Low-risk Prostate Cancer Research Articles

A 20-year population-wide cohort study on association of aspirin and risk of gastrointestinal and non-gastrointestinal cancer.

830 Background: Aspirin has been shown to reduce the risk of various gastrointestinal (GI) and non-GI cancers 1,2 . However, little was known about at what age aspirin should be started for maximal chemoprotective better on GI cancer. Furthermore, the randomised controlled trial on aspirin for primary prevention use in healthy elderly (ASPREE) showed no association between aspirin and cancer incidence despite the limitation of short follow-up duration 3 . The current study aims to investigate the 20-year risk of cancer using aspirin in a territory-wide Hong Kong population cohort. Methods: The study included all aspirin users from 2000 to 2019, and non-aspirin users matched by age and sex at a ratio of 1:2. Enrolled subjects with a history of cancer at enrolment, cancer incidence or death within 6 months were excluded. The incidence of individual GI and non-GI cancer was presented as the primary outcome. Baseline characteristics between aspirin and non-aspirin users were adjusted in the survival analysis by inverse probability of treatment weighting (IPTW). The fine-grey model has been used to address bias from competing risk of death. The sub-distribution hazard ratio was presented for the association of aspirin use and risk of GI and non-GI cancers. Results: The current study included 538,147 aspirin users and 968,378 non-users with a mean age of 64.8 years. A total number of 36,683 cases of GI cancer (2.4%) and 47,196 cases of non-GI cancers (3.1%) were observed. Aspirin was associated with a lower risk of several common individual GI cancers, including colorectal cancer (SHR 0.78, 95% CI 0.76-0.81), liver cancer (SHR 0.67, 95% CI 0.64-0.70), stomach cancer (SHR 0.79, 95% CI 0.75-0.84) and pancreatic cancer (SHR 0.85, 95% CI 0.79-0.91), but not oesophageal cancer. On the other hand, aspirin was associated with a lower risk of prostate cancer (SHR 0.95, 95% CI 0.91-1.00) and breast cancer (SHR 0.76, 95% CI 0.73-0.79), but not lung cancer and kidney cancer. In overall, aspirin was associated with a 24% lower risk of GI cancers (SHR 0.76, 95% CI 0.74-0.78) and a 3% lower risk of non-GI cancers (SHR 0.97, 95% CI 0.95-0.99). Conclusions: Aspirin was associated with a lower risk of most GI cancers, including colorectal cancer, liver cancer, stomach cancer and pancreatic cancer, but not most non-GI cancers. In general, results on the effect of aspirin on GI cancer prevention were consistent with the previously presented 10-year cohort. 1. Bosetti C, Santucci C, Gallus S, Martinetti M, La Vecchia C. Aspirin and the Risk of Colorectal and Other Digestive Tract Cancers: An Updated Meta-analysis through 2019. Ann Oncol. 2020;31(5):558-568. 2. Santucci C, Gallus S, Martinetti M, La Vecchia C, Bosetti C. Aspirin and the risk of nondigestive tract cancers: An updated meta-analysis to 2019. Int J Cancer. 2021;148(6):1372-1382. 3. McNeil JJ, Gibbs P, Orchard SG, et al. Effect of Aspirin on Cancer Incidence and Mortality in Older Adults. J Natl Cancer Inst. 2021;113(3):258-265.

Multi-level Factors to Build Confidence and Support in Active Surveillance for Low-Risk Prostate Cancer: A Qualitative Study.

Active surveillance (AS) is the guideline-recommended treatment for low-risk prostate cancer and involves routine provider visits, lab tests, imaging, and prostate biopsies. Despite good uptake, adherence to AS, in terms of receiving recommended follow-up testing and remaining on AS in the absence of evidence of cancer progression, remains challenging. We sought to better understand urologist, primary care providers (PCPs), and patient experiences with AS care delivery to identify opportunities to improve adherence. A qualitative study involving patients, PCPs, and urologists with experience of AS. PCPs (19), urologists (15), and patients (15) in Michigan. Participants were recruited through a statewide quality improvement collaborative. Semi-structured interviews were conducted virtually from June 2020 to April 2021. The Theoretical Domains Framework and the Behavior Change Wheel's Capability, Opportunity, and Motivation model guided interviews and coding. Thematic analysis was used to identify shared perspectives on AS care delivery. Three main themes emerged from the PCP, urologist, and patient data collected related to AS care delivery that were needed to improve AS adherence: (1) building patient confidence in AS by leveraging provider roles and expertise and creating connection through communication across the care team and with patients; (2) building confidence in AS through psychosocial support by involving families and peers, and addressing anxiety and uncertainty; (3) building AS support within healthcare processes and electronic health record systems. These themes reflect opportunities for interventions at the care team, community (family and peers), and health system levels that could better support individualized care and overcome challenges to AS adherence through team-based approaches.

