Received Radical Prostatectomy Research Articles

Dose-escalated Salvage Whole-pelvic Radiotherapy for Biochemical Recurrence After Radical Prostatectomy for High-risk Prostate Cancer.

To investigate the institutional experience of dose-escalated salvage whole-pelvic radiotherapy (WPRT) with the simultaneous integrated boost (SIB) technique in patients with biochemical recurrence (BCR) after radical prostatectomy for high-risk prostate cancer. This retrospective study included 21 patients with BCR who received radical prostatectomy for high-risk prostate cancer and underwent salvage RT. Clinical target volume (CTV) of the whole pelvis (CTV56) included the prostate bed, common iliac, external iliac, internal iliac, and obturator lymph node regions. The boost CTV (CTV66) included the prostate bed. Planning target volumes (PTV) were generated by adding a margin of 6-8 mm to CTV (PTV56 and PTV66). Doses of 56.1 and 66 Gy in 33 fractions were delivered to PTV56 and PTV66, respectively. The 5-year biochemical progression-free survival, overall survival, and cause-specific survival rates were 72%, 94%, and 94%, respectively. A grade 3 late genitourinary toxicity event of gross hematuria was observed in one patient (4%). Acute and late toxicities of grade ≥3, other than gross hematuria, were not observed in any patient. Dose-escalated salvage WPRT using the SIB technique provides appropriate tumor control without increasing the incident of significant toxicities.

Delaying Surgery in Favorable-Risk Prostate Cancer Patients: An NCDB Analysis of Oncologic Outcomes

IntroductionConcern for overtreatment in very low-, low-, and favorable intermediate-risk prostate cancer has promoted a more conservative approach through active surveillance (AS) with comparable survival outcomes. We analyzed the National Cancer Database (NCDB) to determine if delaying radical prostatectomy greater than 6 months is associated with an increase in the rate of adverse pathology or secondary treatment (adjuvant or salvage) at radical prostatectomy. MethodsUtilizing the NCDB from 2004 to 2019, 40 to 75-year-old men with very low-, low-, and favorable-intermediate-risk prostate cancer, as defined by the National Comprehensive Cancer Network, were identified for this study. These individuals received radical prostatectomy either before or after 6 months following diagnosis. Clinical, demographic, and pathologic characteristics were obtained. Adverse pathologic outcomes were defined as pT3-4N0-1 and/or positive surgical margins. Multiple logistic regression models were used to predict delays in treatment, adverse pathologic outcomes, and receipt of secondary therapy. Survival analysis was performed using the Cox Proportional Hazards Model and the Kaplan-Meier Method. ResultsOf the 195,397 patients who met inclusion criteria, only 13,393 patients received surgery 6 months after diagnosis. The median time of delay was 7.5 months compared to 2.3 months in the immediate treatment group. Overall, delaying surgery had no statistically significant impact on adverse pathologic outcomes, regardless of risk category. However, when accounting for the interaction between race and delayed treatment, non-Hispanic black patients who received a delay in treatment were more likely to experience adverse features (OR 1.12, 95%CI 1.00-1.26, P = .041). Conversely, patients who had delayed surgery were less likely to receive additional therapy (either adjuvant or salvage) (OR 0.60, 95%CI 0.52-0.68, P < .001). Survival analysis showed that both groups fared well, with a 5-year survival of 97% for both groups. The treatment group was not predictive of survival. ConclusionOverall, delaying surgery more than 6 months following diagnosis did not have a significant impact on adverse pathologic features or overall survival. However, when specifically looking at non-Hispanic black patients with a treatment delay, these patients were at increased risk for adverse features, suggesting that the negative impact of treatment delay depends on the patient's race. As race is a social construct, this finding likely points to the complex socioeconomic factors that contribute to overall health outcomes rather than any inherent disease characteristics. Lastly, delayed treatment patients were actually less likely to require secondary therapy, regardless of race, possibly reflecting high clinician acumen in selecting patients appropriate for treatment delay. The results suggest that patients who ultimately “fail” AS and require subsequent surgery have overall comparable survival outcomes. However, pathologic outcomes are dependent on the patient's underlying race, with non-Hispanic black patients experiencing an increased risk of adverse outcomes if treatment is delayed.

