Search

Background: Prostate cancer recurrence after definitive local therapy usually involves the bone and regional lymph nodes. Case Report: We present the case of a 72-yearold male patient with an isolated lung nodule, seven years after radical prostatectomy for prostate cancer, pT2bN0 and Gleason score 7(4+3), and prostatic-specific antigen (PSA) levels within normal limits. The nodule was considered as a primary lung cancer and the patient was subjected to lobectomy. The immunohistochemical staining showed that the tumor was PSA(+) and NKX3.1 (+), revealing that it was metastasis from prostatic cancer and that wedge resectomy was the proper procedure. Three years later the patient is disease-free, suggesting the importance of aggressive treatment of oligometastatic disease. Conclusion: Metastasis to the lung is present in more than 40% of men with metastatic prostate cancer; however, lung metastases without any bone or lymph node involvement are extremely rare and only a handful of cases are reported in the literature. Surgical excision of the metastatic lung site is the most common therapeutic approach associated with a good prognosis. [ABSTRACT FROM AUTHOR]

Negative and equivocal MRI of the prostate can miss some significant cancer. Outcomes from 469 patients with low suspicion of significant cancer were investigated in a tertiary level British hospital. A predictive score was developed to better assess patients' risk. The results show that using PSA-density in community follow-up and the predictive score in specialist risk assessment could minimise missed diagnosis. Introduction: Clinically significant prostate cancer (csCaP) with Gleason =3 + 4 is found in 10% negative prebiopsy multiparametric (mp) MRI cases and varies widely for equivocal mpMRI cases. The objective of this study was to investigate long-term outcomes of patients with negative and equivocal mpMRIs and to develop a predictive score for csCaP risk stratification in this group. Patients and Methods: Patients who underwent an upfront mpMRI between May 2015 and March 2018 with an MRI score Likert 1 to 3 were included in the study. Patients had either a CaP diagnosis at MRI-targeted biopsy or were not diagnosed and attended follow-up in the community. Outcomes were analysed through the Kaplan-Meier estimator and Cox Model. Regression coefficients of significant variables were used to develop a Risk of significant Cancer of the Prostate score (RosCaP). Results: At first assessment 281/469 patients had mpMRI only and 188/469 mpMRI and biopsy, 26 csCaP were found at biopsy, including 10/26 in Likert 3 patients. 12/371 patients discharged without CaP after first assessment were diagnosed with csCaP during a median of 34.2 months' follow-up, 11/12 diagnosis occurred in patients omitting initial biopsy. csCaP diagnosis-free survival was 95.7% in the MRI group and 99.1% in the biopsy group. From these outcomes, a continuous RosCaP score was developed: RosCaP = 0.083 x Age - 0.202 x (1/PSA Density) + 0.786 (if Likert 3), and 4 risk classes were proposed. Limitations include retrospective design and absence of external validation. Conclusion: Age, PSA Density and MRI Likert score were significantly associated to the risk of csCaP and utilised to devise the novel RosCap predictive score focused to support risk assessment in patients with negative or equivocal mpMRI results. [ABSTRACT FROM AUTHOR]

PARPi have become new treatments in mCRPC. Toxicities of treatment are less well established. Our review encompassess all published studies of PARPi in mCRPC outlining both hematological and non-hematological toxicities. Overall PARPi appear to be have consistent hematological toxicities across malignancies with an overall low toxicity burden. There is emerging evidence for the use of poly (ADP-ribose) polymerase inhibitors (PARPi) in patients with mCRPC with patients harboring germline or somatic mutations deriving clinical benefit. However, the toxicity profile of PARPi in mCRPC is not well established. In March 2022 a literature search was conducted across 4 databases - Medline, PubMed, Cochrane Library and Embase. In total, 14 relevant studies were identified cumulating in 2066 patients that were treated with PARPi. The overall ORR to PARPi alone or in combination with other therapy was 37% (246/666). In 5trials that investigated PARPi alone, the ORR was 39% (141/361). Treatment emergent adverse events (TEAEs) of any grade were reported in 96% (1034/1080) in PARPi treatment arms. TEAEs of grade > = 3 were reported in 57% (611/1080). 45% (457/1006) experienced treatment interruption whilst 31% (310/989) required dose reductions. 11% (114/1006) of patients had their treatment discontinued directly as the result of toxicity associated with the trial medications. The most common hematological toxicity was anemia, reported in 490/1160 (42%) patients. and lowered white blood cell count were the next 2most common toxicities, reported in 186/655 (28%) and 133/729 (18%) respectively. The 3most common non-hematological toxicities reported were nausea, fatigue and anorexia reported in 440/1013 (43%), 340/1013 (34%) and 274/1013 (27%) patients respectively. Overall, TRAEs associated with individual PARPi are still emerging with hematological toxicities being most apparent. Further toxicities will be informed from future clinical trials to allow improved treatment selection, education and management of toxicities in prostate cancer. [ABSTRACT FROM AUTHOR]

Antibody-drug conjugates (ADCs) reflect a new promising approach in prostate cancer, even more so after the practicechanging results in other malignancies, either hematologic or solid. ADCs consist of monoclonal antibodies (mAb) targeted at specific antigens overly expressed on cancer cells compared to normal cells. A cytotoxic payload is attached to the mAb using a stable linker. In prostate cancer, PSMA, STEAP1, TROP2, CD46 and B7-H3 are antigens currently being studied as targets for ADCs. In this paper, we discuss the composition of ADCs and focus on their application and challenges as treatment options in prostate cancer. [ABSTRACT FROM AUTHOR]

This prospective study investigated the health-related quality of life (HRQoL) of the patients with an early prostate cancer (PC) treated with radiotherapy (RT) without hormonal treatment compared to that in the agestandardized general male population. Patients have equal overall HRQoL measured with the 15D instrument compared to the general male population. Patients had more depression at the beginning of RT, and their sexual activity remained at a lower level after RT. Background: The effects of radiotherapy (RT) patients' health-related quality of life (HRQoL) are usually compared to those of other treatment modalities instead of HRQoL of the general population in oncological studies. We examined HRQoL of patients with an early prostate cancer (PC) not receiving hormonal treatment up to 3 years after RT using the 15D instrument and the FACT-P questionnaire. Methods: The 15D results were compared to those in the agestandardized general male population (N = 952) using an independent-sample t test. The study population (N = 73) received RT either with 78/2 Gy, 60/3 Gy or 36.25/7.25 Gy fractionation. Results: No significant differences in the mean total HRQoL scores were found between the RT groups and the general male population at any time point. Patients with PC had more depression (P = .015) and distress (P = .029) than the general male population before the treatment and depression up to 3 months after treatment (P = .019), which did not persist at 3 years. The sexual activity dimension had declined by the end of treatment, and this decline persisted 3 years later (P = .033). Excretion functions were worse compared to those in peers at the end of treatment (P < .001) but no longer at 3 months and later after RT. Regarding the FACT-P, HRQoL remained good at 3 years after RT in all the treatment groups and there were no significant differences between the different RT groups at this time point. Conclusion: This study demonstrated that patients treated with RT for early PC had similar HRQoL compared to the age-standardized general male population at 3 years after treatment. [ABSTRACT FROM AUTHOR]

We evaluated the effect of Ra-223 on the incidence of bone fractures and mortality compared with standard of care in patients with metastatic, castration resistant prostate cancer. We used real-world data from Swedish population-based healthcare registries. The results were imprecise and compatible with both a slight benefit or harm for both fractures and mortality in all lines of treatment. Aim : Estimate the effect of Radium-223 (Ra-223) on the incidence of bone fractures, prostate cancer death, and allcause death compared with other standard treatments for metastatic, castration-resistant prostate cancer (mCRPC). Methods : Using a cohort design, we estimated the effect of Ra-223 on the risk of bone fractures, all-cause and prostate cancer-specific mortality across different lines of treatment for mCRPC using Prostate Cancer data Base Sweden (2013-2018). The comparator group comprised other standard treatments for mCRPC. We used 36-month risk differences and hazard ratios (HRs) as effect estimates. Results : The number of eligible individuals was 635, 453, 262, and 84 for the first-, second-, third-, and fourth-line cohorts, respectively. When compared Ra-223 to other standard treatments, the difference in the 36-month risk of fracture was 6% (95% confidence interval [CI], -7% to 18%) in the first-line cohort (n = 635) and 8% (95% CI, -7% to 18%) in the second-line cohort (n = 453). The number of fractures in the third-/fourth-line cohorts was too small for an adjusted comparison. The difference in 36-month mortality was higher in the first-line cohort 13% (95% CI, -3% to 31%), but lower in the second- and third-/fourthline cohorts -8% (95% CI, -23% to 7%) and -14% (95% CI, -21% to 16%) respectively. Most deaths were due to prostate cancer. Conclusion : Results suggest that the difference in the risk of fractures is small, if any. A difference in the risk of mortality may be present in first-line treatment, but a decreased risk of mortality was observed in second and later lines of treatment. The results on mortality need to be considered in the context of potential unmeasured or residual confounding. [ABSTRACT FROM AUTHOR]