Dosimetric comparison of CyberKnife and conventional linac prostate SBRT plans: analysis of the PACE-B Study.

In the PACE-B study, a non-randomised comparison of toxicity outcomes between stereotactic body radiotherapy (SBRT) platforms revealed fewer urinary side-effects with CyberKnife (CK) compared to conventional linac (CL) SBRT. This analysis compares baseline characteristics and planning dosimetry between the CK-SBRT and CL-SBRT cohorts in PACE-B, aiming to provide insight into possible reasons for differing toxicity outcomes between the platforms. Dosimetric parameters for the surrogate urethra (SU), contoured urethra, bladder, bladder trigone (BT), and rectum were extracted from available CT planning scans of PACE-B SBRT patients. The SU and BT were retrospectively delineated. Dose levels analysed included Dmax, D2, D50, and D95, where D(n) represents the dose (Gy) to (n)% of the structure. Baseline characteristics and planning dosimetry between CK-SBRT and CL-SBRT cohorts were compared using Mann-Whitney U, t-test, and chi-squared tests. Of the 414 patients who received SBRT, 169 (41%) were treated with CK-SBRT and 245 (59%) with CL-SBRT, with dosimetric parameters available for 94% of patients (390/414). There was a non-statistically significant trend towards more low-risk prostate cancer in the CK-SBRT cohort (12% vs. 6% p=0.02 (ns)). Margins were similar between platforms, except posteriorly where CK-SBRT had smaller margins. CK-SBRT plans had significantly higher median SU Dmax (45.9Gy vs. 42.8Gy, p<0.0001), D2% and D50% compared to CL-SBRT plans. Additionally, CK-SBRT plans had significantly higher median BT Dmax (43.4Gy vs. 41.6Gy, p<0.0001), D2% and D95%, as well as higher median bladder Dmax, D50% and D95%. CK-SBRT plans had lower median rectal D2% (35.5Gy vs. 36.0Gy, p<0.0001), but higher rectal D50% and D95%. Although the CK-SBRT cohort showed lower urinary toxicity, the planned doses to urinary substructures were actually higher, likely due to heterogeneous dose planning. Factors like intrafraction tracking or other confounding variables may explain the differences in toxicity outcomes between the treatment platforms.

Physician Payment Incentives and Active Surveillance in Low-Risk Prostate Cancer

Active surveillance in men with less aggressive prostate cancer is inconsistently used despite clinical guidelines. Renumeration generally favors treatment over conservative management and may contribute to the variable adoption of active surveillance, which suggests that value-based payment incentives may promote guideline-concordant care. To describe the adoption of active surveillance in low-risk prostate cancer, following the initiation of a novel payment incentive sponsored by a commercial payer to support its use. This cohort study included men with prostate cancer diagnosed between 2015 to 2021 with data registered with the Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide quality-improvement collaborative of practicing urologists. Eligible participants were men with newly diagnosed low-risk or low-volume, favorable intermediate-risk prostate cancer who were eligible for active surveillance. Data were analyzed from January 2015 through December 2021. Health insurance payment incentive established between June 9, 2017, and September 30, 2018, to encourage active surveillance adoption within MUSIC. Upon meeting the target (ie, at least 72% of men with low-risk disease consider or initiate surveillance), the insurer would provide enhanced reimbursement on claims covered by preferred provider organization plans independent of diagnosis. Active surveillance adoption relative to the preincentive period among men with low-risk prostate cancer. Secondary analyses examined practices by baseline surveillance use and proportion of patients with eligible insurance plans, as well as patients with favorable intermediate-risk disease. We identified 15 273 patients (median [IQR] age, 65 [59-70] years), of whom 10 457 (68.5%) had low-risk disease. The percentage of these men electing for surveillance increased, from 54.4% in 2015 (729 of 1340 men) to 84.1% in 2021 (1089 of 1295 men). Relative to the preincentive period, the payment incentive was not associated with increased surveillance use among patients with low-risk disease (odds ratio [OR], 0.96; 95% CI, 0.75-1.24) during its application. Secondary analyses similarly did not demonstrate an association between the payment incentive and active surveillance adoption. A payment incentive was not associated with increased active surveillance adoption in men with low-risk prostate cancer relative to the preincentive period. Value-based reimbursement incentives may require tailored implementation that considers existing reimbursement policy and practice characteristics to improve prostate cancer care quality.

