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Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning—Part II
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Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning—Part II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (20 January 2024) | Viewed by 6820

Special Issue Editor

Dr. Theodoros Tokas

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Guest Editor
Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
Interests: prostate biopsy; prostate cancer; endourology; prostate hyperplasia; urinary stone disease; laparoscopy; robotic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Due to the success and impact of the Special Issue, "Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning" (https://www.mdpi.com/journal/jcm/special_issues/Prostate_Cancer_JCM), the editors of JCM have decided to announce a second Special Issue.

Prostate cancer (PCa) is the second most frequent malignancy observed in men. The tumors vary in terms of aggressiveness, ranging from non-aggressive tumors that can be safely monitored to tumors with a poor prognosis that are only suited to palliative treatment. Using contemporary imaging methods, biomarkers, and nomograms, precise stratification, particularly of the most clinically heterogeneous portion of the tumors of intermediate-risk patients, provides a better framework for their management.

Targeted biopsy enhances the diagnosis of clinically significant Pca, as routine transrectal ultrasound is not always reliable. The use of magnetic resonance imaging (MRI) can help to identify indications for prostate biopsy and is fundamental for local staging. When MRI is not available, less expensive contemporary ultrasound-based methods can provide high-quality imaging. More precise staging methods, such as PSMA PET/CT, have been adopted for the staging of aggressive tumors. However, there is currently an insufficient body of data to support their subsequent management.

The early detection and management of PCa can be supported by genetic counseling and germline testing. Biomarkers based on urine, serum, and tissue enable PCa detection among patients and facilitate risk stratification.

All of these techniques function together to create risk calculators/nomograms, which may be used to forecast the cancer risk, the likelihood of an aggressive malignancy, and the likelihood of a good treatment response.

The aim of this Special Issue of the Journal of Clinical Medicine is to provide new insights into PCa, focusing on advances in diagnostics and treatment planning.

Dr. Theodoros Tokas
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prostate cancer
  • prostate biopsy
  • prostate imaging
  • ultrasound
  • magnetic resonance imaging
  • MRI
  • PET scan
  • biomarkers
  • nomograms

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Related Special Issue

Published Papers (4 papers)