The authors reviewed and sumarised the literature about active surveillance in prostate cancer. It provides a useful reference on patient selection criteria, surveillence investigations, barriers and enablers of active surveillence and evolving technologies that will be used in the future. The use of PSA screening has led to downstaging and downgrading of prostate cancer at diagnosis, increasing detection of indolent disease. Active surveillance aims to reduce over-treatment by delaying or avoiding radical treatment and its associated morbidity. However, there is not a consensus on the selection cr iter ia and monitoring schedules that should be used. This article aims to summarize the evidence supporting the safety of active surveillance, the current selection cr iter ia recommended and in use, the incidence of active surveillance, barriers existing to its uptake and future developments in patient selection. [ABSTRACT FROM AUTHOR]

In this study, we investigated whether intense neoadjuvant therapy could increase the risk of complications in radical prostatectomy. After analyzing 124 patients we concluded that intense neoadjuvant therapy doesn't increase morbidity of radical prostatectomy and reduces positive surgical margins. The association of neoadjuvant therapy with extended pelvic lymphadenectomy may increase the risk of perioperative thromboembolic events. Introduction: Recent studies about intense neoadjuvant therapy followed by Radical Prostatectomy (RP) lack standardized cr iter ia regarding surgical complications and comparison to a group of patients who underwent RP without the use of neoadjuvant therapy. The aim of this study is to describe and compare the perioperative complication rates. Materials and Methods: This was a prospective, single-center phase II trial in patients with high-risk prostate cancer (HRPCa). The control group included HRPCa patients who underwent RP outside the clinical trial during the same study recruitment period. The interventional group was randomized (1:1) to receive neoadjuvant androgen deprivation therapy plus abiraterone with or without apalutamide followed by RP. Complications observed up to 30 days of surgery were classified based on the Clavien-Dindo classification. Uni- and multivariate analyses were carried out to assess predictive factors associated with perioperative complications. Results: In total, 124 patients with HRPCa were underwent to RP between May 27, 2019 and August 6, 2021, including 61 patients in the intervention group and 63 patients in the control group. The general and major complications in the intervention group reached 29.6% and 6.6%, respectively, and 39.7% and 7.9% in the control group, respectively. There was no significant difference between groups. We observed 4.9% of thromboembolic event in the neoadjuvant group. Conclusions: There was no significant increase in morbidity rate in RP after intense neoadjuvant therapy. The association of intense androgen deprivation neoadjuvant therapy with RP and extended pelvic lymphadenectomy may increase the risk of a perioperative thromboembolic events. [ABSTRACT FROM AUTHOR]

Elderly men are less likely to receive local therapy for prostate cancer, despite data showing improved outcomes in those with high-grade cancer. Using the National Cancer Database, we found that elderly men who underwent local therapy, particularly surgery, had improved survival rates compared to those that underwent hormone therapy or observation. Non-age based approach and proper patient selection is critical. Introduction: Elderly men are underrepresented in prostate cancer (PCa) literature, with management based on individualized care pathways and life expectancy. Reports have shown survival benefit with radiation (XRT), surgery, and hormone (ADT) in localized disease. The objective of this study was to assess treatment trends and overall survival (OS) among men 75 years of age and older with cT1c PCa. Methods: The National Cancer Database was queried to identify patients with cT1c PCa, aged 75 years and older, between 2004 and 2016. We excluded individuals with N1/NX or M1/MX disease, unknown treatment, treatment with both XRT and surgery, surgery other than radical prostatectomy (RP), or PSA > 10 ng/ml. We described 4 treatment cohorts: observation, XRT, surgery, and ADT alone. Treatment trends and OS were analyzed using SPSS. Results: Among 49,843 patients, 7% had surgery, 66% had XRT, 5% had ADT alone, and 22% were observed. From 2004-2016, a large decline in XRT was noted, with an increase in surgery and observation. Men receiving ADT alone were significantly older, with higher Gleason's score, and lower incomes. Cox regression revealed survival benefit for surgery and XRT (HR 0.44 and 0.69, P < .001 respectively); ADT had worse survival than observation (HR 1.23, P < .001). Conclusion: Fewer men 75 years of age and older with cT1c PCa are being diagnosed and treated. Rates of XRT have declined, with rises in surger y and obser vation. Sur vival benefit was seen for surgery and XRT among elderly men, which highlights the importance of proper patient selection for improved outcomes in a highly individualized sphere. [ABSTRACT FROM AUTHOR]

(1) Background: Local therapy is highly promising in a multimodal approach strategy for patients with low-volume metastatic prostate cancer (mPCa). We aimed to systematically assess and summarize the safety, oncologic, and functional outcomes of cytoreductive prostatectomy (cRP) in mPCa. (2) Methods: Three databases were queried in September 2022 for publications that analyzed mPCa patients treated with cytoreductive prostatectomy without restrictions. The outcomes of interest were progression-free survival (PFS), cancer-specific survival (CSS), overall survival (OS), perioperative complication rates, and functional outcomes following cRP. (3) Results: Overall, 26 studies were included in this systematic review. Among eight population-based studies, cRP was associated with a reduced risk of CSS and OS compared with no local therapy (NLT) after adjusting for the effects of possible confounders. Furthermore, one population-based study showed that cRP reduced the risk of CSS even when compared with radiotherapy (RT) of the prostate after adjusting for the effects of possible confounders. In addition, one randomized controlled trial (RCT) demonstrated that local therapy (comprising 85% of cRP) significantly improved the prostate-specific antigen (PSA)-PFS and OS. Overall, cRP had acceptable perioperative complication rates and functional outcomes. (4) Conclusions: Mounting evidence suggests that cRP offers promising oncological and functional outcomes and technical feasibility and that it is associated with limited complications. Well-designed RCTs that limit selection bias in patients treated with cRP are warranted. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to develop a radiomic tool for the prediction of clinically significant prostate cancer. Methods: From September 2020 to December 2021, 91 patients who underwent magnetic resonance imaging prostate fusion biopsy at our institution were selected. Prostate cancer aggressiveness was assessed by combining the three orthogonal planes-Llocal binary pattern the 3Dgray level co-occurrence matrix, and other first order statistical features with clinical (semantic) features. The 487 features were used to predict whether the Gleason score was clinically significant (≥7) in the final pathology. A feature selection algorithm was used to determine the most predictive features, and at the end of the process, nine features were chosen through a 10-fold cross validation. Results: The feature analysis revealed a detection accuracy of 83.5%, with a clinically significant precision of 84.4% and a clinically significant sensitivity of 91.5%. The resulting area under the curve was 80.4%. Conclusions: Radiomic analysis allowed us to develop a tool that was able to predict a Gleason score of ≥7. This new tool may improve the detection rate of clinically significant prostate cancer and overcome the limitations of the subjective interpretation of magnetic resonance imaging, reducing the number of useless biopsies. [ABSTRACT FROM AUTHOR]

Currently, the active surveillance of men with favorable intermediate-risk localized prostate cancer (PCa) is a longstanding controversy, in terms of their oncological outcomes, and radical prostatectomy would constitute a similar concern of overtreatment, regarding its functional outcomes. Thus, focal therapy could be considered in men belonging to favorable intermediate-risk group. Among all focal therapies, high-intensity focused ultrasound (HIFU) was the most studied methodology in clinical trials. Although HIFU provided better functional outcomes than radical prostatecomy, the oncological outcomes were inferior in men with intermediate-risk localized PCa. Two articles have been published discussing the feasibility and clinical outcomes of robot-assisted partial prostatectomy (RAPP), and both the functional and oncological outcomes were superior than those with HIFU. However, the rate of positive surgical margins (PSMs) was reported as high in the literature. Here, we present a case of favorable intermediate-risk localized PCa with an isolated tumor at the anterior apex. After reconstructing a personal three-dimensional (3D) image, we utilized it in a 3D image-guided precise excise, followed by intraoperative frozen specimen review. We found that this method may present a resolution to the high PSM rate documented in the current literature regarding RAPP. This method merits further study with a well-designed prospective study. [ABSTRACT FROM AUTHOR]

