Objective:To compare the early and long-term recovery outcomes of post-prostatectomy incontinence (PPI) among patients undergoing Retzius-sparing robotic-assisted laparoscopic prostatectomy (RS-RARP), conventional 2-layer reconstruction, and conventional 3-layer total reconstruction. Methods:We conducted a retrospective cohort study of 79 patients who underwent RARP by at a single tertiary center. Patients were grouped as RS-RARP (n=19), 2-layer RARP (n=30), and 3-layer RARP (n=30). The primary outcome was PPI recovery, defined as "pad-free", which was evaluated at immediate, 1, 3, and 6 months after RARP to distinguish between early (immediate/1 month) and long-term (3/6 months) outcomes. Secondary outcomes included cystographic parameters like bladder neck (BN) angle and BN downward distance. Statistical analysis utilized ANOVA and Chi-square tests, with p<0.05 considered significant. Results:All three groups achieved excellent long-term continence rates (≥96.7% at 6 months, p=0.723). The RS-RARP group demonstrated a borderline statistical advantage of early PPI recovery at the immediate timepoint (89.5% vs. 60.0% in the other two groups, p=0.049). A similar favorable clinical trend was observed at the 1-month follow-up, though the difference did not reach statistical significance (p=0.251). Cystographic analysis revealed a significant difference in mean BN angle (p=0.001): 128.5∘for RS-RARP, 107.7∘for 2-layer RARP, and 120.1∘for 3-layer RARP. Conclusion:All three RARP techniques yield excellent long-term continence rates. RS-RARP demonstrated a favorable advantage in immediate PPI recovery, which supports the benefit of anterior structure preservation. However, the observed significant anatomical difference in BN angle did not translate into a statistically significant functional difference in long-term PPI recovery, highlighting the multifactorial etiology of continence restoration.

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:This study evaluated the impact of varying systematic biopsy (SB) core numbers on the detection rates of prostate cancer (PCa) and clinically significant PCa (csPCa) in men with magnetic resonance imaging (MRI)-suspicious lesions undergoing MRI-ultrasound fusion biopsy; and to assess biopsy-related complications. Methods:This retrospective, non-randomized cohort study included 356 patients who underwent multi-parametric MRI followed by MRI-ultrasound fusion targeted biopsy (TB) combined with SB for suspected PCa (Prostate Imaging Reporting and Data System score ≥ 3). Patients were divided into two groups based on the number of SB cores received: ≤ 6 SB cores (n = 200) and > 6 SB cores (n = 156). Primary outcomes were overall PCa and csPCa (Gleason Grade Group ≥ 2) detection rates. Secondary outcomes included the added diagnostic value of SB for csPCa, SB upgrading rates, and post-biopsy complications. Results:No significant difference was observed in the overall PCa detection rate between the ≤ 6 cores and > 6 cores groups (58.0% vs 50.0%, P = 0.081) or in the overall csPCa detection rate (42.5% vs 37.2%, P = 0.182). The added diagnostic value of SB for csPCa detection (3.0% vs 3.8%, P = 0.439) and SB upgrading rate (7.0% vs 9.6%, P = 0.241) were comparable between the groups. However, the complication rate was significantly lower in the group receiving ≤ 6 SB cores compared to that receiving the > 6 SB cores (15.5% vs 26.3%, P = 0.009). Subgroup analysis indicated that SB provided significantly higher added value for csPCa detection in older patients (≥ 67 years; 5.3% vs 1.6%, P = 0.049). Multivariable logistic regression demonstrated that receiving >6 SB cores was not significantly associated with increased detection of csPCa. Conclusion:These findings seem support optimizing and potentially reducing the systematic component of combined biopsy. Further prospective studies are warranted to confirm these results and refine personalized biopsy protocols.

Introduction The diagnosis and treatment of prostate cancer often disrupt patients’ and their spouses’ established family lives, requiring them to reestablish a sense of balance. This study aims to develop and evaluate a dyadic co-learning intervention derived from the activation-reinforcement-adjustment theory of family resilience for patients with prostate cancer and their spouses.Methods and analysis An experimental study design was employed. Prostate cancer patients and their spouses (n=60 pairs) will be recruited from the outpatient department. Following baseline assessment, participants will be randomly assigned to either the intervention group or the control group (1:1). The intervention group receives an 8 week dyadic co-learning intervention and usual care, whereas the control group receives usual care. All participants complete follow-up assessments at 10 weeks and 16 weeks after the pretest. Structured questionnaires included the Resilience Scale, the Walsh Family Resilience Questionnaire, the Loneliness Scale, the Chinese Happiness Inventory, the Brief Fatigue Inventory and the Expanded Prostate Cancer Index Composite. Statistical analyses include independent-samples t tests, χ2 tests and mixed linear models.Ethics and dissemination This study protocol was approved by the Chang Gung Medical Foundation Institutional Review Board (No. 202 202 198B0). The study findings will be disseminated through international conferences and publication in peer-reviewed journals.Trial registration number ClinicalTrials.gov ID: NCT07196488 (First Submitted 2025-09-06).

