Objectives High-intensity focused ultrasound (HIFU) has emerged as an important modality for focal therapy in localized prostate cancer (PC). However, intraoperative prostate swelling and displacement during HIFU can compromise the millimeter-level precision required for focal therapy. Therefore, we evaluated the clinical utility of a novel directional compression (DC) technique using a simple attachment designed to achieve efficient prostate-directed compression during transrectal HIFU. Methods A retrospective matched-cohort study of 120 patients who underwent focal therapy with HIFU for localized PC between 2022 and 2025 was conducted. Sixty consecutive patients treated with DC technique were matched 1:1 with patients treated with conventional compression based on prostate-specific antigen (PSA) level, Gleason score, T stage, and prostate volume. Procedural outcomes, magnetic resonance imaging (MRI) findings, PSA kinetics, and complications were compared between the groups. Results Baseline characteristics, PSA reduction , and nadir values were comparable in the groups. In contrast, the DC group showed significantly reduced treatment preparation time (3 vs. 5 min, p<0.001), initial water volume (31 vs. 100 mL, p<0.001), additional intraoperative water adjustments (9 vs. 40 mL, p<0.001), HIFU ablation time (16 vs. 19 min, p<0.001), total procedural time (20 vs. 28 min, p<0.001), and treatment interruptions caused by rectal gas release (0 vs 1, p<0.001) compared to that in the conventional group. Contrast-enhanced MRI revealed complete perfusion loss within the target area in all cases without rectal injury. Complication rates were low; urethral stricture occurred in 1.7% of patients in both groups, whereas transient external hemorrhoids were observed only with conventional compression. Conclusions DC technique significantly improves procedural efficiency and reduces technical complexity during focal therapy using HIFU without compromising oncological efficacy or safety. This technique may represent a practical adjunct for improving reproducibility and precision in focal therapy with HIFU for localized PC.
Background Fast progression from metastatic hormone-sensitive prostate cancer (mHSPC) to metastatic castration-resistant prostate cancer (mCRPC) is associated with poor prognosis. We evaluated whether baseline plasma circulating tumor DNA-derived prostate-specific antigen and prostate-specific membrane antigen were associated with progression to metastatic castration-resistant prostate cancer and improved risk stratification beyond conventional serum biomarkers in mHSPC. Methods We prospectively analyzed 35 patients with mHSPC who underwent baseline ctDNA analysis using droplet digital PCR. ctDNA was extracted from plasma and quantified using droplet digital PCR targeting PSA and PSMA. The primary endpoint was progression to mCRPC. Survival analyses were performed using Kaplan–Meier methods, Cox regression, and restricted mean survival time (RMST). Results During a median follow-up of 29 months, 24 patients progressed to mCRPC. Elevated ctDNA-PSA and ctDNA-PSMA were significantly associated with shorter time to progression (both P < 0.001). In Cox analyses, ctDNA-PSA (HR 1.82, P = 0.002) and ctDNA-PSMA (HR 1.59, P = 0.009) were associated with progression risk. RMST analysis at 24 months demonstrated greater reductions in progression-free time for ctDNA-PSA (−10.8 months) and ctDNA-PSMA (−8.7 months) compared with serum PSA (−7.3 months). Conclusions Baseline ctDNA-PSA and PSMA provide complementary prognostic information for progression from mHSPC to mCRPC and may improve risk stratification in patients with mHSPC.