Pretreatment prostate-specific antigen density as a predictor of biochemical recurrence in patients with prostate cancer: a meta-analysis

BackgroundA consensus has not been reached on the value of prostate-specific antigen density (PSAD) as a predictor of biochemical recurrence of prostate cancer. This meta-analysis aimed to evaluate the association between PSAD and biochemical recurrence of prostate cancer after primary treatment.MethodsTwo authors systematically searched PubMed, Web of Science, and Embase databases (up to August September 10, 2023) to identify studies that assessed the value of pretreatment PSAD in predicting biochemical recurrence after primary treatment (radical prostatectomy or radiotherapy) of prostate cancer. A random effect model was used to pool adjusted hazard ratios (HR) with 95% confidence intervals (CI) for biochemical recurrence.ResultsNine studies with 4963 patients were eligible for the meta-analysis. The reported prevalence of biochemical recurrence ranged from 4 to 55.1%. For patients with higher PSAD compared to those with low PSAD, the pooled HR of biochemical recurrence was 1.59 (95% CI 1.21–2.10). Subgroup analysis showed that the pooled HR of biochemical recurrence was 1.80 (95% CI 1.34–2.42) for patients who received radical prostatectomy, and 0.98 (95% CI 0.66–1.45) for patients who received radiotherapy.ConclusionsElevated pretreatment PSAD may be an independent predictor for biochemical recurrence of prostate cancer after radical prostatectomy. Determining PSAD could potentially improve the prediction of biochemical recurrence in patients with prostate cancer.

Abstract PR007: Neighborhood socioeconomic deprivation, racial segregation, and prostate tumor RNA expression of stress-related genes among African American and European American men

Abstract INTRODUCTION: African American (AA) men experience greater prostate cancer incidence and mortality compared to European American (EA) men. Growing literature supports associations of neighborhood social factors (NSF) including neighborhood socioeconomic deprivation and residential segregation with advanced or aggressive prostate cancer, and AA men may experience these factors to a greater extent than EA men. Here we tested associations of NSF with prostate tumor RNA expression of stress-related genes, hypothesizing that these factors would be related and contribute to prostate tumor aggressiveness. METHODS: We leveraged available transcriptomic data from prostate tumor tissue for AA and EA men with prostate cancer who received radical prostatectomy surgery at the University of Maryland Medical Center. We geocoded each participant’s address at diagnosis, determined the corresponding census tract, and assigned tract-based Area Deprivation Index (ADI) and Racial Isolation Index (RI) scores to each participant. Based on data availability, ADI analyses included men diagnosed in 2005 or later (118 AA men and 43 EA men), and RI analyses included those diagnosed in 2009 or later (110 AA men and 37 EA men). We evaluated 105 stress-related genes, including those in the Conserved Transcriptional Response to Adversity, among others. We fit separate linear regression models for expression of each gene in relation to ADI or RI, respectively. Models were adjusted for race and age and year at surgery. We obtained q-values (p-values adjusted for multiple comparisons) using the Benjamini-Hochberg method. RESULTS: Median (interquartile range) ADI scores were 116 (101-131) for AA men and 91 (83-103) for EA men, and RI scores were 0.68 (0.38-0.87) for AA men and 0.10 (0.05-0.14) for EA men, indicating greater neighborhood deprivation and Black residential segregation among AA participants. The greatest values for these scores were concentrated in central and west Baltimore. ADI scores were positively and significantly (p&amp;lt;0.05) associated with expression for 11 genes. One gene, HTR6 (serotonin pathway), remained significant after multiple comparison adjustment (beta=0.0029, 95% confidence interval: 0.0014-0.0043; p&amp;lt;0.001; q=0.02). RI scores were positively and significantly associated with expression for 7 genes (p&amp;lt;0.05), but findings did not remain significant after multiple comparison adjustment. Four genes, including HTR6, IFIT2 and MX2 (roles in Type I IFN response), and IGLL1 (antibody synthesis) were significantly associated with both ADI and RI (p&amp;lt;0.05). Top findings among AA men only were similar to the overall results (AA and EA men combined). CONCLUSIONS: We identified several genes in stress-related pathways whose expression in prostate tumor tissue was higher among men with higher neighborhood deprivation or higher racial segregation. Additional analyses will consider other neighborhood measures, including historical redlining, to further investigate the role of NSF in prostate tumor RNA expression, tumor aggressiveness, and prostate cancer disparities. Citation Format: Joseph Boyle, Jessica Yau, Jimmie L. Slade, Derrick Butts, Yuji Zhang, Teklu B. Legesse, Ashley Cellini, Kimberly Clark, Jessica Wimbush, Nicholas Ambulos Jr., Jing Yin, Arif Hussain, Eberechukwu Onukwugha, Cheryl L. Knott, David C. Wheeler, Kathryn Hughes Barry. Neighborhood socioeconomic deprivation, racial segregation, and prostate tumor RNA expression of stress-related genes among African American and European American men [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR007.