Development and Validation of a Deep Learning Model Based on MRI and Clinical Characteristics to Predict Risk of Prostate Cancer Progression.

Purpose To validate a deep learning (DL) model for predicting the risk of prostate cancer (PCa) progression based on MRI and clinical parameters and compare it with established models. Materials and Methods This retrospective study included 1607 MRI scans of 1143 male patients (median age, 64 years; IQR, 59-68 years) undergoing MRI for suspicion of clinically significant PCa (csPCa) (International Society of Urological Pathology grade > 1) between January 2012 and May 2022 who were negative for csPCa at baseline MRI. A DL model was developed using baseline MRI and clinical parameters (age, prostate-specific antigen [PSA] level, PSA density, and prostate volume) to predict the time to PCa progression (defined as csPCa diagnosis at follow-up). Internal and external testing was performed. The model's ability to predict progression to csPCa was assessed by Cox regression analyses. Predictive performance of the DL model up to 5 years after baseline MRI in comparison with the European Randomized Study of Screening for Prostate Cancer (ERSPC) future-risk calculator, Prostate Cancer Prevention Trial (PCPT) risk calculator, and Prostate Imaging Reporting and Data System (PI-RADS) was assessed using the Harrell C-index. Optimized follow-up intervals were derived from Kaplan-Meier curves. Results DL scores predicted csPCa progression (internal cohort: hazard ratio [HR], 1.97 [95% CI: 1.61, 2.41; P < .001]; external cohort: HR, 1.32 [95% CI: 1.14, 1.55; P < .001]). The model identified a subgroup of patients (approximately 20%) with risks for csPCa of 3% or less, 8% or less, and 18% or less after 1-, 2-, and 4-year follow-up, respectively. DL scores had a C-index of 0.68 (95% CI: 0.63, 0.74) at internal testing and 0.56 (95% CI: 0.51, 0.61) at external testing, outperforming ERSPC and PCPT (both P < .001) at internal testing. Conclusion The DL model accurately predicted PCa progression and provided improved risk estimations, demonstrating its ability to aid in personalized follow-up for low-risk PCa. Keywords: MRI, Prostate Cancer, Deep Learning Supplemental material is available for this article. ©RSNA, 2025.

Long-term oncological outcomes of active surveillance for low-risk prostate cancer diagnosed during the MRI era.

Active surveillance (AS) is the recommended approach for managing Grade-Group1 (GG1) prostate cancer (PCa). Incorporating MRI at entry improve patient selection and outcomes. To evaluate long-term oncological outcomes of patients receiving AS selected with MRI at entry. Retrospective analysis of a single-center cohort of patients selected for AS from 2007 to 2022. Inclusion criteria were GG1 PCa with MRI prior to systematic and targeted biopsies. A per-protocol re-biopsy at one year has not been part of the AS inclusion criteria since 2015. Main outcome was cumulative incidence of: biopsy grade reclassification, AS discontinuation, active treatment, post-active treatment biochemical recurrence, metastasis, and mortality. Secondary outcome was the identification of risk factors for AS discontinuation. Cohort consists of 354 men. Median follow-up is 6.3 years (IQR: 3.2-9.1). Median PSA was 6.3ng/mL (5.0 to 8.5). At 10 years post-diagnosis, the cumulative incidence was 29.6% (95%CI: 23.3-36.2%) for grade reclassification, 40.0% (95%CI: 32.8-47.0%) for AS discontinuation, 36.9% (95% CI: 30.0-43.7) for active treatment, 9.4% (95% CI: 3.7-18.4) for post-active treatment biochemical recurrence and 0.5% for metastatic progression (2 patients). No PCa-related deaths were observed. PI-RADS score, and the number of positive biopsies at inclusion were identified as predictive factors for AS discontinuation. In this cohort of AS patients with MRI at entry, 60% of men remained on AS at 10 years, with less than 1% developing metastatic disease and no PCa-related mortality. These results support AS management with MRI at entry and add to share decision-making with patients. Level 2.