Background Infectious complications remain a major concern following prostate biopsy and traditionally necessitate routine antibiotic prophylaxis. With the increasing adoption of the transperineal approach, infection rates have substantially decreased, raising questions regarding the necessity of routine antibiotic use. This study evaluated the safety of performing transperineal prostate biopsy (TPB) without antibiotic prophylaxis among low-risk patients. Methods A randomized, double-blind, parallel-group controlled trial was conducted at two tertiary centers in the Philippines. Low-risk patients scheduled for TPB were randomized to either no antibiotic prophylaxis (Group A) or a single intravenous dose of cefoxitin (Group B). TPBs were performed using MRI/ultrasound fusion-guided techniques. Primary outcomes were symptomatic urinary tract infection (UTI) and sepsis within 30 days after biopsy. Secondary outcomes included hospital admissions and non-infectious complications. Results A total of 140 participants were enrolled, with 70 patients assigned to each group. Baseline characteristics were comparable between groups. No symptomatic UTI or sepsis occurred in either group (0/70 vs. 0/70). The observed absolute difference was 0% (90% CI, −4.19 to 4.19). Although the observed confidence interval lay within the prespecified non-inferiority margin, the absence of events precluded definitive demonstration of non-inferiority. Positive urine cultures findings in asymptomatic participants were observed in 4.5% and 6.3% of participants in Groups A and B, respectively, none of which required treatment or progressed to clinically significant infection. No hospital readmissions occurred in either group. Urinary retention occurred in 2.9% and 4.3% of participants in Groups A and B, respectively. Conclusion Among carefully selected low-risk patients undergoing TPB, no symptomatic infections were observed regardless of antibiotic use. These findings suggest the feasibility of performing TPB without routine antibiotic prophylaxis while reducing unnecessary antibiotic exposure and supporting antimicrobial stewardship. However, larger adequately powered multicenter studies are needed before definitive conclusions regarding non-inferiority can be made. Trial Registration ISRCTN17045111. Retrospectively registered on June 8, 2025.
Traditional two-dimensional models have limitations in mimicking the tumor microenvironment, prompting the emergence of advanced technologies such as 3D printing. This review explores the transformative role of 3D printing in PCa research and treatment, spanning from in vitro modeling to clinical applications. We highlight key materials used in prostate-specific 3D-printed scaffolds, such as chitosan–alginate, collagen, GelMA, and PLGA, as well as the integration of relevant cell types like PC-3, LNCaP, DU145, and MSCs. In clinical practice, 3D printing has improved surgical planning, radiation therapy precision, and the design of personalized drug delivery systems using antiandrogens and chemotherapeutics like docetaxel. Despite substantial promise, challenges remain in biomaterial optimization, model standardization, and regulatory approval. Nonetheless, continued innovations position 3D printing as a pivotal tool in the future of PCa treatment.
Background To compare oncologic outcomes of high-intensity focused ultrasound (HIFU), conventional radical prostatectomy (CRP), and robotic radical prostatectomy (RRP) in Asian patients with localized prostate cancer using a large real-world dataset and propensity score–based inverse probability of treatment weighting (IPTW). Methods This retrospective cohort study included 2,239 patients with localized prostate cancer treated at Chang Gung Memorial Hospital (2001–2020): 415 with HIFU, 1,536 with RRP, and 288 with CRP. Biochemical recurrence (BCR) and all-cause mortality were assessed using Cox proportional hazards models. IPTW was performed to balance confounders between the HIFU and RRP groups. Survival outcomes were analyzed overall and across NCCN risk groups. Results RRP was associated with significantly lower risk of BCR compared with HIFU (adjusted HR 0.72; 95% CI 0.58–0.88; p=0.002). In IPTW-weighted analyses, RRP demonstrated significantly superior 5- and 10-year BCR-free and overall survival in high- and very high-risk patients. No significant differences were observed in low- and intermediate-risk patients. CRP consistently showed outcomes between RRP and HIFU but became infrequent after 2006. Conclusions In this large real-world Asian cohort, RRP provided superior oncologic outcomes compared with HIFU among high- and very high-risk patients, whereas both modalities achieved comparable outcomes in low- and intermediate-risk disease. These findings support risk-stratified treatment selection and reinforce RRP as the preferred approach for aggressive prostate cancer.
Background Previous studies of Parkinson disease (PD) in men with benign prostatic hyperplasia (BPH) have primarily compared alpha-1 blocker subclasses. Whether recorded BPH is associated with subsequent PD diagnosis, including among men with no recorded alpha-1 blocker use, remains uncertain. Methods We conducted a retrospective matched cohort study using the Longitudinal Health Insurance Database 2010 (1996–2013). Men aged 40–99 years with a first qualifying recorded BPH diagnosis during 2000–2012, following a minimum 4-year period without recorded BPH, were matched 1:1 by age and index date to men with no recorded BPH throughout the available claims period. BPH and PD each required at least two diagnostic claims. Cox proportional hazards models and propensity-score-adjusted Cox models evaluated subsequent recorded PD. An exploratory analysis classified patients with BPH as having long-term recorded alpha-1 blocker use exceeding 6 months or no recorded use; exposure was analyzed as a fixed category. Results The primary analysis included 21,564 men with recorded BPH and 21,564 controls. PD was diagnosed in 500 men with recorded BPH (2.3%) and 183 controls (0.8%). The propensity-score-adjusted hazard ratio (HR) was 2.45 (95% confidence interval [CI], 2.07–2.91). In the exploratory analysis, PD occurred in 186 of 8,664 long-term users (2.1%) and 41 of 1,991 patients with no recorded use (2.1%). Relative to controls, the corresponding propensity-score-adjusted HRs were 1.93 (95% CI, 1.56–2.38) and 2.80 (95% CI, 1.99–3.92). Conclusion Recorded BPH was associated with a higher proportion and hazard of subsequent recorded PD diagnosis. However, prodromal urinary dysfunction, differential surveillance, control selection, and residual confounding may have contributed to the association. Recorded BPH should therefore be interpreted as a possible clinical or care-pathway marker rather than a causal risk factor. The medication-stratified findings were exploratory and do not establish benefit or harm from alpha-1 blockers.
