioid prescriptions, and Foley catheters were removed after approximately 4 days. At 6 weeks, 3, 6, and 12 months postprocedure, potency rates, defined as a SHIM score ≥17, were 45.0%, 77.7%, 83.3%, and 87.5%, respectively. When potency was defined as having erections sufficient for penetration, the rates were 80.0%, 88.8%, 88.8%, and 93.7% for the same time intervals. Regarding urinary function, 60.0% were continent at 1 week, increasing to 85.0% by 6 weeks, 88.8% at both 3 and 6 months, and reaching 93.7% at 12 months postsurgery. Oncologically, 30.0% experienced upgrading and 40.0% upstaging within this cohort. Negative surgical margins were attained in 85.0% of the cases and the median PSA was 0.4 ng/mL 12 months after SP-TVRAPP. Two men were found to have residual GG1 cancer in the protocol biopsies and are currently on active surveillance. At a mean follow-up of 15.5 months (0.2-34.8) months, none of the patients has required secondary interventions, and all remain free of both clinically significant residual prostate cancer and metastatic disease. Conclusions: SP-TVRAPP represents a promising treatment for certain patients with localized prostate cancer. This targeted surgical method has been associated with faster postoperative recovery and has demonstrated high rates of early recovery in erectile function and urinary continence while ensuring oncologic safety.

The Effect of PDEODE and PQ4R Strategies on The Development of Reflective Thinking and Self-Efficacy in Mathematics among Ninth-Grade Female Students in Palestine

This study investigates the effect of PDEODE and PQ4R strategies on the development of reflective thinking and self-efficacy in mathematics among ninth grade female students in Palestine. PDEODE and PQ4R are two educational strategies based on constructivist theory, each consisting of six sequential steps; the steps of the PDEODE strategy are: Prediction, Discuss, Explain, Observe, Discuss, Explain, while the steps of the PQ4R strategy are: Preview, Question, Read, Reflect, Recite, Review. The experimental approach was used in a quasi-experimental design based on the application of pre-post measurement. The sample of the study consisted of (96) ninth grade students. It was intentionally chosen from the students of Al-Mughraqa Preparatory Girls School, and the sample was divided into three groups. The first experimental group studied using PDEODE strategy, the second experimental group studied using PQ4R strategy, and the third control group studied using the usual method. The study materials and tools included the teacher's guide, the reflective thinking test, and the self-efficacy scale. The results of the study are as follows: There are statistically significant differences at the level of significance ( = 0.05) between the mean scores of the students of the three experimental groups and the control group of the ninth grade in the reflective thinking test and the self-efficacy scale in mathematics in favor of the two experimental groups. The study showed that the size of the effect of the two strategies was large, and that there is a statistically significant positive correlation at the level of significance ( = 0.05) between the degrees of reflective thinking and self-efficacy in mathematics among female students of the two experimental groups of the ninth grade in Palestine. The study recommended training mathematics teachers to use PDEODE and PQ4R strategies in teaching mathematics for all grades. Keywords: PDEODE strategy, PQ4R strategy, reflective thinking, self-efficacy, mathematics.

Evaluation of Potential Candidate Genes in the Differentiation of Neoplastic and Non-neoplastic Conditions of Endometrium

Abstract Background Endometrial cancer is one of the most common malignancies and alternative successful biomarkers are needed in the diagnostic process. Objectives This study aimed to investigate candidate genes' diagnostic potential in endometrial neoplasia. Material and Methods The expression levels of USP28, JAG2, AURKA, PGK1, HRPT1, EZH2, YAP, and P53 genes were evaluated by qPCR and/or immunohistochemistry analyses on endometrioid-type adenocarcinomas including all three grades, as well as from non-atypical hyperplasia, and atypical hyperplasia. Results We determined significant (p < 0.05) increases in USP28, PGK1, EZH2, JAG2, AURKA, and YAP mRNA expressions in endometrial cancer tissues. Significant differences in the expressions of USP28 and P53 genes were determined between tumor grade groups (p = 0.002, and p = 0.005, respectively). Immunohistochemically, significant differences were found between the study groups (p < 0.001) and tumor grades (p = 0.013) by the evaluation of USP28. Statistically significant differences were found between all study groups (p < 0.001) and tumor grades (p = 0.008) in terms of PGK1 immunohistochemical expressions. A positive correlation (p = 0.002, r = 0.356) was found between p53 and PGK1. Conclusions Considering our qPCR and immunohistochemistry results together, it was concluded that USP28, PGK1, EZH2, JAG2, AURKA, HPRT1and YAP expressions could offer beneficial expression values in precancerous lesions and endometrial cancer.