High- dose- rate (2 fractions of 13.5 Gy) and low-dose-rate brachytherapy as monotherapy in prostate cancer. Long term outcomes and predictive value of nadir PSA

This study aims to evaluate the outcomes of patients treated for low-risk (LR) and favorable intermediate risk (FIR) prostate cancer with brachytherapy (BT) in monotherapy with LDR or HDR and its relationship with nadir PSA (nPSA). We retrospectively analyzed 139 patients (2005-2019) with exclusive LDR (46%. 145/160 Gy) /HDR (54%. 2 implants of 13.5 Gy each separated 10 days). 69% LR and 31% FIR. PSA nadir was grouped into two categories: ≤ 0.2 ng/mL and > 0.2 ng/mL. Median patient age was 69 years (46-84). Seventy-six patients (55%) received androgen deprivation therapy, and 37% received neoadjuvant therapy. Median follow-up period was 90 months. Actuarial biochemical failure-free survival (BFFS), local control (LC), overall survival (OS), and cause-specific survival (CSS) rates for the total cohort were 78%, 87%, 68%, and 98% at 10 years, respectively. BFFS, LC, OS and CSS in nPSA ≤ 0,2 ng/ml was 90%, 96%, 67%, 100% at 10 years respectively, whereas, those with a nPSA > 0.2 ng/ml had a BFFS, LC, OS and CSS of was 37%, 51%, 72%, 90% at 10 years respectively Statistical significance between both groups was reached in BFFS (p=0,000), LC (p=0,000) and CSS (p=0,007)). In the univariate analysis, there was no difference between risk stratification, BT technique, ADT, or the development of bouncing. Prostate brachytherapy as monotherapy (LDR and HDR) is an effective treatment option for patients with LR and FIR prostate cancer. nPSA ≤0,2 ng/ml is a representative value that provides prognostic information for favorable outcomes in this group of patients.

ERG and PTEN Role on Active Surveillance for Low-Risk Prostate Cancer in the Multiparametric MRI Era.

Our study aimed to correlate ERG and PTEN expressions in prostate biopsy with multiparametric magnetic resonance imaging PI-RADS score, clinical reclassification, and prognosis of very low-risk prostate cancer (PCa) patients under active surveillance (AS). We evaluated 101 very low-risk PCa patients under AS between 2013 and 2018. They were followed with DRE, PSA, MRI, and re-biopsies every 1-2 years. Per cause biopsy was recommended if PSA > 10 ng/mL, suspicious DRE, or PI-RADS ≥ 4 was present. ERG and PTEN expressions were assessed by immunohistochemistry at biopsy. Reclassification was defined by PSA > 10 ng/mL, re-biopsy with > 3 positive cores, > 50% positive core, Gleason Score (GS) upgrading ≥ 3 + 4 or extreme GS upgrading ≥ 4 + 3. We correlated ERG and PTEN with reclassification, PI-RADS, pathologic outcomes, and biochemical recurrence in patients surgically treated after reclassification. After a 49.2-month follow-up, 80% of patients showed reclassification, and GS upgrading was the most common criterion. Seventy-four out of 81 patients with reclassification underwent local treatment and seven had biochemical recurrence during a mean 39.7-month follow-up. At biopsy, positive ERG expression was found in 39.6% of patients and PTEN loss in 12.6%. PTEN loss was associated with GS upgrading (OR = 9.7, p = 0.011) in univariate analysis. PTEN loss was correlated with GS upgrading; these patients had a 9.7-fold greater chance of upgrading when compared to PTEN-positive patients. ERG-positive was associated with PI-RADS ≥ 4 (OR = 2.8, p = 0.026). At multivariate analysis, PI-RADS ≥ 4 was predictor of GS upgrading (OR = 25.2, p < 0.001); MRI PI-RADS score remained an independent factor for extreme GS upgrading, together with PSAd > 0.15 (OR = 15.1, p = 0.012 and OR = 5.76, p = 0.012, respectively). Neither ERG-positive nor PTEN loss were associated with upgrading during AS. ERG and PTEN biomarkers, despite commonly studied in advanced PCa, have yet no defined role in very low-risk PCa under AS. PI-RADS score was an independent predictor of GS upgrading and extreme upgrading during AS.