Protocol for SNOTOB study: radical prostatectomy without prostate biopsy following 18F-PSMA-1007 PET/CT based on a diagnostic model: a single-centre, single-arm, open-label study

IntroductionNowadays, invasive prostate biopsy is the standard diagnostic test for patients with suspected prostate cancer (PCa). However, it has some shortcomings such as perioperative complications, economic and psychological burden on...

Prostate‑specific antigen density and preoperative MRI findings as predictors of biochemical recurrence in high‑risk and very high‑risk prostate cancer.

Patients with high-risk prostate cancer after prostatectomy have a particularly high chance of being diagnosed with biochemical recurrence (BCR). Patients with BCR have a greater risk of disease progression and mortality. The present retrospective observational study aimed to clarify the risk factors for the BCR of prostate cancer after radical prostatectomy in patients with high-risk and very high-risk prostate cancer. Patients diagnosed with prostate cancer who received radical prostatectomy in a single center from January 2009 to June 2020 were included in the study. Data from medical records were reviewed and the patients were followed up for ≥6 years. The primary outcome was BCR within 1 year after surgery. A total of 307 patients were included, with 187 in the high-risk group and 120 in the very high-risk group as classified by the National Comprehensive Cancer Network (NCCN) guidelines. Patients in the very high-risk group had a lower BCR-free survival rate compared with those in the high-risk group, with a high risk of BCR even if their PSA levels were initially undetectable after prostatectomy, and a high risk of postoperatively detectable PSA. In patients with undetectable PSA after prostatectomy, BCR was associated with the initial PSA density, imaging stage (T3aN0M0 and T3bN0M0), and pathologic stage (any N1). Postoperatively detectable PSA was associated with pathologic stage (T3bN0M0 and any N1) In conclusion, preoperative MRI imaging stage and PSA density are predictors for short-term BCR after prostatectomy. NCCN-defined high-risk patients with a high initial PSA density, imaging stage (T3aN0M0 and T3bN0M0), and pathologic stage (any N1) had a higher risk of BCR when compared with other patients with undetectable PSA, while those with pathologic stage (T3bN0M0 or any N1) displayed a higher risk of postoperatively detectable PSA. These findings may help urologists to identify patients for whom active therapeutic protocols are necessary.

Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy.

Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49-0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.

MP11-17 SIGNET RING CELLS ON PROSTATE BIOPSY IN THE SETTING OF PRIMARY ACINAR ADENOCARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP11-17 SIGNET RING CELLS ON PROSTATE BIOPSY IN THE SETTING OF PRIMARY ACINAR ADENOCARCINOMA Daniel Nemirovsky, Zoe Blake, Alexander Kenigsberg, Neil Mendrihatta, Jacob Enders, Michael Rothberg, Antoun Toubaji, Sandeep Gurram, and Peter Pinto Daniel NemirovskyDaniel Nemirovsky More articles by this author , Zoe BlakeZoe Blake More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Jacob EndersJacob Enders More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Antoun ToubajiAntoun Toubaji More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003226.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Signet ring cells (SRC) on pathology are typically associated with gastric carcinoma, but are also rarely seen in other malignancies, including prostate cancer (PCa). Though primary SRC adenocarcinoma of the prostate is a well-described aggressive malignancy, there is a paucity of literature describing the oncologic significance of SRC on prostate biopsy in patients with primary acinar adenocarcinoma. In this study, we aimed to describe the clinicopathologic characteristics and outcomes of these patients. METHODS: A prospectively collected database of patients with PCa was queried for presence of SRC on prostate biopsy. Patients with primary SRC adenocarcinoma were excluded. Demographics, imaging, pathological and treatment data were collected. Patients who received radical prostatectomy (RP) without neoadjuvant therapy were examined for adverse features, including extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymphovascular invasion (LVI), as well as post-RP biochemical recurrence (BCR). RESULTS: Between 2014-2022, 46 patients with SRC on biopsy were found. Clinicopathologic data is displayed in Table 1. Patients had a mean of 2.2 cores with SRC on biopsy, and 40/46 (87.0%) of these cores were GG ≥4. Oncologic outcomes are shown in Table 2. Every lesion containing SRC was MRI-visible, 93.3% of which were PIRADS 4 or 5. Of 14 patients with available whole-mount pathology data after RP, 12/14 (85.7%) had Gleason grade group ≥ 3 disease. 5/14 (35.7%) patients had EPE, 4/14 (28.6%) had SVI, and 3/14 (21.4%) had LVI. 3/14 (21.4%) patients experienced BCR post-RP, with a median time to BCR of 12 months (3-28). CONCLUSIONS: Signet ring cells on biopsy were typically identified in the setting of MRI-visible high-grade acinar adenocarcinoma and frequently associated with adverse features on whole mount pathology. While the biological significance of signet ring features in prostate cancer remains to be elucidated, clinical and pathologic correlates suggest an association with high risk disease and should prompt further study of this entity. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e131 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Zoe Blake More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Jacob Enders More articles by this author Michael Rothberg More articles by this author Antoun Toubaji More articles by this author Sandeep Gurram More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

