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Clinical implications of endogenous testosterone density on prostate cancer progression in patients with very favorable low and intermediate risk treated with radical prostatectomy

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Asian Journal of Andrology 2023年第5期25卷 556-563页

作者： Antonio Benito Porcaro Alessandro Tafuri Andrea Panunzio Clara Cerrato Alberto Bianchi Sebastian Gallina Stefano Vidiri Damiano D'Aietti Emanuele Serafin Giovanni Mazzucato Alessandro Princiotta Davide Brusa Matteo Brunelli Vincenzo Pagliarulo Maria Angela Cerruto AlessandroAntonelli Department of Urology University of VeronaIntegrated University Hospital of VeronaVerona 37126Italy Department of Urology Vito Fazzi HospitalLecce 73100Italy Department of Pathology University of VeronaIntegrated University Hospital of VeronaVerona 37126Italy

We tested the association between endogenous testosterone density(ETD;the ratio between endogenous testosterone[ET]and prostate volume)and prostate cancer(PCa)aggressiveness in very favorable low-and intermediate-risk PCa patients who underwent radical prostatectomy(RP).Only patients with prostate-specific antigen(PSA)within 10 ng ml^(-1),clinical stage T1c,and International Society of Urological Pathology(IsUP)grade group 1 or 2 were included.Preoperative ET levels up to 350 ng dl^(-1)were classified as abnormal.Tumor quantitation density factors were evaluated as the ratio between percentage of biopsy-positive cores and prostate volume(biopsy-positive cores density,BPCD)and the ratio between percentage of cancer invasion at final pathology and prostate weight(tumor load density,TLD).Disease upgrading was coded as ISUP grade group>2,and progression as recurrence(biochemical and/or local and/or distant).Risk associations were evaluated by multivariable Cox and logistic regression models.Of 320 patients,151(47.2%)had intermediate-risk PCa.ET(median:402.3 ng dl^(-1))resulted abnormal in 111(34.7%)cases(median ETD:9.8 ng dl^(-1)ml^(-1)).Upgrading and progression occurred in 109(34.1%)and 32(10.6%)cases,respectively.Progression was predicted by ISUP grade group 2(hazard ratio[HR]:2.290;P=0.029)and upgrading(HR:3.098;P=0.003),which was associated with ISUP grade group 2(odds ratio[OR]:1.785;P=0.017)and TLD above the median(OR:2.261;P=0.001).After adjustment for PSAdensity and bodymass index(BMI),ETDabovethemedianwas positivelyassociatedwithBPCD(OR:3.404;P<0.001)and TLD(OR:5.238;P<0.001).Notably,subjects with abnormal ET were more likely to have higher BPCD(OR:5.566;P=0.002),as well as TLD(OR:14.998;P=0.016).Independently by routinely evaluated factors,as ETD increased,BPCD and TLD increased,but increments were higher for abnormal ET levels.In very favorable cohorts,ETD may further stratify the risk of aggressive PCa.

关键词： endogenous testosterone density prostate cancer radical prostatectomy tumor progression

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Prostate Health Index(phi)and its derivatives predict Gleason score upgrading after radical prostatectomy among patients with low-risk prostate cancer

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Asian Journal of Andrology 2022年第4期24卷 406-410页

作者： Jia-Qi Yan Da Huang Jing-Yi Huang Xiao-Hao Ruan Xiao-Ling Lin Zu-Jun Fang Yi Gao Hao-Wen Jiang Yi-Shuo Wu Rong Na Dan-Feng Xu Department of Urology Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Department of Urology Huashan HospitalFudan UniversityShanghai 200040China.

To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.