Association between low density lipoprotein cholesterol levels and prostate cancer risk in non-hypertensive middle-aged and older American men

Often linked with the risk of various diseases, blood low-density lipoprotein cholesterol (LDL-C) levels are typically deemed more favorable when lower. The objective of this investigation is to elucidate the link between blood LDL-C levels and the risk of prostate cancer (PCa) in middle-aged and older men without hypertension in the United States. Utilizing continuous data from the National Health and Nutrition Examination Survey (NHANES) database spanning 2003–2010, a selection of 1,223 non-hypertensive men aged ≥ 40 years was made from a pool of 41,156 participants, ensuring no missing information. Regression analyses were employed to investigate the correlation between blood LDL-C levels and the PCa risk, while identifying potential inflection points indicative of threshold effects. Additionally, we scrutinized the linkage between cholesterol-lowering prescription drug usage and PCa. In our study of 2,224 participants, we found no significant correlation between blood LDL-C levels and the PCa risk after adjusting for confounding variables (Odds Ratio = 0.99; P-value > 0.05). However, upon conducting a subgroup analysis, we discovered a meaningful correlation between lower blood LDL-C levels and an increased PCa risk in the non-hypertensive population (Odds Ratio = 0.99; P-value < 0.05). Meanwhile, we identified a threshold effect and a tipping point at an LDL-C levels of 67 mg/dl. Furthermore, a significant correlation was identified between cholesterol-lowering prescription drug usage and a heightened PCa risk in the non-hypertensive population (Odds Ratio = 18.87; P-value < 0.05; P for interaction < 0.05). Our results indicate that in non-hypertensive middle-aged and older men residing in the United States, lower blood LDL-C levels are not necessarily better and the PCa risk escalates when blood LDL-C levels drop below 67 mg/dl, which may guide early screening and prognosis of PCa in specific populations. This finding calls for further validation via larger sample sizes and a more in-depth analysis of PCa history.

PRIMARY scoring in 68Ga-PSMA PET/CT: correlation with prostate cancer risk groups and its potential impact on active surveillance.

The PRIMARY scoring system is a scale designed to identify clinically significant intraprostatic malignancies on 68Ga-PSMA PET/CT images. Active surveillance is a management method for patients with low-risk prostate cancer. In this study, we aimed to assess the efficacy of PRIMARY scoring in identifying appropriate candidates for active surveillance based on the distribution within prostate cancer risk groups. The data of 134 patients diagnosed with PCa by biopsy who underwent 68Ga-PSMA PET/CT imaging for post-diagnostic staging purposes were retrospectively analyzed. Age, total PSA, ISUP grade, prostate lesion SUVmax values, PI-RADS scores, and PRIMARY scores were recorded. Patients were classified into low-risk and intermediate/high-risk groups. In the intermediate/high-risk group, the PRIMARY score was 1-2 in 17.6% and 3-5 in 82.4% of patients. In the low-risk group, the PRIMARY score was 1-2 in 34.7% and 3-5 in 65.3% of patients. None of the patients in the low-risk group had a PRIMARY score of 5. The most frequent PRIMARY score in both groups was 4, and there was a significant difference between the average SUVmax values of the intermediate/high and low-risk groups with a PRIMARY score of 4 (p = 0.018). The sensitivity of PRIMARY scoring in detecting patients in the intermediate/high-risk group was 82.3%, the specificity was 34.6%, and the positive predictive value (PPV) was 68.6%. When a cut-off SUVmax value 5.0 was used for the PRIMARY score of 4, the sensitivity was 67.0%, the specificity was 65.3% and the PPV was 77.0%. In the ROC analysis, the area under the curve was 0.727 for PRIMARY scoring, 0.662 for PI-RADS, and 0.744 for their combined mean. The PRIMARY scoring system can complement PI-RADS scoring in mpMRI for selecting patients suitable for active surveillance. Revising the PRIMARY score 4 with an SUVmax cut-off value may increase the specificity.