Computer-aided diagnosis based on 3D deep convolutional neural network system using novel 3D magnetic resonance imaging sequences for high-grade prostate cancer

Abstract Background With the rising incidence of prostate cancer (PCa), there is a global demand for assistive tools that aid in the diagnosis of high-grade PCa. This study aimed to develop a diagnostic support system for high-grade PCa using innovative magnetic resonance imaging (MRI) sequences in conjunction with artificial intelligence (AI). Materials and methods We examined image sequences of 254 patients with PCa obtained from diffusion-weighted and T2-weighted imaging, using novel MRI sequences before prostatectomy, to elucidate the characteristics of the 3-dimensional (3D) image sequences. The presence of PCa was determined based on the final diagnosis derived from pathological results after prostatectomy. A 3D deep convolutional neural network (3DCNN) was used as the AI for image recognition. Data augmentation was conducted to enhance the image dataset. High-grade PCa was defined as Gleason grade group 4 or higher. Results We developed a learning system using a 3DCNN as a diagnostic support system for high-grade PCa. The sensitivity and area under the curve values were 85% and 0.82, respectively. Conclusions The 3DCNN-based AI diagnostic support system, developed in this study using innovative 3D multiparametric MRI sequences, has the potential to assist in identifying patients at a higher risk of pretreatment of high-grade PCa.

Utilization of Radical Prostatectomy Versus Radiation Therapy for Gleason Grade Group 5 Prostate Cancer Before and After USPSTF Grade D Recommendation Against Prostate‐Specific Antigen Screening in 2012

ABSTRACTObjectivesThe 2012 United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate‐specific antigen (PSA) screening has resulted in a shift to higher‐stage prostate cancer (PC) at diagnosis. We evaluate the utilization of radical prostatectomy (RP) versus radiation therapy (RT) in the US for Gleason grade group 5 (GG5) prostate cancer before and after 2012.MethodsWe identified 34,011 men with localized GG5 PC undergoing primary therapy with (1) RP or (2) RT + androgen deprivation therapy (ADT) between 2004 and 2017 from the National Cancer Database. The chi‐square test was used to compare the relative use of RP and RT before versus after 2012. Annual use of RP versus RT from 2004 to 2017 was compared using Cochran‐Armitage test for trend. We modeled the effect of treatment year on the use of RP using multivariable logistic regression.ResultsAcross all centers, the use of RP increased from 31% to 41% (p for trend < 0.001). 2012 was associated with significant inflection for increase in RP use in all centers. There was an increased odds of receiving RP after 2012 (adjusted OR 1.34, 95% CI 1.28–1.40, p < 0.001).ConclusionsUtilization of RP for GG5 PC has significantly increased in the United States over the past decade. It remains unknown if outcomes may be compromised in this group of high‐risk men, many of whom require post‐prostatectomy RT and/or ADT. Prospective comparison of RP versus RT + ADT for GG5 PC are needed to determine optimal treatment for these patients.

Biplanar or Monoplanar Prostate Biopsy: Should Transrectal and Transperineal Ap-proaches be Combined for Prostate Cancer Detection?

The accurate diagnosis of prostate cancer (PCa) remains challenging, particularly because standard biopsy techniques do not routinely include anterior zone, leading to potential missed diagnoses in this region. This study evaluates the accuracy and safety of biplanar stereotactic biopsy for diagnosing anterior clinically significant PCa (csPCa). After propensity score matching analysis, data from 256 patients were retrospectively analyzed, including 128 in the biplanar group (transrectal targeted biopsy with transperineal systematic biopsy) and 128 in the monoplanar group (transperineal targeted biopsy with transperineal systematic biopsy). PCa detection rates, lesion locations, csPCa, clinically insignificant PCa (ciPCa), and complication incidences were compared. Univariable and multivariable logistic regression models evaluated factors influencing biopsy outcomes. No significant differences were observed in overall PCa detection, ciPCa, posterior lesions, or postoperative complications between biplanar and monoplanar groups. The biplanar group demonstrated a higher detection rate for anterior csPCa (P=0.025). The overall International Society of Urological Pathology grade group (ISUP GG) distributions for Prostate Imaging Reporting and Data System (PI-RADS) scores 3 to 5 were not significantly different. Logistic regression identified age and PSA levels as independent predictors of higher detection rates, while univariable analysis showed that prostate volume had a significantly smaller effect on PCa detection rates in the biplanar group compared to the monoplanar group. Postoperative complications showed no statistically significant differences. In conclusion, biplanar stereotactic biopsy was superior to monoplanar biopsy in detecting anterior csPCa. Both methods demonstrated no significant differences in overall PCa detection rates and safety.