MP71-17 CAN FUNCTIONAL ELECTRICAL STIMULATION BE AN EFFECTIVE TREATMENT FOR POST PROSTATECTOMY INCONTINENCE?

You have accessJournal of UrologyCME1 Apr 2023MP71-17 CAN FUNCTIONAL ELECTRICAL STIMULATION BE AN EFFECTIVE TREATMENT FOR POST PROSTATECTOMY INCONTINENCE? Pin Chun Liu, Yi-Sheng Lin, Yen-Chuan Ou, Chao-Yu Hsu, and Min-Che Tung Pin Chun LiuPin Chun Liu More articles by this author , Yi-Sheng LinYi-Sheng Lin More articles by this author , Yen-Chuan OuYen-Chuan Ou More articles by this author , Chao-Yu HsuChao-Yu Hsu More articles by this author , and Min-Che TungMin-Che Tung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-prostatectomy incontinence (PPI) is a bothersome complication after receiving radical prostatectomy. Incontinence may significantly interfere with quality of life and increase activity dependency. Functional electrical stimulation (FES) is one of the treatment tools of urinary incontinence. FES is the only conservative management in Taiwan National Health Insurance. The aim of this study was to analyze the effectiveness of FES in PPI treatment. METHODS: Patients who received robotic-assisted radical prostatectomy between 2019 to 2022 with complications of PPI were enrolled. The patient received FES twice every week (one course). Urinary distress inventory, short form (UDI-6), overactive bladder symptom score (OABSS) and Incontinence Impact Questionnaire, Short Form (IIQ-7) were applied for incontinence symptoms assessment and quantification. Measurements were obtained before and after 3 courses of FES treatment. Pre-FES and post-FES scores were collected and analyzed by pair sample T-test. RESULTS: Questionnaire data of 33 patients with PPI were collected in this study. No complication was noted during the whole treatment course of FES. Bothersome questionnaire scores significantly improved at follow up when compared to the baseline. The average score of OABSS (10.8 to 8.48, p=0.00017) and UDI-6 (8.18 to 5.65, p=0.00026) both got significant reductions. But there is no difference between pre and post-FES IIQ-7 score (10.26 to 8.46, p=0.09). CONCLUSIONS: Our study revealed the incontinence symptoms improvement after receiving functional electrical stimulation therapy. Functional electrical stimulation is a safe and effective treatment for post-prostatectomy incontinence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1021 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pin Chun Liu More articles by this author Yi-Sheng Lin More articles by this author Yen-Chuan Ou More articles by this author Chao-Yu Hsu More articles by this author Min-Che Tung More articles by this author Expand All Advertisement PDF downloadLoading ...