Background: Carcinoma of the prostate is the most diagnosed tumors and the second top reason of cancer-related deaths in American men, The programmed death-ligand 1 (PD-1/PD-L1 pathway was a T-cell checkpoint pathway that sent repressing signals to T cells that can constrain immunity, PD-L1expression and relation to both pathological, clinical parameters and prognosis were studied in many cancers. proliferation cell nuclear antigen (PCNA)is proliferating cellular nuclear antigen, PCNA is an acidic nuclear protein, expressed mainly in phase S of the cellular cycle. We intended in this work to explore the immunohistochemical expression of PDL1 & (PCNA) in cancer prostate and correlate their expression with other clinicopathologic parameters. Methods: 46 cases of prostatic adenocarcinoma were collected from Pathology Department. Faculty of Medicine. Zagazig University between June 2018 to June 2020, using anti PDL1 & (PCNA) antibodies. Results: For PDL1 expression19 cases were positive (41.3%), showing membranous and cytoplasmic expression in tumor cells. Statistically significant relation was found between PDL1 expression and Age, grade, and stage, those who received chemotherapy. For PCNA expression 33 cases were positive (71.7%) showing nuclear expression. Statistically significant relation was found between PCNA expression and grade and stage and those who received chemotherapy. There is non-significant positive correlation between PDL-1 and PCNA. Conclusions: PDL1 may be a likely new marker or therapeutic goal for prostatic carcinoma cases, PCNA commonly used as a prognostic marker as an indicator of malignant cellular proliferation. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the variability, associated actors, and the design of nomograms for individualized testosterone recovery after cessation of androgen deprivation therapy (ADT). Materials and Methods: A longitudinal study was carried out with 208 patients in the period 2003 to 2019. Castrated and normogonadic testosterone levels were defined as 0.5 and 3.5 ng/mL, respectively. The cumulative incidence curve described the recovery of testosterone. Univariate and multivariate analyzes were performed to predict testosterone recovery with candidate prognostic factors prostate-specific antigen at diagnosis, clinical stage, Gleason score from biopsy, age at cessation of ADT, duration of ADT, primary therapy and use of LHRH (luteinizing hormone-releasing hormone) agonists. Results: The median follow-up duration in the study was 80 months (interquartile range, 49–99 mo). Twenty-five percent and 81% of patients did not recover the castrate and normogonadic levels, respectively. Duration of ADT and age at ADT cessation were significant predictors of testosterone recovery. We built two nomograms for testosterone recovery at 12, 24, 36, and 60 months. The castration recovery model had good calibration. The C-index was 0.677, with area under the receiver operating characteristic curve (AUC-ROC) of 0.736, 0.783, 0.782, and 0.780 at 12, 24, 36, and 60 months, respectively. The normogonadic recovery model overestimated the higher values of probability of recovery. The Cindex was 0.683, with AUC values of 0.812, 0.711, 0.708 and 0.693 at 12, 24, 36, and 60 months, respectively. Conclusions: Depending on the age of the patient and the length of treatment, clinicians may stop ADT and the castrated testosterone level will be maintained or, if the course of treatment has been short, we can estimate if it will return to normogonadic levels. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated prostate cancer risk associated with pioglitazone use. Materials and Methods: The Taiwan’s National Health Insurance database was used to create a propensity score-matched cohort of male patients with type 2 diabetes mellitus newly diagnosed in 1999-2005 and aged ≥25 years at baseline. The matched cohort included 20437 ever users and 20437 never users of pioglitazone. The patients were followed up for the incidence of prostate cancer until December 31, 2011. Hazard ratios (HRs) were created from Cox regression weighted on propensity score. Results: Prostate cancer was diagnosed in 121 ever users of pioglitazone (incidence: 175.84 per 100,000 person-years) and 143 never users of pioglitazone (incidence: 216.66 per 100,000 person-years). When ever users were compared to never users of pioglitazone, the HR was 0.815 (95% confidence interval [CI], 0.639–1.039; p=0.0987). When ever users were categorized into tertiles of cumulative duration of pioglitazone therapy (<6.83, 6.83–20.23, and >20.23 months), the HRs were 1.044 (95% CI, 0.741–1.471), 0.975 (95% CI, 0.690–1.377) and 0.539 (95% CI, 0.374–0.778), respectively. For the tertiles of cumulative dose of <5,040, 5,040–15,330, and >15,330 mg, the HRs were 1.008 (95% CI, 0.710–1.429), 1.090 (95% CI, 0.785–1.515) and 0.484 (95% CI, 0.330–0.711), respectively. A significantly lower risk associated with pioglitazone use could only be seen in patients aged <65 years (HR, 0.578; 95% CI, 0.360–0.927) but not in patients aged ≥65 years. Conclusions: A significantly lower risk of prostate cancer is observed after a cumulative duration of pioglitazone therapy for >20.23 months or a cumulative dose of >15,330 mg. The risk reduction is mainly observed in patients aged <65 years. [ABSTRACT FROM AUTHOR]

Purpose: To establish a prospective registry for the active surveillance (AS) of prostate cancer (PC) using the Korean Urological Oncology Society (KUOS) database and to present interim analysis. Materials and Methods: The KUOS registry of AS for PC (KUOS-AS-PC) was organized in May 2019 and comprises multiple institutions nationwide. The eligibility criteria were as follows: patients with (1) pathologically proven PC; (2) pre-biopsy prostate-specific antigen (PSA) ≤20 ng/mL; (3) International Society of Urological Pathology (ISUP) grade 1 or 2 (no cribriform pattern 4); (4) clinical T stage ≤T2c; (5) positive core ratio ≤50%; and (6) maximal cancer involvement in the core ≤50%. Detailed longitudinal clinical information, including multi-parametric magnetic resonance imaging and disease-specific outcomes, was recorded. Results: From May 2019 to June 2021, 296 patients were enrolled, and 284 were analyzed. The mean±standard deviation (SD) age at enrollment was 68.7±8.2 years. The median follow-up period was 11.2 months (5.9–16.8 mo). Majority of patients had pre-biopsy PSA ≤10 ng/mL (91.2%), PSA density <0.2 ng/mL2 (79.7%), ISUP grade group 1 (94.4%), single positive core (65.7%), maximal cancer involvement in the core ≤20% (78.1%), and clinical T stage of T1c or lower (72.9%). Fifty-two (18.3%) discontinued AS for various reasons. Interventions included radical prostatectomy (80.8%), transurethral prostatectomy (5.8%), primary androgen deprivation therapy (5.8%), radiation (5.8%), and focal therapy (1.9%). The mean±SD time to intervention was 8.9±5.2 months. The reasons for discontinuation included pathologic reclassification (59.6%), patient preference (25.0%), and radiologic reclassification (9.6%). Two (4.8%) patients with pathologic Gleason score upgraded to ISUP grade group 4, no biochemical recurrence. Conclusions: The KUOS established a successful prospective database of PC patients undergoing AS in Korea, named the KUOS-AS-PC registry [ABSTRACT FROM AUTHOR]

Objective: The prevalence of benign prostatic hyperplasia (BPH) will increase after the age of 40 years, with an occurrence of 8-60% at age 90 years. The presence of comorbid illnesses became the main reason for the selection of minimally invasive surgical techniques for the treatment of BPH. The aim of this study was to investigate the efficacy of bipolar radiofrequency (BRF) thermotherapy of refractory urinary retention secondary to BPH in patients with comorbidities. Materials and Methods: Between May 2017 and September 2019, the BRF thermotherapy system was used in 13 patients with permanent urethral catheter requiring surgical treatment for BPH, who either could not undergo surgery due to their comorbidities. The outcomes of patients were retrospectively analyzed. The mean age of patients was 79.92±6.38 years (67-90). The mean prostate volume and prostatic urethra length of patients was 62.92±11 ml (43-80) and 31.38±11.02 (23-40) mm, respectively. The mean follow-up was 10.69 months. Results: A total of 13 patients were evaluated for success of treatment in eliminating the need for a permanent urinary catheter. Only one patient no longer required urinary catheter (0.76%). Two patients with unsuccessful treatment had transurethral resection of the prostate. One patient required blood transfusion due to severe hematuria 6 months after surgery. The other patients with unsuccessful BRF thermotherapy were monitored with permanent urethral catheter for refractory urinary retention. Conclusion: BRF thermotherapy is an alternative treatment modality for the patients with a high anesthesia risk. However, the level of efficacy of this technique for patients with refractory urinary retention due to BPH should be evaluated with high number of cases. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia is defined as a disorder, which has different ways of treatment depending on the symptomatology, the response to drug therapy, and the occurrence of complications. Pharmacological treatment of benign prostatic hyperplasia involves the use of mainly two groups of drugs: alpha 1 blockers and 5 alphareductase inhibitors (5ARIs). Side effects commonly occur during treatment with 5ARIs such as erectile dysfunction, decreased libido, and deterioration of psychological well-being. This paper aims to determine the association between DHEAS deficiency and the occurrence of side effects of 5ARI therapy that relate to the psychological well-being of patients with BPH. The analysis included 250 patients with benign prostatic hyperplasia (BPH), of whom 130 were treated with an alpha 1 blocker, while 120 patients were treated with a combination of tamsulosin and 5ARIs. The evaluation was conducted through questionnaires: IPSS (International Prostate Scoring System) to quantify BPH symptoms and PhQ-9 questionnaire for self-evaluation of depressive symptoms. The results showed that impaired psychological well-being occurred in 26 patients (22.5%) in the study group after 6- and 12-month therapy, which was statistically significant in this group (p<0.05). In these patients, there were also initially reduced serum values of dehydroepiandrosterone sulfate (DHEAS) (p<0.05). In this analysis, we concluded that the occurrence of impaired psychological well-being in patients treated with 5ARIs correlates with initially lower serum values of DHEAS before the start of therapy, which should be taken into account when using these medications. [ABSTRACT FROM AUTHOR]