초등 사회과 교육과정에 나타난 가계와 기업의 역할 분석

This study analyzes the key changes in the 2022 revised elementary social studies curriculum focusing on the behaviors of households and firms as economic agents and explores corresponding teaching strategies. A content analysis of the statements of achievement standards in the 2015 and 2022 revised elementary social studies curricula revealed that the 3rd and 4th grade group emphasizes the concept of rational choice, rooted in scarcity and decision-making, and the 5th and 6th grade group focuses on the interrelationship between economic agents and introduces new concepts such as "freedom of enterprise," "labor rights," and "corporate social responsibility." Based on these findings, this study proposes teaching strategies addressing rational choices by households and firms, the relationships between economic agents, and corporate social responsibility. This study suggests: first, it is necessary to design inquiry activities in elementary schools related to the rational consumption of households, incorporating budget constraints, products with the same price, and opportunity costs; second, the rational decision-making of firms should move beyond interest-driven activities to focus on profit-seeking and production activities centered on resource utilization; and third, teaching corporate social responsibility as a concept that integrates long-term profit-making with societal contributions.

Investigating the impacts of culturally relevant engineering design (CRED) on students’ perception and engagement in k-12 stem classroom

This study highlights effective strategies for enhancing student interest and participation in STEM education through culturally relevant approaches. Both quantitative and qualitative research approaches were engaged for this study. A survey was created and sent online to a group of grade 8 to 12 STEM students who completed the study. The interview questions were made and sent to 6 teachers. The qualitative data was taken and analyzed using descriptive findings and quantitative data was taken and analyzed via the Statistical Package for the Social Sciences (SPSS) software to find relationships between culturally relevant engineering design (CRED) and students' perceptions and engagement in Science, Technology, Engineering, and Mathematics (STEM) classrooms. Our findings reveal a significant positive correlation between students' perceptions of culturally relevant engineering design and their engagement in STEM learning activities. Specifically, students who perceive culturally relevant engineering design positively demonstrate higher levels of engagement in STEM learning.

The 5-year results of the Stratified Cancer Active Surveillance programme for men with prostate cancer.

To report 5-year outcomes from the STRATified CANcer Surveillance (STRATCANS) programme based on progression risks using National Institute for Health and Clinical Excellence (NICE) Cambridge Prognostic Group (CPG) at diagnosis, prostate specific antigen density and magnetic resonance imaging (MRI) visibility. Men with CPG1 and CPG2 disease selecting active surveillance (AS) were included into STRATCANS and allocated to one of three increasing follow-up intensities. Outcome measures were: (i) treatment for CPG≥3 progression (main outcome), (ii) any treatment, (iii) conversion to watchful waiting (WW), (iv) patient self-attrition, and (v) mortality. A total of 297 men (median age 66.0 years) were reviewed. The median (interquartile range, mean) follow-up for men still on AS was 4.9 (2.7-7.6, 5.3) years. In the cohort, 38.0% were CPG2 and 25.0% Grade Group (GG) 2 at AS entry. Overall, 214/297 (72.1%) remained treatment free: 158 (53.1%) were still on AS, 17 (5.7%) died of other causes, and 39 (13.1%) progressed to WW/discharge. Only 10 (3.4%) left AS from anxiety. There were no cancer deaths or metastatic events. In all, 80 men (26.9%) converted to treatment due to biopsy/MRI progression but only 35 (11.7%) of these reached CPG≥3 disease. Treatment for CPG≥3 occurred in 7.6% of CPG1 and 18.5% of CPG2 disease and 9.9% of GG1 and 17.5% of GG2 disease. By STRATCANS tier, treatment for CPG≥3 disease was 4.7% in STRATCANS 1, 12.9% in STRATCANS 2, and 27.4% in STRATCANS 3 (P < 0.001). STRATCANS had an area under the curve (AUC) of 0.74 for predicting CPG≥3 progression out-performing stratification by GG (AUC 0.64), CPG (0.69) and Likert score (0.51) alone or a combination of MRI visibility and GG (0.64). Longitudinal data have allowed further refinement of the STRATCANS schedule. The STRATCANS 5-year outcomes demonstrate that a simple risk stratified surveillance using a prognostically meaningful endpoint is safe, durable, has low treatment rates, high patient compliance and appropriately tailors monitoring based on risks of progression. A website and implementation toolkit are now available.