Decisional Regret Two-Year after Diagnosis with Low-risk Prostate Cancer in a Population-based Sample

Decisional Regret Two-Year after Diagnosis with Low-risk Prostate Cancer in a Population-based Sample

Abstract A009: Integrative multiomic analysis of extracellular vesicle transcriptomics profiling combined with cfDNA methylation reveals improved stratification of low-risk and high- risk prostate cancer patients in urine-based liquid biopsy

Abstract Introduction: Prostate cancer (PCa) ranks as the second most frequently diagnosed cancer and the sixth most prevalent cause of cancer-related mortality in men globally. In this study, we employ a multiomic approach that utilizes both urine cfDNA and extracellular vesicle (EV) RNA-derived analytes to improve the risk stratification of individuals with prostate cancer and compare this to multi-parametric MRI performance as well as risk calculators in the same cohort. Materials and Methods: Urine was collected from 95 individuals comprising 51 benign or low-risk (Grade Group (GG) &amp;lt;=1), 10 intermediate-risk (GG2) and 44 high-risk PCa patients (GG 3-5). EV-RNA and cfDNA were concurrently isolated from each urine specimen to exploit complementary information. We developed an EV-RNA sequencing platform targeting mRNAs and lncRNAs and targeted 50 million reads per sample; and cfDNA methylome profiling reached an equivalent sequencing depth. Expression of EV-RNA and splice variant Differential Transcript Usage (DTU) and cfDNA methylation patterns were analyzed using Bio-Techne’s multiomic platform. Machine learning-based feature selection algorithms identified biomarker signatures from each analyte. Receiver-operator characteristic curves (ROC) were generated utilizing leave-one-out cross-validation of naïve Bayes classifier models to compute the area under the curve (AUC). Individual signatures were integrated to create a multiomic classifier. Results: Differential gene expression (DEx) analysis identified 18 DEx genes between low and high-risk patients with both known and novel implications in PCa. Splice variant analysis unveiled 60 genes previously implicated in PCa with DTU. Over 18,000 differentially methylated bases were detected between high and low-risk PCa patients. Feature selection analysis identified the top ten features of EV-RNA expression, splice variants, and cfDNA methylation, resulting in an integrative multi-analyte signature. The multiomic signature demonstrated an AUC of 0.92, surpassing any individual analyte’s performance, as well as the performance achieved by PSA (AUC = 0.52) and MRI PI RADS(AUC=0.65). Conclusions: While biomarker signatures obtained from each analyte in this study resulted in effective stratification of PCa risk, the multiomic signature further improved the discriminatory power—underscoring the complementary nature of the signals. Thus, a multiomic biomarker discovery strategy leveraging cfDNA and EV cargo exhibits significant potential as a risk assessment tool for high-grade prostate cancer. This approach can facilitate more informed decision-making in the context of biopsy procedures. Citation Format: Sudipto K Chakrabortty, Dulaney Miller, Kyle Manning, Rikky Xing, Jeff Cole, Christopher Benway, Sinead Nguyen, Allan George, Yiyuan Yao, Elena M Cortizas, Christian Ray, Siva Gowrisankar, Seth Yu, Allan Pollack, Sandra M Gaston, Sanoj Punnen, Johan Skog. Integrative multiomic analysis of extracellular vesicle transcriptomics profiling combined with cfDNA methylation reveals improved stratification of low-risk and high- risk prostate cancer patients in urine-based liquid biopsy [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A009.

Predictive factors of immediate continence after conventional robot-assisted radical prostatectomy: a single-institution retrospective study.

To assess the predictive factors of immediate urinary continence after robot-assisted radical prostatectomy. This study included 282 patients who underwent conventional robot-assisted radical prostatectomy at our institution from April 2019 to March 2024. The primary outcome was immediate urinary continence, defined as the absence of urine leakage immediately after urinary catheter removal on postoperative day 6 or 7. In addition, the immediate urine loss rate, defined as the 24-h urine loss volume divided by the total urine volume after catheter removal, was calculated. The multivariable logistic model was used to assess the possible predictive factors of immediate continence (urine loss rate of 0%). The factors included age, body mass index, Charlson Comorbidity Index, pre-existing lower urinary tract symptoms, presence of an inguinal hernia, prostate volume, membranous urethral length, stratified cancer risk, surgeon's experience, and nerve-sparing procedure. In addition, a multiple linear regression model was established to investigate the associations of the same predictors with immediate urine loss rate (%). We also presented our techniques to achieve immediate continence. The patients' median age was 70 (interquartile range: 63.0-73.0) years. Approximately 39% (n = 111) of patients presented with immediate continence. Age, inguinal hernia, membranous urethral length, and low risk for prostate cancer were associated with immediate continence. These were also statistically significant predictors of immediate urine loss rate. Our study identified factors predicting immediate urinary continence after conventional robot-assisted radical prostatectomy. This information is potentially valuable for preoperative counseling in patients undergoing robot-assisted radical prostatectomy.

