OBJECTIVE:Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is a novel staging modality for prostate cancer (PCa) patients with a high positive predictive value for lesions within and outside of the prostate. To assess the ability of the maximum standardized uptake value (SUVmax) at PSMA PET/CT to predict adverse pathology at radical prostatectomy (RP). MATERIAL AND METHODS:Within a high-volume center database, we identified intermediate and high-risk PCa patients who had a PSMA PET/CT with an available intraprostatic SUVmax before RP between 2016 and 2021. Logistic regression modeling was used to test for the ability of SUVmax to predict non-organ confined disease or adverse pathology (non-organ confined and/or Gleason grade group ≥3) during RP. Kaplan-Meier analyses were used to compare biochemical recurrence (BCR)-free survival after RP stratified according to SUVmax. RESULTS:Overall, 544 patients were identified. Of those, median lesional intraprostatic SUVmax was 9.5 at PSMA PET/CT. Median PSA was 8.1 ng/ml prior to RP. 50.7% vs. 49.3% had D'Amico intermediate and high-risk characteristics. Median follow-up was 24.6 months. BCR-free survival at 48 months after RP was 72.1% vs. 62.2% (p = 0.03) for patients with SUVmax <9.5 vs. SUVmax ≥9.5 at PSMA PET. In logistic regression models, SUVmax (continuously coded and stratified in <9.5 vs. ≥9.5) represented an independent predictor for non-organ confined disease and adverse pathology. CONCLUSIONS:SUVmax ≥9.5 at PSMA PET/CT is an independent predictor of adverse pathology at RP. Moreover, it is associated with worse BCR-free survival after RP.

To test the impact of fixing a peritoneal flap of the bladder to the plexus Santorini as final step of robot-assisted radical prostatectomy (RARP) to reduce the incidence of symptomatic lymphoceles and postoperative complications. A two-armed prospective randomised, controlled, single-centre trial on 1080 patients with prostate cancer who underwent RARP with bilateral pelvic lymph node dissection was carried out. Patients in the intervention arm received fixation of the peritoneal flap of the bladder to the plexus Santorini at the end of surgery (Michl-technique, MT); in the control group, surgery was performed without this modification. The primary endpoint was the rate of lymphoceles requiring intervention. Secondary endpoints were total lymphocele rate, other complications ≥ grade IIIa according to Clavien-Dindo and continence rates within one year after RARP. Overall, between June 2017 and October 2019, 531 patients were randomised to the MT and 549 to the control arm. There were no differences in both arms with respect to age at surgery, PSA, BMI, prostate volume, surgical time, blood loss, and time to removal of the catheter. Overall, in median 14 lymph nodes were dissected and 337 (32

Background and objective: Stockholm3 is a comprehensive blood test amalgamating protein biomarkers, genetic indicators, and clinical data to predict clinically significant prostate cancer risk (International Society of Urological Pathology grade >= 2 upon biopsy). Our study aims to externally validate Stockholm3 and compare its performance with the use of prostate-specific antigen (PSA) and the Rotterdam Prostate Cancer Risk Calculator (RPCRC) for clinically significant prostate cancer detection. Methods: We gathered data from men subjected to prostate biopsies at the Martini-Klinik, Germany, between 2014 and 2017. Participants were selected based on elevated PSA levels or suspicious digital rectal examinations, all undergoing a 10-12-core systematic biopsy without a magnetic resonance imaging-targeted biopsy. We assessed Stockholm3 and RPCRC performance for clinically significant prostate cancer detection. Furthermore, we compared the proportion of men recommended for biopsy and biopsy outcomes with Stockholm3 and RPCRC against PSA >= 3 ng/ml. Key findings and limitations: Our study encompassed 405 biopsied men, with a median age of 66 yr (interquartile range [IQR]: 60-72), PSA levels at 7 ng/ml (IQR: 5.2-10.8), and Stockholm3 scores at 18 (IQR: 10-34). Among them, 128 men (31%) received clinically significant prostate cancer diagnoses. Employing the recommended Stockholm3 threshold (>= 15) could have reduced unnecessary biopsies by 52%, while detecting 92% of clinically significant cases compared with using PSA >= 3 ng/ml as a biopsy criterion. Both Stockholm3 and RPCRC exhibited strong discrimination, with area under the curve values of 0.80 (95% confidence interval [CI]: 0.76-0.85) and 0.75 (95% CI: 0.70-0.80), respectively. Stockholm3 demonstrated good calibration, while RPCRC underestimated the risk compared with observed outcomes. Moreover, Stockholm3 yielded positive clinical net benefits, whereas RPCRC yielded negative net benefits for clinically relevant thresholds. Conclusions and clinical implications: Stockholm3 utilization could detect 92% of clinically significant prostate cancer cases while simultaneously reducing unnecessary biopsies by 52%, compared with the PSA >= 3 ng/ml criterion, based on our analysis within a cohort of men who underwent systematic biopsies. Patient summary: In a German clinical cohort of 405 men, Stockholm3, a blood test for early prostate cancer detection, exhibited favorable clinical benefits. It identified a substantial number of clinically significant cases while reducing unnecessary biopsies by over half in men without the disease and those with clinically nonsignificant prostate cancer. (c) 2024 Published by Elsevier B.V. on behalf of European Association of Urology.