Which patients with negative PSMA-PET imaging can safely avoid biopsy for prostate cancer? a novel step towards PSMA-based biopsy-free strategy.

This study aimed to identify if a subset of men can safely avoid or delay prostate biopsy based on negative results of prostate-specific membrane antigen positron emission tomography (PSMA-PET). Among 341 consecutive cases in a prospective biopsy cohort (NCT05073653), 111 treatment-naïve men with negative PSMA-PET (PRIMARY-score 1/2) were included. All participants underwent PSMA-PET and histopathological examinations. Clinically significant prostate cancer (csPCa) was defined as Grade Group ≥ 2. Multivariate logistic regression was employed to identify predictors of non-csPCa. Receiver operating characteristic (ROC) analysis was performed to detect non-csPCa on prostate pathology. PSMA-postive patients were additionally reviewed to assess the imaging and pathological outcomes. Younger age was identified as an independent predictor (P = 0.006) for the absence of csPCa. ROC analysis of csPCa revealed the largest areas under the curve of 0.77 (0.67-0.87) and 0.78 (0.68-0.88) for individual age in the entire PSMA-negative cohort and the MRI subset, respectively (both P < 0.001). The negative predictive value (NPV) of PSMA-PET for csPCa detection improved with a decreasing age, from 88% in all, to 98% in men aged under 65 yrs (98% vs. 88%, P = 0.021), and to 100% in men aged under 60 yrs (100% vs. 88%, P = 0.040). The NPV of PSMA-PET improved from 88 to 94% when combined with negative MRI, and to 100% in men with negative MRI and aged under 65 yrs. The prevalence was 57% for csPCa and 65% for PCa of any grade. We preliminarily propose that omission or postponement of prostate biopsy should be considered for men under the age of 65 yrs with negative PSMA-PET scored as PRIMARY 1 or 2. Conversely, prostate biopsy might be considered in biopsy-naïve men aged 65 yrs or older with strong clinical suspicion of PCa, despite negative PSMA-PET. Further prospective and external evaluation is needed to prove the robustness of this novel strategy.

SABR tolerance after prostatectomy: pushing the boundaries of ultrahypofractionation.

To evaluate the feasibility and tolerance of ultra-hypofractionated SABR (stereotactic ablative radiation therapy) protocol following radical prostatectomy. We included patients undergoing adjuvant or salvage SABR between April 2019 and April 2023 targeting the surgical bed and pelvic lymph nodes up to a total dose of 36.25 Gy (7.25 Gy/fraction) and 26 Gy (5.2 Gy/fraction), respectively, in 5 fractions on alternate days with an urethra sparing protocol. Acute and late adverse effects were assessed using the CTCAE v5.0. Pearson's chi-square test for categorical variables was used to compare characteristics and possible associations among different subgroups. Adjuvant radiation therapy (ART) was administered to 40 high-risk patients (detectable post-surgery PSA, Grade Group 4/5, nodal involvement, R1/R2 resection margin), while salvage radiotherapy (SRT) was delivered to 60 patients with rising PSA levels post-undetectable values. Elective nodal irradiation was performed in 57 patients, with 11 additional patients receiving a simultaneous integrated boost (total dose: 40 Gy in 5 fractions) for macroscopic nodal disease. Twenty-four high-risk patients underwent 24-months androgen deprivation therapy (ADT). Treatment was well-tolerated with minimal toxicity. The maximum grade of SABR-related toxicity observed was grade 3. Acute gastrointestinal (GI) toxicity included seven cases of grade 2 and one of grade 3, while acute genitourinary (GU) events were limited to grade 2 in eight patients. Early-late toxicity included two cases of grade 3 and seven of grade 2 for GI, and 11 cases of grade 2 for GU. No toxicity above grade 3 was reported. With a median follow-up of 24 months (6-60 months), 14 patients experienced disease recurrence. Ultra-hypofractionated adjuvant/salvage SABR appears feasible and safe. Longer follow-up is needed to validate observed outcomes.

Constructing and Validating Models for Predicting Gleason Grade Group Upgrading Following Radical Prostatectomy in Localized Prostate Cancer: A Comparison between Machine Learning Algorithms and Conventional Logistic Regression.