MP29-19 PRE-OPERATIVE PLASMA METABOLITES CAN PREDICT THE RISK OF BONE METASTASIS IN PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP29-19 PRE-OPERATIVE PLASMA METABOLITES CAN PREDICT THE RISK OF BONE METASTASIS IN PROSTATE CANCER Saurav Subedi, Federico La Manna, Katja Ovchinnikova, Eugenio Zoni, George N. Thalmann, and Marianna Kruithof-de Julio Saurav SubediSaurav Subedi More articles by this author , Federico La MannaFederico La Manna More articles by this author , Katja OvchinnikovaKatja Ovchinnikova More articles by this author , Eugenio ZoniEugenio Zoni More articles by this author , George N. ThalmannGeorge N. Thalmann More articles by this author , and Marianna Kruithof-de JulioMarianna Kruithof-de Julio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003257.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Early identification of prostate cancer (PCa) patients that are most likely to develop a lethal disease is still a major hurdle. While for most patients, a radical treatment will result in the eradication of the disease, about 70% of patients with advanced PCa are diagnosed with bone metastasis, a lethal feature with limited treatment options. There is growing evidence suggesting that lipid metabolism cooperates with the genetic landscape of prostate cancer. Currently, several studies have shown that the metabolome of PCa could be used as non-invasive diagnostic and prognostic tool. In this study, we analyzed the plasma of 73 prostate cancer patients to identify metabolites with diagnostic or prognostic value. METHODS: The plasma was collected during fasting and shortly before the patient received radical prostatectomy. The patients were then followed up for up to 10 years, to monitor the development of bone metastases. Targeted metabolomics was run on the pre-operative plasma. 10 different machine learning models were tested on the available metabolomics data-set. All patients provided informed consent for participation in this study. RESULTS: By using machine learning algorithms, we identified a signature of 41 metabolites either positively or negatively associated with the development of bone metastatic PCa. Neural network and support vector machine yielded the best results for classification of metastasis based on the metabolites. Furthermore, linear support vector machine and Gaussian process generated the best regression models for determination of time-to-bone metastasis using absolute Spearman`s R correlation. Determination of both the classification of bone metastasis and time-to-metastasis were identified based on 41 metabolites in the Neural network and support vector machine algorithms. The top-four metabolites associated with bone metastatic progression were lysophosphatidylethanolamine(LPE 22:5/0:0)b, butyrylcarnitine (C4), pyruvic acid and dodecanoylcarnitine (C12), whereas monoacylglycerol (MAG 14:0/0:0), MAG (0:0/22:5), acetylornithine and MAG (0:0/14:0) were the bottom-four metabolites. CONCLUSIONS: In this study, we evaluated metabolites in the plasma of prostate cancer patients to determine if we could identify a predictive signature of metastatic progression. Our studies show that metabolic phenotypes have substantial clinical value. Given the context of precision medicine, we show the feasibility of a simple metabolomics test on the plasma of patients that could help stratify patient`s risk of lethal disease based on the presence/absence of signature metabolites. Further studies in a larger cohort will be required in order to test the signature metabolites found in our study to test the reliability for patient stratification. Source of Funding: Swiss Cancer Research Foundation (KFS-5510-02-2022-R) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e389 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Saurav Subedi More articles by this author Federico La Manna More articles by this author Katja Ovchinnikova More articles by this author Eugenio Zoni More articles by this author George N. Thalmann More articles by this author Marianna Kruithof-de Julio More articles by this author Expand All Advertisement PDF downloadLoading ...

This Month in Adult Urology.

This Month in Adult Urology.

Tumor Location and a Tumor Volume over 2.8 cc Predict the Prognosis for Japanese Localized Prostate Cancer.

(1) Objective: Our study investigated the prognostic value of tumor volume and location in prostate cancer patients who received radical prostatectomy (RP). (2) Methods: The prognostic significance of tumor volume and location, together with other clinical factors, was studied using 557 patients who received RP. (3) Results: The receiver operating characteristic (ROC) curve identified the optimal cutoff value of tumor volume as 2.8 cc for predicting biochemical recurrence (BCR). Cox regression analysis revealed that a tumor in the posterior area (p = 0.031), peripheral zone (p = 0.0472), and tumor volume ≥ 2.8 cc (p < 0.0001) were predictive factors in univariate analysis. After multivariate analysis, tumor volume ≥ 2.8 cc (p = 0.0225) was an independent predictive factor for BCR. Among them, a novel risk model was established using tumor volume and location in the posterior area and peripheral zone. The progression-free survival (PFS) of patients who met the three criteria (unfavorable group) was significantly worse than other groups (p ≤ 0.001). Furthermore, multivariate analysis showed that the unfavorable risk was an independent prognostic factor for BCR. The prognostic significance of our risk model was observed in low- to intermediate-risk patients, although it was not observed in high-risk patients. (4) Conclusion: Tumor volume (≥2.8 cc) and localization (posterior/peripheral zone) may be a novel prognostic factor in patients undergoing RP.