Active Surveillance as Preferred Treatment for ISUP Grade I Prostate Cancer: Confronting the ProtecT Trial.

The advantages of active surveillance (AS) in low-risk prostate cancer (PC) have already been widely demonstrated. The 15-year results of the Prostate Testing for Cancer and Treatment (ProtecT) trial were published recently, reflecting worse oncological outcomes of their active monitoring programme (AMP) compared with radical prostatectomy (RP) or radiotherapy (RDT). Our objective was to analyse the survival of patients with International Society of Urological Pathology (ISUP) grade I PC depending on the treatment received and point out the differences between an AS protocol and the AMP established in the ProtecT trial. A retrospective study of patients with ISUP grade I PC managed by AS, RP or RDT was conducted. A comparative intention-to-treat survival analysis was performed. Our AS protocol included routine 18-core surveillance biopsies of all patients. On the basis of this assumption, the patients included in AS were divided into two groups: Those who met the rebiopsy criteria of the ProtecT trial and those who should not have been biopsied in accordance with this trial. Of the total 2865 patients, 981 met the selection criteria with a median follow-up of 7.7 years: 448 (45.7%) in AS, 399 (40.7%) in RP and 134 (13.7%) in RDT. The median age at diagnosis was 66.9, 63.2 and 69.2 years, respectively. The AS and RP groups were comparable in all the variables. The overall and cancer-specific survival results were similar, but the AS group had better metastasis-free survival. The RDT group presented worse clinical features in prostate-specific antigen and stage and worse survival outcomes compared with the other groups (p < 0.005). Out of the 448 patients included in AS, 100 met some of the criteria for rebiopsy of the ProtecT trial. Amongst the 348 patients who did not meet any criteria, 138 (39.6%) ended up receiving active treatment due to Gleason progression, increasing number of positive cores or both in the majority of cases (94.4%). Surveillance biopsy is a major factor that contributes to achieving good oncological results in AS. Active monitoring is not comparable with an AS protocol, and thus, the results of the ProtecT trial are poorly assessable.

Predictive Value of PSA Density in Pathological Discordance Terms in Patients who Undergo Robotic Surgery for Low-risk Prostate Cancer: An Analytic Cross-sectional Study of a Tertiary Reference Center

Predictive Value of PSA Density in Pathological Discordance Terms in Patients who Undergo Robotic Surgery for Low-risk Prostate Cancer: An Analytic Cross-sectional Study of a Tertiary Reference Center

Nutritional Supplement with Fermented Soy in Patients Under Active Surveillance for Low-Risk or Intermediate-Risk Prostate Cancer: Results from the PRAEMUNE Trial.

Background/Objectives: To investigate the effect of a fermented soy supplement during 18 months in patients under active surveillance (AS) for low-risk and selected favorable intermediate-risk prostate cancer (PCa), with an emphasis on PSA modulation. Methods: Low-risk patients with ISUP grade 1, clinical stage cT1 or cT2a, PSA < 10 ng/mL and favorable intermediate-risk patients with ISUP grade 2 (<10% pattern 4), clinical stage T2b-c, PSA 10-20 ng/mL. The primary outcome was PSA response defined as maximum PSA rise less than or equal to 0.87 ng/mL after 1 year, based on the weighted average of PSA velocity (PSAV) in previous studies in similar populations. Secondary outcomes were disease progression, adverse histology on repeat biopsy or switch to active therapy. In addition, primary and secondary outcomes with imputed data were also determined as sensitivity analyses, using Mann-Whitney U or Chi-squared tests. Results: Overall, 92 (61.3%) of 150 patients showed a PSA level response. This was more evident in ISUP 1 patients and resulted in fewer follow-up MRIs and fewer control biopsies, as well as a fewer number of positive control biopsies with statistical significance in the imputed dataset. Obtaining a PSA response was numerically associated with less initiated therapy. Conclusions: a fermented soy supplement in patients under AS for low-risk and selected favorable intermediate-risk PCa could be useful in selecting patients who may remain under AS or who may need to switch to active therapy.

