Postoperative biochemical recurrence (BCR) of prostate cancer (PCa) remains a major clinical challenge, and traditional risk assessment systems show suboptimal predictive performance for PCa recurrence. This study aimed to develop and validate interpretable machine learning (ML) models for predicting PCa postoperative recurrence by integrating multi-dimensional clinical features, and to construct a simplified and practical prognostic model for individualized risk stratification. A total of 320 PCa patients (125 recurrences vs. 195 non-recurrences) who underwent laparoscopic radical prostatectomy (LRP) at the primary center were retrospectively enrolled as the internal cohort, and 144 patients (50 recurrences vs. 94 non-recurrences) from another campus were included as the external validation cohort. Ten ML algorithms were used to construct prediction models with clinicopathological, preoperative hematological and nutrition-inflammation features. Stratified sampling and ten-fold cross-validation were used for model training and validation, and SHAP analysis was adopted for feature importance evaluation and model interpretability. Recursive feature inclusion was performed to optimize the model, and clinical cutoffs of key indicators were determined. The gradient boosting machine (GBM) model achieved the best predictive performance in the internal cohort with an AUC of 0.891, which was significantly superior to the UCSF-CAPRA score (AUC = 0.703) and the D’Amico classification (AUC = 0.610). A simplified 5-feature GBM model [positive surgical margin, preoperative hemoglobin-albumin-lymphocyte-platelet (HALP) score, postoperative Gleason score, preoperative maximum prostate specific antigen, preoperative lactate dehydrogenase (LDH)] achieved an AUC of 0.912 in the internal cohort and 0.895 in the external cohort, with excellent calibration and higher net clinical benefit. The optimal cutoffs were 41.31 for preoperative HALP score and 182.61 U/L for preoperative LDH. Low HALP was associated with shorter recurrence-free survival (HR = 0.30, P < 0.0001), and high LDH indicated increased recurrence risk (HR = 1.37, P = 0.083). A three-tier risk stratification system was established based on the cutoff values to predict postoperative recurrence risk. The ML model integrating preoperative HALP score, LDH and core clinicopathological features has high accuracy and good clinical applicability for predicting PCa postoperative recurrence. Validated successfully in both internal and external cohorts, the 5-feature simplified model can serve as a practical tool for individualized recurrence risk assessment, facilitating optimized clinical management of PCa patients.

INTRODUCTION:Catheter-related bladder discomfort (CRBD) is a common and distressing complication after transurethral prostate surgery (TUPS). Many patients experience moderate to severe symptoms, which may delay recovery and reduce patient satisfaction. Currently, there are no standardised expert consensus statements or international guidelines for CRBD management. The ultrasound-guided anterior approach of sacral plexus block (anterior SPB) is a novel regional anaesthesia technique that may reduce CRBD through effects on multiple neural pathways. This trial is designed to evaluate the efficacy and safety of this technique in patients undergoing TUPS. METHODS AND ANALYSIS:This randomised, double-blind, placebo-controlled trial will enrol 90 male patients aged 50-80 years who are scheduled for elective TUPS under general anaesthesia. Participants will be randomly assigned (1:1) to receive either bilateral anterior SPB with 0.25% ropivacaine (20 mL per side) or saline placebo after anaesthesia induction. The primary outcome is the incidence of moderate-to-severe CRBD within 24 hours postoperatively. Secondary outcomes include the overall incidence and severity of CRBD, postoperative pain scores, rescue analgesia requirement, opioid consumption, emergence agitation, time to ambulation, quality of recovery, patient satisfaction and length of hospital stay. Safety outcomes include block-related, surgery-related and systemic adverse events. Data will be analysed using both modified intention-to-treat and per-protocol approaches. ETHICS AND DISSEMINATION:Ethical approval was obtained from the Ethics Committee of Beijing Chaoyang Hospital Affiliated to Capital Medical University on 25 April 2025 (2025-Ke-405-1). The results will be disseminated through peer-reviewed publications and presentations at academic conferences. TRIAL REGISTRATION NUMBER:ChiCTR2500102595.

