A PSMA PET/CT-based risk model for prediction of concordance between targeted biopsy and combined biopsy in detecting prostate cancer.

PURPOSE: This study is to investigate the diagnostic value of 68Ga-PSMA-11 in improving the concordance between mpMRI-TB and combined biopsy (CB) in detecting PCa. METHODS: 115 consecutive men with 68Ga-PSMA-11 PET/CT prior to prostate biopsy were included for analysis. PSMA intensity, quantified as maximum standard uptake value (SUVmax), minimum apparent diffusion coefficient (ADCmin) and other clinical characteristics were evaluated relative to biopsy concordance using univariate and multivariate logistic regression analyses. A prediction model was developed based on the identified parameters, and a dynamic online diagnostic nomogram was constructed, with its discrimination evaluated through the area under the ROC curve (AUC) and consistency assessed using calibration plots. To assess its clinical applicability, a decision curve analysis (DCA) was performed, while internal validation was conducted using bootstrapping methods. RESULTS: Concordance between mpMRI-TB and CB occurred in 76.5% (88/115) of the patients. Multivariate logistic regression analyses performed that SUVmax (OR= 0.952; 95% CI 0.917-0.988; P= 0.010) and ADCmin (OR= 1.006; 95% CI 1.003-1.010; P= 0.001) were independent risk factors for biopsy concordance. The developed model showed a sensitivity, specificity, accuracy and AUC of 0.67, 0.78, 0.81 and 0.78 in the full sample. The calibration curve demonstrated that the nomogram's predicted outcomes closely resembled the ideal curve, indicating consistency between predicted and actual outcomes. Furthermore, the decision curve analysis (DCA) highlighted the clinical net benefit achievable across various risk thresholds. These findings were reinforced by internal validation. CONCLUSIONS: The developed prediction model based on SUVmax and ADCmin showed practical value in guiding the optimization of prostate biopsy pattern. Lower SUVmax and Higher ADCmin values are associated with greater confidence in implementing mono-TB and safely avoiding SB, effectively balancing benefits and risks.

Modified Retzius-sparing robot-assisted radical prostatectomy for cases with anterior tumor: a propensity score-matched analysis.

OBJECTIVE: To compare the outcomes between a modified Retzius-sparing robot-assisted radical prostatectomy (mRS-RARP) technique and conventional robot-assisted radical prostatectomy (Con-RARP) technique for cases with anterior prostate cancer (PCa), especially positive surgical margin (PSM) rates and urinary continence (UC). PATIENTS AND METHODS: We retrospectively included 193 mRS-RARP and 473 Con-RARP consecutively performed by a single surgeon for anterior PCa. Perioperative complications, pathology, and continence were compared after propensity score matching using 9 variables. RESULTS: After matching (n = 193 per group), PSM were not significantly different in the two groups (16.1% in mRS-RARP group vs. 15.0% in Con-RARP group, p = 0.779). The UC at catheter removal and at 1-month was significantly higher in the mRS-RARP (24.9% vs. 9.8%, p < 0.001; 29.0% vs. 13.5%, p < 0.001, respectively), but not at 3-, 6-, and 12-month follow-ups (p = 0.261, 0.832, and 0.683, respectively). CONCLUSION: mRS-RARP seems to be an oncologically safe approach for patients with anterior PCa. Compared with the conventional approach, mRS-RARP approach shows benefits in the short-term postoperative UC recovery.

Extracellular Matrix Stiffness Regulates Microvascular Stability by Controlling Endothelial Paracrine Signaling to Determine Pericyte Fate.