Prostate cancer remains a leading cause of male cancer mortality. Although prostate-specific antigen (PSA) screening can reduce this burden, early conflicting evidence hindered its population-level adoption. In 2009, the European Randomized Study of Screening for Prostate Cancer (ERSPC) showed a mortality benefit despite concerns about overdiagnosis, whereas the highly contaminated Prostate, Lung, Colorectal, and Ovarian (PLCO) trial showed no benefit. This apparent conflict drove prohibitive international guidelines, notably the 2012 United States Preventive Services Task Force (USPSTF) grade D recommendation, making the formal adoption of organized screening more difficult worldwide.Countries nevertheless developed pragmatic workarounds spanning implicit testing (de facto population testing without formal national designation) and explicit programs (government-endorsed national initiatives). Sweden illustrates an implicit but highly organized approach, whereas Japan reflects an implicit, fragmented, market-driven model; Lithuania and Kazakhstan represent explicit programs implemented despite restrictive global guidelines.Meanwhile, screening withdrawal in the United States was followed by a clinically significant resurgence of metastatic disease. The 2025 ERSPC 23-year final report showed markedly improved screening efficiency (number needed to invite [NNI] 456; number needed to diagnose [NND] 12), and prebiopsy magnetic resonance imaging (MRI) now helps mitigate overdiagnosis. Together with Global Cancer Observatory (GLOBOCAN) 2022 data, these international trajectories support policy discussions on formal, systematic, risk-adapted organized screening in countries facing a rising prostate cancer burden.
Objectives The aim of this study was to elucidate the impact of prior transurethral resection of the prostate (TURP) on functional and surgical outcomes following robot-assisted radical prostatectomy (RARP). Methods Electronic medical records of 6,031 patients who underwent RARP were retrospectively reviewed to identify 173 patients with a previous surgical history of TURP self-reported at admission. Patients were propensity-score matched at a 1:4 ratio for age, body mass index (BMI), biopsy Gleason grade group (GG), and clinical stage. Perioperative International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) scores were assessed, as were achievement of continence and rate of postoperative re-catheterization. Results A total of 865 cases were included in the final analysis, with 173 and 692 patients with and without a recorded history of TURP. Patients with TURP were more likely to harbor less aggressive pathology at RARP including lower pathologic stage (pT≥3 26.2% vs. 36.3%; p=0.012) and lower mean PSA (10.3±10.7 vs. 14.2±24.8; p=0.002). Operation time and console time were longer in the TURP (+) group (p=0.001 and 0.022, respectively), with higher rate of estimated blood loss (p=0.004). The positive surgical margin rate did not differ significantly (p=0.063). The re-catheterization rate after RARP was not adversely affected (4.6% vs. 2.2%, p=0.072), although TURP (+) patients were more likely to experience immediate urinary leakage or retention (6.9% vs. 3.2%, p=0.023). Rate of achieving pad-free status was not significantly different (88.3% vs. 90.0%, p=0.532), although patients with previous TURP took longer to achieve continence (6.0±9.9 months vs. 4.3±5.5 months, p=0.044). Conclusion RARP following TURP is challenging, with longer console times and increased blood loss, but does not necessarily prevent eventual continence. Patients with prior TURP should be educated on longer times to reach pad-free status and the favorable prognosis after surgery.