The occurrence of Gleason grade group upgrading (GGU) significantly impacts both treatment strategy development. We aim to develop an optimal predictive model to assess the risk of GGU in patients with localized prostate cancer (PCa), by comparing traditional logistic regression (LR) with seven machine learning algorithms. A retrospective collection of clinical data was conducted on patients who underwent RP at Wuhan Central Hospital (January 2017 to December 2023, n=177) and Jiangxi Cancer Hospital (July 2019 to February 2024, n=87). The least absolute shrinkage and selection operator (LASSO) regression was employed to filter the clinical characteristics of patients. Subsequently, models were conducted using multivariate LR, along with seven diverse machine learning algorithms: eXtreme Gradient Boosting, Decision Tree, Multilayer Perceptron, Naive Bayes, k-Nearest Neighbors, Random Forest, and Support Vector Machine. By employing the receiver operating characteristic curve, accuracy, brier score, recall, calibration curve, and decision curve analysis, we compared the predictive capabilities and clinical utility of eight models to identify the optimal one. In the evaluation of eight models, the LR model demonstrated superior performance. In the modeling set, it achieved an AUC of 0.826 (95% CI: 0.808 - 0.845), accuracy of 0.765, and a brier score of 0.167. In the validation set, it kept good results with an AUC of 0.819 (95% CI: 0.758 - 0.880), accuracy of 0.725, and a brier score of 0.180. The calibration curve, brier score， and DCA also demonstrated the excellent calibration and net benefit of the LR model. After conducting a comprehensive multi-model comparison, we concluded that the LR model was optimal for predicting GGU, which was confirmed by external validation. Our study also revealed percent free prostate-specific antigen density as a predictive factor for GGU, offering a novel approach for managing localized PCa patients.

Discordance between prostate MRI and PSMA-PET/CT: the next big challenge for primary prostate tumor assessment?

An increasing number of patients with prostate cancer (PCa) undergo assessment with magnetic resonance imaging (MRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT). This offers comprehensive multimodality staging but can lead to discrepancies. The objective was to assess the rates and types of discordance between MRI and PSMA-PET/CT for primary PCa assessment. Consecutive men diagnosed with intermediate and high-risk PCa who underwent MRI and PSMA-PET/CT in 2021-2023 were retrospectively included. MRI and PSMA-PET/CT were interpreted using PI-RADS v2.1 and PRIMARY scores. Discordances between the two imaging modalities were categorized as "minor" (larger or additional lesion seen on one modality) or "major" (positive on only one modality or different index lesions between MRI and PSMA-PET/CT) and reconciled using radical prostatectomy or biopsy specimens. Three hundred and nine men (median age 69 years, interquartile range (IQR) 64-75) were included. Most had Gleason Grade Group ≥ 3 PCa (70.9% (219/309)). Median PSA was 9.0 ng/mL (IQR 5.6-13.6). MRI and PSMA-PET/CT were concordant in 157/309 (50.8%) and discordant in 152/309 (49.1%) patients; with 39/152 (25.7%) major and 113/152 (74.3%) minor discordances. Of 27 patients with lesions only seen on MRI, 85.2% (23/27) were clinically significant PCa (csPCa). Of 23 patients with lesions only seen on PSMA-PET/CT, 78.3% (18/23) were csPCa. Altogether, lesions seen on only one modality were csPCa in 80.0% (36/45). MRI and PSMA-PET/CT were discordant in half of patients for primary PCa evaluation, with major discrepancies seen in roughly one out of eight patients. Question While both MRI and PSMA-PET/CT can be used for primary tumor assessment, the discordances between them are not well established. Findings MRI and PSMA-PET/CT were discordant in about half of the patients. Most prostate lesions seen on only one modality were significant cancer. Clinical relevance MRI and PSMA-PET/CT are often discordant for assessing the primary prostate tumor. Using both modalities for primary prostate tumor evaluation can provide complementary information that may substantially impact treatment planning.

Clinical Validation of MyProstateScore 2.0 Testing Using First-Catch, Non-DRE Urine.

The 18-gene MyProstateScore 2.0 (MPS2) test was previously validated for detection of Grade Group≥2 (GG≥2) prostate cancer using post-digital rectal examination (DRE) urine. To improve ease of testing, we validated MPS2 using first-catch, non-DRE urine. Patients provided first-catch urine prior to biopsy. MPS2 values were calculated using previously-validated models differing only by extent of clinical data included: biomarkers alone (BA; no clinical data), biomarkers and clinical factors (BA+CF), and biomarkers, clinical factors, and prostate volume (BA+CF+PV). The primary outcome was GG≥2 cancer on biopsy. MPS2 performance and clinical consequences of testing were compared to PSA and the Prostate Cancer Prevention Trial risk calculator (PCPTrc). The cohort included 266 men with median PSA 6.6 ng/mL (IQR 4.9-9.1), of which 103 (39%) had GG≥2 cancer on biopsy. The area under the curve for GG≥2 cancer was 57% for PSA, 62% for PCPTrc, and 71%, 74%, and 77% for MPS2 models. Under a testing approach detecting >90% of GG≥2 cancers, MPS2 testing would have avoided 36-42% of unnecessary biopsies, as compared to 13% using the PCPTrc. In patients with a prior negative biopsy, MPS2 testing would have avoided 44-53% of repeat biopsies, as compared to only 2.6% using PCPTrc. Using first-catch urine, MPS2 meaningfully improved the proportion of biopsies avoided relative to PCPTrc while maintaining highly-sensitive detection of GG≥2 cancer. Non-DRE testing provides a convenient, objective, and highly-accurate testing option to reduce the need for imaging and biopsy in men with elevated PSA.