This study aimed to investigate the role of concurrent transurethral resection of prostate with high-intensity focused ultrasound treatment in decreasing the early post-operative complications. A retrospective study was conducted in Linkou Chang Gung Memorial Hospital, a tertiary medical center in Taiwan. Patients with localized prostate cancer who underwent 1 session of high-intensity focused ultrasound treatment between January 2021 and December 2023 were included. Primary outcome analyzed was the short-term complication of acute urinary retention at 6 months. Propensity score matching was utilized to reduce possible confounding factors and bias. A total of 83 patients, with 33 patients receiving high-intensity focused ultrasound treatment only and 50 patients receiving concurrent transurethral resection of prostate with high-intensity focused ultrasound treatment, were included in the analysis. Concurrent transurethral resection of prostate treatment group achieved a significantly lower incidence of acute urinary retention, with no increase in other post-operative complication. The present study showed that concurrent transurethral resection of prostate with high-intensity focused ultrasound treatment achieved a superior functional outcome with a lower incidence of acute urinary retention. This finding may prompt physicians in treating prostate cancer patients with higher risks of bladder outlet obstruction to consider performing concurrent transurethral resection of prostate with high-intensity focused ultrasound treatment.

The DAVINCI SP system is an advanced robotic surgery platform allowing an endoscope and three articulated instruments to enter the body through a single incision while maintaining workspace triangulation. This open-label, single-arm clinical trial (ClinicalTrials.gov Identifier: NCT05403190 18/05/2022) evaluates the feasibility of using the DAVINVI SP system for extraperitoneal-approach robot-assisted radical prostatectomy (RaRP) in Taiwan. Two surgical techniques, the conventional anterior approach and the Hood technique, were used for RaRP. The primary endpoint was the success rate of RaRP with the DAVINCI SP system without conversion to multiport RaRP or open surgery. Secondary endpoints included perioperative variables, oncological outcomes, and functional outcomes. The study achieved a 100% success rate for the primary endpoint. Patients who underwent RaRP with the DAVINCI SP system had lower postoperative pain scores and shorter hospital stays. Additionally, 93.33% did not require a drain tube post-surgery, 80% achieved undetectable PSA levels at six months, and 96.67% regained continence within three months. The oncologic and continence outcomes are comparable between patients receiving conventional anterior approach or Hood technique. In conclusion, the DAVINCI SP system allows an effective extraperitoneal-approach RaRP, offering reduced pain, shorter hospital stays, and low drain tube placement rates.Trial registration: ClinicalTrials.gov (Identifier: NCT05403190 18/05/2022).

Robotic-assisted partial nephrectomy has emerged as the standard surgical procedure for managing localized kidney cancers, with bleeding risk being a primary clinical consideration. This investigation seeks to establish simple predictive indicators for hemorrhage-related adverse events. We performed a retrospective review of sequential patients undergoing robotic-assisted partial nephrectomy at a single tertiary medical center. Patient records and radiographic studies were analyzed to obtain clinical parameters. Tumor characteristics (size, infiltration depth, and standardized nephrometry measurements) were assessed by an experienced radiologist. Bleeding-related outcomes included surgical blood loss, transfusion requirements, reoperation, and need for angiographic intervention. Predictive factors for hemorrhagic events were examined statistically. The study included 260 participants. Median nephrometry scores were 8.5 (PADUA) and 7.0 (RENAL). The average tumor size measured 39.1 mm with a mean penetration depth of 2.02 mm, and the median renal ischemia duration was 25.5 min. Mean operative hemorrhage volume was 147 ml. Transfusion was administered to 12.7