Purpose The aims of this study were to evaluate National comprehensive cancer network (NCCN) risk migration on follow-up biopsy during active surveillance (AS) for prostate cancer and to identify predictors of clinically significant upgrading higher. Materials and methods We retrospectively reviewed a single-center cohort of patients managed with AS. Among 728 patients in the overall AS cohort, 241 underwent follow-up biopsy, and 220 were eligible for the final analysis. The coprimary endpoints were any upward risk reclassification and clinically significant upgrading to unfavorable intermediate risk or higher (≥UFI) (clinically significant upgrade). Logistic regression analyses were performed, and receiver operating characteristic analysis was used to determine the optimal cutoff for predicting a ≥ UFI upgrade. Results Any upward risk reclassification was observed in 51 of 220 patients (23.2%), clinically significant upgrading to ≥ UFI in 22 of 220 patients (10.0%). Age, prostate-specific antigen density, and family history of prostate cancer were independent predictors of any upward risk reclassification. Age (odds ratio: 1.135, 95% confidence interval: 1.047–1.229; P = 0.002) and Prostate Imaging reporting and data system (PIRADS) 4–5 lesions (odds ratio: 4.428, 95% confidence interval: 1.653–11.862; P = 0.003) were independent predictors of a ≥UFI upgrade. The optimal age cutoff was 67 years (area under the curve: 0.736), with 86.4% sensitivity and 50.5% specificity. The rate of ≥UFI upgrade was highest in patients aged ≥67 years with PIRADS 4–5 (12/40, 30.0%) and lowest in those aged <67 years with PIRADS ≤3 (1/70, 1.4%). Conclusions Risk migration and clinically significant upgrading are not uncommon on follow-up biopsy during AS. Older age and PIRADS 4–5 identify a subgroup at particularly high risk for clinically significant upgrading and may help guide intensified surveillance and earlier discussion of definitive treatment.
Background Multiparametric magnetic resonance imaging (MRI)-targeted biopsy has improved prostate cancer detection, yet the relative diagnostic contributions of MRI fusion-targeted biopsy and systematic transrectal ultrasound-guided (TRUS) biopsy across prostate-specific antigen (PSA) and PSA density (PSAD) levels remain uncertain. We evaluated the incremental detection of clinically significant prostate cancer (csPCa) between these techniques. Methods This retrospective single-center paired cohort study included 376 men with biopsy-proven prostate cancer who underwent both MRI fusion-targeted and 12-core systematic TRUS biopsy in the same session for a PI-RADS ≥3 lesion. csPCa was defined as ISUP Grade Group ≥2. Detection was compared overall and across PSA strata (<4, 4–10, 10.01–20, 20.01–50, >50 ng/mL) and PSAD groups (<0.10, 0.10–<0.15, ≥0.15 ng/mL/cc) using exact McNemar testing on discordant pairs. Results Overall prostate cancer detection was similar between MRI fusion-targeted and systematic TRUS biopsy (318/376, 84.6% vs 316/376, 84.0%; p=0.927). csPCa was detected in 226/376 patients (60.1%) by MRI fusion-targeted biopsy and 212/376 (56.4%) by systematic biopsy; 60 MRI-only and 46 systematic-only discordant cases were observed (p=0.206). MRI fusion-targeted biopsy showed numerically higher csPCa detection across the intermediate PSA range (4–50 ng/mL), with the largest absolute difference of 9.1 percentage points at PSA 20.01–50 ng/mL (n=33); no PSA-stratified comparison reached statistical significance. csPCa detection increased with PSAD for both techniques across all three PSAD strata. Conclusion MRI fusion-targeted and systematic TRUS biopsies were complementary for csPCa detection. MRI fusion-targeted biopsy showed a numerical advantage in the intermediate PSA range, while csPCa detection increased with PSA density for both techniques. These findings support risk-stratified interpretation of biopsy yield and do not support routine omission of systematic cores when MRI fusion-targeted biopsy is performed.