Prognostic value of intraductal carcinoma subtypes and postoperative radiotherapy for localized prostate cancer

BackgroundIntraductal carcinoma of the prostate cancer (IDC-P), as a specific pathological type in prostate cancer which usually implies a poor prognosis. IDC-P morphology can be divided into two subtypes: Pattern 1, sieve like or loose cribriform structures; Pattern 2, solid or dense cribriform structures. The purpose of the study is to identify the impact of IDC-P and its subtypes on the prognosis of patients undergoing post-operative radiotherapy (PORT) after radical prostatectomy (RP) due to localized prostate cancer(PCa).MethodsWe performed a retrospective study of patients with localized PCa treated by RP followed by PORT or not. Patients with localized PCa who underwent RP from August 2013 to December 2020 were included in this study. Inclusion criteria: post-operative PSA dropped to less than 0.1 ng/ml after RP, had at least 1 poor prognostic risk factor (including high Gleason’s grouping; positive surgical margins; seminal vesicle invasion; extraprostatic extension; and lympho-vascular invasion), and were eligible for adjuvant radiotherapy.; In this study, patients who underwent salvage radiotherapy after RP due to biochemical recurrence (two consecutive PSA > 0.2 ng/ml) were also included, but not patients with persistent postoperative PSA > 0.1 ng/ml. Exclusion criteria: patients using other types of therapy prior to biochemical recurrence. Screening cases with pathological results of intraductal carcinoma, subtyping was completed by a pathologist, grouped by intraductal carcinoma (+/-; pattern 1/ 2) and treatment regimen (RP + PORT / RP only), Kaplan-Meier curves were plotted based on the time to biochemical recurrence-free and overall survival of the patients, and Cox regression analyses were performed. Finally, based on the results of Cox regression analysis, we initially predicted the probability of biochemical recurrence and death of the patients by plotting the nomogram.ResultsA total of 139 patients were included in this study with a median follow-up of 61.5 months. K-M curves showed that patients with “IDC-P (+) RP only” had the worst prognosis; patients with IDC-P could have a survival benefit after receiving PORT; whereas patients with non-intraductal carcinoma had a better prognosis than the above patients with or without PORT. In addition, patients with IDC-P(+) pattern 2 were more likely to experience biochemical recurrence and death. Multivariate Cox regression analysis showed that pattern 2 was a risk factor for biochemical recurrence and death. Other BCR-related risk factors in the research: Gleason grading group 5 (HR = 3.343, 95% CI: 1.616–6.916, P = 0.001), PM (HR = 2.124, 95% CI: 1.044–4.320,P = 0.038) and PORT (HR = 0.266, 95%CI: 0.109–0.647, P = 0.004). Other OS-related risk factors in the research: Grading group 5 (HR = 3.642, 95%CI:1.475–8.991, P = 0.005), SVI (HR = 2.522, 95% CI: 1.118–5.691, P = 0.026) and PORT (HR = 0.319, 95%CI: 0.107–0.949, P = 0.040).ConclusionPatients suffering from localized prostate cancer with IDC-P(+), especially IDC-P pattern 2, are more susceptible to biochemical recurrence and death after radical prostatectomy. While postoperative radiotherapy can alleviate the negative prognostic impact from IDC-P. It is implied that IDC-P can also be an indicator to be considered in PORT decision making to some extent.