BACKGROUND: The differentiation of pericytes into myofibroblasts causes microvascular degeneration, ECM (extracellular matrix) accumulation, and tissue stiffening, characteristics of fibrotic diseases. It is unclear how pericyte-myofibroblast differentiation is regulated in the microvascular environment. Our previous study established a novel 2-dimensional platform for coculturing microvascular endothelial cells (ECs) and pericytes derived from the same tissue. This study investigated how ECM stiffness regulated microvascular ECs, pericytes, and their interactions. METHODS: Primary microvessels were cultured in the TGM2D medium (tubular microvascular growth medium on 2-dimensional substrates). Stiff ECM was prepared by incubating ECM solution in regular culture dishes for 1 hour followed by PBS wash. Soft ECM with Young modulus of ≈6 kPa was used unless otherwise noted. Bone grafts were prepared from the rat skull. Immunostaining, RNA sequencing, RT-qPCR (real-time quantitative polymerase chain reaction), Western blotting, and knockdown experiments were performed on the cells. RESULTS: Primary microvascular pericytes differentiated into myofibroblasts (NG2+αSMA+) on stiff ECM, even with the TGFß (transforming growth factor beta) signaling inhibitor A83-01. Soft ECM and A83-01 cooperatively maintained microvascular stability while inhibiting pericyte-myofibroblast differentiation (NG2+αSMA-/low). We thus defined 2 pericyte subpopulations: primary (NG2+αSMA-/low) and activated (NG2+αSMA+) pericytes. Soft ECM promoted microvascular regeneration and inhibited fibrosis in bone graft transplantation in vivo. As integrins are the major mechanosensor, we performed RT-qPCR screening of integrin family members and found Itgb1 (integrin ß1) was the major subunit downregulated by soft ECM and A83-01 treatment. Knocking down Itgb1 suppressed myofibroblast differentiation on stiff ECM. Interestingly, ITGB1 phosphorylation (Y783) was mainly located on microvascular ECs on stiff ECM, which promoted EC secretion of paracrine factors, including CTGF (connective tissue growth factor), to induce pericyte-myofibroblast differentiation. CTGF knockdown or monoclonal antibody treatment partially reduced myofibroblast differentiation, implying the participation of multiple pathways in fibrosis formation. CONCLUSIONS: ECM stiffness and TGFß signaling cooperatively regulate microvascular stability and pericyte-myofibroblast differentiation. Stiff ECM promotes EC ITGB1 phosphorylation (Y783) and CTGF secretion, which induces pericyte-myofibroblast differentiation.

Prediction of false-positive PI-RADS 5 lesions on prostate multiparametric MRI: development and internal validation of a clinical-radiological characteristics based nomogram.

BACKGROUND: To develop a risk model including clinical and radiological characteristics to predict false-positive The Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions. METHODS: Data of 612 biopsy-naïve patients who had undergone multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy were collected. Clinical variables and radiological variables on mpMRI were adopted. Lesions were divided into the training and validation cohort randomly. Stepwise multivariate logistic regression analysis with backward elimination was performed to screen out variables with significant difference. A diagnostic nomogram was developed in the training cohort and further validated in the validation cohort. Calibration curve and receiver operating characteristic (ROC) analysis were also performed. RESULTS: 296 PI-RADS 5 lesions in 294 patients were randomly divided into the training and validation cohort (208 : 88). 132 and 56 lesions were confirmed to be clinically significant prostate cancer in the training and validation cohort respectively. The diagnostic nomogram was developed based on prostate specific antigen density, the maximum diameter of lesion, zonality of lesion, apparent diffusion coefficient minimum value and apparent diffusion coefficient minimum value ratio. The C-index of the model was 0.821 in the training cohort and 0.871 in the validation cohort. The calibration curve showed good agreement between the estimation and observation in the two cohorts. When the optimal cutoff values of ROC were 0.288 in the validation cohort, the sensitivity, specificity, PPV, and NPV were 90.6%, 67.9%, 61.7%, and 92.7% in the validation cohort, potentially avoiding 9.7% unnecessary prostate biopsies. CONCLUSIONS: We developed and validated a diagnostic nomogram by including 5 factors. False positive PI-RADS 5 lesions could be distinguished from clinically significant ones, thus avoiding unnecessary prostate biopsy.

Unraveling the relationship between soil carbon-degrading enzyme activity and carbon fraction under biogas slurry topdressing.

Biogas slurry, a by-product of the anaerobic digestion of biomass waste, predominantly consisting of livestock and poultry manure, is widely acclaimed as a sustainable organic fertilizer owing to its abundant reserves of essential nutrients. Its distinctive liquid composition, when tactfully integrated with a drip irrigation system, unveils immense potential, offering unparalleled convenience in application. In this study, we investigated the impact of biogas slurry topdressing as a replacement for chemical fertilizer (BSTR) on soil total organic carbon (TOC) fractions and carbon (C)-degrading enzyme activities across different soil depths (surface, sub-surface, and deep) during the tasseling (VT) and full maturity stage (R6) of maize. BSTR increased the TOC content within each soil layer during both VT and R6 periods, inducing alterations in the content and proportion of individual C component, particularly in the topsoil. Notably, the pure biogas slurry topdressing treatment (100%BS) compared with the pure chemical fertilizer topdressing treatment (CF), exhibited a 38.9% increase in the labile organic carbon of the topsoil during VT, and a 30.3% increase in the recalcitrant organic carbon during R6, facilitating microbial nutrient utilization and post-harvest C storage during the vigorous growth period of maize. Furthermore, BSTR treatment stimulated the activity of oxidative and hydrolytic C-degrading enzymes, with the 100%BS treatment showcasing the most significant enhancements, with its average geometric enzyme activity surpassing that of CF treatment by 27.9% and 27.4%, respectively. This enhancement facilitated ongoing and efficient degradation and transformation of C. Additionally, we screened for C components and C-degrading enzymes that are relatively sensitive to BSTR. The study highlight the advantages of employing pure biogas slurry topdressing, which enhances C component and C-degrading enzyme activity, thereby reducing the risk of soil degradation. This research lays a solid theoretical foundation for the rational recycling of biogas slurry.