关键词： Gleason score Prostate Health Index prostate biopsy prostate cancer radical prostatectomy upgrading

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A novel nomogram provides improved accuracy for predicting biochemical recurrence after radical prostatectomy

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Chinese Medical Journal 2021年第13期134卷 1576-1583页

作者： Hai-Zhui Xia Hai Bi Ye Yan Bin Yang Ruo-Zhuo Ma Wei He Xue-Hua Zhu Zhi-Ying Zhang Yu-Ting Zhang Lu-Lin Ma Xiao-Fei Hou Gregory JWirth Jian Lu Department of Urology Peking University Third HospitalBeijing 100191China Department of Surgery Division of UrologyGeneva University HospitalGenevaSwitzerland

Background:Various prediction tools have been developed to predict biochemical recurrence(BCR)after radical prostatectomy(RP);however,few of the previous prediction tools used serum prostate-specific antigen(PSA)nadir after RP and maximum tumor diameter(MTD)at the same time.In this study,a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival(BCRFS).Methods:A total of 337 patients who underwent RP between January 2010 and March 2017 were retrospectively enrolled in this study.The maximum diameter of the index lesion was measured on magnetic resonance imaging(MRI).Cox regression analysis was performed to evaluate independent predictors of BCR.A nomogram was subsequently developed for the prediction of BCRFS at 3 and 5 years after RP.Time-dependent receiver operating characteristic(ROC)curve and decision curve analyses were performed to identify the advantage of the new nomogram in comparison with the cancer of the prostate risk assessment post-surgical(CAPRA-S)score.Results:A novel nomogram was developed to predict BCR by including PSA nadir,MTD,Gleason score,surgical margin(SM),and seminal vesicle invasion(SVI),considering these variables were significantly associated with BCR in both univariate and multivariate analyses(P<0.05).In addition,a basic model including Gleason score,SM,and SVI was developed and used as a control to assess the incremental predictive power of the new model.The concordance index of our model was slightly higher than CAPRA-S model(0.76 vs.0.70,P=0.02)and it was significantly higher than that of the basic model(0.76 vs.0.66,P=0.001).Time-dependent ROC curve and decision curve analyses also demonstrated the advantages of the new nomogram.Conclusions:PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR.By incorporating PSA nadir and MTD into the conventional predictive model,our newly developed nomogram significantly improved the accuracy in predicting BCRFS after RP.

关键词： Nomogram PSA nadir Tumor diameter Magnetic resonance imaging Biochemical recurrence radical prostatectomy

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Metabolic syndrome,levels of androgens,and changes of erectile dysfunction and quality of life impairment 1 year after radical prostatectomy

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Asian Journal of Andrology 2021年第4期23卷 370-375页

作者： Yann Neuzillet Mathieu Rouanne Jean-François Dreyfus Jean-Pierre Raynaud Marc Schneider Morgan Roupret Sarah Drouin Marc Galiano Xavier Cathelinau Thierry Lebret Henry Botto Department of Urology Hospital FochUVSQ-Paris-Saclay UniversitySuresnes 92150France Department of Clinical Research and Innovation Hospital FochUVSQ-Paris-Saclay UniversitySuresnes 92150France Sorbonne University Paris 75013France Department of Urology Hospital Louis PasteurColmar 68000France Department of Urology Hôpital Pitié-SalpêtrièreAssistance Publique-Hôpitaux de ParisSorbonne UniversityParis 75013France Department of Urology Montsouris InstituteParis-Descartes UniversityParis 75014France

Robust data evaluating the association of preoperative parameters of the patients with quality of life after radical prostatectomy are lacking.We investigated whether clinical and biological preoperative characteristics of the patients were associated with impaired patient-reported quality of life(QoL)and sexual outcomes 1 year after radical prostatectomy.We evaluated patient-reported outcomes among the 1343 men participating in the AndroCan trial(NCT02235142).QoL and erectile dysfunction(ED)were assessed before and 1 year after radical prostatectomy using validated self-assessment questionnaires(Aging Male's Symptoms[AMS]and the 5-item abridged version of the International Index of Erectile Function[IIEF5]).At baseline,1194 patients(88.9%)accepted to participate.A total of 750(55.8%)patients answered the 1-year postoperative questionnaires.Out of them,only 378(50.4%of responders)provided answers that could be used for calculations.One year after prostatectomy,ED had worsened by 8.0(95%confidence interval[CI]:7.3–8.7;Pradical prostatectomy.Baseline bioavailable testosterone levels were significantly correlated with smaller changes on AMS somatic subscores postprostatectomy.These findings may be used to inform patients with newly diagnosed prostate cancer.