MRI versus non-MRI diagnostic pathways before radical prostatectomy: Impact on nerve-sparing, positive surgical margins, and biochemical recurrence

PurposeMagnetic resonance imaging (MRI) prior to biopsy has improved detection of clinically significant prostate cancer (CaP), but its impact on surgical outcomes is less well established. We compared MRI vs. non-MRI diagnostic pathways among patients receiving radical prostatectomy (RP) for impact on surgical outcomes. Materials and methodsMen diagnosed with CaP and receiving RP at Loyola University Medical Center (2014–2021) were categorized into MRI or non-MRI diagnostic pathways based on receipt of MRI before prostate biopsy. Primary outcomes of interest included positive surgical margin (PSM) rates, the performance of bilateral nerve-sparing, and biochemical recurrence (BCR). Multivariable logistic regression models, Kaplan-Meier curves, and Cox proportional hazards regression were employed. ResultsOf 609 patients, 281 (46.1%) were in the MRI and 328 (53.9%) in the non-MRI groups. MRI patients had similar PSA, biopsy grade group (GG) distribution, RP GG, pT stage, and RP CaP volume compared to non-MRI patients. PSM rates were not statistically different for the MRI vs. non-MRI groups (22.8% vs. 26.8%, P = 0.25). Bilateral nerve-sparing rates were higher for the MRI vs. non-MRI groups (OR 1.95 (95%CI 1.32–2.88), P = 0.001). The MRI group demonstrated improved BCR (HR 0.64 (95%CI 0.41–0.99), P = 0.04) after adjustment for age, PSA, RP GG, pT, pN, and PSM status. On meta-analysis, a 5.2% PSM reduction was observed but high heterogeneity for use of nerve-sparing. ConclusionsAn MRI-based diagnostic approach selected patients for RP with a small reduction in PSM rates, greater utilization of bilateral nerve-sparing, and improved cancer control by BCR compared to a non-MRI approach even after adjustment for known prognostic factors.

Frailty Assessment for Outcome Prediction of Patients With Prostate Cancer Receiving Radical Prostatectomy: A Meta-Analysis of Cohort Studies.

A meta-analysis was conducted to investigate the association between frailty and postoperative complications in patients with prostate cancer following radical prostatectomy. A systematic search of PubMed, Embase, and Web of Science was conducted for relevant cohort studies. A random-effect model was chosen to combine the results. Five cohort studies including 171,929 patients were included. Results showed that patients with frailty had higher risk of severe postoperative complications (Clavien-Dindo IV complications, risk ratio [RR]: 1.87, 95% confidence interval [CI]: 1.67 to 2.10, p < .001; I2 = 18%) and all-cause mortality (RR: 2.89, 95% CI: 1.86 to 4.50, p < 0.001; I2 = 18%). Subgroup analyses showed consistent results in patients receiving open and robot-assisted radical prostatectomy, and also in studies with univariate and multivariate analyses. In conclusion, preoperative frailty may be a predictor of severe postoperative complications and all-cause mortality of patients with prostate cancer following radical prostatectomy.

Impact of adherence to criteria on oncological outcomes of radical prostatectomy in patients opting for active surveillance: data from the PRIAS-JAPAN study.

This study aimed to evaluate whether oncological outcomes of radical prostatectomy differ depending on adherence to the criteria in patients who opt for active surveillance. We retrospectively reviewed the data of 1035 patients enrolled in a prospective cohort of the PRIAS-JAPAN study. After applying the exclusion criteria, 136 of 162 patients were analyzed. Triggers for radical prostatectomy due to pathological reclassification on repeat biopsy were defined as on-criteria. Off-criteria triggers were defined as those other than on-criteria triggers. Unfavorable pathology on radical prostatectomy was defined as pathological ≥T3, ≥GS 4+3 and pathological N positivity. We compared the pathological findings on radical prostatectomy and prostate-specific antigen recurrence-free survival between the two groups. The off-criteria group included 35 patients (25.7%), half of whom received radical prostatectomy within 35months. There were significant differences in median prostate-specific antigen before radical prostatectomy between the on-criteria and off-criteria groups (6.1 vs. 8.3ng/ml, P=0.007). The percentage of unfavorable pathologies on radical prostatectomy was lower in the off-criteria group than that in the on-criteria group (40.6 vs. 31.4%); however, the differences were not statistically significant (P=0.421). No significant difference in prostate-specific antigen recurrence-free survival was observed between the groups during the postoperative follow-up period (median: 36months) (log-rank P=0.828). Half of the off-criteria patients underwent radical prostatectomy within 3years of beginning active surveillance, and their pathological findings were not worse than those of the on-criteria patients.

TNFRSF13B is a potential contributor to prostate cancer.