Disentangling the impact of biogas slurry topdressing as a replacement for chemical fertilizers on soil bacterial and fungal community composition, functional characteristics, and co-occurrence networks.

The application of biogas slurry topdressing with drip irrigation systems can compensate for the limitation of traditional solid organic fertilizer, which can only be applied at the bottom. Based on this, we attempted to define the response of soil bacterial and fungal communities of maize during the tasseling and full maturity stages, by using a no-topdressing control and different ratios of biogas slurry nitrogen in place of chemical fertilizer topdressing. The application of biogas slurry resulted in the emergence of new bacterial phyla led by Synergistota. Compared with pure urea chemical topdressing, the pure biogas slurry topdressing treatment significantly enriched Firmicutes and Basidiomycota communities during the tasseling stage, in addition to affecting the separation of bacterial and fungal α-diversity indices between the tasseling and full maturity stages. Based on the prediction of community composition and function, the changes in bacterial and fungal communities caused by biogas slurry treatment stimulated the ability of microorganisms to decompose refractory organic components, which was conducive to turnover in the soil carbon cycle, and improved multi-element (such as sulfur) cycles; however it may also bring potential risks of heavy metal and pathogenic microbial contamination. Notably, the biogas slurry treatment reduced the correlation and aggregation of bacterial and fungal symbiotic networks, and had a dual effect on ecological randomness. These findings contribute to a deeper comprehension of the alterations occurring in soil microbial communities when substituting chemical fertilizers treated with biogas slurry topdressing, and promote the efficient and sustainable utilization of biogas slurry resources.

Flushing control strategies to improve the stability of a biogas slurry drip irrigation system: Behavioral characteristics and mechanisms.

Biogas slurry drip irrigation can mitigate environmental pollution and reduce the use of chemical fertilizers to enable sustainable development. However, the stability of the biogas slurry drip irrigation system (BSDIS) is disrupted by emitter clogging; hence, it is essential to explore the flushing control strategy of BSDIS. By means of combining actual measurement and simulation, this study investigates the BSDIS stability based on the three technical parameters of the flushing control strategy. Appropriate flushing control strategies can improve system stability and cause spatial differences on the drip irrigation tape. Under various flushing control strategies, the system stability primarily undergoes delays, sensitivity, and ineffectiveness of flushing with time. Compared with the without flushing and emitter outlet downward-oriented treatment, the optimal flushing combination (the high frequency flushing + emitter outlet upward-oriented treatment) reduces the emitter clogging content by approximately 70.97% and increases system stability by 189.1%. In the internal hydrodynamics, the laying direction of emitters does not change the movement characteristics of water flow, although the clogging particles do not completely follow the water flow, with some particles settling owing to gravity, thereby clotting the emitters. When clogging occurs, the increase in flushing speed is conducive to the increase in turbulent kinetic energy on the inlet surface of the emitter, which facilitate the flushing of clogged substances. This study proposes optimal flushing strategy parameters along with a new management mode for the waste liquid represented by biogas slurry.

Biogas slurry topdressing as replacement of chemical fertilizers reduces leaf senescence of maize by up-regulating tolerance mechanisms.

Worldwide physiological research has aimed to decelerate the aging of crop leaves by optimizing fertilization measures to improve crop or biomass yield. Solid organic fertilizers can be combined with chemical fertilizers to delay the aging of crop leaves. Biogas slurry is a liquid organic fertilizer produced by the anaerobic fermentation of livestock and poultry manure and other resources, and it can partially replace chemical fertilizers in field application via drip irrigation systems. However, the impact of biogas slurry topdressing on leaf aging remains unclear. This study investigated treatments with no topdressing (control, CK) and five topdressing patterns of biogas slurry replacing chemical fertilizer (nitrogen) at 100%, 75%, 50%, 25%, and 0% (100%BS, 75%BS, 50%BS, 25%BS, CF). The effects of different proportions of biogas slurry on leaf senescence rate, photosynthetic pigments, osmotic adjustment substances, antioxidant defense enzymes, and nitrogen metabolism related enzyme activities of maize were analyzed. Subsequently, the mechanisms of biogas slurry topdressing on the leaf senescence rate of maize were explored. The results showed that the mean decreasing rate of relative green leaf area (Vm) treated with biogas slurry decreased by 3.7%-17.1% and the duration of leaf area duration (LAD) increased by 3.7%-17.1% compared with the results for CK. The maximum senescence rate of 100%BS was delayed by 4.4 and 5.6 d compared to the results for CF and CK, respectively. During the senescence of maize leaves, the use of biogas slurry topdressing increased the content of chlorophyll, decreased the water loss and the accumulation rate of malondialdehyde and proline in leaves, and increased the activities of catalase, peroxidase, and superoxide dismutase in the later growth and development periods of maize. In addition, biogas slurry topdressing improved the nitrogen transport efficiency of the leaves and ensured continuous and efficient ammonium assimilation. Furthermore, there was a strong correlation between leaf senescence and the investigated physiological indices. Cluster analysis showed that the 100%BS treatment exhibited the most prominent effect on leaf senescence. Biogas slurry topdressing as a substitute for chemical fertilizer can be potentially used as an anti-aging regulation measure for crops to decrease the damage induced by senescence.