Purpose: PARP inhibitor (PARPi) therapy is approved for patients with metastatic castration-resistant prostate cancer (mCRPC) and homologous recombination repair (HRR) genomic aberrations. However, only a fraction of patients with BRCA1/2 mutations respond to PARPi therapy. In this pilot study, we assess PARP-1 expression in prostate cancer patients with and without HRR genomic alternations using a novel PARP-based imaging agent.Procedures: Nine advanced prostate cancer patients were studied with PET/CT and [18F]FluorThanatrace (FTT), an analogue of the PARPi rucaparib. Images were analyzed using maximum standardized uptake values (SUVmax). PARP expression was assessed by immunohistochemistry (IHC) when feasible (n = 4).Results: We found great variability in FTT uptake (SUVmax range: 2.3-15.4). Patients with HRR mutations had a significantly higher SUVmax (p = 0.0379) than patients with non-HRR mutations although there was an overlap in FTT uptake between groups. Three patients without HRR and one with HRR mutations had similarly high PARP1 IHC expression.Conclusions: FTT-PET/CT may serve as an alternate biomarker for PARP1 expression and a potential method for PARPi treatment selection. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the incidence rate and management impact of oligometastatic disease detected on 18F-fluciclovine (Axumin™) PET/CT in men with first biochemical recurrence (BCR) of prostate cancer (PCA) after definitive primary therapy. Methods and Materials: We retrospectively reviewed our clinical database for men with PCA who underwent 18F-fluciclovine PET/CT for imaging evaluation of BCR with negative or equivocal findings on conventional imaging. We included patients with up to and including 5 metastases (oligometastases) regardless of imaging evidence for local recurrence in the treated prostate bed. We examined the association between mean serum prostate specific antigen (PSA) levels with the number of oligometastases (non-parametric ANOVA) and between patients with or without local recurrence (Student t-test). The management impact of oligometastatic disease was tabulated. Results: We identified 21 patients with oligometastases upon first BCR (PSA 0.2–56.8 ng/mL) out of 89 eligible patients. There was a significant difference (p = 0.04) in the mean PSA levels between patients with local recurrence (n = 12) and those without local recurrence (n = 9). In the subgroup of analysis of patients without local recurrence, there was no significant association between mean PSA level and number of oligometastases (p = 0.83). Distribution of oligometastases included 66.7% isolated nodal disease and 33.3% bone only. Twelve (57.1%) patients had change in management to include change in ADT, salvage therapy, or both. Treatment change was initiated in 62.5%, 28.6%, 66.7%, 100%, and 100% of patients with 1, 2, 3, 4, and 5 oligometastatic lesions, respectively. Conclusion: The incidence rate of oligometastatic disease in men with first BCR of PCA undergoing 18F-fluciclovine PET/CT for imaging evaluation of BCR was 23.6% in our eligible patient population. There was no significant association between serum PSA level and the number of oligometastases. Treatment management was affected in 57.1% of patients with oligometastases. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the association of the maximum standardized uptake value (SUVmax) in positron-emission tomography targeting prostate-specific membrane antigen (PSMA-PET) prior to salvage radiotherapy (sRT) on biochemical recurrence free survival (BRFS) in a large multicenter cohort. Methods: Patients who underwent 68 Ga-PSMA11-PET prior to sRT were enrolled in four high-volume centers in this retrospective multicenter study. Only patients with PET-positive local recurrence (LR) and/or nodal recurrence (NR) within the pelvis were included. Patients were treated with intensity-modulated-sRT to the prostatic fossa and elective lymphatics in case of nodal disease. Dose escalation was delivered to PET-positive LR and NR. Androgen deprivation therapy was administered at the discretion of the treating physician. LR and NR were manually delineated and SUVmax was extracted for LR and NR. Cox-regression was performed to analyze the impact of clinical parameters and the SUVmax-derived values on BRFS. Results: Two hundred thirty-five patients with a median follow-up (FU) of 24 months were included in the final cohort. Two-year and 4-year BRFS for all patients were 68% and 56%. The presence of LR was associated with favorable BRFS (p = 0.016). Presence of NR was associated with unfavorable BRFS (p = 0.007). While there was a trend for SUVmax values ≥ median (p = 0.071), SUVmax values ≥ 75% quartile in LR were significantly associated with unfavorable BRFS (p = 0.022, HR: 2.1, 95%CI 1.1–4.6). SUVmax value in NR was not significantly associated with BRFS. SUVmax in LR stayed significant in multivariate analysis (p = 0.030). Sensitivity analysis with patients for who had a FU of > 12 months (n = 197) confirmed these results. Conclusion: The non-invasive biomarker SUVmax can prognosticate outcome in patients undergoing sRT and recurrence confined to the prostatic fossa in PSMA-PET. Its addition might contribute to improve risk stratification of patients with recurrent PCa and to guide personalized treatment decisions in terms of treatment intensification or de-intensification. This article is part of the Topical Collection on Oncology—Genitourinary. [ABSTRACT FROM AUTHOR]

This study aims to systematically identify and review published economic evaluations related to the treatment of mHSPC and assess their quality. These datas will help to provide a better understanding of these treatments and a better use of healthcare resources. The management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has been significantly modified by the availability of innovative but expensive treatments, increasing the economic burden of prostate cancer. Here, we aimed to systematically identify and review published economic evaluations (EEs) related to the treatment of mHSPC and assess their quality. A systematic search was performed of the PubMed and Cochrane databases. Three reviewers independently selected EEs by defined inclusion and exclusion cr iter ia. They extracted all data from each EE (general information, study population, data about the EE, interventions and comparators, and outcomes). They also assessed the quality of the selected EEs according to Drummond's checklist. Fourteen EEs published between 2016 and 2021 were eligible for the systematic review. The EEs found ADT + docetaxel to be the most cost-effective of all available treatments as a first-line strategy for mHSPC (abiraterone acetate plus prednisone, enzalutamide, and apalutamide). Five EEs showed that a simple price reduction of abiraterone acetate of 50% to 75% could change the results to render this treatment also cost-effective relative to that with docetaxel. Twelve EEs were of high quality, with a Drummond score ≤ 7. Analysis of the 14 EEs identified by our systematic review, amongst which 78.6% met high quality standards, showed that ADT + docetaxel tends to be the most cost-effective alternative for mHSPC. These results were assessed by sensitivity analysis. The data provided by this systematic review help to provide a better understanding of these treatments and the better use of healthcare resources. [ABSTRACT FROM AUTHOR]

Prostate radiotherapy is associated with worse outcomes in bladder cancer, but the effect on BCG efficacy is not well-characterized. In our single-institution retrospective study we evaluated BCG outcomes in NMIBC patients who have undergone prostate radiotherapy compared to patients with no prior history. The risk of recurrence after BCG for NMIBC does not vary according to prior prostate radiation treatment. Introduction: Prostate radiotherapy is associated with worse oncologic outcomes in patients with bladder cancer. The underlying mechanism is incompletely understood but is thought to be related to an altered microenvironment promoting tumorigenesis. However, there is a gap in the literature regarding how the effect of BCG varies according to prior radiotherapy in patients with non-muscle invasive bladder cancer (NMIBC). In this context, we sought to evaluate oncologic outcomes in NMIBC patients who have previously undergone prostate radiotherapy compared to patients with no prior history of pelvic radiotherapy. Methods: This is a retrospective cohort study that includes all patients who received intravesical for NMIBC at our institution from 2001 to 2019. Patients were stratified into 3 cohorts: prior radiotherapy (RT), radical prostatectomy (RP), and no prostate cancer (No PCa). The outcomes of interest were recurrence at 1-year, progression to muscle-invasive bladder cancer (MIBC), and progression to metastatic disease. Comparisons were also made bet ween cohor ts with respect to elapsed time from radiation therapy. Wilcoxon ranksum test was used for comparing continuous variables, while 2 and Fischer's exact tests were used to examine categor ical var iables. Results: In 199 total patients who underwent BCG for NMIBC, 23 had a prior history of prostate radiotherapy treatment, while 17 underwent prior radical prostatectomy. Overall, 41.2% of patients had recurrence at 1 year. There was no difference in the number of induction or maintenance BCG administrations received between the cohorts within the first year. There was no significant difference in recurrence at 1 year between the 3 cohorts (P = .56). There was also no difference in progression to MIBC or progression to metastatic disease with P = .50 and 0.89, respectively. Conclusion: The risk of recurrence after induction BCG treatment for high-grade NMIBC does not vary according to prior radiation treatment for prostate cancer. [ABSTRACT FROM AUTHOR]