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Research

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12 pages, 501 KiB  
Article
Prostate Biopsy in the Case of PIRADS 5—Is Systematic Biopsy Mandatory?
by Wojciech Malewski, Tomasz Milecki, Stanisław Szempliński, Omar Tayara, Łukasz Kuncman, Piotr Kryst and Łukasz Nyk
J. Clin. Med. 2023, 12(17), 5612; https://doi.org/10.3390/jcm12175612 - 28 Aug 2023
Cited by 1 | Viewed by 1606
Abstract
Combining systematic biopsy (SB) with targeted biopsy (TB) in the case of a positive result from multiparametric magnetic resonance imaging (mpMRI) is a matter of debate. The Prostate Imaging Reporting and Data System (PIRADS) score of 5 indicates the highest probability of clinically [...] Read more.
Combining systematic biopsy (SB) with targeted biopsy (TB) in the case of a positive result from multiparametric magnetic resonance imaging (mpMRI) is a matter of debate. The Prostate Imaging Reporting and Data System (PIRADS) score of 5 indicates the highest probability of clinically significant prostate cancer (csPC) detection in TB. Potentially, omitting SB in the case of PIRADS 5 may have a marginal impact on the csPC detection rate. The aim of this study was to determine whether SB can be avoided in the case of PIRADS 5 and to identify potential factors allowing for performing TB only. This cohort study involved n = 225 patients with PIRADS 5 on mpMRI (PIRADS 2.0/2.1) who underwent transperineal or transrectal combined biopsy (CB). CsPC was diagnosed in 51.6% (n = 116/225) of cases. TB and SB resulted in the detection of csPC in 48% (n = 108/225) and 20.4% (n = 46/225) of cases, respectively (TB vs. SB, p < 0.001). When the TB was positive, SB detected csPC in n = 38 of the cases (38/108 = 35%). SB added to TB significantly improved csPC detection in 6.9% of cases in absolute terms (n = 8/116) (TB vs. CB, p = 0.008). The multivariate regression model proved that the significant predictors of csPC detection via SB were the densities of the prostate-specific antigen—PSAD > 0.17 ng/mL2 (OR = 4.038, 95%CI: 1.568–10.398); primary biopsy setting (OR = 2.818, 95%CI: 1.334–5.952); and abnormal digital rectal examination (DRE) (OR = 2.746, 95%CI: 1.328–5.678). In a primary biopsy setting (n = 103), SB detected 10% (n = 6/60) of the additional cases of csPC (p = 0.031), while in a repeat biopsy setting (n = 122), SB detected 3.5% (n = 2/56) of the additional cases of csPC (p = 0.5). In the case of PSAD > 0.17 ng/mL2 (n = 151), SB detected 7.4% (n = 7/95) of additional cases of csPC (p = 0.016), while in the case of PSAD < 0.17 ng/mL2 (n = 74), SB detected 4.8% (n = 1/21) of the additional cases of csPC (p = 1.0). The omission of SB had an impact on the csPC diagnosis rate in patients with PIRADS 5 score lesions. Patients who have already undergone prostate biopsy and those with low PSAD are at a lower risk of missing csPC when SB is avoided. However, performing TB only may result in missing other csPC foci located outside the index lesion, which can alter treatment decisions. Full article
(This article belongs to the Special Issue Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning—Part II)
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12 pages, 6278 KiB  
Article
Predictors of Extraprostatic Extension in Patients with Prostate Cancer
by See Hyung Kim, Seung Hyun Cho, Won Hwa Kim, Hye Jung Kim, Jong Min Park, Gab Chul Kim, Hun Kyu Ryeom, Yu Sung Yoon and Jung Guen Cha
J. Clin. Med. 2023, 12(16), 5321; https://doi.org/10.3390/jcm12165321 - 16 Aug 2023
Cited by 4 | Viewed by 1760
Abstract
Purpose: To identify effective factors predicting extraprostatic extension (EPE) in patients with prostate cancer (PCa). Methods: This retrospective cohort study recruited 898 consecutive patients with PCa treated with robot-assisted laparoscopic radical prostatectomy. The patients were divided into EPE and non-EPE groups based on [...] Read more.
Purpose: To identify effective factors predicting extraprostatic extension (EPE) in patients with prostate cancer (PCa). Methods: This retrospective cohort study recruited 898 consecutive patients with PCa treated with robot-assisted laparoscopic radical prostatectomy. The patients were divided into EPE and non-EPE groups based on the analysis of whole-mount histopathologic sections. Histopathological analysis (ISUP biopsy grade group) and magnetic resonance imaging (MRI) (PI-RADS v2.1 scores [1–5] and the Mehralivand EPE grade [0–3]) were used to assess the prediction of EPE. We also assessed the clinical usefulness of the prediction model based on decision-curve analysis. Results: Of 800 included patients, 235 (29.3%) had EPE, and 565 patients (70.7%) did not (non-EPE). Multivariable logistic regression analysis showed that the biopsy ISUP grade, PI-RADS v2.1 score, and Mehralivand EPE grade were independent risk factors for EPE. In the regression assessment of the models, the best discrimination (area under the curve of 0.879) was obtained using the basic model (age, serum PSA, prostate volume at MRI, positive biopsy core, clinical T stage, and D’Amico risk group) and Mehralivand EPE grade 3. Decision-curve analysis showed that combining Mehralivand EPE grade 3 with the basic model resulted in superior net benefits for predicting EPE. Conclusion: Mehralivand EPE grades and PI-RADS v2.1 scores, in addition to basic clinical and demographic information, are potentially useful for predicting EPE in patients with PCa. Full article
(This article belongs to the Special Issue Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning—Part II)
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9 pages, 637 KiB  
Article
The Impact of Multiparametric Magnetic Resonance Imaging on Treatment Strategies for Incidental Prostate Cancer after Holmium Laser Enucleation of the Prostate
by Kwang-Jin Ko, Seongik Choi and Wan Song
J. Clin. Med. 2023, 12(14), 4826; https://doi.org/10.3390/jcm12144826 - 21 Jul 2023
Viewed by 1403
Abstract
Purpose: To investigate the impact of multiparametric magnetic resonance imaging (mpMRI) on treatment strategies for incidental prostate cancer (iPCa) after holmium enucleation of the prostate (HoLEP); Methods: Data from 1781 men who underwent HoLEP for clinical bladder outlet obstruction between September 2009 and [...] Read more.
Purpose: To investigate the impact of multiparametric magnetic resonance imaging (mpMRI) on treatment strategies for incidental prostate cancer (iPCa) after holmium enucleation of the prostate (HoLEP); Methods: Data from 1781 men who underwent HoLEP for clinical bladder outlet obstruction between September 2009 and March 2022 were reviewed retrospectively. Among patients with confirmed iPCa, those with prostate-specific antigen (PSA) levels < 10 ng/mL and who underwent mpMRI 3 months after HoLEP were included. Pathologic results, including Gleason grade (GG) and tumor volume, were identified. mpMRI was interpreted using the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2). Treatment strategies for iPCa according to GG alone, or according to a combination of Gleason grade and mpMRI, were analyzed and compared. Results: Of 1764 men with serum PSA levels < 10 ng/mL, iPCa was confirmed in 64 (3.6%) after HoLEP. Of the 62 men who underwent mpMRI, the median (IQR) age at the time of HoLEP was 72.5 (66.5–78.0) years. The median PSA level and prostate volume were 3.49 (1.82–5.03) ng/mL and 49.6 (38.5–85.4) cm3, respectively. The pathologic results of iPCa were as follows: GG1 = 42 (67.7%), GG2 = 13 (21.0%), GG3 = 2 (3.2%), GG4 = 1 (1.6%), and GG5 = 4 (6.5%). Of the patients with GG1 and GG2, 78.6% (33/42) and 53.8% (7/13), respectively, underwent active surveillance (AS). However, of 42 patients with GG1, 27 (64.3%) had a PI-RADSv2 score of 2, and 24 (88.9%) of them underwent AS. Of the 13 patients with GG2, 4 (80%) with a PI-RADSv2 score of 2 underwent AS. All patients with GG 3–5 were clinically expected to have locally advanced PCa and be treated with radiotherapy and/or ADT. Conclusions: For patients with iPCa of GG 1–2 after HoLEP, mpMRI helps to establish a treatment strategy by allowing risk stratification to select those who should be considered for AS or active treatment. Full article
(This article belongs to the Special Issue Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning—Part II)
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Review