Environmental microcystin exposure triggers the poor prognosis of prostate cancer: Evidence from case-control, animal, and in vitro studies.

Microcystin-leucine-arginine (MC-LR) is positively linked with multiple cancers in humans. However, the association between MC-LR and the risk and prognosis of prostate cancer has not been conducted in epidemiological studies. No reported studies have linked MC-LR exposure to the poor prognosis of prostate cancer by conducting experimental studies. The content of MC-LR was detected in most of the aquatic food in wet markets and supermarkets in Nanjing and posed a health risk for consumers. MC-LR levels in both prostate cancer tissues and serum were significantly higher than controls. The adjusted odds ratio (OR) for prostate cancer risk by serum MC-LR was 1.75 (95%CI: 1.21-2.52) in the whole subjects, and a positive correlation between MC-LR and advanced tumor stage was observed. Survival curve analysis indicated patients with higher MC-LR levels in tissues exhibited poorer overall survival. Human, animal, and cell studies confirmed that MC-LR exposure increases the expression of estrogen receptor-α (ERα) and promotes epithelial-mesenchymal transition (EMT) in prostate cancer. Moreover, MC-LR-induced decreased E-cadherin levels, increased vimentin levels, and increased migratory and invasive capacities of prostate cancer cells were markedly suppressed upon ERα knockdown. MC-LR-induced xenograft tumor growth and lung metastasis in BALB/c nude mice can be effectively alleviated with ERα knockdown. Our data demonstrated that MC-LR upregulated vimentin and downregulated E-cadherin through activating ERα, promoting migration and invasion of prostate cancer cells. Our findings highlight the role of MC-LR in prostate cancer, providing new perspectives to understand MC-LR-induced prostatic toxicity.

Pan-cancer analysis identifies LMNB1 as a target to redress Th1/Th2 imbalance and enhance PARP inhibitor response in human cancers.

BACKGROUND: Emerging evidence suggests that LMNB1 is involved in the development of multiple cancer types. However, there is no study reporting the potential role of LMNB1 in a systematic pan-cancer manner. METHODS: The gene expression level and potential oncogenic roles of LMNB1 in The Cancer Genome Atlas (TCGA) database were analyzed with Tumor Immune Estimation Resource version 2 (TIMER2.0), Gene Expression Profiling Interactive Analysis version 2 (GEPIA2), UALCAN and Sangerbox tools. Pathway enrichment analysis was carried out to explore the possible mechanism of LMNB1 on tumorigenesis and tumor progression. The therapeutic effects of LMNB1 knockdown combined with PARP inhibition on human cancers were further investigated in vitro. RESULTS: LMNB1 upregulation is generally observed in the tumor tissues of most TCGA cancer types, and is verified in kidney renal clear cell carcinoma using clinical specimens of our institute. High level of LMNB1 expression usually predicts poor overall survival and disease free survival for patients with tumors. Mechanically, LMNB1 level is positively correlated with CD4+ Th2 cell infiltration and DNA homologous recombination repair gene expression. In vitro experiments reveal that targeting LMNB1 has a synergistic effect on prostate cancer with PARP inhibitor treatment. CONCLUSIONS: LMNB1 is a biomarker of CD4+ Th2 cell infiltration and DNA homologous recombination repair in human cancers. Blockage of LMNB1 combined with PARP inhibitor treatment could be a promising therapeutic strategy for patients with cancers.

PSMA uptake on [68Ga]-PSMA-11-PET/CT positively correlates with prostate cancer aggressiveness.