OBJECTIVE:To evaluate the efficacy and safety of Xia Li Qi capsules (XLQ) for benign prostatic hyperplasia (BPH) and explore its mechanisms of action involving the p38-Janus kinase/signal transducer and activator of transcription (p38-JAK/STAT) pathway. METHODS:In this randomised controlled trial, 115 patients with BPH received XLQ (n = 58) or placebo (n = 57) for 8 weeks. The primary endpoint was change in International Prostate Symptom Score (IPSS) from baseline to Week 8; secondary endpoints included the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), maximum urinary flow rate (Qmax), mean urinary flow rate (Qave), prostate volume, post-void residual urine volume, quality of life (QOL), and the International Index of Erectile Function-5 (IIEF-5). Baseline-adjusted analysis of covariance (ANCOVA) was performed for between-group comparisons. In vitro, experiments using BPH-1 cells were conducted to assess cell proliferation, inflammatory cytokines levels, androgen receptor (AR)-related genes, and p38-JAK1-STAT3 signalling. RESULTS:Both groups showed significant improvements in IPSS, NIH-CPSI, Qmax, Qave, and QOL (all p < 0.001). No significant between-group differences in IPSS or NIH-CPSI after adjustment. At Week 8, Qmax and Qave were significantly higher in the XLQ group (both p < 0.001), with reduced residual urine volume (p = 0.010). QOL improvement favoured XLQ before correction (p = 0.018) but did not survive multiple-comparison correction; prostate volume and IIEF-5 were unchanged. In vitro, XLQ inhibited BPH-1 proliferation, reduced interleukin (IL)-6, IL-1β, and tumour necrosis factor-α (TNF-α), suppressed AR-related gene expression, and decreased the phosphorylation of p38, JAK1, and STAT3 phosphorylation; these effects were partially reversed by p38 activation. CONCLUSIONS:XLQ improves urinary function in BPH patients, potentially by the inhibiting of inflammation and AR signalling via the p38-JAK/STAT axis. CLINICAL TRIAL REGISTRATION:The study was registered at Clinicaltrial.gov (https://www.chictr.org.cn/showproj.html?proj=14405), registration number: (ChiCTR1900022393).

ObjectiveTo study the expression of KLK3, FOLH1, and PCA3 in pelvic lymph nodes of prostate cancer (PCa) patients and the relationship between molecular level detection of lymph nodes and biochemical recurrence (BCR).MethodsA retrospective selection of 26 PCa patients with mediate and high risk undergoing radical prostatectomy combined with pelvic lymph node dissection in the same treatment group of the Department of Urology, Beijing Chaoyang Hospital from April 2021 to August 2022. The expression of prostate cancer-specific molecular biomarkers KLK3, FOLH1, and PCA3 in 59 lymph nodes were detected by polymerase chain reaction (PCR), and 11 pelvic lymph nodes from 7 patients undergoing radical cystectomy were used as controls. The threshold was determined based on the average relative expression of each gene. The biochemical recurrence-free survival (BRFS) was determined through postoperative follow-up, and the Kaplan-Meier survival curve was used to compare the BRFS of different lymph node metastasis (LNM) levels (pN0molN0, pN0molN1, pN1molN1).ResultsA total of 59 lymph nodes obtained from 26 patients were tested. Histopathological examination before the experiment confirmed that 10 patients had LNM. PCR molecular analysis confirmed that in 10 metastatic lymph nodes (pN1molN1) of 10 patients with LNM, the expression of KLK3, FOLH1, and PCA3 genes increased. Of the 26 patients, 5 had BCR. Molecular lymph node analysis can improve the sensitivity of predicting BCR compared to pathological diagnosis. The level of LNM is related to the patient's BRFS.ConclusionPCR analysis of KLK3, FOLH1, and PCA3 expression enables the molecular detection of lymph-node metastasis and, when combined with standard histopathological examination, improves the accuracy and sensitivity of lymph-node staging. It also refines risk stratification for postoperative BCR, particularly by identifying pathologically node-negative patients at increased risk. Molecular lymph-node assessment based on these markers may therefore serve as a useful prognostic tool to guide adjuvant treatment decisions, although larger prospective studies are needed to validate these findings.

The objective of this study is to evaluate the clinical presentations, treatment strategies, and prognostic factors for prostate diffuse large B-cell lymphoma (DLBCL), aiming to improve patient management and outcomes. We conducted a retrospective analysis of four prostate DLBCL cases treated at Beijing Chaoyang Hospital between 2014 and 2024, integrating these findings with data from the surveillance, epidemiology, and end results (SEER) dataset (2000-2021) to provide a broader context. All four patients underwent thorough diagnostic evaluations, and immunohistochemistry (IHC) confirmed their diagnoses. Kaplan-Meier survival curves and Cox regression analysis were applied to the SEER dataset to assess overall survival and treatment efficacy. P-values below 0.05 considered statistically significant. All four patients were diagnosed with prostate DLBCL via biopsy and confirmed by IHC, with extraprostatic involvement in three cases. Two patients achieved complete response, and one had partial response. In the SEER database, Kaplan-Meir analysis found that 59 patients had a 5-year survival rate of 59 months when it dropped in half, while multi-variable Cox regression highlighted age (HR 10.45, p < 0.001), surgery (HR 0.38, p = 0.0292), and radiation (HR 0.35, p = 0.0212) as the survival predictors. Although chemotherapy was administered in clinical practice, its impact was not statistically significant in our analysis. Prostate DLBCL is aggressive with diverse clinical presentations, making early detection and personalized treatment essential. Surgery and radiotherapy significantly improve patient outcomes, but the prognostic impact of chemotherapy, despite its widespread use, requires further validation through clinical trials.