This retrospective multicenter cohort evaluated the relationship between D'Amico intermediaterisk and pathological grade group 1 (pGG1) after robot-assisted radical prostatectomy (RARP). Among intermediate-risk group prostate cancer patients, those with pGG1 have a good prognosis. The study provides guidelines for identifying patients eligible for active surveillance which is important to avoid unnecessary treatments. Introduction: We aimed to examine the relationship between D'Amico intermediate-risk and pathological grade group 1 (pGG1) after robot-assisted radical prostatectomy (RARP). Patients and Methods: In this retrospective multicenter cohort study, D'Amico intermediate-risk prostate cancer patients who did not receive neoadjuvant therapy, and underwent RARP at 10 institutions in Japan were examined for preoperative factors associated with pGG1. Results: In total, we enrolled 1161 D'Amico intermediaterisk prostate cancer patients. The pGG1 and pGG ≥2 groups comprised 73 (6.3%), and 1088 (93.7%) cases, respectively. Biochemical recurrence-free survival (BCRFS) of the pGG1 group was equivalent to that of the D'Amico low-risk patients. Among the 3 D'Amico intermediate-risk factors (IRF), the pGG1- rate was 24% with prostate-specific antigen (PSA) of 10 to 20 ng/mL alone, and 30% with cT2b alone. Both groups had significantly higher pGG1-rates than other groups. Down-grading from biopsy GG ≥2 to pGG1 was relatively rare (3.9%). Patients with pGG1 were further stratified by prostate volume (PV) (cutoff, 40 cc) among patients with one IRF and PSA of 10 to 20 ng/mL. Patients with one IRF, PSA of 10 to 20 ng/mL, and PV > 40 cc had a relatively good BCRFS similar to that of the D'Amico low-risk group. Conclusion: Among intermediate-risk prostate cancer patients, those with pGG1 have a good prognosis. Downgrading from biopsy GG ≥2 is rare, and definitive treatment may be recommended for patients with biopsy GG ≥2. Patients with one IRF, PSA of 10 to 20 ng/mL, and PV > 40 cc who are eligible for RARP may be candidates for active surveillance. [ABSTRACT FROM AUTHOR]

Radiographic pretreatment tumor size is not currently included within prostate cancer staging or riskstratification. In this single-center review of 631 patients, we identify prognostic groups based on the risk group, maximum tumor diameter, and extracapsular extension. The importance of pretreatment tumor size may vary based on treatment modality. Introduction: Maximum tumor diameter (MTD) on pretreatment magnetic resonance imaging (MRI) has the potential to further risk stratify for men with prostate cancer (PCa) prior to definitive local therapy. We aim to evaluate the prognostic impact of radiographic maximum tumor diameter (MTD) in men with localized prostate cancer. Patients and Methods: From a single-center retrospective cohort of men receiving definitive treatment for PCa (radical prostatectomy [RP] or radiotherapy [RT]) with available pretreatment MRI, we conducted univariable and multivariable Cox proportional-hazards models for progression using clinical variables including age, NCCN risk group, radiographic extracapsular extension (ECE), radiographic seminal vesical invasion (SVI), and MTD. RP and RT cohorts were analyzed separately. Covariates were used in a classification and regression tree (CART) analysis and progression-free survival was estimated with the Kaplan-Meier method and groups were compared using log-rank tests. Results: The cohort included 631 patients (n = 428 RP, n = 203 RT). CART analysis identified 4 prognostic groups for patients treated with RP and 2 prognostic groups in those treated with RT. In the RP cohort, NCCN low/intermediate risk group patients with MTD > = 15 mm had significantly worse PFS than those with MTD < = 14 mm, and NCCN high-risk patients with radiographic ECE had significantly worse PFS than those without ECE. In the RT cohort, PFS was significantly worse in the cohort with MTD > = 23 mm than those < = 22 mm. Conclusion: Radiographic MTD may be a useful prognostic factor for patients with locoregional prostate cancer. This is the first study to illustrate that the importance of pretreatment tumor size may vary based on treatment modality. [ABSTRACT FROM AUTHOR]

The role of androgens in body composition is well known. Androgen deprivation therapy (ADT) has shown beneficial effects in the treatment of advanced prostate cancer (PCa). Given that androgens are important for the homeostasis of different organs, the effects of ADT can affect body composition and therefore adipose tissue. Computed tomography (CT) and magnetic resonance imaging (MRI) are non-invasive methods that allow for quantification of the different fat compartments. In this review we describe the effects of ADT on abdominal adipose tissue in PCa patients. [ABSTRACT FROM AUTHOR]

Focal therapy (FT) has emerged as a potential treatment for localized prostate cancer (PCa) with encouraging functional outcomes. According to the compelling evidence based on meta-analyses and recent trials, erectile function (EF) is mostly retained at 6 and 12 months after FT when compared to baseline. These findings are consistent across different energy sources reported to date. However, overall, quality of life, including impotence, was not the endpoint for most studies. Additionally, impotency has not been consistently reported in most of the recent literature. Furthermore, confounding factors such as baseline potency and usage of phosphodiesterase 5 inhibitors (PDE5-I) were also frequently undisclosed. Long-term functional outcomes are awaited. To fully comprehend how FT affects EF, more extensive long-term randomized clinical trials using EF as a primary outcome are needed. [ABSTRACT FROM AUTHOR]

Background Financial toxicity is emerging as an important patient-centered outcome and is understudied in prostate cancer patients. We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better evaluate the role of financial discussions in patient counseling. Methods Utilizing the Comparative Effectiveness Analysis of Surgery and Radiation dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance for localized prostate cancer. Financial burden and treatment regret were assessed at 3- and 5-year follow-up. The association between financial burden and regret was assessed using multivariable longitudinal logistic regression controlling for demographic and disease characteristics, treatment, functional outcomes, and patient expectations. Results Of the 2924 eligible patients, regret and financial burden assessments for 3- and/or 5-year follow-up were available for 81% (n = 2359). After adjustment for relevant covariates, financial burden from "finances in general" was associated with treatment regret at 3 years (odds ratio [OR] = 2.47, 95% confidence interval [CI] = 1.33 to 4.57; P  = .004); however, this association was no longer statistically significant at 5-year follow-up (OR = 1.19, 95% CI = 0.56 to 2.54; P  = .7). Conclusions In this population-based sample of men with localized prostate cancer, we observed associations between financial burden and treatment regret. Our findings suggest indirect treatment costs, especially during the first 3 years after diagnosis, may impact patients more profoundly than direct costs and are important for inclusion in shared decision making. [ABSTRACT FROM AUTHOR]

• Caffeic acid phenethyl ester (CAPE) loaded Zinc oxide nanoparticles/Chitosan (ZnONPs/CS) formulation was prepared. • The prostate cancer treatment effectiveness of this formulation was evaluated. • The hybrid ZnONPs/CS-CAPE system can kill prostate cancer cells at concentrations as low as 3 μg/mL. • The significant changes are observed in the cellular macromolecules of HCA, LnCaP and PC-3 cancer cells incubated with ZnONPs/CS-CAPE sample. The synthesis of zinc oxide nanoparticles/chitosan (ZnONPs/CS) formulation loaded with Caffeic acid phenethyl ester (CAPE) was performed to evaluate its prostate cancer treatment efficiency within the scope of this research. It has been hypothesized that a dual active materials delivery system containing ZnO and CAPE loaded Chitosan (CS) nanoparticles has better bioavailability compared to single one against to cancer cells. ZnONPs were synthesized between 45 and 60 nm particle sizes and then they were capped with CS biodegradable polymer prior to load with CAPE bioactive molecule. ZnONPs/CS-CAPE system was characterized by using Fourier Transform Infrared (FTIR) for structural elucidation, Scanning Electron Microscope (SEM) for particle size determination, High Performance Liquid Chromatography (HPLC) system for determination of CAPE amount. 131I CAPE and 131I ZnONPs/CS-CAPE labeled by the Iodogen method with 131I were used in-vitro cell culture experiments. Cell viabilities (%) of CAPE and ZnONPs/CS-CAPE were examined using Cell Counting Kit-8 assay on PC-3 (human adenocarcinoma prostate), LnCaP (human carcinoma prostate), and RWPE-1 (human normal prostate). IC 50 values of ZnONPs /CS -CAPE on all cells were found 2-fold lower than neat CAPE. Based on the FTIR data, the most significant spectral changes (lipid, protein, nucleic acids, glycogen) were monitored for the PC-3 and LnCaP cancer cells incubated with ZnONPs/CS-CAPE samples while being exposed to neat CAPE molecules caused small cellular changes when compared to RWPE-1 healthy cell lines. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose/objectives: High-intensity focused ultrasound (HIFU) remains investigational as primary treatment for localized prostate cancer but is sometimes offered to select patients. At HIFU failure, data guiding salvage treatment is limited to small retrospective series with short follow-up. We evaluated our institutional experience using salvage radiation therapy (SRT) after HIFU failure. Materials/methods: We conducted a retrospective analysis of patients with local failure post-HIFU who received salvage image-guided external beam radiation therapy (EBRT) delivered via intensity-modulated radiotherapy (IMRT). Our primary endpoint was biochemical failure-free survival (bFFS) defined as prostate-specific antigen (PSA) nadir + 2 ng/mL. Secondary endpoints included metastasis-free survival (MFS) and overall survival (OS). Endpoints were evaluated using Kaplan-Meier analysis. Results: From 2013 to 2018, 12 out of 96 patients treated with primary HIFU received SRT via conventional or moderate hypofractionation. Median time from HIFU to SRT was 13.5 months. Seven patients had stage migration to high-risk disease at the time of SRT. Mean PSA prior to SRT was 8.2ug/L and mean nadir post-SRT was 1.2ug/L. Acute International Prostate Symptom Score (IPSS) as well as International Index of Erectile Dysfunction (IIEF) scores were similar to baseline (p = 0.5 and 0.1, respectively). Late toxicities were comparable to those reported after primary EBRT for localized prostate cancer. At a median follow-up of 46 months, the OS was 100%. The 5-year bFFS and MFS were both 83.3%. Conclusions: To our knowledge, we report one of the largest series on contemporary SRT post HIFU failure. We show that SRT is feasible, effective and carries no additional acute or delayed toxicity. [ABSTRACT FROM AUTHOR]