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP58)1 May 2024MP58-13 LONG-TERM BIOCHEMICAL RECURRENCE IN PATIENTS WITH LYMPH NODE INVASION UNDERGOING RADICAL PROSTATECTOMY AND LYMPH NODE DISSECTION Felix Preisser, Raisa S. Abrahms-Pompe, Markus Graefen, and Derya Tilki Felix PreisserFelix Preisser , Raisa S. Abrahms-PompeRaisa S. Abrahms-Pompe , Markus GraefenMarkus Graefen , and Derya TilkiDerya Tilki View All Author Informationhttps://doi.org/10.1097/01.JU.0001008852.83523.41.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the probability of long-term biochemical recurrence (BCR)-free survival in patients with lymph node invasion (LNI) during radical prostatectomy (RP) and lymph node dissection (LND). METHODS: Patients with LNI during RP and LND from 1996 to 2017 were identified. Kaplan-Meier analyses and Cox regression models were used to test for the risk of biochemical recurrence (BCR) after RP. Patients with neo-/adjuvant hormone therapy or adjuvant radiotherapy (defined as radiotherapy within the first six months after RP) were excluded. BCR was defined as PSA-value >0.2 ng/ml. RESULTS: Of 16.674 patients with RP and LND, 941 had LNI, 618 (65.7%), 150 (15.9%) and 173 (18.4%) had one, two and three or more positive lymph nodes. Median number of removed lymph nodes was 17 (interquartile range: 11-25). Of patients with available PSA-value in the first three months, 36.4% vs. 63.6% had persistent vs. undetectable PSA after RP. Median follow-up was 37.6 months for patients without BCR and median time to BCR was 32 months. At 60 months after RP, BCR-free survival was 37.8% for the overall cohort, 41.7%, 34.8% and 26.4% for patients with one, two and three or more positive lymph nodes and 48.1% vs 10.1% for patients with undetectable vs. persistent PSA, respectively. In multivariable models, undetectable PSA (HR: 0.17, p<0.001), number of positive lymph nodes (HR: 1.05, p=0.04) and ISUP grade group 4-5 (HR: 1.90, p<0.01) were predictors for BCR. The number of men needed to be treated with LND to prevent one BCR at 60 months was 102. CONCLUSIONS: Patients with LNI during RP have a high-risk of long-term BCR and only few remain free of BCR. A large number of LND procedures is needed to achieve one possible cure in men with lymph node metastasis. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e952 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Felix Preisser More articles by this author Raisa S. Abrahms-Pompe More articles by this author Markus Graefen More articles by this author Derya Tilki More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract Introduction/Objective Although most prostate cancers behave in an indolent manner, a small proportion is highly aggressive. Both primary and advanced prostate cancer is widely known as a non-inflamed cancer that is characterized by a paucity of immune infiltration. Methods/Case Report To assess the spatial interplay of more than 30 TIM3, CTLA-4, PD-1/-L1 expressing leukocyte subpopulations in 453 prostate cancers, tissue microarrays were stained with 21 antibodies using our BLEACH&STAIN multiplex fluorescence immunohistochemistry approach and analyzed using a deep learning-based image analysis framework. Results (if a Case Study enter NA) The immune cell density of CD8+ cytotoxic T-cells, CD4+ T-helper cells, FOXP3+ regulatory T-cells, M1/ M2 macrophages, as well as CD11c+ dendritic cells increased consistently along with the Gleason grade in primary prostate cancer (p≤ 0.034 each). In recurrent prostate cancers under therapy, the density of FOXP3+regulatory T-cells and M1 macrophages further increased, while the density of CD8+ cytotoxic T-cells, CD4+ T-helper cells, as well as CD11c+ dendritic cells decreased (p≤0.017 each). Although the immune checkpoint expression of TIM3 on T-cell subsets, macrophages and dendritic cells was upregulated in advanced/ recurrent tumors, the expression level of PD-1 was downregulated in all analyzed T-cell subsets. Conclusion Although prostate cancer is a generally considered a low inflamed tumor, the degree of tumor infiltration by various immune cell subtypes increases markedly along with tumor progression and in recurrent tumors under therapy. Taken together, these data suggest that the evaluation of the spatial distribution of immune cell types along with their immune checkpoint expression can provide relevant clinical information in prostate cancer.