Background and objective:Benign prostatic hyperplasia (BPH) is a major cause of lower urinary tract symptoms (LUTS) in men aged ≥50 yr. Xialiqi capsules are a traditional Chinese medicine mainly used for the treatment of moderate BPH-related LUTS. Methods:We conducted a multicenter, randomized, double-blind, placebo-controlled clinical trial of Xialiqi treatment for 8 wk in a cohort of 395 patients. Changes in BPH-related LUTS were assessed in terms of the International Prostate Symptom Score (IPSS). Irritative and obstructive IPSS subscores and secondary efficacy indicators, including quality of life (QoL) and International Index of Erectile Function (IIEF-5) scores, were also assessed. Safety and tolerability were assessed in terms of adverse events (AEs) and serious AE. Key findings and limitations:At the final time point of 8 wk, the least-squares treatment difference in IPSS between the Xialiqi and placebo groups was -2.33 (95% confidence interval -3.01 to -1.64). Analysis of covariance results suggested that there was no significant difference between the groups in terms of interactions of subgroups or between parameter subgroups. Results for secondary efficacy measures, including Chronic Prostatitis Symptom Index and QoL scores, revealed greater improvement with Xialiqi than with placebo. Safety results show that Xialiqi was well tolerated and AEs were mild. Limitations include the lack of long-term follow-up. Conclusions and clinical implications:Xialiqi was associated with an improvement in LUTS over an 8-wk period among men with moderate BPH symptoms. Patient summary:We looked at the safety and efficacy of Xialiqi capsules for the treatment of benign enlargement of the prostate gland in a large Chinese population. We found that Xialiqi provides an early improvement in urinary symptoms and prostate enlargement in men with moderate symptoms relating to an enlarged prostate.

To evaluate the feasibility and diagnostic accuracy of indocyanine green (ICG)-guided pelvic lymph node dissection (PLND) during laparoscopic radical prostatectomy, and compare the lymph node detection rate and 3-year biochemical recurrence (BCR) rate between PLND and ICG-guided PLND. Sixty-eight patients were randomly divided into intervention and control groups (1:1). The intervention group underwent standard pelvic lymph node dissection (sPLND) and fluorescent visible sentinel lymph node dissection (SLND) after an ultrasound-guided injection of ICG (25 mg), while the control group received sPLND without ICG injection. Kaplan–Meier survival curves were used to compare the two groups of patients for BCR at a point three years post-surgery. In the intervention group, 284 lymph nodes were removed, and 58 lymph nodes were visualized by ICG, including 4 positive lymph nodes. In the control group, 205 lymph nodes were removed. There were three cases of ICG leakage and six cases of lymphocele in the intervention group and one case of lymphocele in the control group. The sensitivity and specificity of ICG-guided lymph node dissection was 80.00

To investigate the impact of neoadjuvant hormonal therapy (NHT) on interleukin‑17 A (IL‑17 A) signaling and inflammation in prostate cancer (PCa), and to explore the role of the IL‑17 A/signal transducer and activator of transcription 3 (STAT3) axis in tumor progression after androgen deprivation. Paired prostate tissue samples from 27 patients receiving ≥ 3 months of NHT were analyzed. Histological inflammation was assessed by hematoxylin-eosin staining. Immunohistochemistry was used to evaluate IL-17 A, interleukin‑17 receptor A (IL‑17RA), interleukin‑17 receptor C (IL‑17RC), STAT3, and androgen receptor (AR). Statistical analyses were performed to examine differences in expression and correlations between markers. Chronic inflammation significantly increased in tumor tissues after NHT (P < 0.05). IL-17 A and IL-17RC expression were higher in tumor tissues than adjacent benign tissues (P < 0.001), with further upregulation after NHT (P < 0.05). Longer NHT duration (≥ 6 months) was associated with elevated IL-17 A and IL-17RC levels. IL-17 A expression positively correlated with STAT3 (r = 0.388, P = 0.045), but not with androgen receptor (AR). Prolonged NHT enhances IL-17 A/IL-17RC-mediated inflammation in prostate cancer, potentially promoting tumor progression through STAT3 activation. Targeting the IL-17 A/STAT3 axis may offer therapeutic potential for advanced prostate cancer, although further validation is required before NHT can be incorporated into clinical guidelines.