Background The objective of this study was to evaluate the clinical and anatomical factors predicting the preservation of antegrade ejaculation following ejaculation-preserving transurethral resection of the prostate (EP-TURP). Materials and methods This prospective cohort study included sexually active men undergoing EP-TURP. Preoperative evaluation included the International Prostate Symptom Score, quality of life, and assessment of ejaculatory function using the Male Sexual Health Questionnaire–Ejaculatory Dysfunction Short Form. Transrectal ultrasonography was used to evaluate prostate size, intravesical prostatic protrusion, supramontanal length, and the presence of a median lobe. The surgical technique involved preserving 1 cm of circumferential urethral mucosa around the verumontanum while performing standard bipolar TURP. Patients were followed up at 3 months postoperatively. Multivariable regression analysis was used to identify predictors of ejaculation preservation. Results A total of 108 patients were included in the final analysis. Significant improvements were observed in postoperative voiding parameters (P < 0.001). Antegrade ejaculation was preserved in 63 patients (58.3%). Preservation was significantly higher in patients with a prostate size <80 g than in those with a prostate size ≥80 g (81.1% vs 36.4%). On multivariable analysis, larger prostate volume (odds ratio [OR]: 0.97, 95% confidence interval [CI]: 0.95–0.99, P = 0.018), increased intravesical prostatic protrusion (OR: 0.75, 95% CI: 0.56–0.99, P = 0.023), and the presence of a median lobe (OR: 0.73, 95% CI: 0.54–0.99, P = 0.048) were independently associated with a lower odds of ejaculation preservation. Conclusions EP-TURP provides significant improvement in voiding parameters while preserving antegrade ejaculation in a substantial proportion of patients. Larger prostate size, significant intravesical prostatic protrusion, and median lobe enlargement are associated with lower preservation rates and should be considered during patient selection and preoperative counseling.
Introduction Although smoking is a key modifiable risk factor for prostate cancer (PCa), its long-term impact on functional recovery remains under-researched. In this study, the association between baseline smoking status and 5-year longitudinal patient-reported functional outcomes was investigated in patients with localized PCa undergoing radical prostatectomy (RP) or radiotherapy (RT). Patients and Methods In this prospective study, 666patients (RP:n=327; RT:n=339) from a urological center were analyzed. The patients were categorized as never-smokers(nS), ex-smokers(eS), or active smokers(aS) at baseline. Validated EPIC-26 questionnaire was performed at diagnosis and annually for 60months. The primary outcomes were the longitudinal trajectories of urinary incontinence(UI) and sexual function, analyzed using linear mixed-effects models and also the interaction of smoking status with time as fixed effects. Results In the RP cohort, UI scores declined sharply in all groups at year 1 (mean:66), a significant divergence emerged by year 4: nS maintained superior function (mean:70; 95%confidence interval[CI]:65–75) compared with eS (mean:62;95%CI:6–69) and aS (mean:52; 95%CI:42–61). Active smokers experienced the most profound deterioration in the sexual domain, with no significant recovery through year 5.In the RT cohort, UI was preserved in nS and eS through year 2 (respective mean scores:84 and 83) but declined significantly in aS during this period (84 at baseline, 70 at year 2). Despite partial recovery by year 5, aS consistently reported the lowest UI scores. Sexual function declined significantly in all groups by year 1, then plateaued through year 5. Linear mixed-effects models confirmed aS as a significant driver of poor longitudinal trajectories for both treatment modalities. Conclusion Active smoking was significantly associated with poorer long-term functional recovery following definitive PCa treatment, particularly sexual function after RP and UI after RT. Clinical counseling should integrate pre-treatment smoking cessation interventions to mitigate quality of life deterioration and enhance functional outcomes.
Background Accurate discrimination between localized and metastatic prostate cancer (PCa) remains a critical unmet need in clinical practice, particularly in patients with equivocal imaging findings or biologically high-risk disease. Circulating tumor DNA (ctDNA) methylation represents a stable epigenetic signal that may reflect tumor burden and disease state. We aimed to evaluate whether plasma ctDNA methylation markers can accurately discriminate disease state beyond conventional clinical parameters. Methods A total of 174 patients were included, comprising localized PCa (n = 73), metastatic hormone-sensitive PCa (mHSPC, n = 16), and metastatic castration-resistant PCa (mCRPC, n = 85). Candidate methylation markers (C2orf88 and HAPLN3) were identified using a machine learning–based approach and quantified in plasma ctDNA. Associations with metastatic disease were evaluated using logistic regression analyses, and diagnostic performance was assessed using receiver operating characteristic analyses. Results Plasma methylation levels of C2orf88 and HAPLN3 increased significantly with advancing disease stage (P < 0.05). In multivariable analysis, C2orf88 (OR 3.47, 95% CI 1.95–6.15; P < 0.001) and HAPLN3 (OR 2.82, 95% CI 1.65–4.82; P < 0.001) were independently associated with metastatic disease. The clinical model demonstrated modest discrimination (AUC range, 0.537–0.828), whereas methylation-based models achieved superior performance (AUC range, 0.807–0.843). The integrated two-marker signature provided the highest discriminatory accuracy (AUC = 0.913), indicating substantial incremental value over conventional clinical assessment. Conclusions A two-marker ctDNA methylation signature enables accurate discrimination between localized and metastatic PCa. This plasma-based epigenetic biomarker captures clinically meaningful disease biology and offers a scalable, noninvasive approach for refined disease stratification.
