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.