BackgroundImmunodeficiencies are genetic diseases known to predispose an individual to cancer owing to defective immunity towards malignant cells. However, the link between immunodeficiency and prostate cancer progression remains unclear. Therefore, the aim of this study was to evaluate the effects of common genetic variants among eight immunodeficiency pathway-related genes on disease recurrence in prostate cancer patients treated with radical prostatectomy.MethodsGenetic and bioinformatic analyses on 19 haplotype-tagging single-nucleotide polymorphisms in eight immunodeficiency pathway-related genes were conducted in 458 patients with prostate cancer after receiving radical prostatectomy. Furthermore, the TNFRSF13B was knocked down in 22Rv1 and PC-3 human prostate cancer cell lines via transfecting short hairpin RNAs and cell proliferation and colony formation assays were performed. The molecular mechanisms underlying the effects of TNFRSF13B were further explored by microarray gene expression profiling.ResultsTNFRSF13B rs4792800 was found to be significantly associated with biochemical recurrence even after adjustment for clinical predictors and false discovery rate correction (adjusted hazard ratio 1.78, 95% confidence interval 1.16–2.71, p = 0.008), and the G allele was associated with higher TNFRSF13B expression (p = 0.038). Increased TNFRSF13B expression suggested poor prognosis in four independent prostate cancer datasets. Furthermore, silencing TNFRSF13B expression resulted in decreased colony formation of 22Rv1 and PC-3 cells through modulating the cell cycle and p53 signalling pathways.ConclusionsThe present study suggests the potential role of immunodeficiency pathway-related genes, primarily TNFRSF13B, in prostate cancer progression.Supplementary informationThe online version contains supplementary material available at 10.1186/s12935-022-02590-2.

Acute, Subchronic, and Chronic Complications of Radical Prostatectomy Versus Radiotherapy With Hormone Therapy in Older Adults With High-Risk Prostate Adenocarcinoma.

PurposeTo compare acute, subchronic, and chronic complications between older patients with high-risk localized prostate cancer (HR-LPC) receiving radical prostatectomy (RP) and high-dose intensity-modulated radiotherapy (IMRT) combined with long-term hormone therapy (HT).Patients and MethodsWe recruited older patients (≥80 years) with HR-LPC from the Taiwan Cancer Registry database. After propensity score matching, logistic regression analysis was used to compare the acute, subchronic, and chronic complication rates between patients who underwent RP (the RP group) and high-dose IMRT combined with long-term HT (the IMRT+HT group).ResultsBenign prostatic hyperplasia (BPH) symptoms and urinary incontinence (UI) were the most common complications over 5 years (BPH symptoms: RP, 17.69%; IMRT+HT, 29.58%; UI: RP, 10.47%; IMRT+HT, 5.50%). Compared with the RP group, the IMRT+HT group had higher odds of BPH symptoms and lower odds of UI and hernia after the 5-year follow-up period. The impotence rates were significantly higher in the IMRT+HT group than in the RP group at 3 months and 1 year after treatment and became nonsignificant after 2 years. At 5 years after treatment, the IMRT+HT group had lower risks of UI (adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.28–0.88) and hernia (aOR, 0.21; 95% CI, 0.11–0.82) and a higher risk of BPH symptoms (aOR, 4.15; 95% CI, 2.82–7.37) than the RP group.ConclusionIMRT+HT was associated with lower UI and hernia risks than RP. By contrast, RP was associated with fewer complications of BPH over the follow-up period and less impotence during the first year after treatment. Our findings provide important and valuable references for shared decision-making for optimal therapy selection among older men with HR-LPC.

Direct comparison of low-dose-rate brachytherapy versus radical prostatectomy using the surgical definition of biochemical recurrence for patients with intermediate-risk prostate cancer

BackgroundWe compared the oncological outcomes of patients who received seed brachytherapy (SEED-BT) with those who received radical prostatectomy (RP) for intermediate-risk prostate cancer.MethodsCandidates were patients treated with either SEED-BT (n = 933) or RP (n = 334). One-to-one propensity score matching was performed to adjust the patients’ backgrounds. We compared the biochemical recurrence (BCR)-free rate using the Phoenix definition (prostate-specific antigen [PSA] nadir plus 2 ng/mL) for SEED-BT and the surgical definition (PSA cut-off value of 0.2 ng/mL) for RP. We also directly compared the BCR-free rates using the same PSA cut-off value of 0.2 ng/mL for both SEED-BT and RP.ResultsIn the propensity score-matched analysis with 214 pairs, the median follow-up treatment was 96 months (range 1–158 months). Fifty-three patients (24.7%) were treated with combined SEED-BT and external-beam radiotherapy. Forty-three patients (20.0%) received salvage radiotherapy after RP. Comparing the BCR-free rate using the above definitions for SEED-BT and RP showed that SEED-BT yielded a significantly better 8-year BCR-free rate than did RP (87.4% vs. 74.3%, hazard ratio [HR] 0.420, 95% confidence interval [CI] 0.273–0.647). Comparing the 8-year BCR-free rate using the surgical definition for both treatments showed no significant difference between the two treatments (76.7% vs. 74.3%, HR 0.913, 95% CI 0.621–1.341). SEED-BT had a significantly better 8-year salvage hormonal therapy-free rate than did RP (92.0% vs. 85.6%, HR 0.528, 95% CI 0.296–0.942, P = 0.030). The 8-year metastasis-free survival rates (98.5% vs. 99.0%, HR 1.382, 95% CI 0.313–6.083, P = 0.668) and overall survival rates (91.9% vs. 94.6%, HR 1.353, 95% CI 0.690–2.650) did not significantly differ between the treatments.ConclusionsThe BCR-free rates did not significantly differ between patients treated with SEED-BT and those treated with RP for intermediate-risk prostate cancer even when they were directly compared using the surgical definition for BCR. SEED-BT and RP can be adequately compared for oncological outcomes.