Background Although 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) represents a promising method for prostate cancer (PCa) diagnosis and staging, comparison of PSMA-based primary tumor characterization to multiparametric magnetic resonance imaging (mpMRI) is still limited. This study evaluated the diagnostic accuracy of 68Ga-PSMA PET/CT to mpMRI against radical prostatectomy (RP) whole gland histopathology in patients with clinically localized PCa. Materials and methods From August 2022 to March 2023, 58 patients with clinically localized prostate cancer who underwent preoperative mpMRI and 68Ga-PSMA PET/CT followed by RP were analyzed. Lesions were classified as mpMRI-positive (PIRADS ≥3) or negative (PIRADS ≤2), and PSMA PET/CT-positive or negative. Clinically significant prostate cancer (csPCa) was defined as grade group ≥2. Per-lesion and per-region (12-region model) analyses were performed against RP histopathology. Results Fifty-eight patients underwent RP, resulting in 74 lesions on final histopathological examination (GG 5 in 3, GG4 in 13, GG 3 in 35, GG 2 in 16, and GG1 in 7). Among 74 lesions, mpMRI-positive and 68Ga-PSMA PET/CT-positive lesions were 48 (64.9%) and 64 (86.5%) lesions, respectively. Among 26 lesions with mpMRI negative, 68Ga-PSMA PET/CT could detect 17 lesions (65.3%). In addition, for csPCa diagnostic accuracy was higher with PSMA PET/CT (85.1%) than with mpMRI (71.6%). With regard to “per region,” a total of 684 regions were evaluated. Compared to mpMRI, 68Ga-PSMA PET/CT showed better sensitivity (66% vs 92%) and positive predictive value (79% vs 91%). Conclusions 68Ga -PSMA PET/CT showed higher sensitivity for intraprostatic lesion detection and identified a proportion of lesions not detected by mpMRI. However, its lower specificity and lower AUC for clinically significant prostate cancer indicate that PSMA PET/CT should not be interpreted as a replacement for mpMRI. Rather, PSMA PET/CT may provide complementary information for lesion localization and treatment planning in selected patients. Further prospective studies with standardized interpretation criteria are warranted.
Background Minimally invasive surgical therapies (MISTs) for benign prostatic obstruction (BPO) are increasingly popular, but their benefits may be overstated. Patients progressively turn to online sources like YouTube and TikTok for health information, with questionable accuracy and clarity, especially in treatments with unclear benefit–risk profile, such as MISTs. This study aims to evaluate the quality, understandability and reliability of content about MISTs for BPO on YouTube and TikTok. Methods We conducted an independent search on YouTube and TikTok for videos about MISTs for BPO, with prespecified eligibility criteria. Video characteristics (views, likes, duration, publication year, procedures discussed) were collected. For each video, quality, understandability and actionability were assessed using the DISCERN and Patient Education Materials Assessment Tool (PEMAT) A/V instruments. Statistical analyses were performed using the Mann–Whitney U test and Spearman’s rank correlation coefficient (ρ). Results Overall, 100 YouTube and 100 TikTok videos were included. Compared to TikTok, YouTube videos were longer and demonstrated better content quality (DISCERN Q16: U = 6,192, p < 0.001, probability of superiority [PS] = 0.62; total score: U = 6,917, p < 0.001, PS = 0.69) but not understandability (U = 4,823, p = 0.67, PS = 0.48), while actionability scores were low across both platforms. The most frequently discussed procedures were Rezum and Aquablation on YouTube, and UroLift and prostatic artery embolization on TikTok. Across the sample, video quality was modestly associated with longer duration (DISCERN Q16: ρ = 0.48, p < 0.01; total score ρ = 0.53, p < 0.01) and slightly more views and likes. Conclusion YouTube and TikTok videos about MISTs for BPO are of adequate understandability, but with suboptimal quality and actionability. Overall, YouTube videos tend to score significantly higher than TikTok ones.