RATIONALE AND OBJECTIVES:Computed tomography (CT) remains the primary modality for assessing renal tumors; however, tumor identification and segmentation rely heavily on manual interpretation by clinicians, which is time-consuming and subject to inter-observer variability. The heterogeneity of tumor appearance and indistinct margins further complicate accurate delineation, impacting histopathological classification, treatment planning, and prognostic assessment. There is a pressing clinical need for an automated segmentation tool to enhance diagnostic workflows and support clinical decision-making with results that are reliable, accurate, and reproducible. MATERIALS AND METHODS:This study developed a fully automated pipeline based on the DeepMedic 3D convolutional neural network for the segmentation of kidneys and renal tumors through multi-scale feature extraction. The model was trained and evaluated using 5-fold cross-validation on a dataset of 382 contrast-enhanced CT scans manually annotated by experienced physicians. Image preprocessing included Hounsfield unit conversion, windowing, 3D reconstruction, and voxel resampling. Post-processing was also employed to refine output masks and improve model generalizability. RESULTS:The proposed model achieved high performance in kidney segmentation, with an average Dice coefficient of 93.82 ± 1.38%, precision of 94.86 ± 1.59%, and recall of 93.66 ± 1.77%. In renal tumor segmentation, the model attained a Dice coefficient of 88.19 ± 1.24%, precision of 90.36 ± 1.90%, and recall of 88.23 ± 2.02%. Visual comparisons with ground truth annotations confirmed the clinical relevance and accuracy of the predictions. CONCLUSION:The proposed DeepMedic-based framework demonstrates robust, accurate segmentation of kidneys and renal tumors on CT images. With its potential for real-time application, this model could enhance diagnostic efficiency and treatment planning in renal oncology.

Background: Artificial urinary sphincter (AUS) implantation is the gold standard for managing persistent stress urinary incontinence after prostate cancer treatment. However, data on long-term outcomes and risk factors in Asian populations remain limited. Methods: We conducted a multi-institutional retrospective cohort study using the Chang Gung Research Database, the largest healthcare system in Taiwan, to evaluate clinical outcomes and predictors of device survival in men receiving AUS (AMS 800) implantation for incontinence after prostate cancer treatment. Baseline characteristics, perioperative factors, and comorbidities were analyzed. Device failure was defined as explantation, revision, or persistent incontinence. Logistic regression and Cox proportional hazards models were used to identify significant predictors. A nomogram for 5-year device survival was developed and internally validated. Results: A total of 50 patients were included from seven branch hospitals, with a median follow-up of 126.5 months. 5-year and 10-year device survival rates were 94% and 40%, respectively. On multivariable analysis, diabetes was consistently associated with an increased risk of device failure (HR 2.966, 95% CI 1.114–7.900). Lower BMI showed an inverse association in logistic regression (OR 0.608, 95% CI 0.397–0.932), but this did not remain significant in Cox analysis. Prior radiotherapy was not a significant risk factor (HR 0.760, 95% CI 0.264—2.190; OR 0.709, 95% CI 0.074—6.828). The nomogram demonstrated good predictive accuracy for 5-year device survival. Conclusions: AUS implantation demonstrates excellent long-term durability in Taiwanese men with incontinence after prostate cancer treatment. Diabetes consistently predicted device failure, while the role of BMI was less certain. These findings provide valuable long-term evidence on AUS outcomes in an Asian population.

BACKGROUND:Psychological resilience is considered a dynamic process or outcome. Most studies that have examined the psychological resilience of prostate cancer survivors have used cross-sectional designs, limiting the understanding of changes in psychological resilience across different stages of the disease. OBJECTIVES:To investigate changes in psychological resilience and demoralization among newly diagnosed prostate cancer survivors from before treatment to 1 year after treatment initiation as well as the associated influencing factors. METHODS:A longitudinal design was adopted, and cases were collected from the outpatient department. Data collection occurred at four time points: prior to treatment after the treatment decision was made and at 3, 6, and 12 months after treatment. Study variables included demographic characteristics, disease characteristics, physical symptoms, fear of cancer recurrence, social participation, cancer-related self-efficacy, psychological resilience, and demoralization. RESULTS:The psychological resilience and demoralization scores of prostate cancer survivors at 3, 6, and 12 months after treatment were similar to their scores before treatment. Survivors with higher fear of cancer recurrence and lower cancer-related self-efficacy had poorer psychological resilience and more severe demoralization. Severe hormonal symptoms and lower interpersonal relationship activity participation were associated with more severe demoralization in survivors with prostate cancer. CONCLUSIONS:Fear of cancer recurrence, self-efficacy, hormonal symptoms, and interpersonal activity participation are associated with psychological resilience and demoralization. IMPLICATIONS FOR PRACTICE:Assessing psychological resilience and demoralization is crucial in prostate cancer care. Integrated self-management interventions that address physical, psychological, and social aspects can enhance survivors' resilience.