关键词： metabolic syndrome quality of life radical prostatectomy sexual outcomes testosterone deficiency

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Relationship of preoperative androgen levels and metabolic syndrome with quality of life and erectile function in patients who are to undergo radical prostatectomy

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Asian Journal of Andrology 2021年第5期23卷 520-526页

作者： Yann Neuzillet Jean-Francois Dreyfus Jean-Pierre Raynaud Mathieu Rouanne Marc Schneider Morgan Roupret Sarah Drouin Marc Galiano Xavier Cathelineau Thierry Lebret Henry Botto Department of Urology Hopital FochUVSQ-Paris-Saclay UniversitySuresnes 92150France Department of Clinical Research and Innovation Hopital FochUVSQ-Paris-Saclay UniversitySuresnes 92150France Sorbonne University Paris 75013France Department of Urology Hfipital Louis PasteurColmar 68000France Department of Urology Hopital Pitie-SalpetriereAssistance Publique-Hopitaux de ParisSorbonne UniversityParis 75013France Department of Urology Institut Mutualiste MontsourisParis-Descartes UniversityParis 75014France

This study aims to investigate whether clinical and biological preoperative characteristics of patients who were to undergo radical prostatectomy were associated with impairment in patient-reported quality of life(QoL)and erectile dysfunction immediately before intervention.We evaluated patient-reported outcomes among 1019 patients(out of 1343)of the AndroCan study,willing to score the Aging Male Symptom(AMS)and the International Index of Erectile Function 5-item(IIEF-5)auto-questionnaires.Univariate linear regression and robust multiple regression were used to ascertain the relationship between demographic,clinical,and hormonal parameters and global AMS or IIEF-5 scores.As a result,most patients(85.1%)of the Androcan cohort agreed to complete questionnaires.Significantly higher IIEF-5 global scores were found in non-Caucasian and obese patients,with larger waist circumference,metabolic syndrome,diabetes mellitus,cardiovascular disease,hypertension,high blood sugar,concomitant medications,and hypogonadism,while the AMS global score was significantly higher in patients with larger waist circumference,metabolic syndrome,high blood pressure,raised glycemia,and concomitant medication.The IIEF-5 global score was correlated to age,dehydroepiandrosterone(DHEA),fat mass percentage,and androstenediol(D5).The AMS global score was significantly correlated to DHEA,D5,and DHEA sulfate.Finally,the multivariate models showed that QoL and erectile function were significantly affected,before surgery,by symptoms and signs that are usually considered as pertaining to the metabolic syndrome,while sexual hormones are essentially correlated to erectile dysfunction.

关键词： erectile function metabolic syndrome quality of life radical prostatectomy testosterone

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Contemporary trends in radical prostatectomy and predictors of recovery of urinary continence in men aged over 70 years:comparisons between cohorts aged over 70 and less than 70 years

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Asian Journal of Andrology 2020年第3期22卷 280-286页

作者： Young Ju Lee Jin-Woo Jung Sangchul Lee Sang Wook Lee Jeong Hyun Kim Sung Kyu Hong Seok-Soo Byun Sang Eun Lee Seong Jin Jeong Departme nt of Urology Seoul National University Bundang HospitalSeongnam 13620Korea Department of Urology Catholic Kwan dong Univerisity International St.Mary's HospitalIncheon 22711Korea Department of Urology Kangwon National University School of MedicineChuncheon 24341Korea.

We evaluated contemporary trends in radical prostatectomy(RP)in men aged>70 years and investigated associations of selected variables with recovery of urinary continence(UC)in two age groups:>70 and70 years[n=610]vs70 years gradually increased up to 30.0%,and the rate of robot-assisted RP and neurovascular bundle(NVB)saving increased continually to 80.0%and 67.4%of older patients,respectively.Although the rate of recovery of UC within 12 months(3 months)in patients aged>70 years was lower than that in those aged S70 years(81.5%[52.6%]vs 88.6%[60.9%],respectively;both P70 years.Therefore,unlike younger patients,only variables(age and MUL),possibly associated with the inhere nt fun ction of the urinary sphi ncter,were predictors of recovery of UC in patients aged>70 years.