Background: Radioligand therapy (RLT) with 177Lu-labeled prostate-specific membrane antigen (PSMA) ligands is associated with prolonged overall survival (OS) in patients with advanced, metastatic castration-resistant prostate cancer (mCRPC). A substantial number of patients, however, are prone to treatment failure. We aimed to determine clinical baseline characteristics to predict OS in patients receiving [177Lu]Lu-PSMA I&T RLT in a long-term follow-up. Materials and methods: Ninety-two mCRPC patients treated with [177Lu]Lu-PSMA I&T with a follow-up of at least 18 months were retrospectively identified. Multivariable Cox regression analyses were performed for various baseline characteristics, including laboratory values, Gleason score, age, prior therapies, and time interval between initial diagnosis and first treatment cycle (intervalDiagnosis-RLT, per 12 months). Cutoff values for significant predictors were determined using receiver operating characteristic (ROC) analysis. ROC-derived thresholds were then applied to Kaplan–Meier analyses. Results: Baseline C-reactive protein (CRP; hazard ratio [HR], 1.10, 95% CI 1.02–1.18; P = 0.01), lactate dehydrogenase (LDH; HR, 1.07, 95% CI 1.01–1.11; P = 0.01), aspartate aminotransferase (AST; HR, 1.16, 95% CI 1.06–1.26; P = 0.001), and intervalDiagnosis-RLT (HR, 0.95, 95% CI 0.91–0.99; P = 0.02) were identified as independent prognostic factors for OS. The following respective ROC-based thresholds were determined: CRP, 0.98 mg/dl (area under the curve [AUC], 0.80); LDH, 276.5 U/l (AUC, 0.83); AST, 26.95 U/l (AUC, 0.73); and intervalDiagnosis-RLT, 43.5 months (AUC, 0.68; P < 0.01, respectively). Respective Kaplan–Meier analyses demonstrated a significantly longer median OS of patients with lower CRP, lower LDH, and lower AST, as well as prolonged intervalDiagnosis-RLT (P ≤ 0.01, respectively). Conclusion: In mCRPC patients treated with [177Lu]Lu-PSMA I&T, baseline CRP, LDH, AST, and time interval until RLT initiation (thereby reflecting a possible indicator for tumor aggressiveness) are independently associated with survival. Our findings are in line with previous findings on [177Lu]Lu-PSMA-617, and we believe that these clinical baseline characteristics may support the nuclear medicine specialist to identify long-term survivors. [ABSTRACT FROM AUTHOR]

In metastatic prostate cancer, optimal sequence of therapies is uncertain. We retrospectively analyzed the treatments and responses of 592 such patients, finding poor response to a first androgen receptor pathway inhibitor helped identify those who appear to derive more benefit from cabazitaxel chemotherapy. Clinicians underutilized cabazitaxel over the study period. These real-world results can support clinician therapeutic decision making. Background: For post-docetaxel treatment of metastatic castrate-resistant prostate cancer (mCRPC), cabazitaxel has demonstrated superior third line PFS and OS compared to androgen receptor pathway inhibitors (ARPIs) in patients who progress within 12 months on first ARPI. The impact of first ARPI response, in particular responses beyond 12 months, on cabazitaxel outcomes in real-world populations is uncertain, as are other factors impacting cabazitaxel use. Materials and Methods: mCRPC patients in Alberta, Canada who received docetaxel from October 1, 2012 to December 31, 2017 were included. We reviewed mCRPC therapies, correlating cabazitaxel use with patient characteristics and TROPIC trial inclusion/exclusion cr iter ia. OS and PFS were evaluated in patients who received cabazitaxel, stratified by time to progression on first ARPI = 12 months (poor ARPI responders, PAR) or > 12 months (strong ARPI responders, SAR), using the Kaplan-Meier method. Results: PAR patients had inferior OS compared to SAR patients (12.3 vs. 24.8 months, P < .001). OS was longer in PAR patients receiving cabazitaxel compared to those not treated with cabazitaxel (16.9 vs. 10.3 months, P = .015), but this benefit was not seen in the SAR group (17.1 vs. 32 months, P = .084). Cabazitaxel use was associated with reduced PFS first line post-docetaxel in SAR (3.5 vs. 14.7 months, P < .001) but not PAR patients. Of 592 patients, 170 (29%) received cabazitaxel post-docetaxel, compared to 280 (47%) and 250 (42%) for abiraterone and enzalutamide. 238 patients (40%) did not have a discussion of cabazitaxel documented. Cabazitaxel use was increased in patients who fit TROPIC trial criteria (P < .001). Conclusions: In a real-world mCRPC cohort, cabazitaxel use was associated with longer OS among PAR patients, but crucially not among strong ARPI responders. Cabazitaxel was used less frequently and later than ARPIs post-docetaxel. These data help support first ARPI progression time as a consideration in treatment sequencing. [ABSTRACT FROM AUTHOR]

We aimed to study whether the use of novel hormonal agents (NHAs) increases the risk of developing visceral or brain metastases (VBMs) in bone metastatic castration-resistant prostate cancer (bmCRPC). Among the 187 bmCRPC patients included, VBMs incidence increased after 2011 (P = .04). Yet, the longer was the treatment with NHAs, the lower was the risk of VBMs. Introduction: The overall survival (OS) of metastatic castration-resistant prostate cancer (mCRPC) patients has improved since 2011 with the use of novel hormonal agents (NHAs). The incidence of brain metastases (mets) has been reported to increase since 2004 with the use of docetaxel, but not the incidence of visceral mets. Our objective was to study whether the use of NHAs increases the risk of developing visceral or brain mets (VBMs). Patients and Methods: mCRPC patients with mets limited to bone (bmCRPC), treated at Tours University Hospital between 2007 and 2015, were included retrospectively. The primary endpoint was to determine whether treatment with NHAs was associated with an increased incidence of VBMs. Secondary endpoints included the search for putative predictive factors to develop VBMs. Results: On 187 bmCRPC patients included, 65 developed VBMs. VBM incidence increased in bmCRPC patients alive after 2011, compared to patients who died before (39.7 vs. 24.6%, P = .04). Meanwhile, their median OS increased from 16.3 months to 28.5 months (P = .01). The longer was the treatment with NHAs, the lower was the risk of VBMs (HR = 0.96, 95% CI [0.94; 0.99]), whereas age < 70 years (HR = 3.33, 95% CI [1.50; 7.40]) and low PSA level at diagnosis (HR = 1.58, 95% CI [1.16; 2.15]) increased this risk. Conclusion: Though retrospective, our results showed an increased incidence of VBMs in bmCRPC patients after 2011. However, this was not associated with NHA exposure duration. The role of NHA exposure remains unclear and needs further investigation. [ABSTRACT FROM AUTHOR]

