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Objective: To morphologically describe tertiary lymphoid structures (TLS) in prostatectomy specimens and correlate them with clinical and transcriptomic features., Methodology: A total of 72 consecutive cases of entirely submitted radical prostatectomy (RP) patients tested with the Decipher Genomic Classifier were included in the study. Images were manually annotated using QuPath tools to denote tumor regions and each cluster of TLS. Clusters of lymphocytes that were surrounded on all four sides by tumor were defined as intra-tumor TLS (IT-TLS). Clusters of lymphocytes at the leading edge of carcinoma with either the prostatic pseudocapsule or benign parenchyma at one end were defined as peri-tumor TLS (PT-TLS). A classification algorithm to distinguish lymphocytes from non-lymphocytic cells using a supervised machine learning model was used. The associations between TLS formation and 265 gene expression-based signatures were examined., Results: The magnitude of total TLS correlations with primary tumor gene expression signatures was moderate (~0.35-0.5) with several HLA, T-cell and B-cell Cluster signatures, showing positive correlation with various metrics for quantification of TLS. On the other hand, immune suppressive signatures (Treg, MDSC) were negatively correlated. While signatures for macrophages, NK cells and other immune cell types were uncorrelated for the most part. PT-TLS was associated with MHC signatures while IT TLS correlated with MHC and T-cell signatures., Conclusions: Clusters of inflammatory cells in the RP specimen can be divided spatially into PT TLS and IT-TLS, each with its unique molecular correlates of tumor immune microenvironment. The presence of TLS is positively correlated with MHC signatures, T- cell and B-cell cluster signatures but, negatively correlated with immune suppressive signatures. A subset of prostate cancer demonstrate a robust inflammatory response, and warrant further characterization in larger cohorts., (© 2024 The Authors. The Prostate published by Wiley Periodicals LLC.)

Introduction: To evaluate the effect of valveless trocar system (VTS) on intra-operative parameters, peri-operative outcomes, and 30-day postoperative complications in patients undergoing robotic-assisted laparoscopic prostatectomy., Methods: A total of 200 consecutive patients undergoing Robot-assisted radical prostatectomy by a single surgeon were prospectively evaluated using either the valveless trocar (n = 100) or standard trocars (n = 100). Patient demographics, intra-operative parameters, length of stay, presence or absence of postoperative nausea and vomiting, analog pain score at 0-6 hours, 6-12 hours, 12-18 hours, and >24 hours, and 30-day postoperative complications were analyzed., Results: There were no significant differences in estimated blood loss, intra-operative urine output, length of stay, or 30-day complication rates between the two groups. While the VTS group had higher Body Mass Index (BMI) (28.45 vs. 27.23; P = 0.049), the operative time was significantly shorter in the VTS group (146 minutes vs. 167 minutes; P < .005). The VTS group experienced fewer episodes of nausea (2% vs. 10%; P = 0.0172). The VTS group had less pain intensity compared to the control in the first 18 hours: 0-6 hours (1.9 vs. 2.5; P = 0.034), 6-12 hours (2.8 vs. 3.6; P = 0.044), and 12-18 hours (2.2 vs. 3.1; P = 0.049), respectively., Conclusion: The use of a valveless trocar system during robot-assisted robotic prostatectomy may shorten operative times, and reduce postoperative pain scores and nausea episodes without increasing the 30-day complication rate. Further prospective randomized trials should be performed to validate these findings., Competing Interests: Conflicts of Interest: All authors declare no conflict of interest regarding the publication of this article.

Background: Positive surgical margin (PSM) is a predictor of biochemical recurrence (BCR) following radical prostatectomy (RP). Attempts to stratify PSM based on linear length, Gleason score, location and number have failed to add to predictive models using margin status alone. We evaluated the prognostic significance of Ki-67 expression in this setting., Methods: Immunohistochemical staining for Ki-67 was done on prostatectomy specimens from 117 patients who had a PSM. Ki67 expression was measured at the margin and in the index lesion. Patients were dichotomized based on Ki-67 expression into three groups. Group 1 with no Ki-67 expression, Group 2 with Ki-67 ≤ 2%, and Group 3 with Ki-67 ≥ 3%. To eliminate the impact of the adjuvant treatment (AT) on the outcome, data were analyzed by the Cox proportional hazards in which AT was Considered as a time-dependent covariate., Results: The discordance rate of Ki-67 expression between matched index lesion and margin specimens was 44/117 (37.6%). There was a trend for higher risk of BCR (HR:2.06, (0.97-4.43), P = 0.06) in patients expressing high Ki67 at the surgical margin although this was not statistically significant. However High Ki-67 expression in the index lesion was an independent predictive factor for BCR in this subset of patients. (HR:4, (1.64-9.80), P = 0.002)., Conclusion: High Ki67 expression in the index prostate cancer lesion is an independent predictor of BCR in patients with positive surgical margin following radical prostatectomy. Our findings need to be validated in a larger cohort.