The aim of this study was to review the current state of molecular testing in metastatic prostate cancer (mPC), including testing modalities, approaches and strategies, and practical ways to implement testing into patient care of candidates for treatment with poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi). We performed a narrative review of publications, over a 15-year period, reporting on the use of testing modalities for biomarker identification in patients with homologous recombination repair (HRR) gene–altered mPC, with a focus on next-generation sequencing (NGS), variability among NGS assays, and their ability to detect certain types of genomic alterations. While NGS has become the most common modality for HRR gene testing, substantial variability among assays to detect certain types of genomic alterations exists. Tumor tissue remains the gold standard for somatic alteration evaluation; however, circulating tumor DNA (ctDNA)–based testing is minimally invasive and an alternative when tissue is unavailable. Nevertheless, both tissue- and ctDNA-based testing modalities face challenges pertaining to disease characteristics, sample acquisition, processing, storage, and the influence of treatment status, which may affect success rates, as well as the likelihood of false-negative and false-positive results. Additionally, choices surrounding germline and somatic testing have important implications for the utility and interpretation of biomarker test results. The adoption of HRR gene mutation testing in mPC remains suboptimal, highlighting a need to identify patients who may benefit from targeted PARPi therapy. The benefits and challenges of various molecular testing approaches using tissue or ctDNA and strategies in patients with mPC must be fully understood to use a practical approach to the integration of molecular biomarker testing.
Background:To identify predictive factors of false-positive results in men with Prostate Imaging-Reporting and Data System (PI-RADS) 4 lesions on multiparametric MRI and to evaluate potential factors for improving risk stratification in this high-risk category. Methods:We retrospectively analyzed 811 men with PI-RADS 4 lesions who underwent prostate biopsy (November 2020-February 2025). Clinical data [age, PSA, PSA density (PSAD), prostate volume] and radiographic features {anatomical location [peripheral zone (PZ) vs. transitional zone (TZ)], multiplicity} were assessed. Multivariate logistic regression analysis identified independent predictors of false-positive results. Interaction between location and multiplicity was evaluated for zone-specific risk profiles. Results:Of the 811 patients, 523 (64.5%) had benign pathology (false-positive). Independent predictors of false-positive results included younger age, lower PSAD, prior negative biopsy, and TZ location. TZ lesions had significantly higher odds of a false-positive result compared to PZ lesions (OR: 6.919, 95% CI: 4.440-10.781, P < 0.001). A divergent pattern was observed between location and multiplicity: in the PZ, multiplicity did not affect cancer risk, whereas in the TZ, multiple lesions showed a trend toward benign pathology (P = 0.087), with the lowest predicted cancer probability (10.0%) in patients with multiple TZ lesions. Conclusion:False-positive PI-RADS 4 assessments were associated with features characteristic of BPH, particularly TZ localization and lower PSAD. Current biopsy recommendations may be suboptimal for patients with these benign-favoring features. Incorporating lesion localization and volume-adjusted metrics into risk stratification could potentially reduce unnecessary biopsies.
Background: The aim of this study was to evaluate and compare the efficacy and safety of transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) for treating benign prostatic hyperplasia using standardized multicenter data. Materials and methods: We retrospectively collected data from six Korean hospitals using the Common Data Model and performed a meta-analysis. Patients were categorized into TURP (control) and HoLEP (experimental) groups, and risk ratios were calculated to compare postoperative outcomes and complications. Sensitivity analyses were conducted by sequentially excluding each hospital’s data to assess the robustness of the findings. Results: HoLEP was associated with significantly lower reoperation and transfusion rates, as well as reduced postoperative use of medications (including alpha-blockers and 5-alpha reductase inhibitors), compared to TURP. Conversely, beta-3 agonist usage was notably higher in the HoLEP group, suggesting the need for further investigation in this area. Sensitivity analyses confirmed that the overall results remained robust across individual hospital exclusions. Conclusions: The meta-analysis demonstrates that HoLEP offers superior efficacy and safety over TURP for benign prostatic hyperplasia treatment, particularly by reducing reoperation and transfusion rates and lowering long-term medication dependency. These findings support the clinical adoption of HoLEP as a viable alternative to TURP, although the increased beta-3 agonist usage in the early postoperative period merits further study.