Deferred treatment is a growing management strategy for low-risk prostate cancer in the United States. However, it is unknown whether changes in practice patterns are influenced by sociodemographic variables. Using the National Cancer Database, we found that black race, low income, and non-private insurance status were associated with smaller increases in deferred treatment. Introduction: Deferred treatment is a growing management strategy for low-risk prostate cancer. However, it is unknown whether this growth is mediated by patient factors. In this study, we sought to evaluate factors associated with deferred treatment in patients with low-risk prostate cancer and shifts in these factors after recent incorporation of active surveillance into national guidelines. Materials and Methods: We identified 137,915 men diagnosed with low-risk prostate cancer (prostate-specific antigen < 10 ng/mL, Gleason score =6, stage cT1-cT2a) in the National Cancer Database from 2010 to 2017. Multivariate logistic regression models were used to determine factors associated with deferred treatment. Interaction variables were added to determine whether trends in use of deferred treatment over time depend on race, income, education, and insurance status. Results: The use of deferred treatment among men with low-risk prostate cancer increased from 14.7% in 2010-2011 to 46.3% in 2016-2017 (P < .001). On multivariate analysis, deferred treatment was associated with older age, more contemporary year of diagnosis, black race, lower income, higher educational attainment, government insurance, being uninsured, treatment at an academic/research facility, and treatment at a facility in New England (each P < .05). Incorporation of interaction variables showed that black race, belonging to the two lowest income quartiles, government insurance, and being uninsured became less associated with deferred treatment in recent years. Conclusions: The use of deferred treatment among men with low-risk prostate cancer increased significantly from 2010 to 2017. However, patients who were black, low-income, and not privately insured experienced smaller increases in deferred treatment. Interventions to increase uptake in these groups present opportunities to improve quality of care. [ABSTRACT FROM AUTHOR]

This study evaluated the combination of phi and multiparametric magnetic resonance in the identification of aggressive prostate cancer to ameliorate the choice of the therapy for each patient. We analysed 177 patients who underwent radical prostatectomy. Combining phi and multiparametric magnetic resonance help to better estimate the risk category of prostate cancer at initial diagnosis, allowing a personalized treatment. Background: The widespread use of prostate specific antigen (PSA) caused high rate of overdiagnosis. Overdiagnosis leads to unnecessary definitive treatments of prostate cancer (PCa) with detrimental side effects, such as erectile dysfunction and incontinence. The aim of this study was to evaluate the feasibility of an artificial neural networkbased approach to develop a combinatorial model including prostate health index (PHI) and multiparametric magnetic resonance (mpMRI) to recognize clinically significant PCa at initial diagnosis. Methods: To this aim we prospectively enrolled 177 PCa patients who underwent radical prostatectomy and had received PHI tests and mpMRI before surgery. We used artificial neural network to develop models that can identify aggressive PCa efficiently. The model receives as an input PHI plus PI-RADS score. Results: The output of the model is an estimate of the presence of a low or high Gleason score. After training on a dataset of 135 samples and optimization of the variables, the model achieved values of sensitivity as high as 80% and 68% specificity. Conclusions: Our preliminary study suggests that combining mpMRI and PHI may help to better estimate the risk category of PCa at initial diagnosis, allowing a personalized treatment approach. The efficiency of the method can be improved even further by training the model on larger datasets. [ABSTRACT FROM AUTHOR]

Our study aimed to illustrate the relationship between clinical characteristics and pathological stage after radical prostatectomy in NCCN high-risk patients, which represent 17% to 31% of newly diagnosed prostate cancers. Our results show increasingly higher rates of non-organ-confined disease with increasingly less favorable clinical characteristics. These lookup tables may be used in the preoperative counselling of highrisk prostate cancer patients. Purpose: To investigate pathological stage at radical prostatectomy (RP) using the "Partin tables" approach in NCCN high-risk (HR) prostate cancer (PCa) patients. Materials and Methods: Within the SEER 2010 to 2016 database, we identified 7,718 NCCN HR PCa patients. Cross-tabulation was used to illustrate the distribution of organ confined disease (OC, pT2), extra-prostatic extension (EPE, pT3a), seminal vesicles invasion (SVI, pT3b), lymph node invasion (LNI, pT2N1), extra-prostatic and lymph node invasion (EPE + LNI, pT3aN1), and seminal vescicale and lymph node invasion (SVI + LNI, pT3bN1), according to preoperative cr iter ia, which consisted in PSA, clinical T stage, biopsy Gleason Score (GS). Binomial 95%CI was constructed for the reported proportions. Results: Median (IQR) PSA levels was 9 (6-20) ng/ml. The majority of patient harbored cT1c (51%) followed by cT2 (35%) and cT3 (14%) stage. Most patients exhibited GS 4 + 4 (43%). Overall, 87 vs. 15 vs. 2% of patients harbored only 1 vs. 2 vs. all 3 HR cr iter ia. At RP, OC, EPE, SVI, and LNI rates were respectively 36%, 27%, 17%, and 19%. Highest levels of OC were recorded for cT1c, PSA < 10 ng/mL and biopsy GS4 + 4. Conversely, EPE, SVI and LNI were the highest in patients with cT3, PSA ≥20 ng/mL and GS 5 + 5. After stratification according to clinical stages, OC rates decreased with increasing PSA levels and GS. Conversely, EPE, SVI and LNI rates increased with increasing PSA and GS. Conclusion: We provide a lookup table to illustrate the relationship between clinical and pathological characteristics in NCCN HR PCa patients. [ABSTRACT FROM AUTHOR]

Background: For many years, the standard treatment of metastatic, hormone-sensitive prostatic carcinoma (mHSPC) was androgen deprivation therapy (ADT) alone. By lowering the testosterone level into the castration range, ADT deprives the tumor of a key growth factor. Methods: For this article, we evaluated the treatment recommendations contained in national and international guidelines (German S3 guidelines and those of the European Society for Medical Oncology [ESMO], European Association of Urology [EAU], and National Comprehensive Cancer Network [NCCN]), as well as pertinent publications revealed by a PubMed search and the congress abstracts of the ESMO and of the American Society of Clinical Oncology [ASCO]. Results: The past few years have witnessed fundamental changes in the treatment of mHSPC. Treatment intensification with docetaxel or with the new drugs directed against the androgen receptor signal pathway (abiraterone, apalutamide and enzalutamide) has been found to lower mortality by 19-40% and is now an integral component of first-line therapy. Relevant new findings have also been obtained with threefold combinations of ADT, docetaxel, and abiraterone or darolutamide. For patients with a light tumor burden, local radiotherapy of the primary tumor improves the probability of survival at 3 years by 8% (45.4 versus 49.1 months, difference 3.6 months; 95% confidence interval, 1.0 to 6.2 months). Conclusion: The treatment of mHSPC is constantly changing. Phase III trials that are now in the recruitment stage, as well as our continually improving understanding of the underlying molecular-pathological mechanisms, will be altering the treatment landscape still further in the years to come. [ABSTRACT FROM AUTHOR]

Prostate cancer treatments disrupt receptive anal intercourse (RAI) for gay and bisexual men (GBM). Sexual dysfunction following prostate cancer treatment may include severe pain in the anorectum during RAI (i.e., anodyspareunia). The purpose of this study was to explore the impact of prostate cancer and its treatments on RAI among GBM. Data were from a cross-sectional online survey of 100 GBM prostate cancer survivors who reported pleasurable RAI prior to treatment. Approximately 47% of the sample reported recent RAI, which was more common among GBM in long-term relationships. RAI was also associated with engagement in other sexual behaviors (e.g., oral and insertive anal sex). Anodyspareunia was reported by 23% of the men who had attempted recent RAI. Anodyspareunia was negatively associated with mental health, performing oral sex on a partner, and bowel function. The overwhelming majority received no information from their healthcare providers about loss of RAI function prior to prostate cancer treatment. Culturally responsive cancer survivorship care may need to address the loss of RAI function for GBM prostate cancer survivors. [ABSTRACT FROM AUTHOR]

Aim: In this study, patients who underwent salvage Radiotherapy (RT) after biochemical recurrence (BCR) were evaluated retrospectively. The aim of this study was to evaluate the factors affecting the time to biochemical recurrence and salvage RT after radical prostatectomy. Materials and Methods: In Ankara Atatürk Education Hospital, patients with prostate cancer who received salvage RT between 01.01.2011 and 01.01.2018 were analyzed retrospectively. Patients who had undergone radical prostatectomy for prostate adenocarcinoma, and received salvage RT for PSA (Prostate-specific antigen) recurrence, were included. Patients who received post-surgery hormone therapy, and received definitive or palliative RT, were excluded. SPSS Ver. 22 software package was used for statistical analysis and the statistical significance limit was accepted as p≤0.05. Results: Results of 84 patients who met the criteria of the study were analyzed. The median follow-up was 78.5 (range 28-172) months and the median time between surgery and RT was 23.7 (range 5.1-136.9) months. The relationship between the time from surgery to BCR and the Gleason Score (GS) was statistically significant; the median time was 16.3 (2.17-125.9) months in the group with GS ≤8, and 8.9 (2.8-20.3) months in the group with GS 9-10 (p=0.05). The relationship between the time from surgery to BCR and Tumor (T) stage was statistically significant. In subgroup analysis, this difference was seen between T3A and T3B stages. That time was 17.8 (range 2.17-73.77) months in T3A and 8.7 (range 2.8-29.6) months in T3B stages (p=0.02). The relationship between the level of nadir PSA and the median time between surgery and BCR was significant. It was median 20.6 (range 5.4-65.2) months in patients with PSA< 0.03 and 8.8 (range 2.2-125.9) months in patients with PSA ≥0.03 (p<0.0001). Conclusion: BCR time is shorter in patients with high GS, advanced T stage, and high postoperative PSA nadir. [ABSTRACT FROM AUTHOR]