Objective:To introduce a unique surgical technique, analyze perioperative data to demonstrate the safety of Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) with preservation of the urethral mucosa at the prostatic apex, and construct a learning curve to assess its feasibility and potential for broader clinical application is the aim of this study. Methods:From June 2020 to June 2024, a urologist at Beijing Chaoyang Hospital, with no prior ThuFLEP experience, was trained under the supervision of an experienced chief physician. A retrospective analysis of 100 Benign Prostatic Hyperplasia (BPH) patients treated with ThuFLEP was conducted. Perioperative data were analyzed, including prostate volume, operative time, and enucleation weight. Statistical methods included T-tests, chi-square tests, and linear regression. Learning curves were constructed using Loess regression, with box plots visualizing differences in operative time, efficiency, and enucleation ratio efficacy. Postoperative follow-up assessed changes in IPSS, Qmax, and urinary incontinence. Results:The learning curve analysis showed a significant reduction in operative time after 56 cases. Linear regression indicated a decrease in operative time (R = -0.5, p < 0.01) and improvements in efficiency (R = 0.14, p < 0.01) and enucleation ratio efficacy (R = 0.41, p < 0.01) with increased experience. Comparing the first and last 50 cases, operative time and enucleation efficiency significantly improved (p < 0.01). Postoperatively, 31% of patients experienced incontinence one week after catheter removal, but all recovered within 12 weeks. IPSS scores improved by 13.67 ± 3.99 points. Conclusions:ThuFLEP with urethral mucosa preservation improves efficiency, reduces operative time, and has a manageable learning curve. Attention to complications and structured mentorship are crucial for successful implementation.

This study explores the causal relationship between hematologic parameters and prostate cancer (PCa) risk, offering insights into potential biological pathways and clinical implications. We used genome-wide association studies to perform forward and reverse Mendelian randomization (MR) within a 2-sample framework. Additionally, multivariable MR was employed to assess the associations between multiple hematological markers and PCa. Several sensitivity analyses were conducted to ensure the robustness of the findings. Univariable MR analysis showed that genetically predicted mean corpuscular volume (OR: 0.942, 95% CI: 0.891-0.996, P = .035) and mean corpuscular hemoglobin (OR: 0.934, 95% CI: 0.882-0.988, P = .018) were associated with reduced PCa risk. Conversely, increases in eosinophil (OR: 1.081, 95% CI: 1.005-1.163, P = .036) and basophil counts (OR: 1.235, 95% CI: 1.006-1.516, P = .044) were linked to higher PCa risk. Multivariable MR highlighted a stronger association between basophil count and PCa (OR: 1.432, 95% CI: 1.028-1.996, P = .034). Reverse MR indicated that PCa may increase neutrophil (OR: 1.012, 95% CI: 1.001-1.023, P = .031) and red blood cell counts (OR: 1.008, 95% CI: 1.000-1.016, P = .042). Our findings reveal causal associations between hematological parameters and PCa, improving understanding of the genetic links and potential interactions between these markers and PCa risk.

ObjectiveTo explore the prognostic value of preoperative hematological indicators for prostate cancer (PCa) patients with laparoscopic radical prostatectomy (LRP) and construct a nomogram prediction model based on hematological indicators and clinicopathological characteristics.MethodPCa patients who underwent LRP in Beijing Chaoyang Hospital from January 2017 to December 2022 were retrospectively analyzed. Clinicopathological data and blood indicators, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), red blood cell distribution width (RDW), prognosis nutritional index were compared between non-recurrence and recurrence groups. The NPL-IRS score was inflammatory response system score based on the cut-off values NLR, PLR, LMR. Kaplan-Meier analysis was used to calculate the prognostic survival curve. Univariable and multivariable Cox regression risk models were used to identify independent risk factors. A nomogram prediction model was developed, and its accuracy was evaluated and validated through receiver operating characteristic (ROC) curve, C-index, and calibration curve. Internal validation was conducted using Bootstrap method, and the model was also evaluated through external validation.ResultsThe number of PCa patients in the training set and external validation set was 210 and 110, respectively. A higher NLR, PLR, RDW, and NPL-IRS score but lower LMR and prognosis nutritional index levels were related to a poor recurrence-free survival (RFS). In training set, the area under the curve (AUC) of the NLR, PLR, LMR, NPL-IRS score, prognosis nutritional index, and RDW were 0.735, 0.710, 0.719, 0.768, 0.728, and 0.599, respectively. Prostate specific antigen density (PSAD), prognosis nutritional index, NPL-IRS score, Gleason score (GS), and positive surgical margin (PSM) were independent risk factors. A new nomogram model was constructed based on these parameters to predict one-year, three-year, and five-year RFS with the AUC of 0.828, 0.867, and 0.892, which could provide an additional clinical net benefit. In external validation set, the AUCs were 0.847, 0.894, and 0.906, respectively.ConclusionsHigher preoperative NLR, PLR, and RDW or lower LMR and prognosis nutritional index are associated with poorer RFS. The nomogram prediction model based on preoperative PSAD, prognosis nutritional index, NPL-IRS score, GS, and PSM provides important postoperative treatment guidance.