BACKGROUND: Conflicting results have been revealed on the relationship between PSMA uptake values (SUVs) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) and prostate cancer (PCa) aggressiveness. This study is to validate the relationship between SUVs with PCa aggressiveness and its role in evaluation of clinically significant PCa (csPCa) and risk stratification. METHODS: We retrospectively enrolled 51 patients who underwent [68Ga]-PSMA PET/CT (PET/CT) before radical prostatectomy (RP). PET/CT results were corrected with whole mount histology. The relationship between SUVs and aggressiveness related indictors including Gleason score, T stage, initial PSA and tumor size were analyzed. The cutoff value for detection of overall PCa, csPCa and intermediate/high-risk PCa were calculated by receiver operating characteristics (ROC) analysis. RESULTS: Both SUVmax and SUVmean positively correlated with Gleason score (SUVmax Spearman r=0.546 P<0.01, SUVmean Spearman r=0.359 P<0.01), PSA level (SUVmax Spearman r=0.568 P<0.01, SUVmean Spearman r=0.529 P<0.01) and tumor volume SUVmax Spearman r=0.635 P<0.01, SUVmean Spearman r=0.590 P<0.01). Tumors with T3 stage had significant higher SUV uptake than T2 (SUVmax 17.49±10.50 vs 9.90±8.7, P<0.01 and SUVmean 17.49±10.50 vs 9.90±8.7, P<0.01). ROC analysis showed cutoff of SUVmax (3.8) and SUVmean (2.8) for overall PCa detection. ROC analysis showed that csPCa and intermediate/high risk PCa had the same cutoff on both SUVmax (8.4) and SUVmean (6.8). CONCLUSIONS: PSMA uptake on PSMA PET/CT positively correlated with Gleason score, T stage, initial PSA and tumor volume. Both SUVmax and SUVmean can be applied as parameters for csPCa detection and risk classification.

[Accuracy of prostatic ultrasonography versus MRI in measuring prostate volume].

OBJECTIVE: To compare the accuracy of different methods of measuring the prostate volume (PV) based on the manifestations of prostatic ultrasonography and MRI. METHODS: Using the drainage method, we measured the volumes of 101 prostatic specimens collected from radical prostatectomy. And with the measures obtained as reference standards, we calculated the PV of the patients with the maximum width (W), height (H) and length (L) of the prostates obtained preoperatively by transabdominal ultrasonography (TAUS), transrectal ultrasonography (TRUS) and MRI using the ellipsoidal formula (PV = W × H × L × 0.52), bullet formula (PV = W × H × L × 0.65) and 3D reconstruction technology. We evaluated the accuracy of the above methods using the Mann-Whitney U test, intraclass correlation coefficient (ICC), and Bland-Altman scatterplot. RESULTS: No statistically significant differences were observed between the specimen and preoperative PVs. The ICCs of the specimen PVs obtained by MRI 3D reconstruction, TRUS bullet formula, MRI ellipsoidal formula and TAUS ellipsoidal formula were 0.978, 0.862, 0.857 and 0.745, respectively. The Bland-Altman scatterplot exhibited that the preoperative PV calculated by MRI 3D reconstruction had the highest consistency with that of the specimen PV, followed by that measured by TRUS bullet formula and that obtained by MRI ellipsoidal formula, while that determined by TAUS ellipsoidal formula had a low consistency. CONCLUSION: The MRI 3D reconstruction technology is the most reliable method for the measurement of PV, followed by TRUS bullet formula, but the latter is recommended for its high applicability in clinical practice.

[Trans-Douglas Retzius' space-sparing robot-assisted simple prostatectomy for large-volume benign prostate hyperplasia].

OBJECTIVE: To report the safety and efficacy of trans-Douglas Retzius' space-sparing robot-assisted simple prostatectomy (RSS-RASP) in the treatment of large-volume BPH. METHODS: This retrospective study included 24 cases of large-volume (>80 ml) BPH treated by trans-Douglas RSS-RASP from August 2019 to June 2021. The patients ranged in age from 55 to 80 (mean 68.5) years, with an average body mass index of 25.1 (20.5－34.9) kg/m2 , median prostate volume of 132.4 (85.6－235.7) ml, and preoperative tPSA of 10.8 (0.5－37.9) ng/ml, IPSS of 25 (3－35) and quality of life (QOL) score of 5 (3－8). Before surgery, 12 of the patients received catheterization for urinary retention, 1 underwent cystostomy, 2 were complicated with hydronephrosis, 1 had stones and diverticulum in the bladder, and 14 were excluded from the cases of PCa by prostatic biopsy. The operation time, intraoperative blood loss, hemoglobin level on the first day after surgery, blood transfusion, and intra- and postoperative complications were recorded. The patients were followed up for 3 to 21 months postoperatively. Comparisons were made before and after operation in the IPSS, maximum urinary flow rate (Qmax), postvoid residual volume (PVR), QOL score, IIEF score and Male Sexual Health Questionnaire (MSHQ) score. RESULTS: Trans-Douglas RSS-RASP was successfully completed in all the 24 cases, with a mean operation time of 175 (100－285) min, intraoperative blood loss of 200 (50－800) ml, hemoglobin decrease of 25 (4－57) g/L on the first day after surgery, postoperative drainage tube indwelling of 3 (2－7) d, and urinary catheterization of 12 (4－18) d. Six (25%) of the patients received intraoperative blood transfusion, 1 underwent transurethral electrocoagulation hemostasis 1 month after surgery because of postoperative bleeding, and 1 received transurethral resection of the cicatrical adhesive tissue of the bladder neck 12 months after surgery. No other complications occurred postoperatively. The IPSS (3 ［1－7］), Qmax (19.6 ［9.9－32.1］ ml/s), PVR (0 ［0－34.9］ ml) and QOL score (2 ［0－3］) of the patients were significantly improved after surgery (P < 0.05), but no statistically significant differences were observed in the IIEF (20 ［19－24］) and MSHQ scores (14 ［13－14］) as compared with the baseline (P > 0.05). CONCLUSION: Trans-Douglas RSS-RASP is a safe and effective minimally invasive method for the treatment of large-volume (>80 ml) BPH, which can improve the urinary function of the patient after operation.