Risk of subsequent primary cancers in bladder cancer survivors

We aimed to investigate the risk of bladder cancer (BCa) survivors developing or dying from 15 specific-subsequent primary cancers (SPCs). A total of 229,554 BCa survivors were identified from the Surveillance, Epidemiology, and End Results database. Incidence and mortality per 10,000 person-years, absolute excess risk (AER) per 10,000 person-years, standardized incidence ratios, and standardized mortality ratios were calculated. Among BCa survivors, 38,207 developed SPCs and 17,546 died of SPCs. The risk of developing and dying from SPCs was significantly high for 10 and 6 of the 12 common SPCs in men, respectively, while for 6 and 5 of the 14 common SPCs in women, respectively. The SPCs with high risk of development in men were colorectal, breast, liver, and pancreatic cancer, and the ones with high risk of death were liver and pancreatic cancer. Moreover, SPCs with a high risk of development or death among young BCa survivors include ureter, kidney and renal pelvis, and lung cancer. In addition, BCa survivors within 1 year of diagnosis have a significantly higher risk of development and death from ureter, kidney and renal pelvis, prostate, and cervix cancer, but a lower risk of prostate cancer than the general population after 5 years of diagnosis. Lung cancer had a significantly high risk of development but a low risk of death. Among BCa survivors, the risk of developing or dying from few SPCs is significantly high. These findings may provide an important basis for clinical follow-up of BCa survivors.

Bidirectional influence between benign prostatic hyperplasia, prostate cancer, and prostatitis and mental disorders: two-sample and multivariate mendelian randomization analyses

Background We aimed to use Mendelian randomization (MR) to determine the causality between fifteen major mental disorders (MDs) and benign prostatic hyperplasia (BPH), prostate cancer (PCa), and prostatitis. Methods The main MR analysis was performed using the inverse variance-weighted (IVW) method. Results The study found that insomnia (odds ratio [OR], 1.6190; p = .0017) was significantly associated with an increased risk of BPH, and mood disorders (OR, 1.1590; p = .0221) was nominally associated with an increased risk of BPH. Conversely, BPH was suggestively associated with a low epilepsy risk (OR, 0.9988; p = .0043), and was nominally associated with an increased risk of insomnia (OR, 1.0061; p = .0291). Furthermore, attention deficit hyperactivity disorder (ADHD) was suggestively associated with a low PCa risk (OR = 0.9474; p = .0058). However, no causal relationship was observed between PCa and MDs. Finally, anorexia nervosa (OR, 1.1686; p = .0248) and depression (OR, 336.5383; p = .0308) were nominally positively correlated with prostatitis. Prostatitis was suggestively associated with increased risk of ADHD (OR, 1.0868; p = .0413). Conclusion Our findings provide clinicians with a basis for developing programs to prevent or treat MDs and prostatic diseases.

Feasibility of Pay for Performance and Transparency Interventions on the Selection and Quality of Observational Management for Patients with Low-Risk Prostate Cancer in the Community Practice.

Feasibility of Pay for Performance and Transparency Interventions on the Selection and Quality of Observational Management for Patients with Low-Risk Prostate Cancer in the Community Practice.

Association between beta-blocker atenolol use and prostate cancer upgrading in active surveillance.

The objective of this study is to investigate the association between the use of beta-adrenergic antagonist atenolol and risk of pathologic upgrade in patients on active surveillance, considering growing literature implicating adrenergic innervation with disease progression mediated through beta-adrenergic signalling. Men with low-risk or favourable intermediate-risk prostate cancer who were placed on an active surveillance protocol between 2006 and 2020 across three diverse urban hospitals were included. Exposure was duration of atenolol use, and outcome was pathologic grade group upgrading (to GG ≥ 3) on final prostate biopsy. Cox proportional hazard regression models were used to determine the associations between atenolol use and risk of upgrading with time, on a per-examination basis. A total of 467 men with initial GG ≤ 2 were included. Postdiagnosis atenolol use was associated with a decreased risk of pathologic upgrade to GG ≥ 3 on final repeat biopsy (HR 0.81, 95% CI 0.39-0.98). Longer duration of postdiagnosis atenolol use (>2years) and greater cumulative atenolol dose (>730 defined daily doses) were associated with a more pronounced decreased risk of upgrade to GG ≥ 3 (HR 0.41, 95% CI 0.05-0.88, and HR 0.32, 95% CI 0.15-0.99, respectively). Initiation of atenolol use prior to prostate cancer diagnosis had a slightly greater protective effect than drug initiation postdiagnosis (HR 0.79, 95% CI 0.43-0.98, and HR 0.83, 95% CI 0.30-0.99, respectively). Beta-adrenergic blockade with atenolol use in men on active surveillance is associated with a reduced risk for clinically significant grade group pathologic upgrade.