Personalized Dynamic Prediction Model for Biopsy Timing in Patients With Prostate Cancer During Active Surveillance

Active surveillance (AS) for patients with prostate cancer (PC) often includes fixed repeat prostate biopsies that do not account for the varying risk of reclassification to significant disease. Given the invasive nature and potential complications of biopsies, a personalized approach is needed to balance the burden of biopsies with the risk of missing disease progression. To develop and externally validate a dynamic model that predicts an individual's risk of PC reclassification during AS. This prognostic study developed a dynamic prediction model using data from the Prostate Cancer Research International: Active Surveillance (PRIAS) study, which was initiated in 2006. Follow-up was truncated until April 2023. External validation was conducted using cohorts from the world's largest centralized AS database, the Global Action Plan Prostate Cancer Active Surveillance initiative database. The PRIAS study is a multicenter, prospective, web-based cohort study monitoring patients undergoing AS, involving more than 175 academic, nonacademic, and private centers across 23 countries worldwide. For the development and external validation of the model, all patients diagnosed with Grade Group 1 PC who underwent at least 1 baseline or follow-up magnetic resonance imaging (MRI) and 1 follow-up biopsy were included. Data were analyzed from September 2023 to January 2024. AS, including prostate-specific antigen (PSA) tests, MRI, and prostate biopsies according to a fixed follow-up schedule. A joint model for longitudinal and time-to-event data was used to predict reclassification to Grade Group 2 or greater on repeat biopsy using predefined baseline and repeated clinical characteristics. Performance was assessed using time-dependent area under the receiver operating characteristic curve and negative predictive value. The development cohort included 2512 patients (median [IQR] age, 65 [59-69] years). Characteristics significantly associated with a higher risk of reclassification were increased age, higher PSA and velocity, lower prostate volume, a suspicious lesion on MRI, and no previous negative biopsy findings. Depending on the threshold and time point used, the model demonstrated a negative predictive value of 86% to 97%. External validation included 3199 patients from 9 other cohorts. The time-dependent area under the curve ranged from 0.81 to 0.84 in the development cohort and 0.52 to 0.90 at external validation. In this prognostic study, the developed dynamic risk model effectively identified patients at low risk of PC reclassification during AS. After prospective validation, this model may support personalized, risk-based AS and reduce the burden of unnecessary biopsies.

Impact of ISUP grade group on cancer-specific mortality in radical prostatectomy-treated prostate cancer patients with organ-confined disease

Introduction: We aimed to test the impact of International Society of Urological Pathology (ISUP) grade group (GG) on cancer-specific mortality (CSM) in organ-confined (pT2) prostate cancer (PCa) at radical prostatectomy (RP). Methods: RP organ-confined prostate cancer (PCa) patients were identified (Surveillance, Epidemiology, and End Results 2004−2015). Cancer-specific survival (CSS) rates were tested in Kaplan-Meier plots and multivariable Cox regression (MCR) models according to GG: 1–3 vs. 4 vs. 5. Sensitivity analyses addressed GG4 and GG5 patients with available primary and secondary Gleason score (GS). Results: Overall, 61 172 patients with RP organ-confined PCa were identified. Of these, 57 715 (94.4%), 2036 (3.3%) and 1421 (2.3%) harbored GG1–3, 4, and 5, respectively. In Kaplan-Meier analyses, seven-years’ CSS estimates were 99.6 vs. 98.2 vs. 93.8% for GG1–3 vs. 4 vs. 5, respectively (p&lt;0.001). In MCR models, GG4 (hazard ratio [HR] 2.72, p&lt;0.001) and 5 (HR 9.95, p&lt;0.001) independently predicted higher CSM, relative to GG1–3. Furthermore, GG5 also independently predicted higher CSM (HR 3.72, p&lt;0.001) vs. GG4. In sensitivity analyses, 1.2, 1.6, and 2.4 CSM events per 1000 person-years of followup were respectively recorded for GS 4+4, 3+5, and 5+3 patients. Conversely, 4.8 vs. 5.3 CSM events per 1000 person-years of followup were respectively recorded for GS 4+5 vs. 5+4/5+5 patients. Conclusions: In organ-confined PCa, at RP, a small proportion of patients harbor GG4–5. These patients exhibit higher CSM than their GG1–3 counterparts. Moreover, detectable mortality rate differences indicate a dose-response effect according to primary and secondary GS. This phenomenon applies in both GG4 and GG5, as well as between GG4 and GG5.

Concordance with final pathology when transitioning from standard transrectal to cognitive targeted transperineal prostate biopsy.