To explore the diagnostic value of the Prostate Imaging–Reporting and Data System version 2.1 (PI-RADS v2.1) for clinically significant prostate cancer (CSPCa) in patients with a history of transurethral resection of the prostate (TURP), we conducted a retrospective study of 102 patients who underwent systematic prostate biopsies with TURP history. ROC analyses and logistic regression analyses were performed to demonstrate the diagnostic value of PI-RADS v2.1 and other clinical characteristics, including PSA and free/total PSA (F/T PSA). Of 102 patients, 43 were diagnosed with CSPCa. In ROC analysis, PSA, F/T PSA, and PI-RADS v2.1 demonstrated significant diagnostic value in detecting CSPCa in our cohort (AUC 0.710 (95%CI 0.608–0.812), AUC 0.768 (95%CI 0.676–0.860), AUC 0.777 (95%CI 0.688–0.867), respectively). Further, PI-RADS v2.1 scores of the peripheral and transitional zones were analyzed separately. In ROC analysis, PI-RADS v2.1 remained valuable in identifying peripheral-zone CSPCa (AUC 0.780 (95%CI 0.665–0.854; p < 0.001)) while having limited capability in distinguishing transitional zone lesions (AUC 0.533 (95%CI 0.410–0.557; p = 0.594)). PSA and F/T PSA retain significant diagnostic value for CSPCa in patients with TURP history. PI-RADS v2.1 is reliable for detecting peripheral-zone CSPCa but has limited diagnostic value when assessing transitional zone lesions. [ABSTRACT FROM AUTHOR]

Purpose: Determine the time-dependent magnitude of intrafraction prostate displacement and a cutoff for the tracking decision. Methods: Nine patients with localized prostate cancer were treated with ultra-hypofractionated radiotherapy (CyberKnife) with fiducial markers. Exact tract kV/kV imaging was used with an average interval of 19–92 s. A Gaussian distribution was calculated for the x-, y-, and z-directions (σx,y,z). The variation of prostate motion (μσ) was obtained by averaging the patients' specifics, and the safety margin was calculated to be MAB = WYm + WBSs. Results: The calculated PTV safety margins were as follows: at 40 s: 0.55 mm (L/r), 0.85 mm (a/p), and 1.05 mm (s/i); at 60 s: 0.9 mm (L/r), 1.35 mm (a/p), and 1.55 mm (s/i); at 100 s: 1.5 mm (L/r), 2.3 mm (a/p), and 2.6 mm (s/i); at 150 s: 1.9 mm (L/r), 3.1 mm (a/p), and 3.6 mm (s/i); at 200 s: 2.2 mm (L/r), 3.8 mm (a/p), and 4.2 mm (s/i); and at 300 s: 2.6 mm (L/r), 5.3 mm (a/p), and 5.6 mm (s/i). A tracking cutoff of 2.5 min seemed reasonable. In order to achieve an accuracy of < 1 mm, tracking with < 50 s intervals was necessary. Conclusions: For ultra-hypofractionated radiotherapy of the prostate with treatment times > 2.5 min, intrafraction motion management is recommended. [ABSTRACT FROM AUTHOR]

Objective: Bone metastases, which show a milder course compared with visceral disease, are among the most common metastatic sites in prostate cancer. In the present study, we aimed to investigate the prognostic factors that influence the survival time in the castration-sensitive phase in patients diagnosed with prostate adenocarcinoma with isolated bone metastasis. Materials and Methods: The prognostic effects of the clinical (performance status, number of bone metastases) and laboratory parameters of a total of 217 patients, of whom the data could be accessed, on survival in the castration-sensitive phase were evaluated. Results: Of the 217 patients included in our study, 144 (66.4%) were metastatic at presentation. The mean age of the patients was 68.4 (42-88) years. The mean follow-up duration was 44 months. Of our 217 patients, 125 (57.6%) were included in the castration-sensitive group and 92 (42.4%) in the castration-resistant group. In multivariate analyses; lactate dehydrogenase, alkaline phosphatase (ALP) levels and the number of bone metastases were independent prognostic factors with a strong correlation with time to castration-resistant prostate cancer. The evaluation of these three parameters within the framework of a prognostic index and subsequent risk stratification revealed median progression-free survival times of 91, 36, 20 and 12 months for the very low-risk, low-risk, intermediate-risk and high-risk groups, respectively. Conclusion: Lactate dehydrogenase, ALP levels and the number of bone metastases were determined as strong and useful prognostic factors in predicting time to castration-resistant prostate cancer in metastatic prostate cancer. [ABSTRACT FROM AUTHOR]

There are uncertainties concerning treatment management in elderly patients diagnosed with localized prostate cancer. The patient's age and morbidity are the most important factors affecting the treatment to be applied. Many screening scales are used for this purpose. It is reported that standard definitive treatments are suitable for patients with a life expectancy of more than 10 years, who are considered fit according to these screening scales. However, treatment options should be discussed in detail with patients in this group, which are already old and getting older. Therefore, elderly patients can be considered as the group that should be given the most information about the side effects of treatments. It is very important to properly evaluate the current state of the patient prior to treatment and inform them well to ensure that they have more rational expectations. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Reconstructive Urology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim: Prostate cancer is currently the second most common cancer in men and chemotherapy is the main treatment for metastatic castrate-resistant prostate cancers (mCRPC). However, chemoresistance leading to treatment failure is inevitable. Thus, therapeutic approaches that can overcome chemoresistance are important areas of research for cancer chemotherapy. Materials and Methods: In the present study, six components of tripterygium wilfordii including celastrol, triptolide, pristimerin, triptonide, demethylzeylasteral, and wilforlide A were screened for their chemosensitizing effect on drug-resistant prostate cancer cell lines PC3 and DU145. The most active compound was further investigated on its potential mechanism of action and in vivo efficacy using a SCID mouse model. Results: Among the six components only wilforlide A significantly enhanced sensitivity to docetaxel (by reducing the IC50 in resistant prostate cancer cell lines). Wilforlide A inhibited Pglycoprotein efflux transporter and downregulated cyclin E2 splice variant 1 mRNA, both have been known as mechanisms of resistance. The chemosensitizing effect was further verified using a xenograft mouse model. In the highdose treatment group, the combination of wilforlide A and docetaxel significantly retarded tumor growth of resistant prostate cancer, although neither docetaxel nor wilforlide A monotreatment groups showed any effect. Conclusion: Wilforlide A was found to enhance the chemosensitizing effect of docetaxel both in vitro and in vivo. Further studies are warranted to verify wilforlide A as a new drug candidate to overcome docetaxel resistance in prostate cancer. [ABSTRACT FROM AUTHOR]

Purpose/objectivesHigh-intensity focused ultrasound (HIFU) remains investigational as primary treatment for localized prostate cancer but is sometimes offered to select patients. At HIFU failure, data guiding salvage treatment is limited to small retrospective series with short follow-up. We evaluated our institutional experience using salvage radiation therapy (SRT) after HIFU failure.Materials/methodsWe conducted a retrospective analysis of patients with local failure post-HIFU who received salvage image-guided external beam radiation therapy (EBRT) delivered via intensity-modulated radiotherapy (IMRT). Our primary endpoint was biochemical failure-free survival (bFFS) defined as prostate-specific antigen (PSA) nadir + 2 ng/mL. Secondary endpoints included metastasis-free survival (MFS) and overall survival (OS). Endpoints were evaluated using Kaplan-Meier analysis.ResultsFrom 2013 to 2018, 12 out of 96 patients treated with primary HIFU received SRT via conventional or moderate hypofractionation. Median time from HIFU to SRT was 13.5 months. Seven patients had stage migration to high-risk disease at the time of SRT. Mean PSA prior to SRT was 8.2ug/L and mean nadir post-SRT was 1.2ug/L. Acute International Prostate Symptom Score (IPSS) as well as International Index of Erectile Dysfunction (IIEF) scores were similar to baseline (p = 0.5 and 0.1, respectively). Late toxicities were comparable to those reported after primary EBRT for localized prostate cancer. At a median follow-up of 46 months, the OS was 100%. The 5-year bFFS and MFS were both 83.3%.ConclusionsTo our knowledge, we report one of the largest series on contemporary SRT post HIFU failure. We show that SRT is feasible, effective and carries no additional acute or delayed toxicity.