Can 68Ga-PSMA-11 Positron Emission Tomography/Computerized Tomography Predict Pathological Response of Primary Prostate Cancer to Neoadjuvant Androgen Deprivation Therapy? A Pilot Study.

PURPOSE: We explored the role of 68Ga-PSMA-11 positron emission/computerized tomography as a predictor of pathological response to neoadjuvant androgen deprivation therapy combined with abiraterone for high risk prostate cancer. MATERIALS AND METHODS: A total of 45 patients with localized high risk prostate cancer who had serial 68Ga-PSMA-11 positron emission tomography/computerized tomography scans before and after 6 months of androgen deprivation therapy plus abiraterone neoadjuvant treatment followed by radical prostatectomy were included in this study. Complete pathological response or minimal residual disease <5 mm on whole mount histopathology was defined as favorable pathological response. The diagnostic performance of prostate specific antigen response and positron emission tomography/computerized tomography response for favorable pathological response was calculated. Univariable and multivariable logistic regression analyses of clinical and imaging variables were also performed to identify favorable pathological response. RESULTS: Compared to the prostate specific antigen response, positron emission tomography/computerized tomography response had a significantly higher specificity in diagnosing favorable pathological response (89.7% vs 62.1%, p=0.043). Preoperative nadir prostate specific antigen (OR 0.121, 95% CI 0.028-0.529, p=0.005), posttreatment maximum standardized uptake value (OR 7.072, 95% CI 2.035-24.579, p=0.002) and posttreatment tumor volume (OR 7.896, 95% CI 1.415-44.054, p=0.018) measured on positron emission tomography/computerized tomography were significantly associated with favorable pathological response in univariable logistic regression analysis. On multivariable logistic regression analysis, only posttreatment maximum standardized uptake value was found to be an independent predictor of favorable pathological response (OR 9.69, 95% CI 1.439-65.242, p=0.020). CONCLUSIONS: 68Ga-PSMA positron emission tomography/computerized tomography has a better diagnostic performance of pathological response to neoadjuvant treatment compared with prostate specific antigen, with maximum standardized uptake value being an independent predictive factor. This pilot study suggests that prostate specific membrane antigen positron emission tomography/computerized tomography may serve as a potential predictor of pathological response to neoadjuvant treatment.

Can 68Ga-PSMA-11 PET/CT predict pathological upgrading of prostate cancer from MRI-targeted biopsy to radical prostatectomy?

PURPOSE: Prostate-specific membrane antigen (PSMA) positron emission tomography (PSMA-PET) is an ideal tool for staging and restaging of prostate cancer (PCa). This study was designed to investigate the prognostic role of preoperative 68Ga-PSMA-11 PET/CT in predicting pathological upgrading from multiparametric magnetic resonance imaging-targeted biopsy (mpMRI-TB) to final radical prostatectomy (RP) specimens in patients with localized PCa. METHODS: A total of 67 biopsy-confirmed localized PCa patients with mpMRI and 68Ga-PSMA-11 PET/CT prior to RP were included. Clinical and imaging characteristics derived from mpMRI and PET/CT were compared in patients with or without pathological upgrading. Predictors for pathological upgrading were evaluated by using univariate and multivariable analyses. A prediction model was developed based on the identified parameters and validated using internal validation. RESULTS: Pathological upgrading from mpMRI-TB to final RP specimens occurred in 38.8% (26/67) of the patients. Multivariable logistic regression analysis showed SUVmax (OR: 1.223, 95% CI 1.068-1.399, p = 0.003); highest tumor grade at mpMRI-TB, ISUP grade group (ISUP GG) 1 vs. 4 (OR: 0.11, 95% CI 0.000-0.452, p = 0.018) and ISUP GG 2 vs. 4 (OR: 0.16, 95% CI 0.001-0.252, p = 0.003); and multifocality on PET/CT (OR: 9.821, 95% CI 1.438-67.085, p = 0.02) were independent risk factors for pathological upgrading. Our developed prediction model based on the identified parameter showed good calibration at internal validation (mean absolute error = 0.033). CONCLUSION: 68Ga-PSMA-11 PET/CT was found to be an ideal biomarker for the prediction of pathological upgrading from mpMRI-TB to RP, especially for patients with lower tumor grade at mpMRI-TB.