Transrectal (TR) prostate biopsy is being increasingly abandoned in favour of a transperineal (TP) approach as well as a targeted biopsy only of the index lesion(s). It remains underreported how these changes could impact concordance at final pathology. We aimed to evaluate the impact of transitioning from standard transrectal (sTR) to cognitive targeted transperineal (cog-tTP) biopsy on final pathology including concordance and upgrading. Analysis of consecutive patients undergoing prostate biopsy and prostatectomy (RP) between January 2018 and May 2022 at a tertiary centre in Western Norway. There were 210 and 239 patients in the sTR and cog-tTP groups, respectively. The mean [IQR] number of biopsies decreased from 12 [4-12] to 3 [3-4] (p< 0.001). The overall rate of concordance between biopsy and final pathology was 64% in both groups (Table 3, Figure 1). 24% Twenty-four per cent (cog-tTP) versus 19% (sTR) had grade group (GG) upgrading, while 12% versus 17% were downgraded (p= 0.2). Regarding positive surgical margins (PSMs) that were >3 mm in extension, there were only 3.3% and 2.1% in the sTR and cog-tTP groups, respectively (p= 0.4). For surgical outcomes associated with RP, no differences in terms of postoperative complications between the groups were found (cog-tTP:10% vs. sTR:6%, p= 0.10). Transitioning from sTR biopsy to targeted cog-tTP biopsy does not compromise concordance at final pathology nor does it increase the risk of tumour upgrading.

Prospective validation study of a combined urine and plasma test for predicting high-grade prostate cancer in biopsy naïve men.

Early and accurate diagnosis of prostate cancer (PC) is crucial for effective treatment. Diagnosing clinically insignificant cancers can lead to overdiagnosis and overtreatment, highlighting the importance of accurately selecting patients for further evaluation based on improved risk prediction tools. Novel biomarkers offer promise for enhancing this diagnostic process. In this study, we aimed to externally validate a previously developed urine and plasma biomarker test in a biopsy-naïve population. Urine and blood samples were prospectively collected from 362 biopsy-naïve men with suspected PC before they underwent transrectal prostate biopsies. The expression levels of a 10-gene mRNA panel were quantified using reverse transcription/quantitative polymerase chain reaction of both urine and plasma. These gene expression levels, combined with clinical features and plasma prostate-specific antigen (PSA) levels, were used to predict the presence of International Society of Urological Pathology grade group ≥ 2 PC. Complete data were available for 314 patients. The sensitivity and specificity of the biomarker test were 87% (95% CI: 79-93%) and 42% (95% CI: 36-49%), respectively. The area under the curve was 0.76 (95% CI: 0.7-0.82) for the biomarker test probability and 0.65 (95% CI: 0.59-0.72) for PSA (p = 0.02). The test's negative predictive value was 89% (CI: 81-94%). This study did not replicate the previously reported high accuracy of the biomarker test, highlighting the need for further refinement and robust external validation to ensure reliable performance across diverse patient populations.

Clinical feasibility of MRI-guided in-bore prostate biopsies at 0.55T.

In-bore MRI-guided biopsy allows direct visualization of suspicious lesions, biopsy needles, and trajectories, allowing accurate sampling when MRI-ultrasound fusion biopsy is not feasible. However, its use has been limited. Wide-bore, lower-field, and lower-cost scanners could help address these issues, but their feasibility for prostate biopsy is unknown. The purpose of our study was to evaluate the feasibility of in-bore MRI-guided prostate biopsy using a large-bore (80cm), 0.55T scanner. Nineteen participants (68 ± 10 years) with suspected prostate cancer (PCa) were recruited for this Institutional Review Board (IRB) approved study (May 2023 -October 2024). Prebiopsy diagnostic scans and intra-procedural T2-weighted images were used for lesion localization. PSA levels, lesion sizes, cancer detection rates, positive core volume percentage, ISUP (International Society of Urological Pathology) grade groups (GG), positive volume cores, skin to target distances, and procedure durations were reported. Seventeen participants underwent biopsies (four transrectal, thirteen percutaneous). Two participants were excluded. Twenty lesions (mean size 1.9 ± 1.2cm) were biopsied which showed various GG cancers (GG1, GG2, GG3, GG4, and GG5), with positive cores ranging from 10 to 100%. 20% of the lesions were benign. Compared to previous biopsies, 22.2% (2/9) had new cancer detections, 22.2% (2/9) showed a GG upgrade, and 33.3% (3/9) had increased positive core volume, while 11.1% (1/9) showed no upgrade and 11.1% (1/9) had benign findings. Among biopsy-naïve participants, 75% (6/8) had cancer detected, and 25% (2/8) had benign findings. One new cancer was detected near a hip prosthesis due to reduced imaging artifacts. Average total procedure time was 77 ± 21min for transrectal and 74 ± 22min for percutaneous biopsies, with times to first core at 45 ± 15 and 53 ± 14min, respectively. Identifying and accurately targeting suspicious prostate lesions is feasible using a 0.55T MRI scanner.