Background/Objective: Prostate cancer (PCa) remains a prevalent and deadly disease, particularly in its advanced stages. Despite various available treatments, resistance to drugs like enzalutamide continues to present significant challenges. This study aimed to investigate the role of Galectin-1 (Gal-1) in enzalutamide-resistant PCa and assess its potential as a therapeutic target to overcome resistance. Methods: The study utilized specific siRNA-mediated knockdown of Gal-1 in enzalutamide-resistant PCa cells to evaluate its effects on cell proliferation and response to enzalutamide treatment. An orthotopic mouse model was employed to examine the in vivo impact of Gal-1 knockdown. Pharmacological targeting of Gal-1 was conducted using LLS30, and its effects were assessed both in vitro and in vivo. RNA sequencing (RNA-seq) analysis was performed to explore the molecular mechanisms underlying the observed effects. Results: The findings demonstrated significant upregulation of Gal-1 in enzalutamide-resistant PCa cells. Gal-1 knockdown inhibited cell proliferation and resensitized resistant cells to enzalutamide treatment in the orthotopic mouse model. Elevated levels of androgen receptor full-length and AR-V7 are key mechanisms under-lying resistance to enzalutamide in PCa. Gal-1 knockdown suppressed AR and AR-V7 expression and their transcriptional activity. Treatment with LLS30 significantly suppressed the growth of enzalutamide-resistant PCa cells and exhibited synergistic effects when combined with enzalutamide. Notably, this combination therapy significantly inhibited the growth of enzalutamide-resistant xenografts in vivo. RNA-seq analysis revealed that LLS30 modulates AR and AR-V7 signaling through the inhibition of associated target genes. Conclusion: These findings highlight Gal-1 as a promising therapeutic target for overcoming enzalutamide resistance in PCa. Targeting the Gal-1/AR/AR-V7 axis with LLS30 presents a novel strategy to enhance enzalutamide efficacy and address drug resistance in advanced PCa.

PURPOSE:To assess the feasibility, acceptability, and effectiveness of an app-assisted self-management intervention for urinary incontinence (App-SMI-UI) in men with prostate cancer. METHODS:We recruited men (n = 85) who had been diagnosed with prostate cancer and experienced urinary incontinence following radical prostatectomy. Participants were randomly assigned to the self-management group (n = 43) or the attrition control group (n = 42). The self-management group underwent a 12-week App-SMI-UI while the control group received a single session of multimedia dietary information. Data was collected at baseline, week 12, and week 16. The variables measured were cancer-related self-efficacy, urinary symptoms, social participation, demoralization, resilience, and satisfaction with the intervention. RESULTS:Compared to the control group, the self-management group had fewer urinary symptoms and a higher willingness to engage in and satisfaction with social activity participation at week 12. By week 16, the self-management group exhibited higher cancer-related self-efficacy, greater participation in interpersonal relationship activities, and continued willingness to engage in and satisfaction with social activity participation. CONCLUSION:The App-SMI-UI contributes to improving urinary symptoms, self-efficacy, and social participation among men with prostate cancer. Healthcare providers can use self-management programs to manage urinary incontinence and support prostate cancer men.

BackgroundThis study employed a convolutional neural network (CNN) to analyze computed tomography (CT) scans with the aim of differentiating among renal tumors according to histologic sub-type.MethodsContrast-enhanced CT images were collected from patients with renal tumors. The patient cohort was randomly split to create a training dataset (90%) and a testing dataset (10%). Following image dataset augmentation, Inception V3 and Resnet50 models were used to differentiate between renal tumors subtypes, including angiomyolipoma (AML), oncocytoma, clear cell renal cell carcinoma (ccRCC), chromophobe renal cell carcinoma (chRCC), and papillary renal cell carcinoma (pRCC). 5-fold cross validation was then used to evaluate the models in terms of classification performance.ResultsThe study cohort comprised 554 patients, including those with angiomyolipoma (n = 67), oncocytoma (n = 34), clear cell renal cell carcinoma (n = 246), chromophobe renal cell carcinoma (n = 124), and papillary renal cell carcinoma (n = 83). Dataset augmentation of the training dataset included this to 4238 CT images for analysis. The accuracy of the models was as follows: Inception V3 (0.830) and Resnet 50 (0.849).ConclusionThis study demonstrated the efficacy of using deep learning models for the classification of renal tumor subtypes from contrast-enhanced CT images. While the models showed promising accuracy, further development is necessary to improve their clinical applicability.