Uncovering the invisible-prevalence, characteristics, and radiomics feature-based detection of visually undetectable intraprostatic tumor lesions in 68GaPSMA-11 PET images of patients with primary prostate cancer.

INTRODUCTION: Primary prostate cancer (PCa) can be visualized on prostate-specific membrane antigen positron emission tomography (PSMA-PET) with high accuracy. However, intraprostatic lesions may be missed by visual PSMA-PET interpretation. In this work, we quantified and characterized the intraprostatic lesions which have been missed by visual PSMA-PET image interpretation. In addition, we investigated whether PSMA-PET-derived radiomics features (RFs) could detect these lesions. METHODOLOGY: This study consists of two cohorts of primary PCa patients: a prospective training cohort (n = 20) and an external validation cohort (n = 52). All patients underwent 68Ga-PSMA-11 PET/CT and histology sections were obtained after surgery. PCa lesions missed by visual PET image interpretation were counted and their International Society of Urological Pathology score (ISUP) was obtained. Finally, 154 RFs were derived from the PET images and the discriminative power to differentiate between prostates with or without visually undetectable lesions was assessed and areas under the receiver-operating curve (ROC-AUC) as well as sensitivities/specificities were calculated. RESULTS: In the training cohort, visual PET image interpretation missed 134 tumor lesions in 60% (12/20) of the patients, and of these patients, 75% had clinically significant (ISUP > 1) PCa. The median diameter of the missed lesions was 2.2 mm (range: 1-6). Standard clinical parameters like the NCCN risk group were equally distributed between patients with and without visually missed lesions (p < 0.05). Two RFs (local binary pattern (LBP) size-zone non-uniformality normalized and LBP small-area emphasis) were found to perform excellently in visually unknown PCa detection (Mann-Whitney U: p < 0.01, ROC-AUC: ≥ 0.93). In the validation cohort, PCa was missed in 50% (26/52) of the patients and 77% of these patients possessed clinically significant PCa. The sensitivities of both RFs in the validation cohort were ≥ 0.8. CONCLUSION: Visual PSMA-PET image interpretation may miss small but clinically significant PCa in a relevant number of patients and RFs can be implemented to uncover them. This could be used for guiding personalized treatments.

Functional and oncologic outcomes of robot-assisted simple enucleation with and without renal arterial cold perfusion in complex renal tumors: a propensity score-matched analysis.

BACKGROUND: To compare robot-assisted simple enucleation with renal arterial cold perfusion (RACP-RASE) and RASE alone in complex renal tumors with regard to perioperative, functional and oncologic outcomes by propensity score-matched analysis. METHODS: Data from 351 patients who underwent RACP-RASE or RASE for complex renal tumors were recorded between September 2014 and December 2017. Propensity score-matched analysis was performed on age, sex, BMI, ECOG score, tumor side and size, preoperative estimated glomerular filtration rate (eGFR), RENAL score and PADUA score. RESULTS: The study included 31 RACP-RASE and 320 RASE procedures. RENAL score and PADUA score were higher and tumor diameter was greater under RACP-RASE than RASE. After matching, the two groups were similar in estimated blood loss (208.3 vs 230.7 ml; p = 0.696) and ischemic time (34.8 vs 32.8 min; p = 0.342). The RACP-RASE group had significantly longer operative time than the RASE group (264.1 ± 55.7 vs 206.9 ± 64.0 min, p = 0.001). There was no difference in the incidence of postoperative complications between the two groups (13.8% vs 24.1%; p = 0.315), as was the overall incidence of positive surgical margins (3.4 vs 0%; p = 1.000). The changes in eGFR significantly differed between the two groups at 3 months (p = 0.018) and 12 months (p = 0.038). More patients in the RASE group were CKD upstaged (p = 0.043). At multivariable analysis, preoperative eGFR and the type of procedure were significant predictive factors for a change of more than 10% in eGFR at 3 months postoperatively. There was no local recurrence or distant metastasis during follow-up. CONCLUSIONS: RACP-RASE is an effective and safe technique for complex renal tumors that can provide appropriate temporary arterial occlusion and renal hypothermic perfusion. Renal arterial cold perfusion may be helpful in protecting renal function in RASE as compared with warm ischemia.

[Modified Vattikuti Institute prostatectomy for the treatment of localized prostate cancer].