In der Vergangenheit dominierte der IIEF‑5 (International Index of Erectile Function) zur Abbildung der erektilen Funktion bei Prostatakrebspatienten. Internationalen Entwicklungen folgend wird in Deutschland in den letzten Jahren mehr und mehr die Domäne „Sexualität“ des EPIC-26 (Expanded Prostate Cancer Index Composite 26) eingesetzt. Ziel dieser Arbeit ist es, für die Versorgung in Deutschland eine praktikable Vergleichsmöglichkeit der Domäne „Sexualität“ des EPIC-26 mit dem IIEF‑5 zu schaffen. Dies ist insbesondere für die Auswertung von historischen Patientenkollektiven notwendig. Für die Auswertung berücksichtigt wurden 2123 Patienten mit einem stanzbioptisch gesicherten Prostatakarzinom der Jahre 2014 bis 2017, die sowohl den IIEF‑5 und den EPIC-26 ausgefüllt haben. Zur Umrechnung der IIEF-5-Summenscores in Werte der EPIC-26-Domäne „Sexualität“ werden lineare Regressionsanalysen berechnet. Die Korrelation zwischen IIEF‑5 und dem Domänenscore „Sexualität“ des EPIC-26 betrug 0,74, was eine hohe inhaltliche Konvergenz der gemessenen Konstrukte nahelegt. Während der Standardfehler der vorhergesagten Werte relativ klein ist, sind die Vorhersageintervalle sehr breit. Es ergibt sich zum Beispiel für den kritischen IIEF-5-Wert von 22 ein vorhergesagter Wert von 78,88 bei einem 95

Purpose: To evaluate the association between radical cystectomy (RC) and cancer-specific mortality (CSM) in patients diagnosed with adenocarcinoma of the bladder (ACB). Moreover, to directly compare the survival advantage of RC between ACB vs. urothelial bladder cancer (UBC). Materials and Methods: Non-metastatic muscle-invasive ACB and UBC patients were identified within Surveillance, Epidemiology, and End Results database (SEER 2000-2018). All analyses were stratified between RC vs. no-RC, in either organ-confined (OC: T2N0M0) or non-organ-confined (NOC: T3-4N0M0 or TanyN1-3M0) stages. Propensity score matching (PSM), cumulative incidence plots, competing risks regression (CRR) analyses, and 3 months' landmark analyses were performed. Results: Overall, 1,005 ACB and 47,741 UBC patients were identified, of whom 475 (47%) and 19,499 (41%) were treated with RC, respectively. After PSM, comparison between RC vs. no-RC applied to 127 vs. 127 OC-ACB, 7,611 vs. 7,611 OC-UBC, 143 vs. 143 NOC-ACB, and 4,664 vs. 4,664 NOC-UBC patients. 36-month CSM rates in RC vs. no-RC patients were 14 vs. 44% in OC-ACB, 18 vs. 39% in OC-UBC, 49 vs. 66% in NOC-ACB, and 44 vs. 56% in NOC-UBC patients. In CRR analyses, the effect of RC on CSM yielded a hazard ratio of 0.37 in OC-ACB, of 0.45 in OC-UBC, of 0.65 in NOC-ACB and of 0.68 in NOC-UBC patients (all P values<0.001). Landmark analyses virtually perfectly replicated the results. Conclusions: In ACB, regardless of stage, RC is associated with lower CSM. The magnitude of this survival advantage was greater in ACB than in UBC, even after control for immortal time bias. (C) 2023 Elsevier Inc. All rights reserved.