关键词： elderly predictor prostate cancer radical prostatectomy urinary incontinence

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Oncological outcomes of patients with ductal adenocarcinoma of the prostate receiving radical prostatectomy or radiotherapy

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Asian Journal of Urology 2021年第2期8卷 227-234页

作者： Mengzhu Liu Kun Jin Shi Qiu Pengyong Xu Mingming Zhang Wufeng Cai Xiaonan Zheng Lu Yang Qiang Wei Institute of Urology Department of UrologyWest China HospitalSichuan UniversityChengduChina Center of Biomedical Big Data West China HospitalSichuan UniversityChengduChina Institute of Urology Department of Urologythe First People’s HospitalYantaiChina

Objective:To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate(DAC)managed with radical prostatectomy(RP)or radiotherapy(RT)and optimize the proper treatment modality to DAC comprehensively.Methods:The cohorts included a total of 528 patients from the Surveillance,Epidemiology and End Results(SEER)database,354 receiving RP and 174 receiving RT.Cox proportional hazards regressions were performed to assess cancer specific mortality(CSM)and overall mortality(OM)between treatment groups.A competing risk analysis was further conducted.Subgroup analyses by age and level of prostate-specific antigen(PSA)were performed.Propensity score matching was implemented.Results:Patients managed with RP had lower risks of CSM and OM compared with RT(before matching:Hazard ratio[HR]=0.24,95%confidence interval[CI]0.13-0.47 and HR=0.26,95%CI 0.17-0.40,respectively;after matching:HR=0.18,95%CI 0.04-0.82 and HR=0.28,95%CI 0.11-0.70,accordingly).Subgroup analyses demonstrated that patients in the middle tertile of the age or with lower tertile PSA level managed with RP took lower risks of OM significantly(HR=0.18,95%CI 0.06-0.57,p<0.01 and HR=0.17,95%CI 0.06-0.54,p<0.01).Conclusion:Among patients with DAC,treatment with RP was associated with better survival outcomes in comparison with RT.Patients with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.

关键词： Ductal adenocarcinoma of the prostate Cancer specific mortality Overall mortality radical prostatectomy Radiotherapy

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The application of virtual reality training for anastomosis during robot-assisted radical prostatectomy

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Asian Journal of Urology 2021年第2期8卷 204-208页

作者： Fubo Wang Chao Zhang Fei Guo Xia Sheng Jin Ji Yalong Xu Zhi Cao Ji Lyu Xiaoying Lu Bo Yang Department of Urology Changhai HospitalSecond Military Medical UniversityShanghaiChina Department of Nursing Changhai HospitalSecond Military Medical UniversityShanghaiChina

Objective:To investigate the application of virtual reality training in vesicourethral anastomosis during robot-assisted radical prostatectomy(RARP).Methods:Three certified robotic urologists who underwent virtual reality training were enrolled in the study group.The other three without training were enrolled in the control group.Parameters were recorded before and after the training.Then a total of 18 patients undergoing RARP were enrolled and randomized assigned to receive anastomosis procedures with certified urologists who either obtained or did not obtain training.The quality of the anastomosis was evaluated.Results:For the virtual training evaluation,the overall score was significantly improved from 65.0±10.8 to 92.7±3.5(p=0.014);the time of anastomosis was shortened;the economy of motion improved;instrument collisions decreased after training(p<0.05).Besides,the effectiveness of the virtual training was evaluated in the 18 real anastomosis procedures which were completed either by three urologists with training or three urologists without training.Most intriguingly,the average time of anastomosis was shortened from 40.0±12.4 min to 25.1±7.1 min(p=0.015).The parameters including time of operation,creatinine level of drainage,postoperative hospital stay and duration of catheter drainage were comparable before and after training.Two leakages,which were observed in procedures by doctors without training,needed salvage sutures by a senior doctor.Conclusions:Virtual reality training enabled surgeons to become quickly familiar with robotic system manipulation,improved their skills for vesicourethral anastomosis and shortened the learning curve,thus helping them operate with high efficacy and quality.