OBJECTIVE: To investigate the effect of modified Vattikuti Institute prostatectomy (mVIP) in the treatment of localized PCa. METHODS: This retrospective study included 50 cases of localized PCa treated by mVIP and another 50 by robot-assisted radical prostatectomy (RARP) from March 2018 to April 2019. We analyzed the baseline data, the surgical techniques used and the results of short-term follow-up. RESULTS: All the operations were completed successfully without conversion to open surgery. The mVIP group, compared with the RARP, showed longer operation time (ï¼»90.35 ± 24.22ï¼½ vs ï¼»84.46 ± 19.18ï¼½ min, P > 0.05), more intraoperative blood loss (ï¼»220.00 ± 15.10ï¼½ vs ï¼»215.00 ± 15.10ï¼½ ml, P > 0.05), shorter postoperative hospital stay (ï¼»5.75 ± 1.45ï¼½ vs ï¼»6.20 ± 1.50ï¼½ d, P > 0.05), and higher rates of positive surgical margins (22.00% vs 14.00%, P > 0.05) and urinary continence at 1 month (76%vs 22%,P < 0.05), 6 months (84% vs 79%, P > 0.05) and 12 months after surgery (96% vs 94%, P > 0.05). CONCLUSIONS: Modified VIP can better preserve the lateral and posterolateral prostatic fascial tissue in the treatment of localized PCa and therefore significantly promote the recovery of urinary continence after surgery.

Retzius-sparing robot-assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single-blind trial with a 1-year follow-up.

OBJECTIVE: To evaluate the impact of Retzius-sparing robot-assisted radical prostatectomy (posterior approach) on early recovery of urinary continence (UC) compared to the conventional approach (anterior approach) for the treatment of clinically localized prostate cancer (PCa). METHODS: A total of 110 consecutive patients with clinically localized PCa were prospectively randomized in a 1:1 ratio to an anterior group (n = 55) or a posterior group (n = 55). The primary outcome was immediate UC, defined as freedom from any pad use within 1 week after removal of the urinary catheter. The UC rate following surgery was also calculated with Kaplan-Meier curves, and the log-rank test was used for statistical comparison. Intra-operative outcomes, pathological data and oncological outcomes, including positive surgical margin (PSM) status and biochemical recurrence-free survival (BCRFS), were also compared between the two groups. The comparison of the two approaches was also analysed in subgroups after risk stratification. RESULTS: Of the patients who underwent the posterior approach, 69.1% achieved immediate UC compared with 30.9% in the anterior group (relative risk 2.24, 95% confidence interval [CI] 1.48-3.51; P = 0.000). The relative Kaplan-Meier curves for UC during the 12-month follow-up revealed statistically better recovery in the posterior group when compared with the anterior group (hazard ratio [HR] 1.51, 95% CI 1.01-2.24; log-rank P = 0.007). No statistically significant differences were observed between the groups regarding complications (P = 0.399), PSM status (P = 0.225) or BCRFS (HR 4.80, 95% CI 0.97-23.78; log-rank P = 0.111). In sub-analyses, no significant difference between the two approaches with regard to UC recovery in patients with high-risk PCa was observed (HR 1.26, 95% CI 0.63-2.51; log-rank P = 0.415). CONCLUSIONS: The Retzius-sparing approach significantly improved early recovery of UC compared to the conventional approach. Further prospective studies are needed to confirm the benefits of the Retzius-sparing approach for clinically localized PCa, especially for high-risk cases.

Tumour location determined by preoperative MRI is an independent predictor for positive surgical margin status after Retzius-sparing robot-assisted radical prostatectomy.

OBJECTIVE: To investigate the influence of tumour location zone on positive surgical margin (PSM) status after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). MATERIALS AND METHODS: A total of 203 consecutive patients with prostate cancer (PCa) who underwent RS-RARP at our centre were divided into three cohorts according to the tumour zonal origin described on preoperative magnetic resonance imaging (MRI). Clinical and pathological characteristics were compared among the three groups. The associations of clinicopathological variables with PSM status after RS-RARP were also evaluated. RESULTS: The rates of PSM in patients with transition zone (TZ) and mixed origin tumours were significantly higher than in patients with peripheral zone tumours (P < 0.01). Of the PSMs in patients with TZ and mixed origin cancers, 42.0% and 40.9%, respectively, were located at the anterior part of the gland. On multivariate analysis, presence of a TZ tumour was significantly associated with a higher PSM rate after RS-RARP (P < 0.01). Sub-analysis showed that high-risk patients with TZ tumours had a higher risk of PSM after RS-RARP (P < 0.01). CONCLUSION: Presence of a TZ tumour is an independent risk factor for PSMs after RS-RARP. Preoperative identification of TZ tumours might aid surgical planning for the Retzius-sparing technique, especially in high-risk patients.