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12 pages, 277 KiB  
Review
Oligometastatic Prostate Cancer—The Middle Child Syndrome
by Ee Jean Lim, Mengyue Su, B. M. Saiduzzaman, Kae Jack Tay, Henry Sun Sien Ho, Theodoros Tokas, Bhaskar Kumar Somani, Vineet Gauhar, John Shyi Peng Yuen and Kenneth Chen
J. Clin. Med. 2023, 12(23), 7198; https://doi.org/10.3390/jcm12237198 - 21 Nov 2023
Viewed by 1502
Abstract
Oligometastatic prostate cancer is an evolving clinical entity as more data from novel imaging tools such as PSMA PET/CT emerges. Recognition of this disease entity allows for unique interventions which differ from conventional treatment of metastatic prostate cancers such as the initiation of [...] Read more.
Oligometastatic prostate cancer is an evolving clinical entity as more data from novel imaging tools such as PSMA PET/CT emerges. Recognition of this disease entity allows for unique interventions which differ from conventional treatment of metastatic prostate cancers such as the initiation of chemotherapy. With metastasis-directed therapy (MDT), there is potential for early eradication of limited disease metastases and a delay in systemic treatment with its associated treatment-related toxicities. This review explores the current evidence and outcomes of different metastasis-directed therapies such as the role of radiotherapy in low volume metastasis and the use of PSMA ligands to facilitate pelvic lymph node dissections. With a deeper understanding of this low metastasis state, it has revolutionized the current viable treatment options, and more studies are ongoing to provide further insights into this unique disease entity. Full article
(This article belongs to the Special Issue Prostate Cancer: Recent Advances in Diagnostics and Treatment Planning—Part II)
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