BackgroundProstate cancer (PCa) is one of the most common malignant tumors in men, and laparoscopic radical prostatectomy (LRP) is commonly used to treat localized and advanced PCa. Positive surgical margin (PSM) is one of the most frequent problems faced by surgeons.AimsThis study aimed to explore the value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) in predicting PSM after LRP.Methods and ResultsThree hundred and twenty patients with PCa were admitted and underwent LRP in Beijing Chaoyang Hospital from January 2017 to June 2023. Patients were randomly divided into a training set (225 cases) and a validation set (95 cases) in a 7:3 ratio. NLR, PLR, and RDW were significantly higher in the PSM group than in the negative surgical margins (NSM) group. In addition, the NLR, PLR, and RDW values correlated with clinical T stage, Gleason score, and seminal vesicle invasion in the PSM group. In training set, ROC curve analysis revealed that the optimal cutoff values of NLR, PLR, and RDW for predicting postoperative PSM in PCa were 2.31, 115.40, and 12.85%, respectively. Multivariate Logistic regression analysis showed NLR and RDW were the clinical independent predictors. The area under the curve (AUC, 0.770, 95% CI 0.709-0.831) for postoperative PSM was the highest when a combination of the three parameters was used, with sensitivity and specificity of 62.5% and 85.2%, respectively. In validation set, the AUC values for NLR, PLR, RDW and the three markers combined were 0.708, 0.675, 0.723, and 0.780, respectively. Correlation analysis showed that in the PSM group, NLR was positively correlated with PLR and RDW, and PLR was positively correlated with RDW. By contrast, in the NSM group, a positive association was only found between NLR and PLR.ConclusionsHigher preoperative NLR, PLR, and RDW values were associated with postoperative PSM. Additionally, the three markers combined may be useful to predict PSM.

ObjectiveThe objective of this study is to evaluate the clinical presentations, diagnostic approaches, and treatment modalities for primary prostate sarcoma postradical prostatectomy, aiming to enhance its diagnosis and management.MethodsWe retrospectively reviewed the clinical records of three male patients diagnosed with primary prostate sarcoma at Beijing Chaoyang Hospital, affiliated with Capital Medical University, from February 2014 to February 2024. All patients underwent transrectal prostate biopsies, which informed the decision to proceed with laparoscopic radical prostatectomies. After surgery, one patient received a combination of epirubicin and ifosfamide as immunotherapy, along with external beam radiotherapy. After comprehensive discussions regarding potential benefits and risks, the remaining two patients decided against undergoing radiotherapy and chemotherapy.ResultsBased on the pathological examination results, two patients were diagnosed with stromal sarcoma and one with spindle cell sarcoma, all classified as high-grade sarcomas. Immunohistochemical analysis showed that all three cases were positive for VIMENTIN, but other results did not show significant specificity. During the follow-up period, one patient died within 12 months, and two patients were lost to follow-up after 6 months. However, there were no evident signs of recurrence observed during the follow-up period.ConclusionsPrimary prostate sarcoma is extremely rare and typically has a poor prognosis once diagnosed. Early diagnosis should be based on pathological and immunohistochemical testing results, followed by prompt surgical treatment and adjuvant radiotherapy and chemotherapy. Despite these measures, recurrence is common, underscoring the need for a detailed and appropriate treatment plan and systematic therapy for affected patients.

Pelvic lymph node dissection is an important step in radical prostatectomy (RP). Extended pelvic lymph node dissection (ePLND), currently employed for patients with intermediate- or high-risk PCa, may lead to overtreatment, prolong the operation time, and increase the risks of complications. Sentinel lymph node (SLN) is defined as the first metastasis lymph node from the primary tumor. In addition, SLN distribution is essential for overall lymph node dissection. However, due to the complex and diverse lymphatic drainage pathways and the inaccuracy of lymphatic tracing technology, SLN distribution and dissection have always been controversial. This review focuses on the application of pelvic SLN tracing technique in radical prostatectomy.