Obesity and biochemical recurrence in clinically localised prostate cancer: a systematic review and meta-analysis of 86,490 patients.

The association of obesity with biochemical recurrence (BCR) after treatment of clinically localised prostate cancer (PC) shows inconsistent results. Our aim was to systematically review all evidence evaluating obesity as a prognostic factor for BCR. We searched PubMed, Web of Science and Scopus, from inception to June 1, 2021. Cohort studies reporting BCR among PC patients stratified by body mass index (BMI) were included. To assess the quality of the selected studies, we used the Newcastle-Ottawa scale (NOS). Risk of BCR among obese patients (BMI ≥ 30 kg/m2) was compared with normal weight (BMI < 25), pooling individual hazard ratios (HR) in random-effect meta-analysis. Associations for continuous BMI per 5 kg/m2 were also calculated. Subgroup analyses were conducted to assess reasons for heterogeneity and causal criteria were formally evaluated. We identified 46 cohort studies including 86,490 PC patients. A total of 14,719 (17.1%) patients developed BCR. There was no consistent definition of BCR. Obesity was associated with BCR (HR: 1.25, 95% CI: 1.11-1.39, I2: 70.3%), and there was a 10% increase (95% CI: 4-15%, I2: 66.3%) in BCR per 5 kg/m2 increase in BMI. The heterogeneity was high but decreased in the subgroup of highest-quality NOS score and when the BMI was measured by the researchers (I2: 0.0%). The association was consistent in patients receiving radical prostatectomy but not in patients receiving other therapies. Obesity showed a moderate, consistent relationship with biochemical recurrence after radical prostatectomy. Measurement of BMI and BCR was variable, highlighting the need for standardised clinical guidelines. Preventive weight control programs may have a role in reducing BCR for clinically localised PC patients.

Out-of-pocket costs for commercially insured patients with localized prostate cancer.

Financial toxicity is an underappreciated component of cancer survivorship. Treatment-specific out-of-pocket costs for patients undergoing localized prostate cancer treatment have not, to date, been described and may influence patient's decision making. We performed a retrospective cohort study among commercially-insured patients in the United States with incident prostate cancer from 2013 to 2018. We captured out-of-pocket and total costs in the year following diagnosis and compared these between patients receiving radical prostatectomy, radiotherapy, and no local treatment using propensity-score weighting adjusting for patient demographics and pre-diagnosis health utilization costs. Among 30,360 included men [median age 59 years, 83% Charlson score 0], 15,854 underwent surgery, 5,265 radiotherapy, and 9,241 no local therapy in the year following diagnosis. In the 6-months preceding diagnosis, median overall and out-of-pocket health care costs were $2022 (interquartile range $3778) and $466 (interquartile range $781), respectively. Following propensity-score weighting, out-of-pocket costs were significantly lower for patients who received no active treatment (adjusted cost $1746, 95% confidence interval [CI] $1704-1788), followed by those who underwent surgery ($2983, 95% CI $2832-3142, P < 0.001), and those who underwent radiation ($3139, 95% CI $2939-3353, P < 0.001) in the 6-months following diagnosis. Similar patterns were seen with out-of-pocket costs 6 to 12 months following index, with overall costs, and with costs attributable to inpatient, outpatient medical, and outpatient pharmacy services. Among commercially insured men with incident prostate cancer, active treatment with surgery or radiotherapy was associated with significantly higher out-of-pocket costs versus those who received no treatment, with little difference observed between treatment approaches.