关键词： Robotic surgery radical prostatectomy Training Virtual reality

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Orgasm-associated urinary in continence(climacturia)following radical prostatectomy:a review of pathophysiology and current treatment options

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Asian Journal of Andrology 2020年第6期22卷 549-554页

作者： Christopher Kannady Jonathan Clavell-Hernandez Division of Urology McGovern Medical School at The University of Texas Health Science Center at HoustonHoustonTX 77030USA St.Joseph Medical Center HoustonTX 77002USA

Orgasm-associated urinary incontinence,or climacturia,is a common side effect after radical prostatectomy(RP)that is gaining more attention due to the distress it causes to patients.A range of treatment options have been reported in the literature and are outlined in this review.The goal of our study is to review the pathophysiology and current management options for climacturia following RP.A PubMed search was used to review the current literature relating to the pathophysiology and the treatment of postprostatectomy climacturia.We reviewed the currently available treatment options and their success rates for climacturia.Several techniques were found to subjectively help improve the amount and bother of patients'climacturia.These include pelvic floor muscle training(PFMT),penile variable tension loop,soft silicone occlusion loop,artificial urethral sphincter,male urethral sling,and the Mini-Jupette graft.Success rates ranged from 48%to 100%depending on the modality used.For patients with erectile dysfunction and climacturia,the Mini-Jupette graft could be a valuable option.Given the lack of validated measurement tools and management options,climacturia has become a challenge for urologists.Albeit a condition that has not garnered much attention,there are several management options from conservative to invasive treatments that have shown a hopeful promise for the treatment of climacturia.These options should be discussed with patients to determine the best treatment for each individual.More clinical trials are n eeded to assess the efficacy and impact of the d iff ere nt treatme nt options before a defi nitive recommendation regarding management can be made.

关键词： climacturia male urethral sling Mini-Jupette graft orgasm-associated urinary inc on tinence prostate can cer radical prostatectomy

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Level of education and mortality after radical prostatectomy

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Asian Journal of Andrology 2017年第2期19卷 173-177页

作者： Michael Froehner Rainer Koch Stefan Propping Dorothea Liebeheim Matthias Hfibler Gustavo B Baretton Oliver W Hakenberg Manfred P Wirth Department of Urology University Hospital 'Carl Gustav Carus' Technische Universit~t Dresden Fetscherstrasse 74 D-01307 Dresden Germany Department of Medical Statistics and Biometry University Hospital 'Carl Gustav Carus' Technische Universitat Dresden Fetscherstrasse 74 D-01307 Dresden Germany Department of Anesthesiology University Hospital 'Carl Gustav Carus' Technische Universitat Dresden Fetscherstrasse 74 D-01307 Dresden Germany Department of Pathology University Hospital 'Carl Gustav Carus' Technische Universitat Dresden Fetscherstrasse 74 D-01307 Dresden Germany Department of Urology University of Rostock Ernst-Heydemann-Strasse 6 D-18055 Rostock Germany

Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education （college, university degree, master craftsmen, comparable profession, or others）, histopathological tumor stage （organ confined or extracapsular）, lymph node status （negative or positive）, and prostatectomy specimen Gleason score （〈7, 7, or 8-10） who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy （hazard ratio [HR]： 0.75, 95% confidence interval [95% CI]： 0.62-0.91, P = 0.0037）. The mortality difference was attributable to decreased second cancer mortality （HR： 0.59, 95% Ch 0.40-0.85, P = 0.0052） and noncancer mortality （HR： 0.73, 95% Ch 0.55-0.98, P = 0.0345） but not to differences in prostate cancer-specific mortality （HR： 1.16, 95% Ch 0.79-1.69, P = 0.4536 in the full model）. In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.

关键词： comorbidity competing risk analysis level of education life expectancy mortality proportional hazards model prostate cancer radical prostatectomy smoking socioeconomic status

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